Embryo(s)

Ever since we started fertility treatment, the one constant has always been that we plan to transfer one embryo at a time. We did that for the first five transfers, even when there were additional embryos available. Our doctor is an advocate for eSET and strongly advises transferring only one embryo at a time. His reasoning is that if it's a healthy embryo that will attach then it's better to have two separate pregnancies rather than risk all the complications of multiples.

There is so much information online, pros and cons for both transferring one or two embryos. For every article that states transferring more than one is dangerous, there's another article that says the opposite. For example, here's an Article educating against multiple embryos vs. Why transferring two is the way to go. The thing is that the article educating against multiples is talking about first transfer success rates. Not sixth transfer. They're not taking into consideration someone who has tried single transfers multiple times without results.

In short, the pros to transfer one are a lowered chance of complications or NICU stay and having multiple chances at a transfer in case one time doesn't work (i.e., lining wasn't right). Pros of transferring two is that they "help each other out," there's a higher chance of pregnancy, and if they both stick, two kids for the price of one. I'm not sure these reasons are scientifically proven one way or another. To me it seems to be the opinion of people who have seen success one way or another. 

There are multiple considerations when deciding how many to transfer, such as maternal age, embryo quality and size, and PGD/PGS testing. For us, the embryos are all top grade PGD-tested. Maternal age is currently 33, and the embryos are all strong blasts that are even younger.

For all intents and purposes, we are prime candidates to transfer one high-quality, normally-tested 6-day blast. But we did that. Five times. Success rates statistically indicate a live birth for every 3 or 4 transfers of a high-quality blast. But here we are, five times failed and still no pregnancy, let alone live birth. 

We have two healthy blasts remaining in the freezer. The doctor said his part about recommending just one at a time but won't oppose if we decide to transfer both. I don't know what the right answer is. On one hand I don't want to risk the pregnancy in any way. The goal is to have healthy babies. A pregnancy complication at 24 weeks with sudden delivery and a prolonged NICU stay is not a success story. I also don't want to transfer two, get a negative beta, and feel like we're back at square one with nothing to show for all these years of trying. 

On the other hand, we tried transferring one and it didn't work. How many times can we do the same thing and expect new results? Maybe it's time to try something different. It's literally the only thing we haven't tried. We've done everything under the sun to make a difference. ERA? Check. Bloodthinners/steriods? Check. Hysteroscopy? Check. Thyroid? Check. At our second opinion in the summer, this was one of the things the doctor mentioned: transferring two may help. It could be that one doesn't secrete the necessary somethings to induce implantation but the other does (clearly I didn't catch all the medical jargon) which may help implantation. If she, as a medical professional, is convinced it can help then maybe it's worth considering.

I took the liberty of creating a simple flowchart for this dilemma. 

I don't want to end up with severe complications that could have been avoided. I'm worried about losing all the embryos and being left with nothing. I'm also at a point where I'm ready to try anything for the sake of building our family. Who's to say they'll even both stick? We don't have a great track record for that. If we transfer two and only one sticks and becomes our baby I'd totally consider that a win. 

I don't want to deal with this clinic anymore. I hesitate to make a change but more than that I don't want to leave while there are embryos in their care. I keep saying that as soon as we're out of embryos we're out of there. If we transfer two then regardless of the outcome we have no strings tied there anymore. We're free to chose another clinic if we so desire. The same is true if we transfer two but one at a time. The difference is the real issue of fighting against treatment fatigue and trying to hold on to stamina to keep going after continued failures.

I feel like we'll only know the right answer once it happens and we're able to see it with 20/20 hindsight. Until then, we get to weigh the pros and cons and hope that whatever we choose has the desired outcome. When discussing this with my husband I was grateful and relieved to come to a decision we're both comfortable with. In a situation where so much weighs on decisions we need to make, it's a blessing to be on the same page with regard to what to do. At the very least we know we're doing everything we can with the information and tools at our disposable.

Hysteroscopy plus

On Friday I went in for the hysteroscopy. Compared to all the other procedures I've had, this ranks as the least uncomfortable. The most painful part was that they had to poke me four times to get a vein for the IV. It took three tries pre-surgery and once during the surgery the anesthesiologist didn't like the positioning of it so he moved it to a new location. It didn't help that they had told me not to eat or drink in prep for surgery so I was dehydrated and all my veins were flat.

Speaking of dehydrated, no one told me to expect to give a urine sample (for a pee stick test) so I went right before checking in. When it was time to give a sample, luckily I was able to squeeze out a few drops. A heads up would've been nice.

