6W 5D: A week of updates

I haven't had the energy to update the blog over the past week.  It's been a whirlwind.

I began bleeding again on Friday.  Because it was the weekend, I decided to make a requisite ER visit.  The hospital website said that our local hospital had a 4-hr ER wait, so we trudged downtown for the 1-hr wait at St. Paul's instead.  The triage nurse informed us upon arrival that the website was never correct.

Daddy, Bug and I waited 2 hours to see a doc, followed by another 1.5 hours awaiting bloodwork.  Unfortunately the ultrasound techs weren't in, but my other tests demonstrated a continued viable pregnancy.  After watching the clientele change from morose elderly women to junkies as the evening wore on - and Bug being recipient of a very large rubber dinosaur another patient had been keeping in her purse - we went home at 2 AM cautiously optimistic.

After a 7:30 AM wake-up call from the hospital, I was back at 9 AM the next morning for my ultrasound.  Lo and behold, I have a Sub Chorionic Hemorrhage causing the bleeding.  No bedrest or less activity is necessary, and they expect the bleeding to subside with time.  My guess, if I can make one, is that the SCH was caused by a vanishing twin, which would also explain the heavy bleeding last Monday.

The u/s was more definitive than the previous tests.  The gestational sac is in the right location - no ectopic, yay! - and the embryo was visible.  It's measuring on-time and with a solid heartbeat.  All wonderful news for 6 weeks even.

My first official ultrasound at Dr. Y's office Monday confirmed the results.  One embryo, with a rising heartbeat (105 at 6W, 115 at 6W2D), and a size that doubled in two days.  I'm glad to have had some good news.

While I was at Dr. Y's office, we also ran my TSH numbers.  It was pretty frustrating.  My TSH is out of the normal range for early pregnancy (3.39), but Dr. Y feels that the number is invalid because we tested too frequently.  Never mind that the number is out of range, and that it's well known both that hypothyroid patients generally need synthroid increases during the first trimester, and that higher numbers lead to a much higher risk of miscarriage.  Normal T4 numbers are between 1-2.5, which is where my numbers had been falling until 2 weeks ago.  Never mind.  He wasn't willing to up my synthroid dose.  Thankfully my GP was, and we've increased the dosage from 62.5 mcg to 75 mcg accordingly.  This is up from 38.5 pre- November IVF cycle.  Wow!

In other news, my symptoms have been intensifying.  I feel like crap.  With Bug, I had minor and very occasional morning sickness.  With this pregnancy, I've had it on a daily - and practically suffocating - basis.  The cravings are intense, and I alternate between craving food and never wanting to touch it again.  My energy is in the toilet, and I spend as much time as possible laying flat in bed.  It's so far proving to be a more exhausting pregnancy than Bug's was, although it's possible that having a toddler while pregnant is partially to blame.

My stomach started rounding a few days ago...thankfully the left over Bug stomach keeps it hidden unless I suck it in.  I'm hoping to share the news on Mother's Day.  7 weeks to go. 

5w4d: Beta #4

Beta #4: 22,097

Still pregnant.  Cleared to first ultrasound on Monday.

Go figure.

5w2d: Bleeding

Bleeding.  <groan>  It's not how I intended today to go.  I'd been cautiously optimistic that everything with this pregnancy would go fine, that my bizarre gush of blood was the end of red.

I woke up to another gush.

I had the HCG test already scheduled, so we headed into the city.  My light cramps were still there, only negated by the low-dose aspirin I'm taking as part of the fertility treatment.

The phlebotomist nearly killed my arm, and decided that one puncture wound on the right just wasn't enough.  She missed the vein and had to puncture the left as well.

Have I mentioned that I really don't like this phlebotomist's blood-drawing touch?

I spoke to the nurse about my concerns over the bleeding, and they agreed that a Rhogam shot to combat my Rh-negative blood was the best option.  Unfortunately, as a blood product, Rhogam shots are only maintained at the blood bank at Women's Hospital.

We drove over to Women's.  By this point, my husband had called in late for work and Bug wasn't happy at having been woken up so darn early.  Yesterday was spring ahead.

We got to Women's, and I was bleeding.  Not just a little spotting, nor a gush.  Full-on, period-like bleeding.  Heavy at times, some clotting, all that jazz.

