Pregnant, but not really …

IMG_4804

Yesterday was my first beta.  I got the call from the clinic a few hours after my blood draw to let me know that my hCG level was a 13.9 mIU/mL, which is low. Like, really low.  I know that <5 mIU/mL  is considered ‘not pregnant’ and anything above 25 mIU/mL is ‘pregnant’. Honestly, I’m not even sure why they are considering me pregnant as my hCG seems to be floating in an indeterminate stage, but the nurse said that they want me to continue taking my medicines (prednisone, baby aspirin, endometrin, estrace, and PIO shots) and will bring me back in two days for another blood draw to see if the numbers have gone up.  While Daddy Graham and I have not given up hope completely that we have a late implanting embryo, we are also realistic in that this is looking like a chemical pregnancy.

During the two week wait, I had a multitude of symptoms.  I felt the strangest tugging sensation behind my belly button that traveled down to the top of my pubic bone.  Cramps that were distinctly different from normal period cramps.  I knew something was going on, I just wasn’t sure what. In the days preceding the beta, I cop to taking some home pregnancy tests so that I could have some sense of where I stood.  Daddy Graham and I had a long discussion about how they were not the end-all-be-all of pregnancy indication, and I tried not to put too much stake in them. Faint positives each and every time, but the lines never grew darker as the days went by.

IMG_4821

Truthfully, while I am sad, I am also feeling alright about the situation.  We knew that this process was not going to be easy, and that odds aren’t necessarily in your favor with IVF and FET (though much greater than other infertility interventions).  We will not be deterred by an unsuccessful cycle, as we are committed to trying again.  Before Daddy Graham and I began this process, we both agreed that having a child would make our lives wonderful but we are not incomplete as a family without children.

We are now #PUPO!!

IMG_4720

Pregnant (until proven otherwise)!

Yesterday’s frozen embryo transfer (FET) went off without a hitch.  I arrived at the fertility clinic at around 9:30 for my first of two scheduled acupuncture appointments (before and after the FET).  The spa-like atmosphere was incredibly relaxing, as I was feeling jangly with nervous excitement.  Unbeknownst to me, I would be wearing the spa robe for the entirety of the day, so there was no need to wear a cute dress (a dress being my appointment attire of choice, as I just have to hitch it up and drop my undies for the table rather than dealing with pants or jeans, etc.).  I had never had acupuncture before, and I’m not sure exactly what my expectations were, but it neither over- or underwhelmed me.  No lightning bolts of pent up chi that were set free just a nice, calm room with a warm blanket for me to bliss out in before the procedure.  For the pre-FET treatment, I had a needle placed in my skull, one on my forehead, one on left hand between my thumb and forefinger, and the rest were centered around my belly button.  After all of the blood draws and self-administered needles, these I was completely oblivious to. I laid there with the needles in for a half hour before having the needles removed and taken to the FET room.

IMG_4712

I was given a lovely net bonnet and warm blanket, and Daddy Graham was brought in fully suited up in surgery scrubs.   Unfortunately, my veins were not complying with the blood draw, so after a few painful, digging attempts, it was decided that we would get my blood after the transfer.  The transfer itself was relatively quick and painless.  Daddy Graham and I were laughing afterwards at the fact that there was no need to be worried about him and an unsightly vantage point of my lady bits in full speculum-ed glory, as it would end up all hanging out in the open anyway.  You really lose any sense of modesty through this process. It didn’t really appear to faze Daddy Graham so, in turn, it didn’t faze me either.  The doctor came in and shared the first picture of Baby Graham with us, and told us that we were transferring a 5BB single embryo.  He reiterated not to get too hung up on the grading system, but that it looked lovely and was a strong candidate for a successful transfer.  We were also happy to find out that they only had to thaw out one for this transfer, and that we still have seven in reserve.

IMG_4714

Once the speculum was in place and the doctor was able to locate my uterus underneath my (very full) bladder using ultrasound, a catheter was thread through my vagina and cervix and into my uterus.  After the correct placement was determined, the embryo was brought in and verified from embryology, and into my uterus it went.  After the doctor removed the catheter, he froze the ultrasound screen and pointed out the little speck that was Baby Graham!  It is hard to fathom that it one split second I went from being not pregnant to, for all intents and purposes, pregnant.  Amazing.

