Our Fertility Journey, Part 3
So we chose IVF. But with or without genetic testing? Genetic testing was an added cost, but it would also increase the likelihood of success by about 10%. Unsure of what to do, my brother, whose brain is wired to think in numbers, convinced us that it was a wise option. We’d been through a lot already, and we could get all of our embryos tested so we could be more confident not only in this cycle but in future ones as well.
So IVF treatment begins. The goal of the first round of meds for IVF is to overstimulate you. You’re not worried about multiples here, in fact, you want as many follicles as you can get. Now there is a fine line between getting a robust response and risking ovarian hyperstimulation syndrome (OHSS), a really debilitating life-threatening condition in which your ovaries fill with fluid, and you suffer from abdominal pain, rapid weight gain, shortness of breath, etc. and people who are naturally high responders do run the risk. So my doctor was a little cautious with me, but not nearly as cautious as when we were naturally timing intercourse.
You take a combination of injectables for almost two weeks leading up to the retrieval. It’s sort of a moving target as it depends on how your follicles are responding as they want as many as they can get to be around 18mm in size which means the eggs inside them are likely mature. During this time, your ovaries swell, you go in for frequent monitoring to make sure things are progressing as planned, and you’re asked to move, but not too much. Walking was my go-to as any sudden movements, jumping, twisting, etc. can cause tremendous pain and also cause ovarian damage.
The two days before the retrieval, you take a trigger shot to induce ovulation at a very specific time, and then the night before the procedure is a whole other choreographed series of injections in the belly and in the glutes.
My mom ended up coming up for the procedure, and I’m really glad she did. For one, you’re under anesthesia so you can’t drive yourself home and my husband had to go back to work after completing his task of sitting in a dark room coercing his healthiest sperm to make an appearance. But secondly, it’s so emotionally taxing. Your body hurts physically from being so abnormally swollen, and you’re worried if they’re going to retrieve enough healthy eggs, if they’ll fertilize, if you’ll have to go through this again. So having her there helped me keep my mind off all of those things.
My usual fertility doc didn’t end up doing the procedure as she is always scheduled for a different OR day, but another doc from the practice, who I’d met once before, performed it. I had never had major surgery before, so I had no idea what to expect, but the whole team in the fertility ward was amazing. They positioned me with legs up in super stirrups, strapped my arms down, and gave me a Propofol drip that put me out. When I woke up, I was being wheeled back to my room, felt just a little crampy, and got to rest with my mom and husband, and nibble on crackers while we waited for the doc to come in.
26 eggs! We actually didn’t know whether that was good of not so good, but the doc seemed really happy, and explained that the average number retrieved is around 15, so we did pretty well. Hopefully we’d have lots of options by the time they had a chance to fertilize and be tested. Because we were doing genetic testing, we were going to do a frozen embryo transfer, so we went back home where I was told to lay low. This also gave my body and ovaries time to decompress post all the hormones before the transfer.
My brother and his family came to visit that weekend to celebrate his birthday, so it was the perfect distraction. I felt pretty good for about a day after the transfer, and then things took a turn for the worse. You’d think that once you remove the eggs, the follicles collapse and your ovaries return to normal. But instead, those empty follicles fill with fluid. And everything becomes distended and pressurized. It hurts to walk, stand, move. Fearing that I was experiencing OHSS. I called my doctor who wanted me in immediately to see if I was indeed on that course. She monitoried me for several days, and after about 10 days of having difficulty moving and even breathing sometimes, the fluid started to drain and my distended belly started to deflate. We were in the clear.
Then finally, I felt normal. I wasn’t on any meds. My eggs had been retrieved. We had found out that 15 fertilized, 7 embryos made it to blastocyst stage for genetic testing, and 5 were genetically healthy. We were hopeful given the good news thus far and were riding that optimism. I remember even telling my husband that for the first time in months, I finally felt good. Like myself. And then that same day, I got my period.
