The Infertility Process

The First, and Almost Last, IVF

After finally getting the results from Dr. Braverman and consulting with our infertility doctor, Andrew and I decided to move on with the next phase of infertility treatments: in vitro fertilization (IVF).  Our doctor convinced us that we should do Preimplantation Genetic Screen (PGS) as well because he said it could reduce the amount of miscarriages due to genetic abnormalities. Because of the PGS testing, all embryo transfers would have to be done as a Frozen Embryo Transfer (FET).

He also let us know that if any are genetically abnormal, he would not transfer them.  I thought it was strange that he would have to verbalize this but I guess some people have tried to transfer genetically abnormal embryos (it’ll become clear why this is important later in my journey but it’ll be in another post).

The first step in the process was to have another saline ultrasound to check for abnormalities in my uterus.  Unfortunately, the doctor found a fibroid; on the other hand, he said it was not in an area where the embryo would implant.  I remember thinking this was a bad sign but tried not to look at it superstitiously and view it more logically.

[Side note: I had a doctor tell me one time that I am probably more superstitious than the average person because I am from Louisiana. I guess being raised with voodoo medicine, drinking hurricanes and having alligators as pets affected my ability to think logically. And for anyone not from Louisiana reading this, I am being sarcastic – about the voodoo and alligators – not about the doctor’s statement or the hurricanes. Moving on…]

Once everything checked out and I cut off my arm and leg to pay the clinic, they scheduled my egg retrieval: June 15, 2017.  We got our medication, ultrasound and laboratory protocol. I was put on a series of Menopur, Cetrotide, Gonal-F, HCG and Lupron injections.  That’s right – ALL injections. I am such a wimp that I had Andrew do all of them even though they were sub-q in my belly.

They did five ultrasounds over the course of 14 days to check the progression of my follicles.  They also did several lab draws to check hormone levels. The second hiccup: my progesterone level the day before the egg retrieval was 3.3 (they wanted it closer to 8).  They called me – I hate to say frantically but a smidge below that – stating I needed to take estrodial (estrogen) pills and to get them as quickly as I could. I don’t know if y’all know how easy it is to find a pharmacy locally that has estradiol in stock – but I will tell you it is not at all easy.  So, I am all hopped up on hormones trying to frantically (yes, I was frantic) find estradiol and get it filled as quickly as possible. Thank you, Costco.

After the first week of medication, I started to have a full, bloated feeling.  As we watched more and more of my follicles grow on the ultrasound, I saw why I was so uncomfortable. Because I have PCOS, I have more than the normal amount of follicles (sounds great but they don’t all mature as they should which is one of the many reasons PCOS causes infertility), the stimulation medications were causing more than the expected amount of follicles to grow.  Thankfully, I only have one ovary so I had less pain and discomfort than if I had two. I was also at less risk of Ovarian HyperStimulation Syndrome (OHSS) – I’ll explain what this is in my next educational post.

The day of the egg retrieval, we asked the doctor if we needed to recheck the progesterone and he said there was no time and it was probably fine. (UGH!)  I feel like this was a time we should have insisted on rechecking the level even if it meant starting over. But we had waited for so long to get to this moment, we trusted the doctor and moved forward.

The egg retrieval itself is fairly quick – I don’t really know how long because I was sedated through it. Why sedation, you ask? Because the eggs are retrieved by sticking a long needle through the wall of the vagina to the ovary (guided by ultrasound) and aspirating the eggs.  So yea, sedate me.

The procedure room is connected to the lab area where they keep, and later fertilize, the eggs.  I do remember having a little uh-uh moment when I was in stirrups and across the room someone peered through the window where they pass the aspirated eggs.  And I am sure she was just seeing where we were at in the procedure to know when to get ready to receive the eggs but I was thinking, “Move along. Nothing to see here.”

Anyways, so I get to go home and wait for a call to tell us how many eggs they were able to retrieve.  The sedation thing provided an extra bonus: I slept until they called with the results.

25 eggs!  We were so excited!  

Now, to explain the funnel effect after egg retrievals.  They retrieve a certain amount. Then, they look and find the eggs that are mature and discard the rest.  Then they put the eggs with the sperm and see how many eggs fertilize discarding the ones that don’t. Then, they check at Day 5, 6 and 7 to see which of the fertilized eggs become blastocysts.  It’s best if they achieve blastocyst stage at Day 5 but there have been pregnancies with healthy babies from Day 6 and 7 blastocysts. If they don’t achieve blastocyst stage by Day 7, they are discarded.  Next the lab grades them by looking at different characteristics. Grade 1 is the best and Grade 4 is the lowest grade they’ll use.

Like I said, we had 25 eggs to start, 13 eggs were mature, 11 fertilized.  Day 6 rolls around and we get no call about blastocysts. We try to be patient because we know they’re busy.  Day 7 comes and goes and still no call. On Day 8, I couldn’t take it and I called myself and left a message. And instead of the embryologist calling like the other days, the infertility doctor called (never a good sign).

He tells us that only 3 made it to blastocysts on Day 7 but none of them graded well.  He also said that although he thinks that none of them are genetically normal, he sent them off to be PGS tested anyway.

I was devastated.  Is there a emotional state beyond devastation?  If there is, I was there. I thought this was it.  End of the road for us. But Andrew looked at me and said, “Well, let’s try again.”  He had read that the first cycle of IVF doesn’t work out for a lot of people and they go on to have success in later cycles.  (I feel like I have to say here that Andrew was upset too. He just went into fix-it mode.)

I know it may seem like a crystal clear option for some but at the time, I was not seeing crystal clear.  So when Andrew said we should try again, it was like a light bulb went off and I thought, “oh yea, let’s try again.”

So I got our bills binder out (yes, we have a binder for our bills) and started looking at the numbers.  I started doing research on grants and loans for people going through infertility treatments. The grant options are limited but I applied for everyone that I could (none of which we were awarded).  We figured the best option was to take out a loan. So, we did.

Since we realized that this would be literally our last chance due to our ages, financial constraints and our general emotional capabilities, we thought we should look into other infertility clinics in the area.  (There are clinics throughout the US and Mexico with pretty great records who provide discounted rates; however, once I take off work and pay for all the travel expenses, we would be right at the same price tag. So we stayed in the area.)  We had stayed with this clinic through our IUI’s and then IVF because we didn’t want to start all over AGAIN. But, we had to make this try count so we decided to go back to where we first started: California IVF.

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