Rough day

Today was a hard day. I worked late and got home around 9:00 PM. My stomach was bothering me and I was in and out of the bathroom all day. I ate just a plain yogurt (probably a bad idea in hindsight), banana, and apple all day. I wasn't hungry because I was busy and occupied.

I got the official timeline from my nurse. There were some notations on the bottom that I thought were just leftovers from the template she used for the last patient or something. I asked about them and she's like, "Oh, those are your biopsies." Wait, what? I had no idea what she's talking about. I asked about it and she said, "With the implantation failure we do perform 2 endometrial biopsies...The biopsy is meant to "wake up" the lining." Yeah, I'm familiar with the terminology what I don't get is why it's in my timeline and why is this the first time I'm seeing it? Did I miss something?? I was very confused. It took me completely by surprise. I remember discussing it at our WTF appointment in the summer after failed FET 3, but it was never decided that we'd do it. In fact, the doc wasn't even convinced that this would help and was just mentioning it as an option. He was  adamant about changing only one thing at a time though. So we went with the ERA option because it would give "concrete" information. We changed protocol for FET 4 based on the ERA results. When that failed, we added the extra meds prednisone/lovenox for FET 5. I'm still unsure where it was decided to add the endo scratch anywhere. My husband doesn't remember it being discussed after the July appointment either. I'm paying too much money for them to treat me like some statistic and randomly add crap to my timeline without asking or even telling me about it.

In addition, we got back PGD results for our embryos. One. It's hard to be upset at a beautiful healthy embryo. And yet I can't stop crying. I'm so, so grateful it wasn't a busted cycle with zero. But one? Just one? All that money and blood, sweat, and tears for one? We went through all that for one? I'm feeling guilty for being upset about the one. I know some people would love to get a healthy embryo from their own eggs/sperm. I know people go through multiple cycles just to get one healthy embryo PGD-tested and ready for transfer. Even so, knowing what I know about our transfer history I'm upset that this cycle resulted in only one shot.

And then since I was crying already, I couldn't stop. I cried for the failed transfers. I cried for the nights of anxiety. I cried for the years we've been childless. I cried for the unknown. I cried because my birthday is tomorrow and not only am I getting older, but the pressure of "what are you doing for your birthday?" has become overwhelming -- the answer is nothing. It's a regular day that happens to be the anniversary of when I was born. I should be calling my mom to say thanks and call it a day. The one thing I wanted to do was travel and we can't do that. I cried that we can't go on a trip. I cried that we don't have money for renovations. I cried because my husband didn't realize I hadn't eaten yet and ate all the good parts from the crockpot meal I put up in the morning since I knew I'd be working late. I cried because the tissues were rough. I cried because the president is a lunatic. I cried because I don't like feeling sorry for myself; I'd rather be a badass. I cried because I want to share good news with my parents so badly. I cried because I'm relieved we got a good embryo from the cycle. I cried because we only got one embryo from this cycle. I cried because I'm scared for the transfer. I cried because I'm worried for the future.

As I was crying I was surfing online and came across a line: "A winner is just a loser who tried one more time." We are not on an easy path. Hope guides us as we stumble along, trying yet one more time.

Silver lining

I've been so stressed about the timeline and frustrated at how looooong everything seems to take. But I can't drive myself nuts trying to hurry things beyond my control, so I'm trying to reel in the impatience and try to take things as they come.

According to the timeline an expected egg retrieval is tentatively scheduled for some time around President's day weekend. I have off that Friday and Monday, so an egg retrieval any time around then would actually work out well. Best case scenario would be a Friday or Sunday retrieval. Least favorite is a Saturday retrieval but it is possible. I don't expect a Monday retrieval since I've never stimmed that long in the past.

Beside that, it looks like if everything behaves and I get my period when expected, we may be able to do a transfer over chol hamoed Pesach. If it has to be in April, may as well be at a convenient time for me, right? Most convenient is after all the prep but before we head back to work full time.

