In case you missed it: Best of Infertility Awareness Week

WHO THIS POST IS FOR:

EVERYONE!


Last week was National Infertility Awareness week, the internet was booming with awesome articles about infertility. It was excited to see folks engage in dialogue and feel a little less alone in all of this. Below is some of the best articles I read this past week. I hope you can share continue to spread the word outside of this designated week.

The Loneliness Of Infertility featured in Elle Magazine ->Absolutely beautiful piece- poetic.

The Pain of Infertility Never Goes away featured in Scary Mommy

Why Infertility Awareness Week Should Matter to Moms  featured in Romper

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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.

MadMenPeggyHeadDesk

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

Is a failed retrieval the end?

WHO THIS POST IS FOR:

  • Couples who are about to start IVF
  • Couples who have had a failed retrieval

A quick recap, a retrieval is when the doctor removes eggs from your ovaries. You may have this done to retrieve eggs for a later use or use those eggs to create embryos. You can learns the ins and outs of the procedure HERE. This post though is not about the basics and the minutia of a procedure, rather its about what happens if things go wrong. Sadly I can tell you about this experience. I am not a doctor, do not take this as medical advice. Rather, this is post to let you know there is hope and you have some control in this situation.

FEBRUARY 2015

I was scheduled for my first retrieval. I was prepped and ready. I was told things were “perfect” days leading up to it. I went in for surgery with 48 or so follicles. I woke up from surgery and my doctor was sitting in my room. She said she had bad news. I looked at my husband and he confirmed (he was told while I was out). She wasn’t able to retrieve a single egg.

I was in shock, how could this be? It didn’t make ANY sense. She said she hadn’t seen this happen before and told me she was so sorry.

Suffice it to say I was devastated. This was a complete whirlwind going from exploring infertility to IVF to a failed transfer all within 4 months.

We scheduled a meeting with her shortly after to discuss options. She let us know she consulted other doctors because she hadn’t had this happen in the past. She didn’t have a  definitive plan, she did have some ideas though. Her uncertainty made me uneasy, I left and made an appointment for a second opinion.

CHECKING YOUR HORMONES THE DAY BEFORE THE PROCEDURE

We met our new doctor and immediately were compelled to switch. While he was surprised at the outcome, it didn’t stump him. He had a slew of potential reasons and explained in great detail what most likely happened.

He then asked one key question, “Did they check your hormones the day after your trigger shot (day before surgery)?” I let him know that was the ONE day I didn’t go in. He looked perplexed and then explained that this was not standard practice. It IS standard practice to check your hormone level the day before to ensure the trigger worked. If your hormones indicate it didn’t work, no big deal, they will give you another and let you bake a few more days.

I have had 3 incredibly successful retrievals since switching doctors. My doctor has retrieved 72 eggs.

TIME IS OF THE ESSENCE

The switch in doctors taught me how incredibly important timing is for a retrieval. As you prepare for a retrieval it is SO important you understand the timeline so that you can advocate for yourself. It is your body and you should have the ability to make the call as to wether you need your blood taken, etc.

There are many retrievals that fail for other reasons (egg quality and quantity) which are difficult/near impossible to prevent or predict. Timing can be managed. I hope this is helpful as you prepare to talk with your doctor.

-Annie

Spring Trends for that IVF Bodacious Body (Dress Edition)

WHO THIS POST IS FOR:

  • Women drugged out of their brains and bloated

My newest cocktail of meds is wreaking havoc on my body in a whole new way, YIPPEE! I was switched from Endometrin to Crinone. I have felt like a slug in the past but Crinone comes with a whole new slew of delightful side effects. Headaches, intensive cramping, increased urination, and of course bloating.. these are just the tip of the iceberg. Nothing makes ya feel better about life than your stomach looking 5 months pregnant when you are not.

With spring around the corner and my anxiety in full force, clothes that make me forget I am bloated have been on my mind. Plus, looking at spring clothes is just simply exciting.

I bring to you a few options that will hide whatever is happening to your body and make ya feel fly. The majority of these items were tried on while in full bloat, thus they are bloat approved.

(Click on images to shop the look)

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ruche

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IUI 411

WHO THIS POST IS FOR:
  • Couples who starting fertility treatments

Its been a hot minute since I had an IUI. I have met a lot of women recently who are just starting the fertility process and thus I thought it might be helpful to talk about what an IUI is and what to expect during your procedure.

THANK YOUR LUCKY STARS

IUIs are a piece of cake. I say this now but I know at the time I was a nervous wreck. Although in hindsight, I had a hell of a lot more hope. I thought I would go in, wham-bam and be done with all this. IUIs seem like a breeze now because it was the beginning of it all. I know starting infertility is scary but I promise you, be thankful that you are only doing IUIs. If you get pregnant off of one, you are super lucky.

Now that that’s out of the way, what is an IUI?

IUI: Intrauterine insemination

Before heading down the IVF road, your doctor will make you undergo an IUI (or several). Insurance actually requires this. IUI is non-invasive.  During an IUI the sperm has to find the egg, think its sexy- become an embryo,  and implant. In IVF the job of the sperm finding the egg happens in a petri dish (not your body) and is carefully monitored as the embryo grows, the embryo is then put back in your body to implant. With an IUI everything happens inside of YOU. Its less lab like, only one person stares into your vagina. Like I said, in comparison its a cake walk. HOWEVER its still unfair and not comparable to creating babies the “natural” way.

