We are all in this together

WHO THIS IS FOR:

EVERYONE!

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It is infertility awareness week, HOORAY! I had the honor of writing a guest blog on the oh so very popular website Neighborhood Parents Network. NPN is a Chicago based community that helps parents from all walks of life find couples who are in the same boat as them.

Check out the post HERE.

If you are in Chicago I highly recommend checking them out. They have groups for adoption, IVF, moms who work, moms who are lawyers, stay at home moms, and the list goes on. They are a wealth of knowledge that I suggest you tap into.

-Annie

#StartAsking

WHO THIS POST IS FOR:

EVERYONE YOU KNOW.

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April 24th- 30th is National Infertility Awareness Week, but let’s get ahead and #startasking now! That’s right, there is a whole month dedicated to educating the masses and holy moly, the masses need it. According to the CDC 12% of women between the ages of 14-44 are  struggle with infertility, thats an insane amount of people. For something that is so far reaching, we need to engage in more dialogue so that we can create a supportive community that fosters positivity so that this horrific process can be a touch better.

I have met countless couples who tell me that they suffered alone for so long. Their friends, their family, colleagues had NO IDEA what they were going through. I can’t imagine living my life without people knowing because infertility consumes your entire being. I am not 100% myself most of the time and for me I need folks to know what is going on so that my behavior or physical state is understood.

But  I digress, so many people keep it a secret because infertility is not discussed in the public space and thus it makes is shameful. Women are often made to feel it is their fault, providing little space to feel comfortable sharing their circumstance. For men, our culture of masculinity confines them to a box that says, “Man+ sperm + “spreading your seed”= MANLY.” Heck, one time I was chatting with someone who I know quite well and is pregnant, and she said, “He feels like a man,” when I asked her how her husband felt about the news of her pregnancy.  

WHAT CAN YOU DO?

Advocate for Legislation

Help ensure legislation passes that protects infertile couples and ensures states require insurance cover treatment. Check out the current pieces of legislation out there and learn what representatives are sponsoring what bills HERE.

Empathize

I write about this a lot but I can not emphasize it enough. If you learn a friend is going through treatment do NOT say, “Oh I know someone who went through IVF, they are pregnant now, it will all work out.” While its great you want to show support and try to provide hope, your friends experience is just that, their experience. We don’t want to hear about it, we just want someone to listen and recognize our own struggle.

Join a support group

Resolve has a great list of groups access the country, find one and join. Having a community that truly understands your feelings and thoughts is invaluable.

#StartAsking

Resolve is hosting a campaign this week to get folks engaging in dialogue around infertility awareness. With infertility comes a slew of questions from “How is this fair?” to “Does my insurance cover this?” to “Where do I start with adoption?” When we ask these questions alone, they begin to eat away at you. When we ask these as a collective, we receive a robust compilation of answers to sift through. While the answers may not always be what we want to hear and they don’t always change your situation, knowledge is power and having an ounce of power during a time when you are utterly powerless is sacred.

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-Annie

ERA: The Test You Never Knew About

WHO THIS POST IS FOR:

  • IVF couples who have defied every statistic thrown their way despite her body doing everything its “supposed” to do.

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Last week was a tough week to say the least. We learned Wednesday (after waiting two extra days in our 2WW— a whole other drag) that we are once again not pregnant. While I am no longer shocked by this news, this one stung a little harder because they used 2 perfect embryos (my $13,000 investment in PGD tells us this) and my lining was the thickest its ever been (around a 9.5). But despite the perfect conditions, once again the transfer failed.

LETS TALK STATS

As a 29 year old woman with no explanation for my infertility, I should have been pregnant well…. 2 years ago. But if we are going by science/stats, we are talking two transfers ago. I have now entered the zone where I am in the extreme minority of IVF parents. We know I have awesome embryos (7 out of 18 are genetically perfect) and my lining is being very cooperative. We can presume from the PGD test that its not an egg or sperm issue (although we can not say this definitively). I have had a  hysteroscopy to make sure my uterus was squeaky clean and HSNs periodically to make sure it remained polyp/scar tissue free. The only place left to examine is when my uterus is most likely to receive an embryo and now we are doing just that.