I'm getting ahead of myself again - who knows how my body will react this time. Experience has taught me to expect the unexpected with possible detours along the way. Even so, I'm determined to stay positive this cycle. I believe this can happen for us. 

Choices

I've been stressing about the possible options moving forward.

The fact that we don't know what can help means that we're just going with trial and error until something sticks. Nothing we tried worked until now, which means everything else is an option.

I found it helpful to write out all the pros and cons of each option, however minuscule.

The first thing I did was go to pdfcalendar.com and print out a 12 week calendar starting at 1/15. I laid out the potential timelines. Being generous for a cushion in case insurance verification takes a while, I estimated a potential baseline at 1/23. From there, it branches out to several options:

• For a new IVF, we're looking at a potential egg retrieval date at about 2/9 
• If we transfer right after, potential FET 2/15 
• If we wait a cycle, potential FET 4/5 
• For only FET, possible transfer on 2/10 

I kind of hate the idea of a possible timeline that doesn't have a transfer until April. Why April? History has shown that it takes my body about 2.5 weeks after an egg retrieval to get my period. They can't start the FET protocol until after a bleed. Once the period comes, it's back on birth control for three weeks before they start the FET meds. That's approx 7-8 weeks total. So, April. I don't want to wait until April to try again. That's four months away! Pesach starts on 4/10 so I'd have a transfer like a week before? I really don't like that.

We talked about all the options and discussed each one. My husband is more gung ho about doing another IVF now than I am. I'm ok either way but I might also be ok just doing the FET. The arguments for it are that it's better to bank embryos while I'm younger; getting it out of the way, since we'll probably have to do it again if we want more children; sooner we get it done, sooner we can keep trying if FET 5 fails. The argument against it? We've been so focused on thinking several steps ahead, but it hasn't really gotten us anywhere. Maybe I should stop being so greedy about trying to get "more children" and just focus on having one first, one at a time. In thinking back about our past trials to try to bank embryos, after the first IVF cycle where we got two healthy embryos, it took three more cycles until IVF 4 to get any additional healthy embryos. Yes, two back-to-back cycles (#2 and #3) resulted in zero transferable embryos. So even if we do IVF now, there's no guarantee it will results in any additional embryos. There are no guarantees at all in this, part of which is what makes it so frustrating.

In the grand scheme of things, waiting an additional 7 weeks for a transfer is not a big deal. I know that. I can be patient if need be. But if we're waiting that much time before we can transfer and then that transfer fails, it's devastating that we've lost all that time.

And that apprehension about waiting is the truth hitting where it hurts. It's not the time I'm really worried about; it's the fear of another failure. I'm continuing to go through the motions and doing what needs to get done, but I have no faith in the protocols anymore. I don't know if it will work. Maybe ever? I don't know. I'm worried and scared. All we can do is continue to do our part, brace for the worst, and hope for the best.

Follow up and then some

Our follow up appointment this morning went as well as it could. Our doctor is a nice person and says the right things to make us feel comfortable. He tries, but he doesn't have answers. If it were up to him he'd say to just keep everything the same and try over and over doing the same thing until it works. If treatment was painless and free of charge, yeah maybe we'd go that route. But since it's not, I feel the need to research the hell out of our options and try something different if the first things didn't work.

We went over several options. He doesn't seem confident that any of them are our silver bullet, so to speak, but is willing to give anything a try. He was patient and answered all our questions. I never felt rushed or dismissed, but I also didn't feel satisfied that we have exhausted all of our options. Here's a summary of what we talked about:

• Blood thinners, baby aspirin, steroids, and anti-inflammatory medication
• Intralipid therapy
• Weight loss
• Fresh IVF or another transfer
• Hormone levels
• Age
• Next steps

Blood thinners, etc.

According to the doctor, the data isn't conclusive one way or the other. If it does work, there's no way to say this is why. He said side effects are minimal, if any. He said he would do both a bloodthinner and an anti-inflammtory combo. I asked about only using one because of the slight chance of side effects on the baby like cleft palate while on steroids. He'd be ok with doing only one, but his suggestion is if you're already gonna do it, go all in with both.