IMG_4707

After I laid on my back for fifteen minutes and my blood was successfully drawn, I was taken back upstairs to the spa for my second acupuncture treatment.  This time, all of the needles were placed along the tops of my lower legs and my feet.  I once again was told to relax (which I tried to do, but I was too excited and overwhelmed with feelings of gratitude).  After the needles were removed, I was able to change into my regular clothes and head home.

I was given instructions to continue all of my prescription protocols (estradiol suppositories, progesterone suppositories, PIO shots, pre-natal vitamins, baby aspirin, prednisone, and tacrolimus) and that I come in for my first beta on August 18.  As it turns out, Daddy Graham and I are away that day, so we had to schedule the beta for August 21. I wonder if I will really be able to resist POAS for that long a time – we shall see.

I am definitely scrutinizing every little change I feel in my body, and trying to determine if the feeling is a pregnancy feeling or not.  I am trying to back off Google, as I know that it will only drive me crazy and that each woman’s pregnancy experience is different from the next. Before I left for the transfer, my mom gave me a huge hug and said something along the lines of “after today your life will never be the same”.  These words have been echoing in my head since yesterday – what a momentous and incredible opportunity to be fully present in the process of creating Baby Graham!

In the meantime, which us luck and sticky baby dust! Stick, Baby Graham, stick!

FET Day Has Been Set!

IMG_4678

Yesterday’s appointment brought the news that we are all set for a frozen embryo transfer on August 9! My lining measured in at 9.31, my estradiol at 987 pg/mL, and both of my ovaries have returned to normal size. Daddy Graham and I are beyond excited (and nervous) to begin this next chapter.  While we prepare mentally and physically for what’s to come, we are busying ourselves with the practical day to day matters, foremost is the lengthy prescription protocol we are currently in the midst of:

Continued (through Wednesday, August 9):

  • Estradiol tablets (2x day), inserted vaginally (to help grow my endometrium lining and keep it thick)
  • Prednisone (2x day) (low dose steroid to help combat inflammation, which is detrimental to implantation)
  • low dose aspirin (1x day) (to help improve blood flow)
  • pre-natal vitamins (which has been on-going since we started this process)

New (beginning Friday, August 4):

  • Cleocin Vaginal Ovules (1x day from Fri-Sun) (vaginal antibiotic in preparation for FET)
  • Progesterone In Oil (the dreaded PIO!) (1x day intramuscularly) (to thicken the uterine lining and prepare the body to support the embryo, so the embryo will successfully implant and grow)
  • Endometrin suppositories (1x day from Sat-Wed) (see PIO – same purpose; my clinic uses a combo of progesterone supplements for a FET)
  • Prograf (Tacrolimus) (2x day from Mon-Wed) (used to decrease the likelihood of the body rejecting the FET)

Whew – also, Daddy Graham and I decided that we would go forward with the three additional treatments I described in the last post: hCG uterine wash and intralipids transfusion (both scheduled for Monday) and acupuncture before and after the FET.

The question that is weighing heavy on our minds right now is how many embryos to transfer – one or two.  There are a lot of considerations that are going in to this decision, with the understanding that Daddy Graham and I will most likely only go through the whole IVF process once.  We actually had always spoken about transferring two – but the NP at my last appointment strongly recommended we go with only one, which left me in a bit of a quandary. On the one hand, two embryos and the possibility of twins is thrilling (siblings! forever playmates!) and on the other, terrifying (greater pregnancy risk! financially overwhelming! the possibility of – gulp – triplets or quads).  When I have envisioned being pregnant, it has always been with one baby – but the chance of having two children and doubling the love is ever-attractive.

Our plan has been that, once my maternity leave is over (fingers crossed I will have enough time saved for 12 weeks), I will return to work and Daddy Graham will stay home with the kiddo(s). We decided on this as my job is well-established and well-paying and Daddy Graham is looking to switch careers.  In fact, during this process, Daddy Graham has been applying to graduate school to become a PA.  A notoriously cutthroat competition for few spots left Daddy Graham feeling like it may be a distant possibility, but today we found out he has progressed to the interview stage!  Having Daddy Graham in school with a little one has now also become intermixed into our decision-making process.  ALL GOOD THINGS!