It was a slow surgery day. So much so that they weren't so concerned with time because they didn't have to keep a tight schedule, especially with me since there was no trigger so no deadline. They requested that we show up 90 min before our scheduled procedure but there was no need for that this time. We waited in the waiting room over half an hour before getting called back, then it was another 30 min before anyone came to start my IV. Usually it's started right away. The nurses and docs were more relaxed and jokey. I already know everyone by name by now and they know us.

The only other part of this was that in prep for the surgery, on Tuesday I got a call from my nurse that they need to update my vitals in prep for the hysteroscopy since it's surgery and my weight was a little borderline when I went in for the HSG early Jan. At the time it was right after a retrieval and Chanukah so I had definitely put on a few holiday pounds. This week I was worried I'd still be bloated from the flight and our trip but early Wed morning I got to the clinic for weight and height check and it was fine.

The procedure itself was uneventful. The doc gave me copies of the pictures they got. He said he took a sample biopsy to be thorough so we'll get results from that next week but for the most part they didn't find anything, as expected.

One thing different this time was that when I woke up I felt an extreme case of annoyance. I was so irritated. When my husband got to the room he was on his phone checking for reception to order an uber and I snapped at him for being on his phone. When he argued back (mistake) I yelled at him that I'm once again on a stretcher and the least he could do was put away his f***ing phone. Later on in the day my sister drove me around to do errands and I criticized her driving. To be fair I was right, but I could have been nicer about it. The annoyance came and went throughout the day and was nearly all gone when I woke up this morning. I don't know what it was about, or if it was related, but it was significant enough for me to remember through the post-anesthesia fog.

I was alert almost immediately after the surgery. From there we went to Rite Aid because I wanted to buy snacks. While there we also got flu shots. We walked to a grocery store to get the snacks and then walked home. It was totally fine. Throughout the day I had a slight headache (may have been due to the sugar rush from the snacks) but for the most part I felt like myself. On Friday night I had a great night's sleep for the first time in a while. I slept solidly for 10 hours straight.

Overall it was a very simple procedure with a straightforward and easy recovery. I was nervous leading up to it, much more so than I needed to be, knowing what I know now. Bonus is that if we do a transfer within 60 days then it counts as an endo scratch.

Israel 2018

We just landed from a ten day trip to Israel. We explored new places, ate delicious food, and enjoyed being on vacation. It was an amazing trip of everything I had hoped and more.

While we were there we got the results of our last cycle. Of the three embryos that were sent to biopsy from ivf 7, none made it through pdg testing. It was devastating news to receive. It was such a blow to our trip high. We had just arrived in Jerusalem when the news came. I spent 10 min crying then we went out and I spent the next hour crying at the kotel. We knew it was a possibility but it doesn't make it any easier to receive the news that we got no embryos from a cycle. 

It's been a week since the news came and I've had time to process, plus I'm so incredibly jet-lagged that it's making emotion seem to move in slow motion. Maybe I'm just all cried out about it. In any case, I've put the busted cycle behind me and am ready to move on. Whatever the path may hold for us, we're facing it with renewed hope and refreshed stamina. 

Kotel - The Western Wall, Jerusalem 

Masada

Israeli flag atop Masada

Safed, artists quarter

Beit Shean national park

Dead sea

Ein Gedi botanical gardens

Mikvah

Last mikvah visit was on a night after some really record-breaking cold. One car in the driveway wouldn't start  which was blocking the car that did start. The battery did not stand a chance in the cold weather. I knew I could call a friend or family member to give me a ride or a jump but they would all ask why I'm going out in the insane cold since everyone was bundling up that night. Side-note, I predict a surge of babies in 9 months.

I wasn't interested in sharing if I didn't have to so I called roadside assistance and asked for a jump. I figured I could shuffle the cars, go do my errand, and deal with the dead battery another (warmer) time. It took an hour for the person to arrive and four minutes to jump my car. I thought about the effort it took to get there that night and wondered if there's any extra zechut for that inconvenience.

I try to take care not to take more than my fair share of time in the prep room or in the actual mikvah. If I wanted to take a few moments, heck even 1 min, to daven then I can nearly guarantee that no one would rush me. To me it doesn't feel right to take time from someone else's experience. Any minute that I'm in there extra is a minute that the next attendee isn't able to use the facility. This is the same philosophy I've shared before about people wearing complicated clothing for the ultrasounds during monitoring. You're entitled to your time and your space and your grace period to get dressed after, but that's it -- any longer and you're imposing on someone else.