Intralipid therapy

He says that he wouldn't even know where to recommend going for this. The data is inconclusive and there is no current practice for any of the physicians in the clinic to recommend this. He knows about it but does not believe there is any value to this expensive therapy.

Weight loss

It's not the first time I'm hearing this. There's no way to know if this is a factor or not, but it's within my control (somewhat) and so I'm not dismissing it. I know it's the only thing he can come up with because everything else is testing normal. If I can lose weight I will, but I'm not pushing off treatment for this. 

Fresh or frozen

We have a unique challenge in that we need to have our embryos PGD tested. In a regular IVF cycle where you don't need genetic testing, you get to transfer on the 5th day after the egg reterival because your lining is primed due to the medication. Since we have one remaining embryo already tested, it presents with a few options: 

• Option 1: just do a FET
• Option 2: do a fresh IVF and transfer 6 days after the egg retrieval 
• Option 3: do a fresh IVF and wait a cycle before the FET

I originally went in thinking we'd do option 2, with a fresh IVF and then a transfer as soon as possible. The doctor said that there is a slight chance that the extra estrogen from the stim cycle might cause a decreased chance of success, so I think we might do option 3. I know it's only a slight chance, but regardless of how small, I don't want to risk it. We have some time to decide. 

Hormone levels

I asked the doctor to review all my hormone levels and double check if everything looks good. No anomalies spotted. Thyroid, prolactin, etc. all ok. If there is a problem it's not showing up here. 

Age

I'll be 33 in March. I'm feeling an immense amount of pressure to not only have a child, but also give it a sibling. Nothing we've done to this point got us any closer to that goal. Some people think that they want a baby. I don't just want a baby - I want a big family. Dreaming big, even if it seems greedy.

We talked with the doctor about doing another IVF before another transfer in order to bank some embryos. He seemed confused at first, so I explained that if we want to have more kids then the next transfer we do, if it works (big if) I'd have to take off about two years from treatment, one for the pregnancy and one for breastfeeding/recovery/having an infant to care for at home. If I'm ever lucky enough to take home a baby, I want to enjoy it as much as possible before having to worry about the next one. I said I was worried about my age and that isn't it better to bank some embryos at my current age rather than waiting?  I'm getting ahead of myself, I know. I should probably try to focus on just #1 before anything else. 

He responded that I don't need to worry about that until age 37 or 38, especially since I've been a good responder until now. I'm not sure how much I believe him about that. I get that he's the professional and he's used to seeing women in their 40s trying to get pregnant, but the only thing I have going for me right now is that I'm still relatively young. Why not use it to my advantage if I can bank some now? 

My other thought process is that iyh when we are trying for #2, we'll have a #1 running around. If I don't have to wait, I'd rather get an IVF/egg retrieval out of the way now instead of having to deal with it later with a toddler. Again, I know I'm getting way ahead of myself, but this is part of my thought process. 

Next steps

So now we have to decide what we want to do next. We have so many unanswered questions and too many unknowns. Here's what we do know: 

• We want to continue trying. 
• We have one healthy embryo in the freezer. 
• We know I can get pregnant. Embryo implanted and continued to grow. Therefore we will focus our efforts on keeping a pregnancy rather than implantation issues.
• We know our insurance coverage won't kick in until mid-Jan at the earliest. 
• We know that since insurance won't kick in before my next period is due, we're looking at a late Jan or early Feb cycle.
• We know that we are nearing our lifetime maximum benefits for fertility treatment coverage so a lot of our treatment moving forward may have to be out of pocket at the reduced insurance rate. 
• We know we want to bank more embryos before doing a transfer. 
• We know we want to wait after the IVF to do a transfer.
• We know we have two options for the next transfer: 
• Change nothing
• Add bloodthinner/steroid protocol
• We know that losing weight is an option. 

