Jul 24, 2011

18 cells heavier

Today was our embryo transfer for our FET. We put back three 3-day embryos, a 5B, 6B, and 7B and now all there is really left to do is hope and pray that 1 or 2 (or 3?!?! eek) will stick and thrive and blossom into souls we will have the privilege of meeting again come spring.

I wrote before how the original plan was to thaw the straw with the 2 embryos that remained from those that were fertilized by regular IVF, an 8B and 5BC. It seemed really questionable, though, whether the 5BC would even have a decent chance of surviving thaw. I still find it odd that they bothered to freeze the 5BC at all. Instead, they decide to thaw all 3 of our ICSI embryos, which were originally rated 8B, 9B, and 9B. All three survived thaw, but not without sustaining battle wounds: one 9B became a 5B, one 9B became a 7B, and the 8B became a 6B. Since none of them survived fully intact, we decided to transfer 3.

To be honest, I had a pretty naive and uninformed view of the thawing process - I thought the embryo would either thaw intact (a viable embryo) or not (a non-viable embryo). I was oblivious to all of the shades of gray in the thawing process - that some of the cells could die, but that if over 50% of the cells remained alive, the embryo would still be considered viable.

No one told us the embryos looked good or said we had an excellent chance or anything like that. Honestly, I don't think our chances of a live baby from this cycle are that great but I always have to keep hoping that this is the time that things will be different...

Jul 23, 2011

quote of the year

"Just tell me this - you're also still trying naturally, right?" - my mom, 7/22/11

(for clarification, she knows the nitty gritty details of all of our failed cycles and also that we are currently in the middle of a medicated FET)

Jul 21, 2011

mikveh night

I am sorry I haven't been so good at writing the past few weeks. My FET cycle has been really uneventful and I've been trying to heal emotionally from our failed IVF and somehow recenter myself. In truth, I've been pretty down and I am having a hard time feeling positive or hopeful, especially since our frosties are of pretty iffy quality. The good news is that assuming they survive thaw, I am on track for a Sunday embryo transfer - that's really soon!

Tonight was my mikveh night (it was actually a little late in my cycle to go to the mikveh, but I spotted a lot this month). The mikveh is a ritual bath that observant Jewish women go to a week after they stop bleeding and it demarcates the separation between menstruation and the time during which a woman is considered ritually pure. The largest practical implication of this practice is that observant Jewish women don't have sex from the time their period starts until their mikveh night.

Many infertile women notoriously find mikveh night difficult because each month serves as another reminder that they are in a new cycle and still not pregnant. Honestly, even as time wore on, I never had a big problem with it. I saw mikveh night as an opportunity for self-renewal and a symbol of new hope and another chance at creating a new life.

By the time mikveh night rolled around each month, the memory of the pain and disappointment of the previous cycle ending had dulled and I could always muster up new hope and some positive energy for a new chance. I would read tehillim (psalms), I would pray...mikveh night was actually a positive spiritual experience for me. I never felt a direct conflict or contradiction between my faith and my hopes and the reality of my situation.

This was the case for the first 21 cycles we tried to conceive, anyway. Not so much anymore. Last month, mikveh night fell a few days before egg retrieval. Luckily, there was no one in front of me and I was in and out in ten minutes, so I really had no opportunity to get all angry and emo about things.

Tonight, there were 7 women in front of me and then 6 who came after. I knew it was going to be a long wait, and then in classic Israeli fashion, two women sort of passively cut in front of me. I just couldn't bring myself to say anything which is absolutely the worst, it just makes me feel like such a sucker and so angry at myself when I can't stand up for myself. That was apparently the beginning of my derailment. And then I had to wait 25 more minutes to finally get called into a room.

By this point, I was doing the whole silent sobbing thing. I knew that if I started talking, I would instantaneously burst into the whole not-so silently sobbing thing. The cleaning woman who was mopping the floor kept trying to make small talk. I just stared at her blankly and silently so she kept repeating herself. Apparently, she was really trying to put me to the test and my solemn face and red-rimmed eyes weren't sending a clear enough message of FOR THE LOVE OF G-D LEAVE ME ALONE WOMAN.

As soon as I got into my changing room I started sobbing. Those big fat ugly uncontrollable tears and of course lots of snot, too. Then I realized that there was no Kleenex or toilet paper in my room for me to clean my face up with. Finally, I gathered myself together the best I could and pressed the buzzer to enter into the mikveh. I immersed, got back into my changing room and proceeded to lose it again. And unlike "a good cry", I didn't feel any better letting it all out, I just felt more deflated.

In truth, I was more angry than sad, angry at the chicks who cut me in line and made me wait 25 more minutes, angry at myself for not speaking up, and more than anything else, I was angry because the mikveh is a reminder that I subscribe to a belief in something larger and in some force that you can reason with and reckon with and yet month after month nothing has changed for me.

