Continued from the first part in this blog series: http://www.onefleshonelove.blogspot.com/2015/10/our-last-4-losses-explained-our-embryo.html
As we had been asked to do, we called our fertility clinic the day that my next cycle started. My meds had come from our fertility pharmacy, and were ready for me to start taking. Our embryo transfer would require me to be on 6 different prescription meds at different times throughout my cycle - 2 different estrogen meds to build my uterine lining (these made me laugh because my body ALREADY massively overproduces estrogen and has for years - in fact, this is the cause of my endometriosis! But, in these frozen embryo transfer cycles, the meds are essentially totally taking over your body's natural mechanism for a month, so these were necessary), 2 different progesterone meds to maintain my uterine lining and help sustain a pregnancy that may result, progesterone in oil (given via intramuscular injections), and an immunosuppressant to keep my body from rejecting the embryos. And, on top of this, baby aspirin, prenatal vitamins, and heavy doses of folic acid. My meds basically took up our entire kitchen countertop!
The first step was to go to our clinic, at the start of my cycle, for a baseline ultrasound, just to make sure all looked good to proceed, and a mock transfer, which is a "practice run" of what the physical embryo transfer procedure would be like. Embryos are very fragile after thawing, so it's important that the transfer process be completed quickly. The mock transfer went pretty easily, and Dr. Deaton felt good about how the real transfer would go a few weeks later. I was cleared to go home and start my meds.
We also decided, for this transfer, to transfer two of the four embryos into my uterus. Transferring two at a time does give you the chance of twins (if both embryos implant), but also give you a better chance of getting pregnant. And after all we'd been through, twins were certainly something we'd be okay with...we didn't want to lose any of these babies! So we decided we would transfer two the first time and keep the other two frozen to further build our family down the road.
The non-injectable meds are pretty easy. The only real problem with them is that they are loaded with enormous doses of hormones, and I'm not sure I was the nicest person to be around during either of my transfer cycles (David says I wasn't bad, but he probably told me that because he may have feared for his life at that time if he'd said anything different ;-) ) I had some headaches from the meds, and some abdominal pain from an ovarian cyst that the meds were shrinking. And the progesterone supplements made me super exhausted. But I feel blessed, because some women have BAD side effects from all of these medications, and mine were, overall, pretty tolerable.
The progesterone-in-oil (PIO) shots are a little different. Fortunately, I only had to do 10 days of PIO as part of my frozen embryo transfer (FET cycle), but, even as someone who doesn't mind needles, I have to admit, the shots intimidated me. I was used to giving myself Ovidrel shots for my IUIs, but those are ENTIRELY different. Ovidrel involves little, short, thin needles, and I gave the shots to myself in the stomach, subcutaneously. Very little pain to administer, and virtually no pain afterward. PIO shots, however, are considered one of the "hardcore" injections in the world of infertility. They involve 1.5 inch needles that go directly into your glute muscle. Seriously, people, hold your thumb and forefinger an inch-and-a-half apart. Picture that being all needle (and a much thicker needle than what we used for Ovidrel). Picture that needle going all the way into your upper muscle. Seriously. And picture it delivering a thick, oily, doesn't-dissolve-easily liquid into your muscle, that will leave it sore for days and days afterward. Yeah, I wasn't looking forward to it. Also, although it is "theoretically" possible for a woman to give herself PIO shots, the area it must be injected into makes that all but impossible, unless you happen to be a professional contortionist, so almost all women using PIO choose to have their husband administer the nightly shots for them. PIO shots are known to hurt. A lot. During, and for days after. Some women admit to crying during, or after each one, and many women have painful knots form in their muscles from the injection that last for days, weeks, or months. Lovely.
So, around day 15 or so of my cycle I had another ultrasound and some blood work, to confirm the other meds were doing what they should, and to make sure we were officially good to go with our transfer. Dr. Deaton told me to go ahead and start my PIO shots that night. I'm not totally sure who was more nervous before the first shot...David, or me. Oh, and have I mentioned how romantic it is to have your husband give you nightly shots in your backside (except that it's not romantic at all)? Like I said, I don't have an issue with needles. Because of our fertility problems, I get blood drawn on a regular basis. When not pregnant, I'm also a regular blood donor. And shots have never been a big deal at all for me. But I'll admit, the thought of these particular shots had me intimidated. David watched the instructional video and, that first night of shots, drew up the progesterone in oil from the vial while I waited nervously.