I was in tears by the time we got back to Olive for the Rhogam shot.  Not because of the shot...and anyway, after my blood draw puncture wounds, an intra-muscular injection is nothing.

Because of the pregnancy I was losing, the child I would never meet.  We spoke at length to Alyson to see where we'd go, and set up a follow-up appointment with Dr. Yuzpe to figure out where to go from here.  At the very least, Alyson assured me that she'd call with today's HCG results.

I went home and cried.  I called my mom, and we cried together.  She can relate; she went through a 2nd trimester miscarriage when I was 7.  The difference was that she didn't need fertility treatment to get pregnant.  Nonetheless, the pain and sense of loss are the same.

I realized just how darn lonely I feel.  How moving to a new place while transitioning to be a stay-at-home mom was not a good antidote for loneliness and confidence.  How I want to be able to call up friends to share it, but realize that many of my friendships here are too precious and new...and how everyone is so busy with their own lives, I'm scared of troubling them with my own sadness.  I feel so damn alone.

I consoled myself with a soda, chips and a Subway Club from the local Subway.  It was my favourite type of sandwich growing up.  I can't remember the last time I had one.  Cold cuts are a no-no in pregnancy.  I gave up soda last year, except for once in a blue moon.  The last time I remember having one?  The morning after I learned that my IVF cycle failed.  I haven't dreamed of touching chips since I started this FET cycle; too many carbs for a pre-diabetic girl.

The food didn't taste very good.  Even though I'd skipped breakfast and lunch by this point.

Alyson called with the results as Ben's sitter was getting ready to leave.  I already knew the results, so figured I should steel myself for the reality of a lost pregnancy.

HCG 24 days post ovulation: 15,868

Huh?

Not quite doubling in the 60 hours since my last test, but pretty darn close.  It should be doubling every 4 days now, after doubling every 2-3 days the first few weeks.

I'm still pregnant.  The bleeding is subsiding, but still there.  Alyson said that she's never had a patient with still doubling HCG numbers who is also bleeding heavily.  As for now, the only thing they can say is that I'm currently pregnant.

I go back Wednesday for my next HCG blood draw.  Steeling myself for bad news after that appointment...even though I've been told to be cautiously optimistic.

It's tough.  I've shed too many tears today.

Bug is asking for his hair to be put into a ponytail.  Life with a toddler goes on, miscarriage or not.

5 weeks (recalculated), spotting and a new beta

So it turns out my numbers were a little off.  My weekly anniversary falls on a Saturday, not a Friday.  Yesterday marked 5 weeks.  This means that our little blastocyst is the result of a Valentine's Day date, and if all goes well, has an EDD the same as its mother and grandmother, November 7th.

...but anyway.  That's a long way off.  After taking Bug for a haircut and drop-in session on Friday, we came back so that I could attempt to make that low-carb pizza recipe I posted here a few days ago.  Bleh, but that's another matter.  I went to the bathroom, and lo-and-behold, there was a gush of blood.  Seriously?  I was also getting light cramps, not unlike what I've felt previously.  I asked my husband to come home and called the doctor's office.

I had bleeding with Bug's pregnancy that landed me on modified bed rest at 28 weeks.  It wasn't as early on, however.  I was lucky to avoid 1st trimester bleeds in their entirety with him.

The sign of a good RE is when they're immediately available for emergencies, I've come to realize.  My RE's office immediately patched me through to my nurse, Alyson.  She said that it could be normal or the sign of an early miscarriage.  Because it's still early on, unfortunately the best way to determine what's going on would be an additional HCG draw.  Could I come in today?  I packed up my wild banshee, who was refusing to wear more than a diaper by this point, and we were at the clinic within 30 minutes.  Blood drawn, in & out, and Alyson called w/ the results an hour later.

My beta was now 8500, a 5-fold increase from Monday, and more than in line with what they were hoping to see.  My HCG is doubling at 45 hours, under the 48-72 they generally see.  Interestingly enough, the beta is not increasing as fast as it did with Bug but is still running at a higher number (and the doubling does slow down at about my levels).

So the good news is that, as of Friday, I hadn't had a miscarriage.  The more unclear news is that we don't know if the bleeding was/is the start of one.  I go back in tomorrow for my weekly HCG reading, which will give us a better sense of what's going on.

