7w3d and still can’t believe it.

Wow, I did not intend to disappear for so long!  I’m not quite sure why, but wasn’t feeling much like writing… the initial days post-beta were so surreal and felt so uncertain, that I didn’t quite even feel like writing.  And then, just the day after our second beta, my sister-in-law (C’s sister) passed away after a long, terrible battle with colon cancer.  That’s not something that is really mine to write about, but it had been a huge part of our lives for the past year and a half.  I will always be thankful that C was able to tell her about our pregnancy before she passed, but it has made this already tenuous period in our lives even more bittersweet and confusing.  

Anyway, other than a few waves of nausea and slightly more fatigue than usual (and I’m usually a pretty sleepy girl!), I have felt very little in the way of symptoms.  This, of course, made me even more anxious as I went into my viability ultrasound, which we did at 6w2d.  I was able to schedule over the lunch hour so that C could join me, which was nice.  (He often claims to be too busy at work to get away, which I find frustrating–it’s not like I’ve had any choice about missing tons of work over the past few months…the least he can do is make a few appointments and be gracious about it.)  Anyway, we arrived early, and they were running behind, of course (which only seems to happen when we’re actually seeing the doctor–the nurses and ultrasound techs always run on time), so I sat there, actually afraid I might throw up (from nerves, not morning sickness!).  Finally, they called us back and we got started.  The tech started scanning, them immediately moved the screen out of my view, so I had a terrible feeling that it was bad news.  I looked at the doctor, and she said “you’ll see soon” and gave me a thumbs up.  So I figured things must be okay (and I’m still not sure why the tech moved the screen!).  Finally, she moved the screen back and showed us the gestational sac, embryo, and yolk sac, all measuring perfectly, and the heartbeat, flickering away.  (We didn’t get to hear it–I’m not sure whether it was just too early or whether their equipment didn’t provide for that?)  She said everything looked perfect and asked whether I was ready to graduate to the OB.  Honestly, I’d kinda hoped to stay with the RE for a few more weeks to get another ultrasound or two before being released, but I guess it’s a good sign that she didn’t think that was necessary.  I also stopped all estrogen and progesterone supplementation and discontinued Metformin–as the doc said, I’m a normal pregnant lady now, just taking prenatal vitamins!  I can’t believe it.  

A week later, I went to my first prenatal appointment with my OB.  (Actually, the first appointment was with a nurse practitioner, although I think that the rest of my appointments will be with the doctor.)  She was nice, but it was a huge change from the RE–they didn’t plan on an ultrasound, but when I expressed disappointment, she did a quick scan herself on their “backup” (aka ancient) machine.  The quality was much poorer than at the RE’s office (whether that was the machine or because it was an external, not a transvaginal scan, I’m not sure) but we saw the little heartbeat, still blinking away.  Otherwise, the appointment was mostly a review of things I already knew (no alcohol, limited caffeine, blah blah), a pelvic exam, a weight check and some bloodwork.  The nurse did corroborate my RE’s admonition of no exercise or sex until 12 weeks (which C is already complaining about–the sex, not the exercise).  My RE said that I should avoid sex because of my still-enlarged and sore OHSS ovaries, but the nurse said that it can cause miscarriage, and “miscarriages already occur in 25% of first trimesters, so you don’t want to increase that.”  Irritating–first of all, miscarriages after seeing a heartbeat are much less common than that (although certainly not nonexistent), and regardless, it seems unnecessary to preemptively blame people who have sex in the first trimester for miscarriages that may occur.  But of course, I’ll follow her directions.

I am finally starting to feel really happy and excited about our baby (which we call Pat, after the SNL character, since we don’t know whether it’s a boy or girl).  I actually thought I’d feel more anxious about things not working out (that’s certainly my nature usually), but somehow I actually feel pretty calm and optimistic.  Who would have guessed?

7dp5dt, and I caved.

I’ve continued to feel incredibly discouraged and pessimistic about this cycle.  I’ve had a few cramps here and there, but no return of the OHSS symptoms, which I figured must mean that implantation did not occur.  My beta is scheduled for Tuesday.  I decided that I wanted to start testing so that I could break the bad news to myself gradually rather than waiting for a single devastating phone call from some unpleasant nurse on Tuesday.  So I broke down this morning.

 

 

 

 

 

 

 

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I don’t even feel happy yet.  I am too worried:

a) that it is residual trigger (although I triggered 14 days ago today–that should be long enough, right?);

b) that the line is too faint for 7dp5dt, indicating a chemical pregnancy (I also tried an internet cheapie Wondfo, and although a line eventually developed after 10 minutes or so, it is a real squinter and didn’t show up in a photo at all); or

c) that it’s some other kind of mistake.  

Now I’m obsessively comparing my test to photos of others’ at 7dp5dt and finding that it appears lighter than just about all of them…although we also only transferred one embryo so there’s essentially no chance of twins for us.  Why do I do this to myself??

