Here We Go Again

As I informed in a previous post, Sean and I are ready to expand the family and try for another Baby Heep...But since we are challenged in that regard, it requires some more planning and effort, and well, medical intervention than the typical case. I wish I had been blogging during our past struggles with infertility. Those years of whole-hearted and hopeful attempts, followed routinely by heartache, encouraged personal growth and undoubtedly shaped me as a mother, wife, friend, and person. (Ultimate mom-blog material!)

Now, I have too mushy a mom-brain to remember every detail of all that we went through to have Willa. But I remember a lot. And despite how difficult it was, it's not something I particularly want to forget.

In a nutshell, we spent about 7 years of trials and intermittent treatment, which covered more unromantic territory than I ever had anticipated. Basic temperature charting eventually lead to a hysterosalpingogram (dye test) and a prescription of the marriage-threatening Clomid. After 6 months of the horrid drug, and no pregnancy, we were referred to a Reproductive Endocrinologist (fertility specialist) and underwent 3 consecutive Intra Uterine Inseminations accompanied by more Clomid. Finally, we switched to stronger injectable ovarian stimulation which helped me to produce 5 follicles and held a lot of promise. And still not a one made a baby. It had been two solid years of tried and failed cycles when we took a break to regroup, recoup, and save up enough money for our next step - InVitro Fertilization. One cycle = $15k.

Most people know what IVF entails, or at least think they do. But for those who haven't a clue or have been misinformed, here's how it works:

I should start by explaining how we got here in the first place. Before you go feeling like you are invading into private territory, let me explain how Sean and I both feel about divulging this information for all the world to see. We are completely open about it and have nothing to hide. Infertility is a scary, lonely world, and we lived in it long enough to get over ourselves, our pride, and our fears of judgement by others who had not ever considered our shoes, let alone walked in them. We wish more people could talk openly about their infertility, and especially that others (fertiles-so to speak) wouldn't get so darned uncomfortable around it.

Now that I've gotten that off my chest...back to our particular case: We were diagnosed with male-factor infertility. With all do respect for modern medicine and the miracle of IVF, I still don't quite understand why no one has come up with a successful treatment for problematic sperm, other than hyper-stimulation of the female. That, basically, is what IVF entails. The female is made hyper-fertile to compensate for male-related issues. I am not complaining - those are just the facts - and I occasionally ponder them.

It was March of 2007 when we took on IVF. I received my air mail package of meds and cried because it overwhelmed me. I remember fear being a pretty strong emotion at that point, too. But determination won out and we pressed on with as much optimism as we could muster. First, I took birth control pills so that my cycle was properly timed. Then I injected Lupron to suppress my ovaries prior to Follistim to stimulate them and Sean and I drove to Austin several times a week to have my blood drawn in the wee hours of morning. My uterus and follicular development were carefully monitored by ultrasound and hormone levels as determined by the blood work. When the follicles had reached maturity, I was scheduled for retrieval and given a shot of HCG, the strategically-timed ovulation trigger. It starts the countdown to ovulation, and retrieval must be performed just before it occurs. I was put under anesthesia for the first time in my life, as Sean was ushered off to take care of his business, which, by the way, is just as low-tech as you can possibly imagine. With an ultrasound-guided needle, the doctor pierced through my vaginal wall and aspirated each follicle directly from an overworked, Herculean ovary. When I woke up, I was in a lot of pain, but happy to hear that 23 eggs had been retrieved - that's almost two year's worth of ovulation, all crammed into one cycle and one very swollen ovary. The embryologists selected 16 viable eggs and performed intracytoplasmic sperm injection, ICSI, on each of them. That's a super-advanced procedure in which a single sperm is selected and injected into a single egg. Twelve fertilized, and 8 matured into healthy blastocysts by day 5 - the day of transfer. Sean and I decided to transfer 2 embryos, which gave us a 60-80% chance at pregnancy and about a 40% chance of twins. The remaining 6 embryos were frozen, and the two week wait began. Melissa, my dear friend/neighbor/registered nurse administered my daily intramuscular progesterone injections into alternating hips with the fattest, longest needle I've ever seen. I turned black and blue and lumpy. But the daily ritual gave me something to focus on throughout the wait. On the day of my Beta HCG, (that's a fancy name for a pregnancy test) I was depressed, terrified, and certain that I was not pregnant. I felt just the same as I did every time before - bloated, uncomfortable, constipated, tender in the breasts - all side effects of the progesterone and other meds I had been taking. When the nurse called, her voice was quiet and serious - just like every other time I had received this call. But her words were different. I was finally pregnant and we had conquered infertility.

Round One, at least.

We are currently undergoing our very first frozen embryo transfer. It is much simpler, medically, and less expensive than a full-blown IVF cycle, but the pregancy rates are significantly lower as well.

This is how a FET goes: First I had a hysterosalpingogram (dye test) to ensure that my uterus is primed for another pregnancy. I am taking oral estrogen 3 times a day to suppress my ovaries and prevent them from making any new eggs, since we are transferring frozen embryos (fertilized eggs) from a previous cycle ~ the 2007 IVF cycle in which Willa was conceived. The estrogen has made me extra sensitive and I've cried an awful lot, but that's the only side effect so far. I had an ultrasound at the start of the cycle to make sure my uterus was cyst-free, and a second one accompanied by a blood test to determine that the estrogen is working properly and preparing my uterus for implantation. Sean and I picked up all six embryos from the cryobank and delivered them to the IVF center for preparations. And we also got a refresher course on progesterone injections. I have one more blood test later this week to check my progesterone level and will begin injections this weekend. Melissa wasn't willing to move back to Fredericksburg or make the daily commute, so it's all up to Sean this time. He is significantly more nervous about it than I am. He compared his needle-phobia to my toothpaste aversion, so I'm actually feeling pretty sorry for him. (Even though I'll be the one getting stuck.) Five days after I start the progesterone, I will go in for transfer. Only about 70% of embryos survive the freeze/thaw process. We are considered very fortunate to have six; Many people don't have any extras to freeze and use in subsequent cycles. Talk about counting our blessings. On the day of transfer, one embryo will be selected and thawed, despite the advice of our doctor who suggested we transfer two, simultaneously, to increase our pregnancy odds from 25% to 35%. Twins, although medically fine and dandy, is not a responsible decision for our household. And contrary to the desperation we felt before having Willa, we now have a sense of patience and acceptance of our circumstances. If that first one survives the thaw, the rest can go back to the cryobank for our future use. If it doesn't, they will thaw another one, and so on.

So that's what we've been up to. How about you?