Now this is ultimately good news as it meant we could begin the transfer prep, but it also meant that I had to go back on medication to stimulate the growth of the endometrial lining in order to promote implantation. Just like for all the other stages, the cycle is meds, blood work, vaginal ultrasound, repeat as you monitor the thickness of your endometrium. Mine took a little longer to get to where my doc was happy, and there was a moment of worry when we may have had to start over as it seemed that it hit a growth plateau, but then it slowly started to pick up again.
My transfer date was scheduled, and my mom decided to come up again to provide some extra support. Although the transfer requires no anesthesia, fewer medications, and is much less involved in general, I still appreciated having my mom here. My husband had to go to work -- darn residency program! -- so it was just us at the hospital.
The tricky part of the transfer, and actually the piece that caused me the most anxiety is that they want you to have a full bladder for the procedure as it enhances visibility for the transfer so the doc knows exactly where to put the catheter and release the embryo. Like most women, I hate the feeling of having to go to the bathroom, and knowing that they were going to be poking and prodding down there, applying pressure to my belly, and then I wasn’t going to be able to go to the bathroom for at least 30 minutes after the procedure gave me the sweats.
My whole morning revolved around timing my water drinking and peeing which was the ultimate distraction for what was about to take place. Luckily, when I got there, the doc was super pleased with how full my bladder was, so I felt like I was at least playing the best role I could in this endeavor.
For the transfer, I was in the same OR as I was for my retrieval, but this time, there was no anesthesiologist, just my doc, some nurses, and the embryologist who decides which embryo is going to get inserted.
When you get genetic testing, each embryo gets a score by the embryologist that ranks them from most viable and healthy to least, but really, by the time they’ve made it through the genetically normal testing, they’ve cleared the important hurdles. So it’s really down to minutiae when it comes to the score they get. Now some people opt to choose the gender of their baby when they get genetic testing, but this is not something we did. My husband and I each had our preferences -- I’m sure you can guess who wanted what -- but we both agreed that we wanted the healthiest embryo to get inserted, whatever that was. We didn’t want to play the Divine.
So I lie on the surgical bed in an incredibly awkward position as this enables the doc to get the best access. Legs up in the air, butt nearly off the edge of the table. Not counting the full bladder and the pressure they have to put on it for the sake of visibility, the procedure feels a lot like getting a Pap smear. Not comfortable, but certainly not unbearable. It’s really neat in that you can watch the procedure unfold on the screen next to you. They thread the catheter through, the embryologist hands the doctor the chosen embryo in liquid, the liquid gets injected into the catheter and into the uterus, and the little embryo goes along with it. Before you wrap up, the embryologist just confirms that the embryo didn’t get stuck in the catheter, and then it’s all done.
Now this is when I totally had a Rachel from Friends moment. Remember when she was pregnant, and she was getting an ultrasound and the doc asked her if she saw the baby in the ultrasound, and she lied and said she did? Everyone in the OR was so excited when the embryo was released into my uterus and they were all like, “Did you see it, did you see it?” And they were just so elated, I said, “Yes, of course! It was so cool!”
But I didn’t see a thing. I had missed it. I saw the catheter, but I didn’t see the burst of fluid and embryo going in. It’s funny now how guilty I felt that I didn’t see it and then how guilty I felt for lying to my team. The doc was happy with how the procedure went and that was all that mattered.
So, the two week wait. Actually, mine was more like 12 days, but no matter how you shake it, it’s hard. This is when you find out if all your months and months of investment have worked. This is when you find out if you have to do it all over again. This is when you get to take your pregnancy test.
So what do you do during the wait? Distract yourself. A lot. Watch movies, binge watch shows, develop a new hobby, cook a lot, clean out your closet, create a capsule wardrobe, call friends and family and ask them lots of questions about themselves so you don’t have to talk about you, listen to podcasts, take long walks. Yes, all the things. And also, start your progesterone shots and your estrogen pills. More meds.