One blast transferred, two on ice, and feeling discouraged.

I am officially 2 days post 5-day transfer (2dp5dt).  My transfer was scheduled for 10:15 am on Easter Sunday.  (I’m not particularly religious, but that did seem like a good day!)  

By about the Friday before (3 days post-retrieval), I was feeling very bloated, painful, and nauseous from ovarian hyperstimulation syndrome (OHSS).  I could not button any of my pants, and C had to buy me a belly band just so that I could wear something other than sweatpants to work.  This got worse on Saturday, and I began having significant shortness of breath, as the fluid accumulation in my abdomen began pressing on my diaphragm.  Before the beginning of my cycle, our doctor had warned us that if I hyperstimulated (which she was concerned about because of my PCOS), we might have to forgo a fresh transfer and freeze all embryos.  The night before transfer, I was up repeatedly, not only because of my extreme discomfort and pain but alternately worrying about the transfer being cancelled or how I would endure significantly more severe OHSS symptoms if I became pregnant.  (Pregnancy hormones make OHSS much worse, especially with a twin pregnancy since hormone levels are higher.)  

Going in on Sunday morning, I was still very worried about this–although I was feeling slightly better than I had on Friday and Saturday, I was still up about 8-10 pounds over my usual weight and very, very bloated (worse than in the photo a few posts back!).  I had arranged for pre- and post-transfer acupuncture treatments, which was very relaxing.  (I am not 100% convinced about the efficacy of acupuncture, but I find it relaxing and like my acupuncturist, and I figure it can’t hurt!)   We met with the doctor who would perform the transfer (not our usual doctor, since at our clinic, doctors rotate the weeks on which they are on procedures, but the same doctor who performed my retrieval) before getting started.  I told her about my OHSS symptoms and she immediately asked “how would you feel about transferring just one embryo?”  She said she was willing to do a transfer that day, but that she strongly recommended against a two-embryo transfer, since the likelihood of twins with two embryos the quality of ours was at least 50%.  She was worried that my OHSS symptoms would progress enough to require hospitalization if I became pregnant with twins.  She told us that we had two excellent quality blastocysts ready to transfer or freeze that day–they were both graded 2 on a scale of 1-3 (but grade 1 embryos are very rare and only occur about 3-5% of the time).   We had 8 remaining embryos that were still growing but had not yet reached blastocyst stage, and would be checked the following day. Given that quality, she estimated that we had a 59% or higher chance of pregnancy with a single embryo transfer, a 69% or higher chance of pregnancy with a double embryo transfer (and a 50% chance of twins).  Given those odds and the risks to my health (as well as the risks of a twin pregnancy), we quickly agreed to transfer just one.  

The transfer itself went quickly and smoothly (the doctor said my lining still looked great) and it was back for post-treatment acupuncture, then home for 24 hours of “couch rest.”  I left the transfer feeling hopeful and positive.

Yesterday, 1dp5dt, I woke up feeling much better physically and much worse emotionally.  Shortly thereafter I received a call from the embryology lab letting me know that only one additional embryo (of our remaining eight) reached blastocyst and was able to be frozen.  The other seven arrested.  I am not sure why, but since waking up yesterday I have felt absolutely convinced that this cycle will not work.  Perhaps it’s the improvement in my OHSS symptoms (although I know it is too early for them to worsen in response to increasing hcg from an early pregnancy), perhaps it’s coming off the valium/acupuncture/transfer high, perhaps its the evidently (relatively) poor quality of my eggs and embryos, or perhaps its just my pessimistic nature, but I am already imagining having to do all of this all over again.  I am already having trouble reading about others’ IVF pregnancies, while until yesterday, they were inspirational to me (this has never been the case for fertiles’ pregnancies!!).  

I know that my despair is unfounded and counterproductive–while I’m not convinced that feeling optimistic really helps the embryo, it could certainly help me–but I don’t know how to stop it.  Why am I mourning this loss that hasn’t even happened yet–and when this is the first cycle, ever, with odds actually on our side?

Retrieved!

I woke up this morning before my alarm, anxious about the retrieval.  I had to be at the clinic at 7:30 for an 8:30 retrieval.  C had to work today–I was hoping he would offer to take the day off, but it’s tough for him to be out on short notice–so my dad came up to drive me.  If that wasn’t awkward enough, I also had to bring C’s “specimen” along with me since he wouldn’t be there in person.  According to the clinic’s instructions, I had the vial wrapped in a towel inside a paper bag.  Since we arrived a little before 7:30 (and the andrology lab doesn’t open until 7:30 on the dot), I wasn’t able to drop off the sample for about 10 minutes.  I hope to never sit next to my dad holding my husband’s semen again!  