Based on that information, we will discuss in the coming days what we want to do and take it from there. 

To his credit the doctor is willing to discuss any option. He's seems mildly interested in helping us succeed, but he's a skilled clinician who is professional and efficient at his job. He told us to take our time to think about things and let him know if we have any questions, asking us to include a phone number in our email if we want him to call to discus anything. 

I think the temporary plan now is to wait for my next period, start an IVF cycle late Jan, wait a cycle and transfer in Feb with the bloodthinner etc protocol. In the meantime to try to lose weight. I'll let that pickle for a few days and if it still seems like a good idea and we both still agree then we'll go forward with that.

I'm a little bit over all this. I'm feeling deflated and drained. This last loss really took a lot out of me. I don't have the same hopeful optimism. The fear of failure is so great that instead of calculating due dates after a transfer, I calculate how soon we can try again in case of a loss. I don't think I'll ever have a sense of relief where it relates to pregnancy.

We spent a large portion of our 20s in debt and unemployment due to the 2008 recession and it took us a while to climb out of it. We're now spending the best time of our 30s suffering with infertility. I feel like we were late to bloom and we're wasting the best of our youth just trying to stay afloat. Where did we go wrong? What did we do to deserve this? More importantly, how do we overcome? If not overcome, how do we shift our goals and priorities to still lead happy lives?

I don't have answers. I just have an emptiness. When I start feeling happy a guilt creeps in. I don't know why or what for, but I feel guilty for trying to be happy. Maybe in a way it feels as though being happy invalidates all the sad things we're going through. I think I just need to not rush the time it takes to let things heal.

We talked about going on a trip to try to get a little space and fresh surroundings, but it's the same issue again that comes up. The more money we spend, the less we have for treatment. Our 10 year anniversary is coming up this summer and I've been saving for a major trip for almost 4 years. It now seems like we may need to use those funds for more treatment. It's unfair and it sucks, but I feel like I have to try everything before giving up. I don't want to live with regrets. We will iyh celebrate our anniversary wherever we are together, but there's only a finite window to build a family. I wanted to compromise and have a quickie getaway nearby, but anywhere nearby that's worth traveling to during this season still has zika issues. It feels like we can't win.

I feel like if we just can keep going we can thrive, not just survive.  We just need a little bit of luck to get through this latest rough patch. I also need to remember to learn to enjoy the journey. I feel blessed that we have the opportunity to try again. Our life is currently being made up of these memories and it is what we make it. We are so fortunate to have the things we do - I'm too superstitious to list them here - and I am thankful every day. 

Updates

It's only been ten days since the last post but I'm happy to report that there are a few new things that have happened since (progress!): 

• Timeline - I started my CD1 and reported it to my nurse who was able to  give me a timeline for our treatment.  It looks like my baseline is scheduled for 2/9 with an estimated ER on 2/26. It would have worked out a lot better schedule-wise if the ER was during President's Day weekend, but I'm happy to get a date and get started. 
• Insurance - My new benefits have been verified at the clinic - yay!  Finally. It took 3 weeks for that info to come in. Now that it's in, they can submit for authorization for an IVF cycle which may take another two weeks. Still... progress!  
• Medication - Since my benefits were verified I was able to go ahead and schedule a delivery for the fertility medication. We had to work around the epic Blizzard 2016 and the delivery came today.
• Halachic all-clear - We were able to schedule an appointment with the Rabbi which I will elaborate more on in another post. We had specific questions which we needed answered before a cycle started and today we got our answers. This was an ongoing conversation my husband and I have discussed almost daily and finally having a resolution puts the issue to rest and gives peace of mind. 

Even though the current schedule puts a transfer later than I wanted, I'm still glad we're moving forward. I'm praying for a successful cycle with embryos to transfer and not a repeat of disastrous IVF #2 where none of the embryos were viable. Late is still better than nothing, so I'll take it, and if it works the extra 6 weeks won't matter in the long run.