ERA TEST

I learned of the ERA (Endometrial Receptivity Array Test) test prior to our transfer when we talked potential outcomes with our doctor. He explained that 99.99999999% of women only need progesterone for 6 days before a transfer. For example if you have a transfer on a Thursday, you start your progesterone on Saturday night. The 6 day period gets your uterus to accept an embryo at the peak time for a transfer. However .0000001% (I made that up but its something like that) of women may need one or two or three days more of progesterone to give the embryo the perfect opportunity to find a new home. Thus, the next step for us is to examine if my uterus needs some extra time to bake.

WHY THE ERA TEST MAKES MY BLOOD BOIL

I know I post about this ALL of the time but I REALLY HATE BEING ON TRANSFER MEDS. I feel and look like shit. I am usually physically ill and always mentally exhausted. I wallow in a place of low self confidence when I am on meds and yearn to be off of them entirely or to be on them and pregnant (in which case I will suck it up and love each side effect).  I am a positive person and can put a rose-y  lens on most things but when I am on my meds I struggle to find the sunshine in the clouds. I have now spent over 150 days on these meds and the end is no where in sight.

In order to do the ERA test you have to do a mock transfer. Yup thats right, I have to go through an entire cycle of meds but do not get the opportunity to transfer. What this means is, once I get my period (it has arrived) I will start back on estrogen, I will go to the doctors twice a week, start on progesterone and go to the hospital for my “procedure.” However instead of having a transfer, they will scrape my uterus, grab a sample and send it to the lab to be biopsied. HURRAY! I will then have a 2WW for my test results (HURRRRRAYYYYY- can you feel the sarcasm oozing out of my pores) and then start back up on my meds for a transfer.

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IS IT THE RIGHT TEST?

Of course only time will tell but from all of the literature Ive read, I am the prime candidate. My doctor did this test with a patient recently and she is pregnant. At this point in the game, that gives me little hope because each time I go through something new, I am told a story by someone that fits this framework.

“OH so many people have a successful transfer by the 2nd time.”

“Statistically most women are pregnant by the 3rd transfer, thats why insurance covers 4 retrievals.”

“This one patient couldn’t get pregnant but once she got her embryos tested she was successful her first time.”

The list goes on.

In a month or so we will once again be waiting patiently to find out test results. The highs will be high and the lows will be incredibly low. We are still on the worst rollercoaster that never seems to end.

**** I called my insurance to ask if its covered because I was told by doctor it wasn’t. (side note: Thankfully this is not near the cost of PGD). It is such a new and rare test that they had never heard of it (neither did the genetic counseling center that manages my referrals). I asked the doctor to submit it with a letter making the case as to why I need it. We shall see if they agree. If you are on the road to the ERA its worth calling your insurance directly to ask because your doctor may presume they won’t cover it which may not be the case.

-Annie

Egg Retrieval Time! PART 1

WHO THIS POST IS FOR:

  • Couples going through a round of IVF
  • Women retrieving eggs to donate and freeze at a later time.
  • Friends of infertile folks

Today was my first day of shots and thus, retrievals are on my mind. Friday I learned I was starting another round and will have another retrieval next week. I am quite excited because this means we are one step closer to getting some answers. Because I will have had 2 retrievals within one month, the info is fresh and ripe for the taking.

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WHAT IS A RETRIEVAL?

If you are going through a cycle of IVF or freezing your eggs you need to have the eggs removed from your ovaries. Your doctor will devise a plan (according to your diagnosis) that will allow them to stimulate your follicles (the magical sacks inside of your ovaries that grow and house your eggs) so that they can remove as many eggs as possible. Your age plays a large part in the number and quality of eggs removed, however you can of course defy the odds. For example you can be young and have poor quality eggs or older with a bunch of eggs ready to go. The doctor will determine a course of action based on the stats that normally apply for your age.

A CYCLE

You will begin your medication and stay on it for about 10-14 days. Your doctor will closely monitor you to figure out how your follicles are growing so that they can fix your medication dosages along the way. The entire process is incredibly calculated  and is contingent upon time thus it requires a lot of oversight.

WHAT MEDS WILL I TAKE?

In order to get your follicles big and juicy (mmmmmmm) they will need to stimulate them. The doctor will use an injectable medication to help get the follicles to grow (I take a shot in the morning and a shot at night). The goal is to get the follicles to grow together. What I mean by this is, you don’t want one follicle thats huge, a few that are medium, and a bunch that are small. The ideal is to get a large group to grow around the same size at the same time. The reason for this is, around day 10 of shots your doctor is going to look at the size of the follicles and determine if you are ready to “trigger.” This means that within 2 days, your follicles will be at the magic size (for my doctor its about 20mm) and he/she will be able to get the most bang for their buck.