So, after all of these daily medication rituals, the day of our transfer rolled around - Wednesday May 13th, 2015. Our clinic has an embryologist, Dr. Wininger. He is a Ph.D. who specializes in the study and care of embryos, and he works with Dr. Deaton (Dr. Deaton is both an ob/gyn and a reproductive endocrinologist) to care for embryos in IVF and embryo adoption procedures. Dr. Wininger thaws the embryos out before a transfer, which in and of itself is a very precise and scientific procedure. Sometimes, embryos actually die in the thawing process. I was so nervous about this. It was hard enough to lose babies during pregnancy, and I didn't want to lose one of our children BEFORE they even had a chance to be safe inside of me.
The day of our transfer, we dropped Joseph off at my parents house and headed to our clinic at the appointed time. We were lead to a room to consult with Dr. Deaton and Dr. Wininger about how the embryos did during the thawing process. Fortunately, we found out that both thawed perfectly and looked wonderful. Our babies were in good shape! One huge advantage of IVF and/or embryo adoption is that parents get a picture of the thawed embryos before transfer. I was very excited to get these "first pictures" of our sweet babies!!!
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| The reason that the top embryo looks more like two embryos is because it was already in the "hatching" process, meaning that it was already in the process of further cell division - a very good sign! I love this picture of these two precious snowflake babies...ours in all ways, except without our DNA. Such a cool miracle! |
After the consult, we were taken back to the transfer room. The transfer room is very sterile and full of equipment, but also very crowded and a flurry of activity. I was on the procedure table, with David holding my hand, a medical assistant with an ultrasound wand on my abdomen, a nurse on the other side of the room, and Dr. Deaton and Dr. Wininger prepared to do the actual procedure.
For most women, an embryo transfer is mildly uncomfortable but not truly painful. I'm a little bit of an unusual case. I have some endometriosis around my cervix which means when ANYTHING passes through my cervix, even an extremely small tube like the one used for an embryo transfer, the area of endometriosis is irritated, and that causes extreme uterine cramping. I'm used to pretty bad pain from my endo, but this is seriously unbearable pain, as bad as what I experienced with my 2nd miscarriage (which was the worst one, physically). So sure enough, when Dr. Deaton started catheter with the embryos through my cervix, I was immediately in some pretty intense pain. To make things worse, my cervix happens to be very narrow, and so it takes a while for Dr. Deaton to find the right angle with the catheter to get through into my uterus. The longer it takes, the longer the extreme cramping goes on, and this transfer took FOREVER. It was awful (physically). I'm pretty certain I broke David's hand from squeezing, but he wasn't about to say a word. Dr. Deaton was even talking about how they could actually see the cramping on the ultrasound screen. But fiinally it was done. I wasn't thrilled with the way that the transfer went, because I also knew that sometimes a lot of cramping during the procedure physically stresses the embryos and can lower your chances for success. But there was nothing to do now but wait and see what happened.
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| Just a few minutes after our May transfer. The "Embryos on Board' sign was made by my mom, and the ultrasound picture was of everything just after transfer (obviously the embryos are too little to see, but it's just cool to know they were in that picture) |
Because we transferred very mature "Day 6" embryos (meaning these two embryos had grown for 6 days after fertilization before they were frozen in 2013), that meant that they were mature enough that they should implant in my body within the next 24-48 hours after transfer. Some doctors advise strict bed rest during this period to help ensure successful implantation. Dr. Deaton just encourages resting as much as possible and avoiding any heavy lifting, etc. Generally, if a Day 6 transfer is successful, a woman will often get a positive home pregnancy test within 5 days or less of the transfer procedure. We went home, and I spend the next 2 days resting at my parents house while David was at work (because someone had to be able to change Joseph for me and other things I wasn't supposed to be doing). It was really hard not to be able to pick Joseph up for a couple of days...he didn't seem to understand. But I still let David put him on my lap every night so I could rock him, and that made us both happy.
I started testing on Saturday morning, 3 days after transfer. While some women do, occasionally, get positives this early on home pregnancy tests (especially if carrying twins), I knew there was a good possibility I would NOT get a positive test this early, yet still be pregnant. So I didn't stress too much. I had hoped to be getting faint positives by that Sunday, though, and so, after not even getting a faint positive on Sunday evening, I was getting pretty discouraged, and so was David. I had a bit of a crying session, worried that these two babies hadn't implanted at all.