I put myself on modified bed rest for the rest of the day.  Interestingly enough, the gush pretty much stopped with that one instance.  I had fading spotting (and fading cramps) the rest of the day.  On Saturday, I literally had a drop or two of red spotting (and cramping) before some light peach spotting  and disappearing cramps through the rest of the day.  Interestingly enough, it occurred at almost the same time both days.

I'm trying to keep my mind busy and distracted as much as possible.  We had a friend's birthday party yesterday, and along the way, the car picked up a completely flat tire while getting off the highway.  We were able to make it to a car dealer, who switched us to the spare, and spent the rest of the day post-birthday-party at Costco awaiting a tire fix on our road hazard warranty.

Unfortunately, I fell in love with jalapeño poppers while we were there.  Darn Costco free samples.  We came home with a big box that happily became my dinner.  They tasted great, but my digestive track has apparently had other thoughts.  I woke up in the middle of the night w/ morning sickness and can still feel the poppers moving through my system.  And we naturally have 1.3 kilos left of them.

Happy Sunday, I hope.

5 weeks and the 2s

My next beta blood draw is Monday; I'm halfway there.  I used my second Clearblue Digital this morning, and it's showing that my HCG has increased.  I used an ovulation test strip yesterday afternoon - I was desperate and realized we didn't have any cheap pregnancy tests on hand - and the test line came up darker and more quickly than the control line did.  We'll find out how much my HCG has increased on Monday.

I went in yesterday for a TSH check-up as well as for measles, mumps and rubella titres.  Bug spent most of the time we waited for the phlebotomist serenaded the waiting room with his versions of the alphabet song, Oh Canada and Apples & Bananas.

I'm feeling exhausted right now.  The queasiness has somewhat abated, but the exhaustion has set in full force.  My brain is pretty foggy and clueless, and my concentration has gone out the window.  I definitely feel off.

It's making for interesting down time.  Since Bug has become obsessively interested in all things digital, I've limited my own screen time as much as I can.  We put the cable boxes away, and my husband uses parental controls on our computer so that I have limited access to it (at my request!).  Any down time that I had after cleaning was filled with reading, yoga DVDs and hot baths.  I can't concentrate, have no energy...and hot baths aren't recommended during pregnancy.  I've taken to reading magazines and newspapers, cleaning more, and banging around on my ukulele.  I'm also thinking of pulling down the sewing machine to try to make a new quilt...but with my pregnancy-induced stupor, am not sure that sharp needles and cutters are the brightest idea.

Of course, wouldn't it be appropriate that the day I get a positive beta was the day my son would hit the 2s (despite being nearly 2.5, that is)?  Over the past wee, he's developed into a full-fledged toddler with a complete mind of his own.  When he can't do what he wants (such as skipping preschool, going barefoot to school, skipping breakfast, wearing pajamas and a dirty diaper all day, throwing rocks, running around at snack time), the screams and hysteria start.  Utter meltdowns at the drop of a hat.

He got two time-outs in preschool yesterday, and was also reprimanded for refusing to wear shoes to class.  When I picked him up earlier in the week, he was in the middle of a different time-out.  This time for throwing rocks.

I'm slowly re-learning how to hold him so that his inevitable flailing kicks are far from my mid-section.  I have to admit, though, that having a kid in the 2s at home is not helping my exhaustion...

Low-carb recipes

A random post for me to store low-carb recipes...in honour of the impending gestational diabetes on my horizon:

Pizza:  http://www.domesticate-me.com/cauliflower-pizza-crust-with-roasted-vegetables-and-goat-cheese/

To tell or not to tell

To tell or not to tell?

I suppose that's the big question with pregnancy.  I knew people who publicly shared their pregnancy news as soon as they saw the positive test results.  I knew others who waited much longer.  With Bug,  we waited until 12 weeks generally, sometimes longer or shorter depending on our relationships.  I guess that's pretty much where my "I'm pregnant" comfort levels falls, with the beginning of the 2nd trimester.

But that aside.  With an IVF cycle, my question is a bit more general...or specific, depending on how you look at it.

When and how do you share that you're going through IVF?

Just like with pregnancy, I don't think there's any one answer.  Having the support is wonderful and encouraging.  It also is tough to share less-than-positive updates.  The hormonal and physical changes of IVF can be daunting.  I couldn't help but wonder whether, aside from the pinpricks and bandaids covering my stomach, my fertility treatment was visibly apparent on the outside.

