I go back next Friday for a post-op appointment with Dr. Nackley, and I'm anxious for that appointment to really discuss her impressions from the surgery and what we should do to move forward. I want to grow our family so desperately, so I hope she has some good ideas for us.
And I think that's the whole story! For now, at least.
Well, that is no longer the whole story. When Kevin and I met with Dr. Nackley, she discussed results from the surgery and also from our latest blood work. My AMH had gone from 0.7 to 0.3, which was discouraging, but made sense considering that large cyst she removed from my ovary. Dr. Nacklay explained that the cyst was probably depleting my egg reserve on the left side. Even though she removed as much of the endometriosis as possible, it wasn't completely gone and would grow back. Her recommendation was to get pregnant as quickly as possible (through IVF) before it had a chance to grow back! It didn't sound as overwhelming as I thought it would be, so I took that to be a good sign. I think we both knew that she was going to recommend IVF, but we then had to decide if we were going to move forward. We wanted another baby and it really just seemed so sad to end our family with two miscarriages and all these failed fertility treatments. So, despite the emotional, physical, and financial burdens, we decided to move forward.
We moved into the consultation area to then meet with the IVF coordinator and an embryologist. They gave us a ton of information and packets full of information that needed to be signed and notarized before we had the "final sign-off" to begin treatment. We spent the next few evenings going through all the paperwork and talking A LOT about everything. We needed to decide whether or not we wanted to do genetic testing on the embryos before transfer, and that proved to be the most difficult decision. In the end, we decided that we would like to test the embryos, which was another $1,500 plus $150 per embryo that was tested. It seemed like a lot of money, but when you are already paying $10,000 for the actual IVF and another $5,000 for medication, what's another two grand? Especially if that helped get a better quality embryo!
Once we had all the decisions made, we made an appointment to have everything notarized. I also ordered my medications, which arrived 2 days later. This is what nearly $5,000 in needles, syringes, and meds looks like...
Kevin was amazing throughout the process and mixed and prepared all the meds, then administered all the injections. It was way more involved than I thought it would be! The first part of the IVF cycle was the FSH, or Follicle Stimulating Hormone. I was instructed to do the injections at the same time each night, so we chose 10 PM. For the first three days, I took 3 vials of a drug called Menopur and 225 ius of Follistem. The Menopur came in two vials, a powder and a diluent. You needed a series of needles and syringes to mix the two vials, combine the three doses, and then administer the one injection. For some reason, that medication really stung as it went in, but I figured it was because it was ultra-concentrated! The Follistem was a pen-like injection that you dialed to the correct dosage. It had to be refrigerated, but wasn't as painful going in as the Menopur.
By this time, I was starting to get pretty sore all over my abdomen. Several of the injections had caused bruising, and I felt like I was running out of places to inject, haha. I alternated sides each night, but I also had a bad head cold and I just felt burned out. I am not normally one to get overwhelmed, but this process was really overwhelming to me. I was running out of one of the medications, and I called the nurse to clarify doses. She told me that both the Follistem and the Menopur were the same drug, just different forms, so I could substitute one for the other. But that I needed at least one vial or Menopur each day. She was sort of impatient with me, which was obnoxious because I wanted some support in figuring out if I had enough medication or not. There was extra medication in each vial of Follistem that wasn't accounted for, and the nurse said that this was normal. But since I didn't know exactly how much that was, how was I supposed to figure out if I had enough?? If I didn't have enough, I needed to get it ordered right away so that I could stay on track with my injections, but she was absolutely no help.
When I got off the phone, I sat down and figured out all my quantities and the different ways I could space it out to ensure that I would have enough. It seemed to work out, but I called Kevin at work to just get a second opinion about my calculations. He thought I was correct, so I tried not to stress. Since we were finishing off the last bits of several different Follistem cartridges, one night I had to have 5 injections since there was no way to combine that medication. I literally felt like a pin cushion. Kevin was really patient and always held his hand on my lower back which made me feel so much better. Several nights, I just cried after my injections. The actual poke hurt, the medication burned, and I just felt weird.
On Day 8, I went in for another estradiol blood test and sonogram. Again, the estradiol was on track, and this time I had 3 larger follicles and 3 smaller ones. That was promising!! I was still concerned, but at least we were seeing growth.
On Day 10, I went in again for estradiol blood work and another sonogram. This time the nurse only saw 2 large follicles and 4 smaller ones. That didn't make sense since I had 3 large ones before, but she explained that maybe two continued to grow bigger and one of the previous bigger ones now was more the size of the smaller ones. I just didn't know what to expect, but she explained that they would aspirate everything at the retrieval and see what fertilized.
On Thursday, November 7th, we headed to the egg retrieval. I was exhausted coming out of the retrieval, but they got 7 eggs, which was exciting! They fertilized them immediately using a process called ICSY (basically injecting the sperm into the eggs), and would call me the next morning to let me know which ones fertilized. The embryologist said that based on their size on Tuesday, probably only 2 would fertilize, but we were hopeful. We had so many friends and family members praying for us, which really gave me a lot of strength.