It is much easier for me at this point to take a strictly medical, detached view of my infertility - that we are doing a series of medical interventions that cumulatively over a long period of time have some chance of eventually being successful. Emotionally, that's pretty easy to reconcile, but if you place your faith in something else, if you believe in something larger, and yet you fail again and again, how is it possible to keep a positive connection with that faith? Eventually, how do you not become consumed by anger or not take it personally? How do you keep finding solace or a measure of comfort in G-d or belief in any larger force when things just stay the same? After a certain point, isn't it just much more comforting to believe in Bad Luck?

Where do I go from here? Is it going to get easier, in the same way seeing friends and family members and acquaintances get pregnant and have children became easier with time? How will I have the strength to keep going if I reach mikveh trip #44 with no live baby?

Jul 12, 2011

Second opinion?

I've decided that while I'm working on this FET, I am also going to try to get a second opinion from someone at another clinic. Not so easy because I haven't yet been successful in getting through to a live person on the phone and it will definitely be a schlep for us, but I've decided it's worth it. I've also decided that it makes most sense to do a private consultation and to think of it as a fact-finding mission while I am concurrently cycling in my current clinic - that way there isn't all of the pressure and rush to deal with the logistical issues of trying to switch clinics and setting up a new cycle under time pressure if it comes to that.

I don't feel like I have received bad care at my current clinic and I think my current doctors are very competent and all, but I've been plugging away in the same clinic for a year now and I just feel like they aren't so proactive. It seems to be more of an institutional attitude than a doctor-specific thing - like the general resistance to 5 day transfers and the practice of freezing all embryos on day 3, even those that are obviously not good quality and then pushing as many FETs as possible.

My current clinic was clearly the best place for me to start since it has a good reputation and it's right at the university hospital where my research lab is located. You couldn't ask for a more convenient arrangement. On the other hand, the mixing of my personal and professional life can be disquieting at times and it would be nice to have a clearer separation between those two aspects of my life. I would say that with the passing of time, it has become psychologically a bit more difficult to do treatment essentially at my workplace and not have that division.

We'll see...I do feel a certain loyalty towards my current clinic and I have certainly gotten comfortable in the current arrangement. However, if I want my treatment to be more proactive, I know it's up to me to take that first step. As part of our supplemental insurance through our health fund, we do have great coverage at a private hospital in Tel Aviv that has a great reputation and seems to be more progressive in their lab practices than our current clinic.

One thing that really annoys me is that clinics in Israel aren't required to report success rates so there is really zero transparency in the system and reputation is built mostly upon word-of-mouth and hearsay. I would so love to know what the IVF success rates are actually like for each clinic - I am sure it would be really enlightening!

Jul 8, 2011

FET #1 begins (not without a bumpy start)

Despite my misgivings about the quality of some of our frozen embies, I am really excited that we're moving straight into a new cycle. It is definitely helping me deal with the disappointment of the failed IVF to have a new opportunity to focus on. True to form, getting things off the ground wasn't quite as easy as I had hoped.

RE 2 told me to come in for my baseline ultrasound and bloodwork yesterday (Thursday). When I had my appointment on Wednesday, he filled out the request form for my health fund to approve the FET. He said the paperwork for a FET was really a formality (unlike with a fresh cycle, where there is always a chance of the request getting rejected) and that the nurses would fax it the next morning when I came in for my baseline. He also said he thought it would get approved that same day.

When I went in yesterday morning for baseline, the nurse I spoke with gave me a really hard time and said that without the approval, she wouldn't give me the form to do the ultrasound and bloodwork and that I wouldn't be able to start estrogen for this cycle until the approval came through or if I agreed to pay for the whole cycle OOP. I proposed that she fax the request immediately and if the approval didn't come through I would pay OOP (the whole situation was pretty ludicrous since we would know if it was approved within a few hours and since it was a formality more than anything).

Anyway, she begrudingly gave me the u/s and blood forms if I agreed to pay, which I brought to be stamped at the reception. I didn't have to pay anything towards this anyway because my specific health fund has an agreement with the hospital so I am automatically covered for as many ultrasounds and blood tests as I need there, whether it's part of a larger treatment cycle or not. After that headache, I had my ultrasound, which showed that my lining was still 12mm and that I had a cyst. I was feeling pretty down about our prospects of actually getting started on this thing based on the ultrasound.

Y called the health fund to see that they received the faxed request. They had indeed and within an hour, it was approved. By this time it was only 10am. It seemed like a lot of drama over nothing and I was super frustrated that the nurse was ready to cancel my cycle because of it, especially since I confirmed with both the head nurse (when I received my beta) and RE 2 (when I had my appointment) that it was okay to send the request for approval on the same day I start meds. I also noticed that the approval was coded "IVF שלב ג", meaning "IVF stage 3" - in other words, it was merely considered an appendage of the original cycle. From there on the day got better - the nurse called me around lunchtime to say that my E2 and P4 levels were fine and that I could begin estrogen today.

