Rosh Hashana 5778

As we get ready to bid this past year goodbye I think about the list of goals I set out for this summer after we found out the pregnancy wasn't progressing. If it had been a viable pregnancy I'd have been 25 weeks pregnant by now. As a way to move forward, I gave myself a list of things I wanted to accomplish by the time the summer was over. In my mind summer ended with Rosh Hashanah.

- Recover from D&C and period return
- Root canal
- Mole removed
- New bedroom furniture
- Second car
- Take a trip
- IVF6 and/or FET6
- New floors on first floor

Other than getting the floors redone, I've pretty much hit every item on that list! I was overly ambitious with regard to doing both an IVF and FET cycles. I didn't think it would take as long as it did to get my period and the first 2/3 of the summer was "wasted" waiting for it. It always feels like everything takes forever between cycles.

I never thought, when first starting this process, that I'd be looking down the barrel of a seventh IVF cycle before even having one child. In theory I know that we've had really good results so far and "it's only a matter of time before success" but in reality it feels like we've gotten the shitty end of the statistic stick every single time. It was statistically low to get a blighted ovum - only 20% of all pregnancies - yet it happened to us. Statistics don't care if you got pregnant naturally or if it was your fifth FET after five IVF cycles.  Statistically speaking, about 30% of embryos that fertilize on day 1 make it to blastocyst stage, yet we just experienced an overwhelmingly low 11% with our latest cycle. I could probably go on but what use is there in dwelling on the failures. I'd rather look at the positives.

So here are the positives. I got pregnant. I stayed pregnant the last time, even after I stopped all meds; it was only the D&C that got rid of the pregnancy because it wasn't viable, just a blighted ovum. We have a healthy embryo in the freezer. We have two other embryos we just sent for testing and we're still holding on some hope that at least one may come back healthy.

This cycle tested my stamina and perseverance more than any other cycle before it. Even knowing what I know now, it's hard to think about how many times we've gone through it; how many more times we may still go through it. I don't know what the future holds.

Last year  I was much more optimistic going into Rosh Hashana. My post was excited and happy. This year I'm burned out. I'm worried about what disappointment may be waiting for us. I believe, somewhere in the back of my mind, that this is still possible for us, but not in the same tangible way I used to. At this point it seems like having babies is what other people do. Getting and staying pregnant with a healthy baby is magical, like winning the lottery.


For this coming year I've set up new goals.

- Take a vacation. We planned to do a trip at the end of October. Now that Florida is supposedly zika-free we wanted to spend a few days on the beach. Hopefully there will still be a Florida after hurricane season. Our quick getaway to NY this weekend was such a boost. I'd forgotten what a refresher it is to get out of your own head and just get a change of scenery, even if it's just one night. We're definitely homebodies and don't like straying too far but I definitely need to keep in mind that we should get outside of our four walls more often.

- Reach a new goal weight. I've decided to continue my diet but less restrictively. I don't want to be
borderline anything anymore, and I know that any weight lost will be helpful in the long run for a potential pregnancy. I've set a goal number in mind, which is 21 lbs lower than what I weighed at last baseline.

- Decide about reno. I want a master bathroom. At this point the whole house belongs to us, but we're working really hard to build a family and God willing there will be little people potty training and bathing in the bathroom in the coming years. If nothing else it adds resale value to the house for when we sell it to afford more treatment :P  Seriously though, there are two options: renovate within the perimeter or add an addition. The addition is clearly the more expensive option but I'm curious by how much more. On one hand I don't want to take out debt unnecessarily. On the other hand what's more debt? I already owe hundreds of thousands on my mortgage, cars, and student loans.... may as well pile it up and enjoy life. My credit cards are clear and I like to keep it that way, if nothing else than as an emergency backup in case we need it for treatment. If a bank wants to lend me money to add a bathroom, who am I to argue? I'm slowly doing the research and finding out what it will entail. It may not happen overnight and that's ok.

- I only have one goal for fertility treatment: take home a baby. I'm not going to put a number on any IVF or FET cycles for the year because it's irrelevant. I hate setting a goal where the success depends on factors outside my control, but it is something we're aspiring to and spending the biggest chunk of our time doing so it goes on my list.

The common greeting this time of year is L'Shana Tova U'Metukah which translates "To a Good and Sweet Year" and the reason behind all the honey as symbolism for a sweet year ahead. It's difficult to go into the prayer season knowing that what we prayed for last year has not been answered. Still, we're still alive and therefore given another chance to get to it this year.

A prayer for something that has already happened is considered t'filat shav which is translated as "wasted prayer." Technically speaking, whatever our embryos are they are. We can't pray for them to change so even though we don't know the results some may say it's a wasted prayer to daven for them to be healthy and transferable. I disagree. I don't think there is such a thing as wasted prayer even if it's not answered the way I wanted.

So instead of harping on prayers that weren't answered last year, I will be channeling my energy on praying for healthy embryos and a successful transfer in the coming year. If you have a minute, any prayer you send up on our behalf would be appreciated.