Progesterone shots. Giant needles of progesterone in oil that get injected into your glutes nightly. I had a love-hate relationship with these. On the one hand, I know they were helping to support a pregnancy if indeed the embryo had successfully implanted as they help maintain your uterine lining. On the other hand, they hurt. They give you bruises and lumps and make walking difficult, especially at first when you haven’t quite found the right pre-and post injection routine and injection technique (warm oil, heating pad, foam roller, pointed massage, and distraction).
Alright, so the day was finally here. My heart is racing just typing this as I remember feeling so anxious for my blood draw. I was trying to be calm, as I knew I had no control over the situation at this point, but my nerves had a mind of their own. I showed up to my clinic, sat down in the chair, and took a slow, deep breath. The nurses tried to make small talk as they drew my blood, but I was barely listening. Band-aid on, and I headed out the door.
Compared to my other pregnancy tests, as nervous as I was, I didn’t feel like this was going to go one way or the other. Unlike the past, I had no symptoms that would suggest I was pregnant -- no tender boobs, no lightheadedness or fatigue. I felt mostly like myself -- other than a sore rear end from the shots. As badly as I wanted it to work out, I also didn’t have any indication that it would or could, so I had nothing to be attached to. IVF isn’t a silver bullet, but I felt confident that we had done our best to maximize the chance of it working it. From there, it was up to science, our little embryo, and a higher power.
Usually, my nurse usually calls me late afternoon with my bloodwork results because the lab has had time to process them and the doctor has interpreted them. So when I got my clinic’s number flashed across my phone at lunch, I was immediately thrown. It was my doctor -- which confused me. My nurse always called me. Was the doctor the one to deliver bad news after a trying IVF cycle? Was she better equipped to support a devastated patient? And guide them through next steps. My head went in a million directions after just hearing her hello. And then she said it, “So, Emily, we have good news.”
At this point, I think I stopped breathing. And then I started crying. My doctor told me the test was positive, and that she was just so happy for us, she couldn’t wait to call me. All of the nerves that had been bottled up and brewing for the past two weeks, and honestly, the past year and a half, released and I started to shake -- uncontrollably. She gave me some medication instructions and assigned me my follow-up appointment, and then I got off the phone and sat down. My whole being was trying to take all of this in.
It took me a moment to gather myself before I managed to call my husband and tell him. He was as shocked, surprised, relieved, happy, overwhelmed as I was, but given he was in the middle of seeing his own patients, he had to get off the phone, but not before tell me we’d celebrate later that night.
Then I called my mom, who was really with me every step of the way and who honestly sounded as nervous as I was when she answered the phone. After tears were shed on both ends of the phone, I hung up and just sat there, still trying to process it all. I thought by telling my husband and mom and putting it out in the universe, it would be more real, but it wasn’t.
And it would take me several weeks, really almost the first whole trimester until it really finally hit me that it was real. That it was happening. That we were finally going to be parents.
So, as much as I wish we would’ve been able to do all of this 100% naturally, going on this journey taught me so much about myself, and taught us more about each other. I also recognize that we’re incredibly lucky to have had our first round of IVF work as so many families struggle with multiple rounds of IVF or run into even more bumps along the road as they try to grow their family. And I look at all of those people, and I am in awe. It’s a trying process that challenges you to your very core and tests your resiliency and stamina -- emotionally and physically.
I’m immensely grateful for the team of physicians, family, and the very few friends that we told who supported us along the way. In sharing our story, I left out all the phone calls, texts, emails, visits, and letters that helped keep me going, but they were so appreciated. We’re also thankful for the other fertility coaches, podcasters, authors who helped me feel empowered and less alone as I scoured resources looking for answers and guidance.
And if you did make it to the end of this, thank YOU for reading. I hope some piece of it resonated with you, and either helped you on your own journey, or shed some light on what this process can be like for someone you care about going through it.
We’re so, so thrilled to meet our little girl this summer. We have a feeling she was worth the wait.