Jul 6, 2011


Today I had an appointment so we can get started with a FET. I am feeling overwhelmed and disappointed, which is how I seem to feel after most of my appointments. I may really consider switching clinics sometime over the next few months because I just consistently feel like we're not being given the very best shot at success. It is difficult for me to tell whether this feeling is just a consequence of my general negativity or whether there is a deeper nugget of truth in it. In short, my 5 frozen embryos are much poorer quality than I thought. My RE would like to transfer an 8-cell B (our best remaining embryo) with a 5-cell BC (in the same straw) for this cycle.

I am not going to lie, the 5 BC sounds really crappy (no offense to you, little guy!) and I am just not feeling it. My RE would then like to do a 2nd FET following this one to exhaust all of our so-so frozen embryos before moving to another fresh cycle. This just sounds like a really low-yield plan to me and it seems unrealistic that all of them will thaw successfully anyway. Perhaps I am just impatient but I find this plan pretty disappointing. Instead, I proposed attempting to thaw all 5 and then culturing the ones that survive the thaw for a couple of days in an attempt to push them to the blastocyst stage and using this as a selection device to weed out the less competent embryos.

My RE was not a fan of this idea and my best guess why is $ - it would be more labor intensive and costly for the lab staff to attempt to grow my embies to the blast stage and it would also mean moving on to another fresh cycle sooner if the FET fails - more costly as well. Just some of the less nice realities of socialized medicine and full IVF coverage. The RE pointed out that by thawing everything and attempting to culture them to the blastocyst stage, we might lose everything and that that would be very disappointing for us. In truth, I would find it much more emotionally draining and disappointing to go through two FETs with not so great embryos and a very low chance of success than to lose all of our embryos and never make it to a frozen transfer.

I guess all of this is sort of a moot point - first we have to see how many even thaw successfully. If we are poised to transfer the 5BC and I am still feeling very negative about things, I could insist on adding in a third since one of our embryos is in a straw by itself. Since we are more or less unexplained at this point (I'd say the mild ovulatory dysfunction/lean PCOS is debatable and I would have gotten pregnant via ovulation induction and IUI if it was the main issue), I asked about the possibility of considering endometriosis or immune factors but the doctor felt that at this point, further testing is unnecessary and would only delay us further in proceeding with treatment.

Lastly, the RE implied (though did not directly say) that he agreed with me that my ER was probably a couple of days too late and that this could have potentially affected the outcome. Tomorrow I go in for bloodwork and ultrasound and if I get the green light, I will start estrogen for the FET tomorrow. So....that's where we're at and as usual I am praying to be pleasantly surprised.

Jul 4, 2011

IVF #1 = BFN

This morning (12dp3dt) I went in for my beta, which was zero. There were no surprises here- after testing on 9dp3dt I tested again on 11dp3dt with another FRER, so it was pretty obvious to me that neither of those beautiful embryos took. Tonight I indulged in my monthly fertility treatment failure sushi extravaganza, of course complete with a glass of red wine. Is it sad or funny or both that I can measure my failures in sushi dinners?

We started this tradition of going out for sushi whenever a treatment failed and/or AF arrived early on in our (in)fertility journey. I remember many a tearful sushi dinner - dinners when I would just burst into tears at the table and the waiter or waitress and people seated around us would do their best to pretend not to notice or sushi dinners when Y would order for me while I sobbed in the restaurant bathroom.

These days with the arrival of bad news every month, I just look forward to the sushi with gleeful anticipation for raw fish. I am much happier, calmer, and more content at our monthly sushi extravaganza. The evolution of the sushi dinners is an interesting frame of reference in how I have changed over time with respect to how I view my infertility.

I am not going to say that it has gotten easier, but my infertility certainly has taken on a chronic disease-like role in how I view it and how it affects my life. It is now a permanent part of my identity and I continue life with it or in spite of it or around it, whereas once it was a constant state of crisis. That sounds awful, but in some sense it was also hopeful - a state of crisis is temporary, it is not sustainable in the long-term. In a strange way, the sense of crisis was an indulgence. It meant that I saw a way out of the crisis and that I in fact expected a way out any day.

Now I ease my way into that huge plate of sushi with a singular focus toward that deliciously raw salmon and tuna - no tears, none of that rawness or surprise or lack of control that I once felt with each new failure. This is my new normal - how could I expect anything different than for things to continue just as they have been and just as they are? How could I reasonably expect not to fail?

Jul 1, 2011

9dp3dt = BFN

I tested this morning with a FRER (from my coveted American stash- I only break out the good guys for special occassions!) and of course it was stark white. I was expecting it since I feel normal and my OHSS symptoms never returned. I am glad I did it - I need a couple of days to emotionally process the failure before I get the infamous beta phone call. You could say I should still hold out some hope but hoping for a miracle at this point (a miracle being not just a positive beta, but a viable pregnancy) just feels cruel and dishonest to myself. I had a late implanter once. For me, I know what that means. That baby's due date was yesterday but I am no closer to holding a live baby in my arms. So it goes. Also, thankfully my beta was moved up 2 days to 12dp3dt (Monday).