Wish us luck and babydust!

Beginning the FET Protocol

IMG_4667

After the egg retrieval procedure, I was given the instruction to phone the office and set up an appointment after the first day of my period so as to begin the next phase on our journey to becoming parents.  As it would happen, my period started on the last day of a mini vacation Daddy Graham and I took to the Adirondacks – and this one has been a doozy.  I can say without hyperbole that this has been the. worst. period. ever. I won’t go into the icky details, but suffice it to say acetaminophen and a heating pad have been my best friends (and Daddy Graham’s back rubs).

Yesterday’s appointment brought the welcome news that I am on track for an estimated frozen embryo transfer (FET) date of August 9.  During the ultrasound, the nurse mentioned that my right ovary was still swollen from the egg retrieval procedure two weeks ago.  She wanted to see the results from my blood panel (Progesterone, TSH, Estradiol, FSH, LH) before giving me a definitive timeline, and if my Progesterone or Estrogen were off then this month’s transfer was in danger of being cancelled.  Thankfully, the numbers came back within the normal range and I will return to the office in a week’s time.

In the interim, I’ve started the FET protocol which entails:

  • Estradiol tablets (2x day), inserted vaginally (to help grow my endometrium lining and keep it thick)
  • Z pak antiobiotics for five days (preventative antibiotic administered anytime they do a procedure with the uterus)
  • Prednisone (2x day) (low dose steroid to help combat inflammation, which is detrimental to implantation)
  • low dose aspirin (1x day) (to help improve blood flow)
  • pre-natal vitamins (which has been on-going since we started this process)

My next appointment will bring another ultrasound and blood panel to see how my lining is progressing.  At that point, I’ll get the next protocol round which will entail progesterone oil shots.  I was also given three optional ‘procedures’ that are all aimed at helping with embryo implantation (text is from my fertility clinic‘s Reproductive Immunology pamphlet):

  1. HCG: HCG uterine wash. The corpus luteum provides the main source of progesterone support. The corpus luteum maintains its activity for 14 days. If an embryo fails to implant and HCG is not secreted, the activity of the corpus luteum will decline. The normal development of pregnancy depends on proper corpus luteum activity. Providing HCG, along with Progesterone, supports the luteal phase in infertility treatments.
  2. Intralipids: Intralipids are a liquid emulsion of fat. It is mainly composed of soybean oil and egg fats. It is similar in effectiveness to IVIG but significantly more affordable for couples who are seeking success after multiple miscarriages. Researchers believe it acts to suppress the body’s natural killer cells and prevent embryo rejection. This is an IV infusion that is performed in our office and generally takes approximately 20-30 minutes. The recommendation is to infuse intralipids before IUI/Egg Retrieval/Embryo Transfer and weekly thereafter to 12-14 weeks gestation.
  3. Acupuncture: My fertility clinic, in it’s east meets west medical philosophy, highly encourages acupuncture for blood flow and fertility before and after the FET procedure.

I know for sure that I want to partake in the acupuncture treatments (and look forward to it!).  The other two Daddy Graham and I are doing more research on, and looking into whether or not insurance will cover them.  In the interim, I am trying to get a lot of rest and eating well.

On a (strange) side note, out of curiosity I slotted my FET date of August 9th into a pregnancy calculator.  As it turns out, the due date if we were to be blessed with a singleton Baby Graham would be April 27 – Daddy Graham’s birthday.  And, if we were to be blessed with twin Baby Grahams, the due date would be April 6 – my birthday.  What are the odds?!?

Recovery and The Deep Freeze

I didn’t anticipate how long it would take to recover from the egg retrieval process.  I keep reminding myself that I had a surgical procedure, and my body needs time to heal.  As someone who rarely takes any pain medication, I am discomfited by prolonged period of feeling “not myself”. Who wouldn’t, right?