But so what? Is it being too considerate on my own account? Let's say I did want to daven a few minutes; does it have to be in the actual mikvah or can I do it in the prep room before or after? Can't I just daven at home - why does it have to be there at all?

Depending on how it goes with the hysteroscopy I may not need to have another mikvah visit before a transfer. If I do need another visit, maybe I should take a few minutes to just daven for this cycle to be different.

Still nothing

The cells were sent out last week and we know to expect "10 business days" which is taking what feels like forever. We've done everything else that expired like infectious bloodwork and the HSG. So now we're just waiting for the hysteroscopy.  I was given a choice whether to start the transfer cycle right after the hysteroscopy or to wait a cycle, assuming they don't find anything and there's no recovery time. If we don't wait a cycle, then first beta will be on my birthday. I feel like it's selfish to not want to risk ruining the day but on the other hand I really don't want to delay. Maybe I can ask them to do the beta the day before. Just thinking about the anxiety of waiting for beta results is making my gut clench in anxiety.

I'm debating whether to chronicle the next FET. I've told my husband I don't want to tell anyone, family included, the next time we transfer. I'm really tired of some people knowing the ins and outs of my uterus, especially when it fails they do nothing comforting or even acknowledge the loss. This is something that non-infertility people get to keep just for themselves, why can't I? So in fairness I would do the same and not share with anyone either. I would be more comfortable sharing news if we hear a heartbeat, even though I feel like at that point I'll be terrified and overwhelmed and want to keep the secret as long as possible. I think this is just another way to try to gain control in a situation where we have none, similar to my POAS strike. 

I scrolled fb today and saw a post from an online friend who posted in our infertility support group in response to someone else having anxiety about being 12 weeks preg and spotting. My friend responded that she's also in the same situation and is advocating for as many ultrasounds as possible to try to alleviate stress. I sent a private message to my friend saying I was so excited to read her news. I know what she went through to get to this point and I was genuinely so happy to see her news. Here's part of the convo:

!!! Just saw your news, so happy for you
Omg I know I wanted to tell you first and then I forgot
I suck im sorry
It's ok
How are you feeling
Ugh I still feel terrible
V excited for you
Please forgive me
I'm a little overwhelmed

It made me uncomfortable that she kept apologizing. I hadn't thought about it that way at all until she made it into a big deal. I was reading a thread that was marked as sensitive so I was already well-braced and totally fine seeing the news. Even though it's appreciated, I never expect a courtesy heads up. And even though I knew they were cycling in October I never asked how it went because I assumed if she wanted to share results, good or bad, she would. Especially since I know I would be weird about people asking me if I wasn't ready to share.

Thinking about it more, I realized my list of courtesy heads up would be incredibly short if I ever get to be the one sharing that special news. It gets shorter every year. It makes me sad whenever I remember that it seems to have worked for everyone else but us. It also makes me sad that I feel people "leave" me when they're no longer on this side of fertility treatment. They abandon blogs, they no longer check in, they can't seem to have a conversation that isn't about their expecting status or new bundle of joy. I don't hold anything against them; I just wish I didn't feel so left behind. Even when I'm in a positive head space and I feel I'm doing just fine and starting to feel hope again, I get into this type of unexpected awkward exchange that brings all the reminders crashing back.

Remembering the blood draws and ultrasounds and the anxiety and the draining efforts of a failed transfer makes me hesitate about even starting to try. I'm worried and maybe a tad scarred from our past failures. If I though an extra cycle to get mentally prepared and braced for this type of mindgame would help, I'd use that in consideration whether or not to delay. But this battle fatigue doesn't seem to be affected by time; in fact the more I think about it the less I want to get started. So when it's time to start, I'll have to stop thinking. 

No news

No news yet about our embryos. I was displeased to find out that the lab didn't send the cells for PGD testing as soon as they were ready; it was only after the holidays that the cells were sent out. Was the genetics lab closed? Was the embryology lab batching with other patients? I don't know. I couldn't get a clear answer why it was delayed and I'm starting to really get frustrated at all the hiccups with this clinic. In the grand scheme of things is a week delay that big a deal? It's not. But it's irritating to feel left out of the loop about our embryos and to not have known to expect that. I'm definitely keeping score. I have a running list of grievances that will come up if we ever need to consider future retrievals. 