In addition to the two shots each day (or however many your doctor gives you), you will introduce a third shot late on in your cycle. Because you are growing all of these follicles, your body will say to itself, “HMMMM this is strange, shouldn’t I ovulate?” Since your body is so smart, your doctor will have you begin an additional injectable so that your ovaries will not ovulate and will wait to release any eggs. In my experience I started taking this particular shot around day 7 of my cycle.

Once your follicles are at a certain point (around 18 mm) your doctor will give you the go ahead to trigger. This is INCREDIBLY TIME SENSITIVE. Depending on when your procedure is, your doctor will give you an exact time to take your medication. This last shot lets the follicles know its go time. “The effect of the “trigger shot” is to send eggs into a reproductive division known as meiosis where the objective end point is a decrease in the number of chromosomes in the egg from 46 to 23 (half) prior to ovulation or egg retrieval.”(READ MORE SCIENCE-Y STUFF HERE). In laymen’s terms, the shot gives the follicles the go ahead to release the eggs from little sacks inside of the follicle. In the process they become mature eggs ready for the taking.

 PREPPING FOR A RETRIVAL

Your doctors office will give you a time to show up for surgery. This is a surgery, you will not be awake for it. Most likely you have a procedure in early morning and will not eat prior to it because of the sedation.

Surgery (especially when new) can be scary. Do what you need to do for yourself to relax. Your partner (or sperm donation vile) will need to be present because you will need the sperm for your freshly retrieved eggs. Immediately following your retrieval the sperm and egg are introduced to one another in a petri dish.

*** Embryo fertilization and testing will be in a post in just a few short weeks, stay tuned!

You will most likely feel pretty crappy (crampy) and tired afterwards, do not make plans. Depending on overstimulation, etc. you may want to ensure you don’t have plans the following day either. Take each day as it comes and show kindness to yourself.

This past retrieval I had a list of TV shows I was waiting to watch so that I would be occupied while I was at home. I recommend you do the same.

BATCHING

Some women opt to get multiple eggs in the bank before transferring. Last year I did a retrieval (it failed), and then did another one. My second retrieval yielded 5 embryos. I defied all odds, after transferring 4 I still wasn’t pregnant. Statistically about half of the embryos should have been genetically sound.

My husband and I decided to search for answers and pursue genetic testing. This testing will help us figure out if it my eggs are my issue. Thus, it makes sense to get as many eggs as possible before testing. This process is called “batching.” Next week I will have a fourth retrieval and finally be done with retrievals forever 🙂

Many older women batch so that they can get a number of embryos to transfer all at once because statistically most of their eggs will have gone bad.

HOLY GUACAMOLE! YOUR OVARIES ARE THE SIZE OF AVOCADOS

A very small percentage of women over stimulate. What this means is, they produce an insane amount of follicles and the result is their ovaries get ridiculously big. In some cases fluid leaks from the ovaries which is quite dangerous. The fluid could leak throughout your body and cause some major damage. Additionally, because your ovaries are so big you can twist an ovary and cause a torsion.

I am one of the lucky women who are prone to this. If you are in this circumstance you will watched even more closely. If your doctor does not mention this, put him in line NOW.

Leading up to and after the retrieval is tough because you can literally feel your ovaries. They are big and heavy. Your stomach becomes huge and you feel super bloated and heavy. Once you get your period, your ovaries will chill out and you will feel better. Waiting around though is not fun, I cant pretend it is.

TRANSFER TIME

Some women will transfer their embryos after a retrieval while others must freeze and wait. If you are doing a fresh transfer, you will be given additional hormones to prep your body for the embryo implantation.

Managing your meds and feelings is a lot. Give yourself permission to be okay with the process. I have talked to so many women and each time I am reminded that its okay that our brains are consumed by this. It doesn’t make you a bad employee, friend, or partner. Its natural, this is intense. Be nice to yourself and try to laugh along the way.-

-Annie

 

POSTS TO COME:

  • Acupuncture before a procedure
  • Make your partner give you shots
  • Overstimulation, scary stuff
  • Transfers, fresh and frozen
  • Genetic testing
  • Failed retrievals, whats next

What the heck is IVF?