Thankfully, I was able to work from home the two days after my procedure, and I rotated between the couch and the bed. My belly continued to feel distended and uncomfortable, as if imaginary weights were pulling it toward my feet.  My digestion was just as altered, which didn’t help my feelings of discomfort.  A close friend of mine had egg retrieval done the year before, and shortly thereafter we went on camping trip (which now seems absolutely absurd to me) and I remember that she was guzzling laxatives – I now empathize whole heartedly.

IMG_4634

The day following the retrieval we heard that, of the 18 eggs that were retrieved, 14 were able to be fertilized!  Daddy Graham and I couldn’t get over the fact that we were growing quite a brood in some nearby petri dishes.  My fertility clinic prefers to do frozen embryo transfers (FET), as it gives the body an opportunity to calm down from the trauma and stimulation of hormones and surgery.  That said, we knew that we would be waiting on pins and needles to find out how many of these 14 fertilized eggs would make it to the 5-day blastocyst stage (or blast) and subsequently cryopreserved.

Yesterday (a week after the retrieval) we learned that we had 8 blasts that were able to be frozen.  Going from 18 to 14 to 8 may seem like quite a decline, but I think that we are exceptionally lucky.  I did ask the embryologist for the “grades” of our embabies (I found this link extremely helpful), and we had 3 that were “good to great” and 5 that were “fair”. It’s hard not to get stuck on this grading system, but from what I understand, it isn’t necessarily a definitive indicator for successful implantation.

IMG_4646

I am now waiting for my period to start so that I can begin the uterine lining thickening protocol (more injections and suppositories, yay).  We are keeping our fingers crossed for a FET in August!

 

Lucky 18

Our egg retrieval today yielded 18 eggs! I’m writing this post from bed as I rest with a heating pad and lots of reading materials. Our cat the empath hasn’t left my side since we got back. 

I was equal parts nervous and excited for today’s procedure, as I’ve never had surgery before and I was more than ready to have my follicles aspirated (if only to alleviate the feelings of being 5 months pregnant!). Daddy Graham and I arrived at the clinic at 7, and he almost immediately was whisked away to do his part. Soon thereafter I was taken back to be prepped for surgery.

I was picturing one of those scratchy hospital gowns and an antisceptic room, but I was given a fluffy robe to wear (that was warm!!) and led to a spa-like room with a leather recliner! All of the staff – the nurses, surgeon, embryologist, and anesthesiologist – were extremely accommodating and helpful. The nurse joked that once the anesthesia was in the IV,  I would wake up and ask when we were about to start and it’d be all over, which is pretty much exactly how it happened! The last thing I remember was having an oxygen mask placed over my face, and the next I was blinking at the nurse. 

For the squeamish, you may want to skip to the next part as I want to write a little bit about what the surgery actually entailed.  Once under anesthesia, the surgeon inserts an ultrasound wand with a slender needle attached. This needle will then go through the vaginal wall and into the ovary where each follicle is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary.  A few hours later the embryologist will insert the sperm into the egg, and then we wait! 

Before we left for home, I was told we had retrieved 18 eggs. It felt like an omen – 18 in Judaism is a lucky number that means ‘life’. While we won’t know until tomorrow how many of the eggs that we retrieved were viable for fertilization, we feel incredibly optimistic.  All we want is for one healthy embryo to stick! It’s amazing to think that in a Petri dish not that far away, our future Baby Graham is beginning his/her life. 

Trigger Happy

IMG_4622This morning’s appointment brought the welcome news that we are ready to trigger for our egg retrieval!  I’ve been really uncomfortable and nauseous the past few days and no wonder – today’s ultrasound revealed at least 20 follicles just on my right ovary.  The nurse actually stopped counting once she hit 12 on each side.  While I am pleased that my body has responded so well to the stimulating hormones, I do realize that it is quality over quantity, so I am really hoping that we are able to retrieve viable, healthy eggs that fertilize.  And, let’s be honest, I’m looking forward to not feeling like a Macy’s Thanksgiving Day Parade float.