With Bug's IVF cycle, I told a few close friends, including one who opened up her house to me as a base for my early morning fertility treatments, and another who'd undergone a (successful) round of IVF herself.

For my November IVF cycle, I told a handful of friends, including some who had faced fertility treatments themselves and others who would be supportive no matter what the outcome.  They were, thankfully.

For last month's FET cycle, we told pretty much no one.  I think the biggest difference was the lack of uncertainty in a FET (versus IVF) cycle.  Don't get me wrong, there's still the crazy-making that a two week wait causes when you know an embryo was transferred.  That alone makes a FET cycle painful.

Unlike an IVF cycle, I had no lead up to the embryo transfer during the FET.  I was on a handful of meds that made me feel pretty normal, relatively speaking.  I didn't have days of shots that were hyper-stimulating both my ovaries and my hormones, nor was there the uncertainty of estrogen levels getting too high, the number of eggs retrieved, the number of mature eggs, ICSI versus standard fertilization, the number of embryos produced, 3 versus 5-day transfer, number of embryos (or blasts) that make it to day 3 (or 5), number transferred, number that make it to freeze.  All while still jacked up on the stimming hormones, which hopefully are leaving your system.  Nor is there the fear of the anesthesia they use during the egg retrieval (propanol or fentanyl, generally speaking), which, even though both of my egg retrievals went smoothly, will probably never abate.  I fear anesthesia.

IVF cycles are tough, physically and emotionally.  If we have to go through any additional, I have no doubt that we will never come up with the perfect number of confidantes.

Whew.  I need a nap.

4W4D

It hasn't set in yet.  As DH was getting ready for work, I bluntly said "I'm pregnant."  He'd already gotten the news yesterday.

It seems strange to be saying it.  The last time I could say I was pregnant, I had a bowling ball moving inside of me and was carrying 28 extra pounds of weight.  While I'm still unfortunately carrying some of that weight, there's no bowling ball.

I feel passably okay, at least compared to the wonder of that 3rd trimester.  Well, aside from some continuing queasiness and a general feeling of being out of sorts.  I'm experiencing a hot flash as I type this.  Won't my red cheeks be a giveaway that something is up?

We Skyped with DH's dad and stepmom last week.  Later in the week, his dad mentioned that something had been bothering them.  "Is Bugsy pregnant?" he asked.  Apparently his stepmom noticed my flushed colouring.  That was at 4DP5DT.

My goal is to not overthink this pregnancy.  I was a wreck for...well, pretty much the entire 9 months of Bug's pregnancy.  I recently read that moms who conceive through ART generally are pretty anxious throughout, worried that something will go wrong.  That was me to a T.  One of my personal goals is to enjoy the pregnancy more than I could with Bug's.  It's hard to do when jacked up on progesterone and estrogen, that's for sure.

Sweet Guy is fast asleep in my lap.  That's one aspect of HCG I adore.

Beta

Beta of 1824.  I am pregnant, more pregnant than I was with Bug during the comparable day of his cycle.

Well, I guess my morning sickness really was just that...

FET #1: 12DP5DT

It's 2:56 PM on beta day.  Yay!  The long wait for my results is (hopefully) almost here.

I had my blood draw at 7:20 this morning.  I was the first one in the queue.  The phlebotomist missed the vein and had to repuncture it.  It was the most painful blood draw I've had.  I hope it's not a bad omen for today's news.

Olive's nurses stop taking incoming calls after 3 PM.  I left a message at 2:50 enquiring on the status of my results.  Naturally, one of his nurses is out of the office today.  It explains why they're backlogged in making calls, but the longer this drags out, the more my heart is pounding.

I still haven't done a home test.  Still queasy with vivid dreams, but not in as bad of a mood as last week.  I'm trying to tell myself that the queasiness is due to the progesterone, and that when I get negative results in the next few minutes, I can console myself with a big cupcake and with the thought that our planned trip to California this summer will go on as planned.

Last cycle, I think they called me around 2 PM with my low beta numbers.  During Bug's cycle, the nurse called me two hours earlier than expected.  My brain can't help but wonder if they're delaying the inevitable because it's not good news.  I've been through that once before...can hopefully handle it again.

I'm trying to will the phone to ring.  It's not working.

FET #1: 11DP5DT

T-1 until beta.  Yay!