This morning I had an opportunity to do a kind act as part of my new year's wishlist. For anyone following the news, the east cost is being pummeled right now by a crazy storm. It's not just accumulations of snow and ice but also insane cold and wind. Luckily my area didn't get the accumulations but the roads have been slippery and it's been very windy and cold. As I was driving on a two way street, a trash can rolled onto the lane opposite mine. I was stopped at a red light. Oncoming traffic was standing still because the first person had the trash can blocking her way. She wasn't a young person. She wasn't sure what to do. So I put my car in park, jumped out (with my keys; I'm not looking to get carjacked), moved the trash can, and got back in my car before the light turned green. She rolled down her window to thank me and I said back something like 'no problem' but I wish I had something clever and inspirational to throw back like, "Pass it forward!" I'll have to work on that.

A friend sent me a job listing from her organization to see if I'm interested. I don't have several of the requirements and I wasn't excited about the job itself, but reading through it I realized I'm ready to consider new opportunities. I may not have time or patience to actively seek them out, but if they come across my desk from a recommendation or a post on social media I'm open to it. Incidentally and completely unrelated, I was watching youtube videos and one of the suggested videos that started playing automatically was an old interview with Steve Carell right before he left The Office. When the interviewer asked him why he's leaving at the end of the season, after some joking, Steve's answer was that after seven years of doing the same thing, "it's time." That sounds like a really appropriate reason to look for something new. 

HSG 2.0

The first time I had an HSG done was in December 2014 when we did all our preliminary testing before our first IVF in the summer of 2015. Last week my doctor suggested it needs to get updated since it's been a while and I've had a few chem preg and a miscarriage/D&C in the meantime.

Last time I was dehydrated and couldn't provide a urine sample so this time I came better prepared. They need to make sure I'm not pregnant but can't they just take my word for it?  After that they took me back to get vitals checked out. My weight was yikes; my bp was fine considering how nervous I was. I knew it would be uncomfortable and I didn't want to be there. She sent me back to the waiting room and I waited about 20 min while they got the room ready. At my scheduled time they took me back, had me undress from the waist down, and get up on the tiny table. Am I the only one who thinks those stirrup things are comfy? It's when they start poking inside that turns it into a nightmare.

She started with what must be the coldest speculum on the planet. Then after cleaning the cervix she started the dye which we could see on the screen spilled everywhere. I understand that's a good thing. She was able to see almost everything but she couldn't see one part. She assured me it wasn't a big deal, she just wanted to get another angle to get a complete picture of the uterus. So she adjusted the speculum and it HURT. A lot. Then she inserted a second catheter with a balloon at the end to prevent the dye from spilling out, and that also HURT. A lot. So much so that an "ouch!" escaped and she stopped to adjust to make it hurt less. It was only a few seconds but it made me tear up and I was trying so hard not to cry. It hurt a lot more than I remember.

She was done a few min after that and showed me the results, telling me everything looked fine. She hadn't been able to see the bottom of the uterus with the first catheter so that's why she added the second one with the balloon. Better to do it all now than have to come back for being sloppy and only getting half pictures. While she was explaining the pictures a nurse was checking my blood pressure and it was through the roof. The doc left but the nurse stayed to clean up and when I saw she wasn't leaving I walked the two feet from the table to the dressing room bare butt. I wanted to get dressed and get out.

Of course there's the niddah aspect of things. Docs say the HSG has to happen between days 5 to 12 of the cycle, which also happen to be exactly the shiva nekiim.  I've gotten pretty good at understanding the halacha to the point where I've figured out the logistical loopholes. A procedure that makes one spot or bleed from a wound doesn't count toward niddah, referred to as dam makkah, because it's not uterine bleeding. However, doing a bedika is problematic during spotting so the question then becomes how to work around it. According to halacha the minimum bedikot are a hefsek, then one bedika each on day 1 and day 7. You could do just that, but if you do get uterine spotting then you can only use the days that had a bedika as "banked." So before the procedure this morning I did a bedika to bank the days I counted so far and skipping the bedikot until the seventh day, giving a chance for things to clear up in the meantime. Between all the procedures we've done to date, the times we've had to ask the rav, and all the information on yoatzot online, I totally got this.

So that's that. It's over and I hope I never have to do it ever again.

Hello 2018

Winter break is over and we're back to work tomorrow. I spent part of my break watching lots of TV. I'm a fan of Survivor and over break I caught up on a few older seasons. One of them was Survivor Palau which aired in 2005. Spoilers ahead, in case you're saving it for watching later. 

In that season, one tribe gets completely decimated by the other. So much so that one tribe is left with one member while the other tribe had 9 people. What struck me about the season was that no matter how many times the losing tribe lost, they still had hope for the next challenge. At first it was lack of team cohesiveness and underestimating the other tribe, but even when they did everything right luck was just not on their side. As an objective observer outside the game watching the cleanly edited version, it was obvious there was no chance in hell they were going to get a comeback. When they were down to three members, one of them, who was a religious muslim, commented that there was a reason god kept him in the game this long and maybe there was a change of tide up ahead. He was voted off next. It was depressing to watch them not only get defeated but to continuously keep hoping for a chance. 