I just had an opportunity to look at my lab results and, to my untrained eye, my estrogen levels look really high: slightly over 9,000 pg/mL.  As I understand it, each follicle will release between 150-200 pg/mL, so I get why my level is sky high but I worry that this could develop into ovarian hyperstimulation syndrome (OHSS) after egg retrieval and/or they will cancel this cycle.  I haven’t heard from my doctor’s office and they are usually really good about calling if there are any issues with my lab results.  Anxious, much?

Tonight I am scheduled to take my first trigger of Lupron.  Due to timing, I will have to give myself a Lupron shot at work tomorrow morning as well, which should be interesting to say the very least. Making IVF viable while I work has been a challenge, but thankfully I have a job with some flexibility and that is accommodating to the many doctor’s appointments that I’ve so far had.

Wednesday, first thing, Daddy Graham and I will head into the Fertility Clinic to have the eggs retrieved and for Daddy Graham to deliver some swimmers.  Fingers crossed that everything goes smoothly and that we are one step closer to Baby Graham!

Doing Battle with … Insurance

IMG_4613

As I had mentioned before, my insurance is covering my IVF (up to $50,000).  I am unbelievably lucky on this front, I know.  There are numerous women and couples who fork over their life savings for treatment which, as we all know, isn’t a guarantee that you will one day have a baby.  This doesn’t mean I don’t have to battle my insurance company for coverage of medicine …

As you all know, I’m currently in the middle of my first IVF cycle.  I was given a laundry list of prescriptions for the stimulating hormones which had to be fulfilled through a specialty pharmacy.  Four of the medicines required prior approval: the follistim (contains follicle-stimulating hormone (FSH) to help produce follicles/eggs), menopur (contains FSH and luteinizing hormone (LH) to help produce follicles/eggs), cetrotide (prevents premature ovulation by blocking the hormone that causes eggs to be released from the ovaries), and leuprolide (used as the trigger before IVF).  After much time spent on the phone with both the Fertility Clinic and Specialty Pharmacy through my insurance carrier, I was given the prior approval for three out of the four. Mind you, I was given approval after I had started the cycle – my Fertility Clinic was kind enough to “front” me the medicine that I needed with the understanding that, when my prescriptions came in, I would turn them over.   Leuprolide, however, was deemed “unnecessary” by my insurance carrier and denied.

Denied!  Even though it was a script written by my doctor for their IVF protocol.  Even though it was reviewed twice. Even though I am in the middle of my hormone therapy regimen and I need the medicine as soon as possible.  The specialty pharmacy said that my doctor could fax in a “letter of medical necessity”; the prior approval department at the doctor’s said they would be happy to do this but it could take up to two weeks to review.  TWO WEEKS?  Not the two week wait I am comfortable with … Instead, I am looking at paying out of pocket for the medicine, which is incredibly frustrating.

One more hurdle to clear. Deep breath in.

Bunches o’ Grapes

The follicles are growing!! Today was the first ultrasound since beginning the follistim and menopur and it appears that my ovaries are responding well to the stim meds – so far there are at least four follicles growing on each side (the nurse couldn’t give me a definitive number of follicles because they were “on top of one another”).  I return for another ultrasound and blood work on Friday… here’s hoping for continued growth! 

It’s really the only time I’m hoping that my ovaries are like bunches of grapes. 

Stims in the Woods

The view from our family cabin on Lake George, NY


My family’s annual 4th of July holiday reunion landed smack in the middle of our IVF injections schedule and I’m here to report that, while maybe a little awkward that Daddy Graham and I would disappear at 6 pm on the dot to go through our routine with MUCH STERILIZATION, it was completely doable.  

In fact, being able to enjoy family and do our normal things (go to the beach, laze about a campfire, eat picnic food with abandon) was imperative – resuming our life as usual instead of obsessing over our ever-present conception journey was a lovely and important reminder of the necessity of balance. 

So far, I’ve had no noticeable side effects from the menopur and follistim. I’ve actually been feeling great – fingers crossed that this continues! My next appointment for an ultrasound and blood work to see how the follicles are progressing is tomorrow morning.  I’m feeling confident and positive that we will be successful with IVF and that at next year’s family reunion, Baby Graham will be there with us!