I was eventually able to drop it off (accompanied by a notarized consent form from C allowing me to do so–their procedures are strict, although understandably so!), and I was called back shortly thereafter.  The nurse took me to a recovery room, where I signed more consent forms and changed into a gown, robe, booties and cap.  Everyone who came into the room said “A and C?” and then expressed surprise that C wasn’t with me.  I did feel somewhat sad and lonely without him, especially as I waited alone.  But things moved quickly, and after short conversations with the doctor (not my usual doctor–at our clinic, each doctor is on procedures for one week a month–and the anesthetist, we got started.  The anesthetist took me to the procedure room, where I lay on a stretcher.  She placed an IV and told me that she’d give me a cocktail of versed and propofol, and that I’d be out within 20 seconds.  I remember feeling like I was floating towards the ceiling, and the next thing I knew I was waking up in a recovery room and the nurse was telling me we got 16 eggs.  

Embarrassingly, I immediately burst into tears.  (And I am NOT a public crier.)  I absolutely know that 16 is a good number and that many women would be thrilled with that number.  But since I’d had over 38 measurable follicles on Sunday, I was, apparently, expecting a lot more.  The nurse told me that 16 is better than average, and that they prefer that we don’t get too many more than that, since quality suffers.  The doctor came in and said the same thing–she said 16 is excellent.  (In my propofol high, I said “I bet you say that to everyone.”  She said only if they get a similar number.)  She also said that there were many many follicles, but most did not contain mature eggs.  If I’d stimmed another day or two, I would have had more mature ones, but they had to cut me off after only 7.5 days because of risk of OHSS.  I know that the doctors made the right call for my health.  (I also know that if my estradiol had risen higher, I wouldn’t have been allowed to do a fresh transfer, and I am thankful that it is looking likely that we will be able to do so–unless I have severe symptoms in the meantime, we should be in good shape for a fresh transfer.)  I am a little embarrassed now by my reaction–16 is a great number and I am grateful.  I should not have allowed myself to get greedy.

After a few more minutes of resting, some crackers, water and Tylenol, I got dressed and ready to go.  They made me ride in a wheelchair out to meet my dad in the lobby and go down to the car.  (I insisted I could walk, but they wouldn’t let me–I know it’s for liability reasons.)   Dad took me home and stayed with me at the house for an hour or two to make sure I was feeling okay.  I was amazed by how quickly I recovered from the anesthesia–I felt essentially normal by the time we got back to the house (and we live only about a 10 minute drive from the clinic).  I am feeling sore and crampy, but nothing unbearable.  C came home over his lunch break and brought salty Chinese food, which was a nice treat.  I spent the rest of the day watching tv and napping, and it’s been a good excuse for a lazy couch day!  

We won’t get an update on our embryos (not even a fertilization report) for two days.  That seems so long–I know from reading others’ accounts that many get a fertilization report the day after retrieval.  I will be very anxious until I hear.  We’ll get a second update after 4 days, at which point they’ll also set the time for our 5-day transfer, which will be Easter Sunday.  As one of the nurses told me, that is a good day for eggs!  I really hope so.

That was fast.

Things have happened quickly!  After only six measurable follicles over 11 mm on Thursday (stim day 6) and an E2 level of 709, I returned yesterday to find that I had over 30 measurable follicles and an E2 level of 2534.  The doctor was concerned about a risk of hyperstimulation with that rise, and directed me to stop all stims immediately.  I was concerned–I’d only stimmed for 7.5 days (I do Menopur in the morning and Gonal-F in the evening) and I didn’t have any follicles over 16 mm (and most were more like 12-13).  How could it be time to stop already?  I went back this morning and found that they were right–the follicles had grown a lot, with one at 24, one at 22 and a bunch at 16-18.  (I had a total of 38 measurable, although many of those were in the 12-14 mm range and will likely be immature.)  The clinic called later this afternoon and told me my E2 was only 3216–they were much happier with the slower rise (likely a result of stopping stims).  I trigger tonight at 8:30 pm for an 8:30 am retrieval Tuesday morning.  I can’t believe it’s already here!  I was expecting a Wednesday or Thursday retrieval, not Tuesday.  Unfortunately Colin can’t make the retrieval since he has to work.  (He has Wednesdays off, so I’d been hoping for a Wednesday retrieval.)  But if we end up with a fresh 5-day transfer, that will be on a Sunday and he could go for that!  

Speaking of a fresh transfer, that’s still up the air, but looking more likely to be possible given my lower than expected E2.  Fingers crossed!  I know that delaying 8 weeks isn’t the end of the world, but it would be a disappointing setback at the moment.  My doctor also said that if we are allowed to do a fresh transfer, she would likely only allow us to transfer one embryo, as the higher hCG level from a twin pregnancy makes OHSS worse.  I’d really prefer to transfer two (despite being aware of the risks with twins) but will be happy with either.  Fingers crossed!