Despite how burned out I feel with the latest blow, with a new year comes renewal and hope. Wishing all a year of flowering prosperity, a year of happiness and success, a year of fertility and calm, a year of abundance, health, and love, a year of peace and blessing.  L'Shana Tova!

Gutted

Only two.

Got the final update on our embryos this morning and there were no additional ones that made it to blast. Our final count being sent for testing is two embryos. Knowing the odds of what it takes for them both to come back healthy I'm not holding my breath. I went into this cycle fully knowing that there's a chance it might be a bust. But when we got 28 eggs and 14 embryos on day 5, the chance for a bust seemed so slim. I knew not to be so excited about the high numbers. I knew we couldn't possibly get all of those. But two? Just two? WTH?????

Can't stop crying. So upset. Asked my doctor to call me. We'll see if he does. My husband is ready to call it quits on these people and move to the second clinic. I don't know what to do next. For now I have to go pack for this stupid trip.

So tired of this merry-go-round from hell. I just want to be done with this stage of life and be raising my babies. This is such a nightmare. The high's mess with your brain and make the low's that much worse. Burned out and sapped of any hope or faith right now.

IVF 6: Recovery

First of all, milk of magnesia directions say a bm is expected within 1/2 to 6 hours. That did not happen. I considered taking a second dose but gave it until morning. It wasn't exactly what I was expecting but still better than nothing.

Second, we got an embryo update. They biopsied 2 embryos today. Just two. They said they're "still watching" the rest but I'm having a difficult time processing the number. I knew to expect attrition; I knew we would likely not biopsy all 14. But to go from Day 5 with 14 to Day 6 with only two biopsied felt like an enormous blow. I know that doesn't mean it's only two for this cycle for sure, but it might be. We only have a 25% chance per embryo for PGD results to come back favorable.

Of course I spiraled from being sad about low numbers to worrying that we may have to do this again to crying that this may never happen for us to just freaking out about what's the point of any of this. I just went through the worst recovery yet and the only thing that kept me going was thinking that we had lots of embryos and there was a chance we'd never have to go through this again. Now I'm not so sure. I'm still not sure.

I need to pull myself together because I have a long week ahead. We're going away for two days tomorrow for a family simcha in New York. I also need to get my act together for Rosh Hashanah: shopping, cooking, laundry, so much to do. People ask what they can do to help and I don't know what to tell them. I can't think ahead enough to know what to ask for.

After Shabbat I listened to the voicemail about the embryo update. As I was processing I got a text from my sister that they're expecting another baby. I'm really happy for her and I appreciate that she texted me early before showing or sharing with the rest of the family. Timing could have been better but it is what it is.

At this point the wind was knocked out of my sails and I'm having a hard time. If I could skip the family get together out of town I would. As it is I don't have anything to wear that doesn't make me look like I have a six-month belly.  As if I don't get enough comments as it is.

Until tomorrow... with whatever news it brings.

IVF 6: Follow up appointment

Yesterday the bloating and discomfort reached levels I couldn't handle so I called my nurse for help. She recommended a few things and said if it's not better in the afternoon to call her again. I called again in the afternoon to report no change and scheduled to come in this morning for an ultrasound. They saw fluid pockets in my belly and around the swollen ovaries but nothing that alarmed them enough to recommend a procedure to drain it.

 

They also asked me to get weighed and for a change I wasn't worried about the number being too high, if only to have some proof that I'm not faking it!  I weighed in wearing my heaviest and longest denim skirt because it's two sizes too big and literally the only thing that fits right now. How's this for irony: my weight was the same number as I had at baseline exactly three weeks ago, to the decimal point.

 

I learned a few things this recovery period:

• Free water is bad. It collects and doesn't pass as easily. Doctor recommended electrolytes so lots of Gatorade.
• Green leafy veg are good. Spinach is bad because of the iron.
• Colace isn't all it's cracked up to be. It's a stool softener, not a laxative. Today doc recommended milk of magnesia. It's been two hours since taking it and still nothing. We'll see.
• Potato chips are recommended! Salt? Starch? Don't remember the reasoning behind why they work, but they do.
• Protein helps. After I spoke to the nurse yesterday morning she recommended upping protein intake so I had an omelette for lunch and this morning I saw a slight difference.

In embryo news, 14 are still growing. They need to biopsy them for PGD testing so they will give them another day or so to reach blast stage. I can't believe we're talking about double digit numbers right now. These are unprecedented numbers for us! I hope it bodes well for good numbers overall.

Shabbat shalom.

IVF 6: Embryo watch

Of the 28 eggs retrieved, 20 were mature, 18 fertilized. It's a ridiculously awesome number. We're cautiously thrilled and we know there's expected attrition.

I've been suffering from the worst post-retrieval symptoms I've ever had after an IVF cycle. The nausea didn't completely go away. I've been painfully gassy and constipated. It's hard to walk, it's hard to move, it's hard to breathe. My stomach is hard and tender to the touch. I remembered this from before but I don't remember it being this bad. I've been afraid to eat because I didn't want to add on more to it. I took some Colace today and hope it does something. I plan to call the clinic in the morning if it doesn't.