At this point last cycle, I felt like myself again following a few days of vaguely feeling pregnant.

As for today...I feel like crap.  I can't eat anything without feeling nauseous, but if I don't eat anything, I feel nauseous.  When I eat something, I feel crampy and nauseous.  I wanted banana bread for breakfast - made w/ almond flour in the chance that I am pregnant and headed down the gestational diabetes path once again - and ate one bite.  It didn't taste good.  The peanut butter (which I normally adore) tasted funny.

The rest of it sat on my plate and my stomach rumbled its sigh of disapproval.  Within 30 seconds, I felt hungry again.  Only this time, nothing sounded good.

Yesterday was a 14-hour day of this feeling.  A l-o-n-g day.  I'm resigning myself to veggie slices and nuts (and ice cream), in an attempt to keep my stomach at bay and a vaguely low-carb diet in check.  Rich ice cream was one of the few sweets that gave me almost zero problems with my blood sugars last time around, and for whatever reason, it tastes really satisfying right now.

If I am pregnant, these symptoms are similar (=more intense) than the morning sickness I felt with Bug.  If I'm not pregnant, I am recording these side effects so that I don't drive myself crazy wondering if they're pregnancy-related on my next cycle.

One day until beta.  Yay!

Medicine awkwardness

The only thing I've found more awkward than a female suppository is when your 2.5 y. o. toddles over to provide a running commentary.

Bug asked if it was mommy's medicine, and then proceeded to hop up on the bed with legs splayed so that he could have some medicine too.

Maybe he'll be an OB/GYN.  As long as it doesn't traumatize him, we're good.

FET #1: 10DP5DT

Monday.  Still two days away.  In the greater scheme of things, it's approaching relatively quickly...but feels like it's taking forever.

Side effects: intermittent cramping, some light queasiness.  Return of fairly vivid dreams, some light lethargy.  I'm not pushing myself with exercise, though, so not sure if the lethargy is more of a placebo effect.  Same with the dreams.  And the cramping and queasiness, for that matter.

Woke up starving in the middle of the night.  I'm pretty sure that's a s/e of the progesterone.  Meals sometimes leave me queasy or with gas cramps.  Bleh.

The cats are pretty darn clingy.  Mama Cat is now spending every night cuddling against my stomach.  Old Guy tries to join her with occasional success (surprising considering that they hate each other).  Sweet Guy joins me for computer time around 50% of the time now.  Considering that he's never been a lap cat in the 9 years I've known him, I'm very much enjoying our cuddles.

Two days until beta.  I'm really looking forward to having some certainty and simply knowing the direction this cycle is taking.

FET #1: 9DP5DT

Oh, beta (blood test) day, why won't you come any closer?  Still 72 hours away.  It feels so long.

Many clinics test anywhere between 9DP5DT (=14DPO) and 12DP5DT (=17DPO).  Our first clinic tested at 13DP3DT.  I was working at the time, so the 2 weeks went by relatively quickly.

Our new clinic's policy is to test at 12DP5DT, which feels so far away from the transfer date.  With both cycles, it naturally has fallen on a Monday.  Which means that I still have an entire weekend to get through before knowing what's up with our little blast.

I don't test early at home.  I've never, ever gotten a positive home pregnancy test on my own, so I don't want to jinx it in any way.  The _only_ true positive I ever got was after the positive beta with Bug's pregnancy.  I took a home test, and received the second line even before the control line appeared.  It was amazing.  On my last cycle, I tested after my inconclusive beta and received a faint test line alongside the control line.

Monday will come, just sometimes it feels like it's not soon enough.

A big test for me is this weekend.  It was at a comparable point last cycle when all pregnancy symptoms (some fatigue, light cramping, queasiness) simply faded away.  I stopped "feeling" pregnant, for lack of a better word, even despite the progesterone and estrogen I continued to take.  I have no idea if I feel pregnant or not right now, but know that returning to feeling 100% like myself is not a symptom I hope to experience.

It's also the point where my cycle should start if the progesterone isn't suppressing it.  It did suppress it last cycle, so I'm not holding out hope.  I'm 31 or 32 days into the current cycle, 14DPO.

We'll see.

Side effects, 9DP5DT: Sleeping a bit better, dreams that aren't 100% vivid but still quite memorable.  Cramps & queasiness yesterday, hot flashes (???), very light & minimal spotting.  Everything comes and goes throughout the day.