The embryologist called the next day (November 8th) with the report: Of the 7 eggs, 4 were mature and all 4 fertilized normally. Of those, she expected about 50% to make it to the blastocyst stage which is required for transfer or freezing.
Then it was just a waiting game!! They would essentially babysit our embryos for the next 5 days, and call us to let us know how they did. Even though we already paid for the genetic testing, it was still up to us if we wanted to proceed with it. We were so back and forth about it, haha. It made sense to get the best possible embryo, but then you also subject the embryo to the cell biopsy, the freeze, and then the thaw. The embryologist assured us that they have good freeze/thaw rates, but we wondered if it was necessary to even do that step. Both of our miscarriages came back genetically normal, so we weren't super worried about egg quality. But that number was tanking so rapidly, so maybe it was more of a concern than we thought?
We were thinking that if we only had one reach blastocyst stage, we would probably just transfer it. Another factor to consider was quality. If the quality wasn''t very good, they wouldn't proceed with the testing...but you could still transfer it. But was that risky to transfer a low quality embryo? So many things to consider and we didn't feel a strong impression one way or the other. Since we were on the fence, Dr. Nackley suggested that we start the progesterone shots to prepare for a Tuesday transfer. If we decided to do testing, we would have done shots for several days for no reason, but that seemed like a small price to pay in case we ended up wanting to do a transfer. (When you do the testing, the cells are sent away for testing and you don't get results for 7-10 days. This is why the embryos are frozen. Once you have results, you start progesterone to prepare the uterus for a frozen embryo transfer.)
I think it was a really good thing that we went camping the next day because it was a great distraction. I wrote more about this in the Turner Falls post, but having such a great bonding weekend as a family really helped buoy me up for the news we would get on Tuesday on 12th.
We drove home Monday from Turner Falls to be prepared for a potential transfer on Tuesday. Well, unfortunately the news on Tuesday wasn't good. The embryologist called about 10 AM to let us know that of the four that fertilized, none of them made it to the blastocyst stage. They were all still at a multi-cell level, which is typical of about Day 3 of development rather than Day 5. (They measured at 6 cells, 8 cells, 10 cells, and another at 6 cells that was possibly dividing.) I was in shock. I was writing all the information down when Kevin walked into the kitchen. The embryologist informed me that they would allow them to grow one more day to see if anything changed, but that it wasn't likely. Not impossible, because she HAD seen them change in the past, but she didn't want us to get our hopes up. Since they don't do day 6 transfers (the uterine lining is out of sync), they would have to freeze anything that made it to blastocyst and wait until they could prepare my uterus again.
I hung up, Kevin and I hugged, and I just tried to process the news. I don't even know if I cried in that moment, I was just too shocked. All of that process for nothing! We were just super surprised since all four had fertilized. Surely one of them could have made it to blastocyst.
As Kevin and I talked, he commented that while he saw me writing down the numbers, he thought that we had all good embryos. He said he still felt that stress about whether or not to do the genetic testing. When I hung up and explained that everything was still at a multi-cell level, he said that all that stress and worry melted away. In a way, he said maybe it was better for things to end here rather than go through all the testing and have it not implant. We might have wondered if we made a mistake doing the testing. Or if we didn't test and then our baby had problems, we would wish we had done the genetic testing. There really were so many unknowns, and in that moment, Kevin felt some sort of peace. I still was so uncertain about what I felt, but I knew that I was discouraged.
Well, we told friends and family and asked for prayers that by some miracle, one of our embryos would make it to blastocyst. They were supposed to call the next morning, but by 2 PM, they still hadn't called. I called them multiple times, and when they finally returned my call, I was told that the embryos hadn't progressed at all. So, that was really it. The process was done and we had absolutely nothing to show for it but two Sharps containers full of needles and syringes, a few extra Ganirelex injections, and a bunch of sterile gauze, alcohol wipes, and needles.
I felt pretty broken. I didn't understand why we had gone through this process to end here. I know lots of people have to go through multiple rounds of IVF before it's successful, but given our numbers and how this cycle went, I didn't feel very optimistic.
I was really glad that Kevin had the rest of that week off because it was helpful for my spirits to have him around. I had many moments of sadness that I just needed him there with me. My friend Megan stopped by one day with a beautiful book and a stack of miniature pies to cheer me up.
That same day, Joanna, Andreia, and Danielle showed up with a basket full of thoughtful gifts and a card. I really felt such strength from these friends and I don't think I could ever thank them enough.