WHO IS THIS POST FOR?
  • YOU JUST LEARNED YOU MAY NEED TO GO TO A FERTILITY DOCTOR.
  • IUI HAS FAILED AND YOU ARE BEING MOVED TO IVF.
  • YOU ARE IN A SAME SEX RELATIONSHIP AND ARE FAMILY PLANNING.
  • WOMEN WHO DON’T WANT KIDS NOW AND ARE CONSIDERING FREEZING THEIR EGGS.
  • SUPPORTIVE/CURIOUS FRIENDS!
IVF= In Vitro Fertilization

In laymen’s terms…. the sexiest way to make a baby. Real talk, IVF is assisted implantation of a fertilized embryo into a womb.

How does IVF happen?

The way families get to the stage of IVF varies. Some couples have to do IVF because of past medical history, while others are counseled to this step after failed rounds of IUI (Intrauterine insemination). There are endless reasons as to why folks need IVF, whatever the reason may be, it is the pits.

IVF can happen in two ways: fresh transfer or a frozen transfer.

STEP ONE:

Get those eggs! Whether you are using an egg donor or your own, the first step is retrieving eggs. If you are using your own eggs you will have a retrieval (ooolala!). If you are receiving a donation, eggs will be removed from a lab and will be fertilized with sperm.

Retrival (Tell me more! Sounds like a blast!)

If you are using your own eggs you must first have your eggs extracted from your ovaries. The cocktail of drugs your doctor uses will vary based on your body’s egg production, hormone levels, medical history, etc. The medications are to help with a few things:

  • Egg production/stimulation (FSH): You want to create as many follicles as possible so that you can get multiple eggs rather then just one during your procedure. Think of your ovaries as a factory for eggs working overtime during your first few days of stimulation.
  • Premature Ovulation: Once you have all of those eggs, you want to keep them in your ovaries! Heck you just worked super hard to create them all, the docs need to ensure you do not release any and ruin the entire plan.
  • Oocyte Maturation: What the what? Since you are keeping your follicles from releasing the eggs (ovulation) the doctors manipulate your timeline (between the 8th and 14th day of being on meds (source: MayoClinic)) with an HCG shot to tells your follicle friends its “go time.” Once you take this shot, you will go in for your procedure (within a very specific time frame), to have the eggs removed.

For your procedure you are put to sleep for the egg retrieval. After a day you feel decent. This of course though depends on your body etc. If you are prone to overstimulation (points to self) the days following the procedure are pretty tough because your ovaries swell to the size of an avocado or bigger, but thats a post for another time!

STEP 2: What to do with the eggs?

After the eggs are retrieved they are fertilized by sperm. Either the sperm meets the egg in a petri dish OR a sperm is shot directly into an egg through a process known as ICSI (future post in the works). Some doctors make you wait three days, while others will make you wait five-six days to see how many embryos fertilized and to measure the quality of the embryos.

Does this sound like a blast yet? Take a deep breath. It is a lot, BUT its do-able! Strong, smart women everywhere are able to get through the process. While it may suck the life out of you at the time, the feeling is temporary. Trust me, it goes away. Okay back to the process!

Fresh Transfer Vs. Frozen Transfer:

For those who are not prone to overstimulation, have a thick lining, and are cleared by their doctor, a fresh transfer will be their route to baby making. What this means is, the embryo will be removed from the lab (immediately following fertilization— day 3-5 depending on the lab) and transferred back into the woman’s uterus. The woman then waits 10 days (known as the 2WW in many IVF communities) to find out if the procedure worked.

A frozen transfer takes a lot more patience. If you overstimulated (cue me again) or have to have a hysteroscopy or have a host of other issues, you will not have your embryos transferred right after your retrieval. Rather, your embryos will be frozen after day 5 or 6 of fertilization. Your doctor will plot a timeline of transfers for you. A transfer requires a completely new round of meds, a new cocktail of drugs, and an additional procedure.

The transfers help the doctor uncover a lot about your ability to get pregnant. Transfers may help reveal if your eggs have gone “bad.”

There is A LOT to IVF. This post is just the quick version. It can be incredibly overwhelming but I assure you, having information makes the process a lot easier. Knowing why they are giving you certain meds, timelines, options etc.,  helps you gain control in a situation where you don’t have any.

-Annie

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