What is In-Vitro Fertilization (IVF)?

In a nutshell, IVF involves joining sperm and egg to create a healthy embryo for patients for whom this process doesn't occur naturally.  It generally involves pumping me full of hormones, retrieving eggs, fertilizing those eggs in a laboratory, watching them grow, and then transferring the best one(s) at either 3 or 5 days past conception.  From there, aside from maintaining relatively high levels of progesterone and estrogen, it's up to my body - and the embryo(s) - to take over.

As straightforward as it seems, the process is far more difficult.  Not every egg will fertilize, nor will every embryo make it to transfer day, nor will every transferred embryo implant.  At the same time, too much pushing can cause the body to become hyper stimulated - a dangerous situation to be in.  My REs - and I think this is indicative of most - have generally tried to maximize my chances for success without pushing me too far.

The following is taken directly from MedLine Plus.  If the description below seems overly convoluted and complicated, well, that's because the entire process is.  It's a long, drawn-out and painful process through which I'm repeatedly willing to put my body for the possible outcome of having a child.

In vitro fertilization (IVF)

In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory
dish. In vitro means outside the body. Fertilization means the sperm has attached to and
entered the egg.

Description

Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg
 attaches to the lining of the womb and continues to grow, a baby is born about 9 months
 later. This process is called natural or unassisted conception.

IVF is a form of assisted reproductive technology (ART). This means special medical
techniques are used to help a woman become pregnant. It is most often tried when other,
 less expensive fertility techniques have failed.

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation

• Medicines, called fertility drugs, are given to the woman to boost egg production.
• Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs.
• During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels. 

Step 2: Egg retrieval

• A minor surgery, called follicular aspiration, is done to remove the eggs from the woman’s body.
• The surgery is done as an outpatient procedure in the doctor’s office most of the time. The woman will be given medicines so she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vaginaand into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.
• The procedure is repeated for the other ovary. There may be some cramping after the procedure, but it will go away within a day.
• In rare cases, a pelvic laparoscopy may be needed to remove the eggs. If a woman does not or cannot produce any eggs, donated eggs may be used. 

Step 3: Insemination and Fertilization

• The man's sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.
• Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.
• If the doctor thinks the chance of fertilization is low, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
• Many fertility programs routinely do ICSI on some of the eggs, even if things appear normal. 

Watch this video about:Intracytoplasmic sperm injection

Step 4: Embryo culture

• When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing.
• Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider pre-implantation genetic diagnosis (PGD). The procedure is done about 3 - 4 days after fertilization. Laboratory scientists remove a single cell from each embryo and screen the material for specific genetic disorders.
• According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos to implant. This decreases the chance of passing a disorder onto a child. The technique is controversial and not offered at all centers. 

Step 5: Embryo transfer

• Embryos are placed into the woman's womb 3 - 5 days after egg retrieval and fertilization. 
• The procedure is done in the doctor's office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman's vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results.
• More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman's age. 
• Unused embryos may be frozen and implanted or donated at a later date.

Why the Procedure is Performed

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including:

• Advanced age of the woman (advanced maternal age)
• Damaged or blocked Fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)
• Endometriosis
• Male factor infertility, including decreased sperm count and blockage
• Unexplained infertility 

Risks

IVF involves large amounts of physical and emotional energy, time, and money. Many couples dealing with infertility suffer stress and depression. 

A woman taking fertility medicines may have bloating, abdominal pain, mood swings, headaches, and other side effects. Many IVF medicines must be given by injection, often several times a day. Repeated injections can cause bruising.

In rare cases, fertility drugs may cause ovarian hyperstimulation syndrome (OHSS). This condition causes a buildup of fluid in the abdomen and chest. Symptoms include abdominal pain, bloating, rapid weight gain (10 pounds within 3 - 5 days), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath. Mild cases can be treated with bed rest. More severe cases require draining of the fluid with a needle.

Medical studies have shown so far that fertility drugs are not linked to ovarian cancer.

Risks of egg retrieval include reactions to anesthesia, bleeding, infection, and damage to structures surrounding the ovaries, including the bowel and bladder.

There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. (However, even a single baby born after IVF is at higher risk for prematurity and low birth weight.) 

It is unclear whether IVF increases the risk of birth defects.