Monday morning I woke up, just expecting another negative. So I was very pleasantly surprised when a faint, faint, FAINT 2nd line appeared. I was pregnant! With babies that were not even genetically related to me, but babies I would love and care for and raise just like my biological son! It was beyond cool. I had a blood test scheduled for that Thursday, so I knew in a few days I'd get to see how my hormone levels were progressing. I tried not to think too much into things that day and just enjoy the fact that I was pregnant!
I tested again the next morning (Tuesday) and was a little disappointed to see the line not getting much darker. Now, granted, darkness of lines doesn't always mean a lot. Different pregnancy tests can come from different dye lots, and that can vary the darkness of lines. For ME, however, lines that aren't gradually getting darker over a progression of a few days have usually meant one thing...that we were leading up to a miscarriage. The tests I took on Wednesday morning and Thursday morning showed lines that sere just slightly darker, but not much. Still, I tried not to think too much into things. I was still getting lines. That meant I was still pregnant. "I'm pregnant today, and I'm going to enjoy it" I kept telling myself and others.
So Thursday rolled around and it was time for my blood test. Now, the initial blood test doesn't always tell you much. It tells you your pregnancy hormone (HCG) level, which may be low or high, but that doesn't necessarily mean anything. It isn't until you go for a repeat blood test several days later that you really get to know how the pregnancy is going, because they want to see your number increasing exponentially from whatever it was at the first test.
I went that morning to get my blood drawn and was told they would call me that afternoon with the results. According to the American Pregnancy Association, hormone levels at 4 weeks pregnant (which is where I was at this point) range anywhere from 5 to 426, which is of course a very large range. My phone rang that afternoon and I found out that, while I was indeed pregnant, my HCG was a very low 23. Obviously, this is very much on the lower end of the hormone spectrum, and also explains why I had zero pregnancy symptoms at that point - no nausea or anything else. I was pretty tired, but most of that was likely from all the progesterone I was taking, not as much from the pregnancy. Basically, my doctor's office said this pregnancy could go either way. Some women with HCG levels this low have their levels increase steadily and well, and go on to give birth to healthy babies (even twins!), while others see their levels fall rapidly and miscarry. I tried to remain hopeful...there was a woman in my online support group who had an initial hcg level of only 7 and was obviously sure things were going to end badly, but she went on to have a healthy baby 8 months later. There are also women who had super high hormone levels at this point and went on to miscarry. So no one really knows anything at this point. I tried to focus on the good stories, but deep down I couldn't help but worry that one or both of the babies we transferred were not doing well. I remember getting my blood drawn at this point during my pregnancy with Joseph, and my numbers were already well into the hundreds (I had SUPER high hcg with him, which explains why I felt so sick for 13 weeks!). And I started to think back to my last miscarriage with our sweet baby, Jesse, and realized that with he/she my numbers were already twice as high at this point, and I still miscarried (and Jesse was just a "singleton," whereas this time I knew there were two babies inside of me, which definitely made me think my numbers should be higher). So like I said, despite my attempts at being positive, I didn't have the best feeling about things.
I kept testing every day and, while the lines held steady for a while and maybe even darkened a bit, a few days later they started getting lighter. It was so, so sad. I knew what that meant, without even having a blood test. I was losing these babies. The only reason I had not started bleeding and cramping was all the medications I was on, which will delay that for a while unless you stop taking them. On the day I went for my next blood test, I got a totally negative home pregnancy test, and I knew it was over. I'd basically gotten positive tests for a little over a week, and had made it to about 5 weeks and 2 days pregnant, and that was the end. When they called me that afternoon with the blood results, my HCG had dropped back to zero already. The babies were with Jesus. I was told I could stop my meds (I never, ever, ever, in any of my pregnancies stop meds until I know with 100% certainty my hcg is zero, or see on ultrasound that baby has no heartbeat), and so I didn't take any more of my medication past that. About 3 days later, the physical miscarriage process took place.
Emotionally, it is never fun. But I felt blessed that I got to carry these babies, even for a short time. I can tell the world that their two little lives mattered so, so much....to God, to our family, and to the world. It felt like an odd place to be in for us - parents to seven children. One biological child here on earth, two biological children in heaven, 2 non-biological children in heaven, and 2 non-biological children still frozen here on earth. It was a lot to wrap our minds around in terms of what God was doing in our life.
We decided to give my body a break for the summer, and to give ourselves an emotional break, too. So, from late May through September, we carried on life relatively as usual, while missing those babies we'd lost, but excited about the ones that would be transferred in the fall.
Which leads us to our October transfer of our remaining two embryos...this story to be continued in part 3...coming soon. (There will be 4 parts overall to this series, lol...told you this was a long story!)
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