We left the office and I just cried on the way home. I felt really emotionally vulnerable for the next few weeks. I have never really experienced anxiety, but I started to worry about certain situations because I didn't want people to ask how I was doing for fear that I would break down. I also don't like feeling fake, so I tend to answer truthfully rather than just say, "I'm fine." One particular day, I was supposed to go to Institute. I used to love going to class, but I just wasn't feeling very social. But, I felt obligated to be there because I started this tradition of going to bagels after class with some of the women from class (one of whom I minister to). As we walked into the building, I felt this anxiety build and I really didn't want to go. I always feel the Spirit in class, which makes me emotional anyway, but add on my raw emotional state, and I just wanted to avoid the situation all together. BUT, I went it and sat next to a girl in my ward. The teacher, Brother Richins, commented that he hadn't seen Stephanie or I in a few weeks (thanks to all the IVF appointments) and asked us to give the prayers for class. I said yes, but really wished he wouldn't have asked me. A few minutes later my friend Katie Peterson sat next to me, so I told myself that if I was really in a bad state, I could always ask her to pray in my place.
Several times during the lesson (which was all about the Savior and how He knows us personally) I was emotional, but overall I felt like I could handle the prayer. But then he showed a clip from Elder Holland and it hit me so hard. A few minutes later he was wrapping up the lesson and I thought I had it together, but as soon as I started the prayer, I couldn't talk. I was fighting back my emotions so hard, and I literally just stood there shaking for probably 30 seconds. I was embarrassed and just wanted to hide, but I eventually made it through the prayer. I quickly sat down, and Katie (who I had just told about the IVF the day before) wrapped her arms around me and just held me while I cried. I was so embarrassed and just felt so vulnerable and raw. That's the only way I can describe it. Katie cried with me, and when I finally stood up, a few other friends were there to hug me and ask how I was doing. Then the teacher asked if I was okay, and I was able to kind of laugh it off and say that I was fine, but not really. I vaguely told him about our failed IVF and he asked if he could make a suggestion. I said yes, and he recommended going to the temple to do initiatories. I thanked him for his suggestion, but shared that I had just done them on Saturday. It was a special experience, but also confusing because the whole blessing is that you will have fruitful loins, which wasn't feeling very uplifting for me at the moment.
I tried to remind myself that I had two of the greatest blessings in Brooke and Colby, but I knew that I would have to go through a grief process as well. In a conversation I had with Kimberly, she asked how long I had the endometriosis. I told her that my doctor thought it had probably been there for years. Kimberly's follow-up comment was that maybe Brooke and Colby were our miracles since the endometriosis was probably present at that time as well. It was something interesting to consider, especially since I couldn't imagine going through this process without any children to love and cling to.
The next few weeks were a bit of a blur, but the holiday season was also a pretty good distraction. Friends and family members continued to check on me, which was really helpful as I processed my feelings and emotions. Mid-December, I met with Dr. Northrop (my regular OB/GYN who I love) to give her the update. She was surprised by the results of everything, and also that they had found Stage 4 endometriosis! I found it interesting that she recommended possibly getting a second opinion. She had asked me what Dr. Nackley had recommended, and I told her that we could try again, but that it would be the same protocol. Dr. Northrop said she had heard great things about Dr. Nackley, but that she had a recommendation for a doctor who she's convinced is a genius. I looked him up when I got home, and sure enough, he has 4 different protocols on his website for women with extremely love AMH. I thought it was interesting, but again, where were we gonna draw the line? It felt overwhelming to consider starting again with protocol one, and then if that didn't work, to go down to 2, 3 or possibly 4. Each round costing another $15-$20k. I talked with Kevin about it, and we both agreed to just let things be for now.
One day, as I was reading the BYU magazine, I came across an article about a man who had lost his job, his marriage, and his health. He was discussing trials and adversity, and he said this...
"There's something essentially important about the challenges and adversity that we face, something of eternal significance. Our trials prepare us to be the person God wants us to be, prepare us to do what He wants us to do. I know from the core of my being that when we go through adversity, it is for our experience and our good. It isn't the adversity that matters, it is the way we respond to it that matters. If we trust God and turn to Him, everything will be all right. That's the key."
I have tried to remember this as I have grieved the baby we thought we would have. I will probably never understand (in this life) the reason we had two miscarriages, or multiple failed fertility treatments, but the way I respond to this adversity will have a profound impact on me, and upon my family. Brooke and Colby need a warm, caring mother, and I want to be that for them. I am not used to feeling so broken, but I know that the more I rely on my Savior and trust in His plan for us, I can feel peace.
I can honestly say that it's getting easier and that I feel peace moving forward just focusing on being the best mom I can be to Brooke and Colby. Sure, there's a chance that we will get pregnant naturally, but I'm not holding my breathe for it to happen. We are just moving forward and trying to make sense of our plan here on earth.
I include this last picture because it reminds me to be positive. One day, when I was struggling emotionally, I walked into TJ Maxx just to look around. I immediately saw this hot pink sweater and was drawn to how bright and cheerful it was. I wasn't feeling either of those things, but I thought maybe this sweater would help remind me to be a bit more bright and cheerful :) I posted it on Instagram with a little caption about what we had been going through. I wasn't posting it as a plea for kind comments, but the comments were definitely kind and extremely uplifting. I truly have amazing friends and neighbors who help strengthen me when I need it!
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