IVF is very costly. Some, but not all, states have laws that say health insurance companies must offer some type of coverage. But, many insurance plans do not cover infertility treatment. Fees for a single IVF cycle include costs for medicines, surgery, anesthesia, ultrasounds, blood tests, processing the eggs and sperm, embryo storage, and embryo transfer. The exact total of a single IVF cycle varies, but may cost more than $12,000 - $17,000.

After the Procedure

After embryo transfer, the woman may be told to rest for the remainder of the day. Complete bed rest is not necessary, unless there is an increased risk of OHSS. Most women return to normal activities the next day.

Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 - 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that helps thicken the lining of the womb (uterus). This makes it easier for the embryo to implant. Too little progesterone during the early weeks of pregnancy may lead to miscarriage.

About 12 -14 days after the embryo transfer, the woman will return to the clinic so that a pregnancy test can be done. 

Call your health care provider right away if you had IVF and have:

• A fever over 100.5 F (38 C)
• Pelvic pain
• Heavy bleeding from the vagina
• Blood in the urine

Outlook (Prognosis)

Statistics vary from one clinic to another and must be looked at carefully.

• Pregnancy rates reflect the number of women who became pregnant after IVF. But not all pregnancies result in a live birth.
• Live birth rates reflect the number of women who give birth to a living child.

According to the Society of Assisted Reproductive Technologies (SART), the approximate chance of giving birth to a live baby after IVF is as follows:

• 41 - 43% for women under age 35
• 33 - 36% for women age 35 - 37
• 23 - 27% for women ages 38 - 40
• 13 - 18% for women age 41 and over

Alternative Names

IVF; Assisted reproductive technology; ART; Test-tube baby procedure

References

Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012: chap 41.

Goldberg JM. In vitro fertilization update. Cleve Clin J Med. May 2007; 74(5): 329-38.

The Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril. Jan 2013;99 (1):44-46.

Jackson RA, Gibson KA, Wu YW, et al. Perinatal Outcomes in Singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103: 551-563.

Update Date: 3/11/2014

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. 

Browse the Encyclopedia

IVF belly

This is my stomach on drugs.  IVF drugs.

Pre-Bug during IVF #1, in 2012.

Post-Bug during IVF #2, 2014.  I never lost my Bug Belly, that's for sure...

Stimming drugs.

We spent months trying to figure out how to recycle the sharps.  Finally brought them back to the clinic for disposal.

FET cycle #1 (from IVF cycle #2) by the numbers

By the numbers:

Drugs used: Synarel (suppression), estrogen 2x daily, progesterone 3x daily, low-dose aspirin
Days stim: xxx

Chance of success given: 70%

TSH: Around .86 at start of cycle, 2.29 during cycle.

Lining check u/s: Feb 13
Embryos transferred Feb 18: 1 5d (4BB)

Symptoms: Lethargy and vivid dreams first week, noticeable cramps and moodiness 6-7DPT.  Cats ridiculously clingy.

IVF Cycle #2 by the numbers

By the numbers:

Drugs used: Menopur, Bravelle, Lupron (trigger due to OHSS concerns), HCG follow-up, estrogen 2x daily, progesterone 3x daily
Days stim: 8

Chance of success given: 70%

TSH: Around 3.5 at start of cycle, hovering around 3 w/ increase in synthroid during cycle.

Eggs retrieved Nov 8: 13
Eggs mature: 8
Eggs fertilized (ICSI): 4
Embryo transferred Nov 13: 1 5d (4AB)

Symptoms: Some pinching, twinges and cramping during first week.  Increasing queasiness over 2nd week.  Around 8DP5DT, a strong feeling that I was pregnant, similar to the general feeling I felt later on in my pregnancy with Bug.

No moodiness, late cramping, or utter exhaustion.  Cats acting like themselves.

Around 10DP5DT, symptoms disappeared suddenly.  I felt like myself again, no hint of pregnancy.

HCG beta 12DP5DT(17dpo): 14
Beta 14DP5DT (19dpo): 6

Stopped progesterone and estrogen on 14DP5DT.