Today I was reflecting back to my husband about my pre-cycle jitters and hesitation. At the time I couldn't exactly pinpoint why I was anxious about another cycle. I chalked it up to just be burned out with fertility treatment. I realize now that this is what I was dreading. The shots are not terrible, the traffic and monitoring are manageable, even the retrieval itself and everything that led to it was tolerable. It's the pain and recovery that are so difficult for me.

It's been a difficult week. Work is so hectic. Friends and family are busy with their own lives with first weeks of school and getting ready for the holidays starting next week. I've been trying to not feel neglected by my support network. I know it's not personal, there's a lot going on. I hope I stop feeling crappy soon.

The new fall theme for the blog reminds me of this time last year. What a crazy 12 months until now. Hope the next 12 are better.

IVF 6: Egg Retrieval

TL;DR version: 28 eggs. Stories in chronological order from Friday to Sunday.

There was a situation on Friday where there was stress for a bit because my follicles were large and there was a chance I'd need to trigger with Lupron, but they needed to see the blood levels before confirming. A Lupron trigger meant not only did I need to run to the pharmacy before they closed on Friday, but I'd also have to arrange for a ride on Shabbat to get bloodwork to see if it absorbed right. I waited on pins and needles all day and emailed my nurse around 1pm. She replied saying there was a machine issue and the bloods needed to be sent to another location (over an hour away) for processing so they won't get info until after 3pm. I got news around 4 pm that trigger will be with HCG so no need to run to the pharmacy and no need to come in on Saturday for bloodwork. Whew.

Trigger went fine on Friday night. The next step was Saturday meds. The antibiotic they usually prescribe is azithromycin which is one dose night before retrieval to help prevent infection. In the past, I've had severe GI issues with it (at first I called it the nervous-shits but then we discovered it was actually from the meds). So this time, I thought I was being clever by asking for a different antibiotic. Enter doxycycline. It's twice a day for five days. Supposedly a more mild medication and less intense on the GI tract. It had been a rough several weeks with the diet and shots - I was already nauseous. But as soon as I took the doxy the nausea reached a whole new level. On Saturday, I took the first dose of doxy in the morning and felt off the entire day. I threw up my coffee. I couldn't even keep water down. My appetite was non-existent but I knew I needed to get something in my system. I tried eating some dry crispix and kept it down for about 20 min but it came back up. Toward evening I tried having an apple and it stayed. I thought maybe the worst had past because I hadn't connected the dots with the doxy. Then I took the evening dose of doxy and it was an immediate reaction. I was again nauseous and so miserable. I thought maybe having some tea and crackers might help. I was willing to try anything and I knew I'd be skipping breakfast the next day. It was Saturday night and I didn't want to take another doxy on an empty stomach in the morning right before retrieval. I called the after-hours line for help. I told the nurse who called back that I have the azithro and that I just can't tolerate the doxy. I didn't want to overmedicate or have a weird combo reaction. She advised taking the azithro and if it comes back up, it comes back. She said they can give me anti-nausea meds in the IV in the morning.

So instead of fighting the nausea, I went to get rid of the night dose of doxy which I knew was going to bother me until it came up, and I didn't want to throw up the azithro. The apple and crackers came back up and, since there was nothing left, I was left dry-heaving on the toilet.  I felt a tiny bit better almost immediately. I was worried about taking the azithro on an empty stomach and I mean completely empty. My husband brought me some dry crispix and I ate a handful. It stayed down for 10 minutes so I took the azithro and hoped for the best.

I woke up several times in the night with my stomach churning in hunger. I was uncomfortable because of the azithro wreaking havoc on my system and I was still nauseous. I got dizzy in the shower and started dry-heaving again. Nothing came out. It took effort to gather myself long enough to take a few deep breaths and pull myself together. By the time I got to the retrieval I was ready for drugs. Pain killers, anti-nausea, whatever they were offering I was accepting. This is from someone who reconsiders Tylenol for a headache. The meds were heavenly. I didn't even care that the IV was bothering me. It was such a relief not to be nauseous.

Retrieval was uneventful and surprisingly smooth. Maybe I'm just used to the drill by now. There was no issue with my weight. I'd lost 6 lbs since baseline. My diet had a lot to do with it but it was also aided along by the nausea. I'm sure I gained some weight from the bloating so it may even be more. I was ready to do the retrieval without anesthesia - there was no way I was canceling the cycle for that but I'm very glad it didn't come down to that! Tomorrow we find out how many eggs were mature and fertilized.

Overall the cycle passed pretty quickly. I hope the wait to results passes quickly too.

IVF 6: Trigger

E2 came back at 2905 - just under the threshold for a Lupron trigger. HCG trigger tonight with retrieval on Sunday. Hoping for good things. Shabbat shalom!