If you have a limited supply of sperm or don’t react to meds, you will be fast tracked to IVF because the probability of you becoming pregnant off an IUI is 20- 25% (the same as two people just trying at home in their comfy bed (age related of course)— I imagine this is how children are made) and time and resources are precious.

Also, according to AmericanPregancy.org, you will not have an IUI if you fall into one of these categories:

  • Women who have severe disease of the fallopian tubes
  • Women with a history of pelvic infections
  • Women with moderate to severe endometriosis
CHLOMID

funny

To prepare you for your IUI you will be put on the infamous Chlomid or something like it. I have met only one woman in my life who wasn’t affected by Chlomid. Most people complain that it makes your mood insane. I personally didnt have mood issues, I had issues with my brain completely malfunctioning. During this period of my life I: yelled at strangers thinking they were friends, walked into walls, showed up to appointments that didn’t exist, triple booked meetings, etc. On Chlomid my brain was like a mush of cotton candy who flew to Phoenix for winter, it was checked out.

Once you know how you will react you can plan accordingly. Maybe you hold off from being super social for the weeks leading up to it.

DOC APPOINTMENTS

You will have a lot of doctors appointment to check your follicles and lining. Right when they think you are going to ovulate, you will have your procedure. This means you will need to be ready to drop your schedule and make it work. Its a lot of pressure because the sperm has to be perfect which means you will have to have sex on specific days leading up to the procedure. Personally for us it was weird because it completely stripped the romance out of creating a child (once again that notion is now long gone).

DAY OF PROCEDURE

When you arrive you will either have your partner provide a specimen or you will give them some from earlier that morning, or the freezer. They will clean the specimen in a machine for about 40 minutes. Essentially they are removing any extra “junk” so that its the purest sperm going towards your eggs. My recommendation, go get brunch so you aren’t sitting there twiddling your fingers.

Once the sperm is “clean”  you will go into the room for your procedure. There are a lot of jokes about being turkey basted BUT that is essentially what they do. Your nurse will place a catheter into your uterus so that the sperm can meet the eggs. This is not comfortable, shocker!

Recommendation: Have your partner hold your hand. Its the most intimate you will be able to get during this.

Once the sperm is inside of you, you will lay there with your booty in the air for 15 minutes (dreamy, right?!). You will then get dressed and wait for two weeks. Its nerve wracking but in the grand scheme of things, its not too bad 🙂

I will be honest, I can’t remember what the aftercare was like. I do know that I ran a 5K while I was waiting so I don’t think it was a lot.

 

-Annie

 

Finding a Therapist

WHO THIS POST IS FOR:

  • Couples going through IVF
  • Women going through IVF

I love therapy. I believe everyone needs it because we all have our own shit. The world would be a better place if we were all a little more self reflective and proactive. But I digress!

I have been in therapy for years and along the way have changed therapists depending on what I needed. When I first started IVF I was with a hippy dippy mediative sort of therapist. While this methodology worked for some parts of my life (like family dynamics) it was not serving me well for IVF. After a suggestion from my doctor I switched therapists and it was the best decision I could have made.

I learned there are therapists who specifically focus on IVF. This means they are well versed in the lingo, know how to empathize with you and can help you navigate the process. You don’t spend your hour explaining procedural information, rather you can dive into the emotional wreck you have become.

I know switching can be daunting. It takes forever to build rapport with your therapist and when you have been with someone for a really long time they know the ins and outs of your family. To me IVF is a whole new beast and having someone who really gets it is essential and worth laying the groundwork.

WHY GET A THERAPIST:
  • They can help you sort through your feelings. Having a third party who isn’t on drugs but understands the effects of the drugs on your mental state can be super helpful.
  • IVF is tough on every and any couple. Ive never met a couple who was like “Yes IVF was the sexiest time in our marriage. It was pure joy!” Having someone to help you navigate those dynamics so you can show love to one another will set you up for long term success.
  • Sometimes you need to be put in your place. When I would get crazy about weight or why things weren’t working, my therapist was my voice of reason. She appealed to me with logic and an empathetic tone.
  • ADDED BONUS: If you can find a therapist who has had infertility issues it is even better because she will truly understand your pain. We have many a laughs during my sessions because of this unfortunate commonality.
TIPS FOR LOOKING FOR A THERAPIST:
  • Search for terms like IVF, medical speciality, medical trauma.
  • Ask your doctor for a recommendation.
  • Call your insurance company to see if they have someone in network that specializes in medical trauma or IVF.
  • Call several different therapists for a phone consult to learn about their philosophy. You are the patient and the one with the $$$, you can ask them how they work with their patients, what drives their work, etc.
  • If you dont like the therapist after the first appointment, switch! You need to be comfortable with being you in front of them.
CASH IS TIGHT! I CANT AFFORD THERAPY!
INSURANCE

In Illinois you get the best coverage for IVF with an HMO. HMOs suck for just about everything else including therapy. Through the IVF process I actually learned that 50% of my therapy costs could be reimbursed for out of network therapy. Shockingly this is not advertised. I recommend calling your insurance provider to find out all options before giving up on therapy.

HEALTH CLINIC

In Chicago there is an amazing organization here called the Chicago Women’s Health Center. When I was going through a crisis years ago and was strapped for cash they let me come in for therapy for only $15 a session! They have a sliding scale based on income. If you are fronting your IVF costs I would imagine most amazing non profits for women would consider your costs. Google women’s health clinics in your area and call to see what recommendations they may have.

-Annie

IVF Clinic - "All I want is a womb somewhere"
IVF Clinic – “All I want is a womb somewhere”

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.

omega-3-eggs
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