I very much connected with the losing tribe. It sounded a lot like our journey to date. No matter what we do we can't seem to catch a break. And no matter what happens we're still hopeful for a different outcome every treatment. After watching that season I was so depressed. I was already down because I was feeling left out of some things. I was down and just feeling sad and sorry for myself. 

I spent New Year's Eve crying in the shower while getting ready to go out to a few parties. I thought of everything we've been through so far and I'm just over it all. I'm so sick of this phase. I'm so over the failures. I'm so done with extra procedures poking and prodding of my uterus just to try to get some answers for why we can't do something that everyone else seems to have been able to master so easily and naturally. I don't want any more blood tests or procedures or medications or shots. If it felt like we were working toward something then it would be worth it, but there's no guarantee that just because we've been doing this for years we'll be successful. What if it wasn't meant to be? What if I was looking at it as an objective outsider I'd see the possible truth that there's no way it's going to happen for us? What if I need to cut our losses and just enjoy my life while accepting that this was just not in the cards for us? 

I know I'm not yet in a place where I'm ready to give up. I'm still in the hopeful-or-bust stage. But it scares me to think that we might have done all this for nothing. That maybe I will be ready to quit soon. Or that my husband will be done before me and we'll have to make a difficult decision. Our second opinion doctor said that the main reason people aren't successful is because they quit. I can't say I blame a single one of them for that decision. What if we're not successful even once we've exhausted all of our resources and stamina? 

I thought about all the things we're putting on hold while waiting for this stage to be over: home renovations, my career, our life. There in the shower on NYE I decided that 2018 was going to be the year we weren't going to do that anymore. 

While I'm not ready to give up on building a family, I am ready to stop giving up everything else. Whatever is in store for us will happen either way. Instead of resolutions for this year I want to make a wishlist. In the spirit of dreaming big, I present my wishlist for 2018:

• Take a big trip. It's time for new experiences, new adventures, and a change of scenery.
• Refinance and take out a loan for home renovations. For starters, bathroom situation needs a solution. I want to renovate the current one and/or add another one. I don't think we can afford an addition but a girl can dream. We also need to update the floors and kitchen counters. If we're really ambitious, adding some rooms in the basement. 
• Career shift. Either take on more responsibilities for a title change and pay increase or start looking somewhere new. I'm done putting my career on hold "just in case" I get pregnant. 
• Focus on relationships. I've prioritized my marriage and my feelings for the past few years, rightly so. Maybe it's time to add to that and expand my horizons by letting more people in like friends and extended family. I can't complain that people aren't there for me when I'm not a great friend to them. Regardless of how good my excuse is for being absent, I still need to do my share if I want the same in return.
• Have a baby. I know this one is completely beyond my control. But maybe having this on a list will help me remember that it is the goal for all those shots and pills and medications and ultrasounds and procedures.
• Eat healthier. Aside from continuing the weight loss attempts, I want to make vegetables more of a highlight in our menus. Even as I write this I groan internally about all the work that this entails, but I hope to make changes in small increments. If I do that there's more of a chance the changes will happen and stick long term.  
• Focus on kindness. There are many days that I know I could use a kind word or a kind gesture because something shitty happened or we got bad news or because infertility sucks. A kind gesture by a friend or stranger goes so far to help me and lift my mood, giving me the strength to keep going. Knowing what a difference it makes for me, I want to help other people feel the same. It doesn't have to be a big deal, but thinking about it and implementing it into every day life with intention can only help make it a better world. 

Every single day is a gift and too often we take it for granted. Each year brought its own challenges and blessings. The year 2015 was rough. I was hopeful 2016 would be different and it wasn't. I was hoping 2017 would be better but it wasn't. We're starting a new year and I'm still hopeful but I can't say I'm not worried and scared for what's in store. I'm less optimistic and more cynical but I'm so grateful for the blessings and I don't want to take them for granted any more just because I get lost in the tunnel vision for what we don't have. I love my life and the people in it. I'm terrified of something happening to take any or part of it away because I complain about one aspect of it that isn't going the way I want. I understand that nothing is guaranteed and my main resolution is to be grateful every day for whatever blessings I have been given.  

The plot line for 2018 has yet to be written... I can only hope that if I get a chance to write the NYE post on 12/31 I'll be able to look back and smile more than cry.