IVF Cycle #1 by the numbers

By the numbers:

Drugs used: Follistim, , HCG (trigger), estrogen, Crinone 4x daily, low-dose aspirin
Days stim: 8-10 (can't remember exact number)

Chance of success given: 66%

Eggs retrieved Jan 17: 5
Eggs mature: 3
Eggs fertilized: 2
Embryos transferred Jan 20: 2 3d: 1 8-cell, 1 2-cell

Symptoms: Nil.  Refused to pay attention to any, other than that the cats were ridiculously clingy.

HCG beta 13dp3dt (16dpo): 400
Beta 17dp3dt (20dpo) 3500

First ultrasound 2/23: 1 baby measuring 7 weeks 4 days (2 days ahead of schedule). EDD October 10th, 2012.

Bug born October 2nd, 2012 following a rocky pregnancy.  (Details posted separately.)

My pathway to infertility

I always wanted to be a mom.  Looking back on it, it's one of those dreams that you can't always discuss openly.  Especially having graduated from a women's college.  To be a mom?  It's something you're supposed to do alongside your professional goals.

But I always wanted to be a mom.  It wasn't supposed to be this hard.  I'm part of the post-women's-lib generation, the one who was taught that pregnancy could happen at any time, and the generation who was given the luxury of the birth control pill as a means of suppressing it.

If only I knew.

My husband and I waited until the supposed "right" time.  Nothing happened.  Visits to the OB led to a prescription for one of the relatively milder fertility drugs, Clomid.  Ultrasounds and monitoring.  Nothing.  I underwent blood tests - all clean.  DH underwent tests - all came back fine.

Looking back, I had the major indicators of a problem nearly going back twenty years.  A cycle that was always a disaster.  Inconsistent and irregular at best.  Debilitating cramps.  Really debilitating cramps.  To the point that I missed work, school, and all life functions on a daily basis.  To the point where 7 cm dilation in Bug's labor didn't feel as bad as my monthly cramps.  I thought it was normal.  Everyone talks about menstrual cramps, so what was the problem?  The awesomeness of the birth control pill hid my cramps for over 10 years and let me function like a vaguely normal human being.

As I've since learned, any sign of _debilitating_ cramps is worth investigating.

I trucked off to a referral with a local reproductive endocrinologist.  Bedside manner of zero.  Major fail.  I was referred to a second reproductive endocrinologist, Dr. Samuel Brown.  Awesome guy, really liked him.  Major disadvantage - clinic 1.75 hours away from our house.   That was irrelevant at this point, just a "minor" inconvenience.  Ha.  Said by someone who clearly hadn't gone through IVF monitoring.

Endometriosis was mentioned by both Dr. Brown and my OB as the surmised cause of my infertility.  The one test that could verify it, a laparoscopy, didn't offer enough in the way of increased pregnancy rates to overcome my fear of the small surgical risks that could occur.  We discussed IUI and other options.  We compared costs, success rates and what would work best for our needs.  I enquired about mini-stim in-vitro fertilization (essentially, a test tube baby created using a lesser number of hormones than full IVF), and eventually decided to pursue it.  The specs of our situation - insurance, probable cause of infertility and financial - made it the best option.

I started suppression for IVF #1 in December of 2011, followed by stims in January of 2012.  A 3DT of two embryos on January 20th gave us our little boy 8 months later.  The 1.75-hr drive to Dr. Brown's clinic at least 10 times during that cycle was inconvenient, but apparently quite worth it.  Very thankful for close friends in Jacksonville who opened up their house and hearts to me during that time.  And for our beloved Prius, Yoda.

After Bug's arrival, I was worn out by a difficult pregnancy as well as the infertility leading up to it.  Figured he'd be an only child.  As he progressed towards toddlerhood, I realized that, while I was content with one, I wanted to see if we could bring another child into this world.

Enter another year of trying.  A diagnosis of treatable postpartum hypothyroidism.  A diagnosis of secondary infertility (technically awarded after 6 months of infertility post-child).  Our cross-country move the year prior necessitated our referral to a new reproductive endocrinologist, Dr. Al Yuzpe.  Endometriosis and laparoscopy broached again.  More bloodwork.  Hysterosalpingogram (HSG) performed in June.  No pain from it (a lovely surprise!), but caused debilitating monthly cramps to return with a vengeance.  Went back on birth control pill.  Not a great way to try to get pregnant.

With such debilitating cramps still on the horizon, we decided to go at the fertility full-force once again.  We pursued our first course of full IVF.  Stims started in late October of 2014; cycle produced three blastocysts on day 5.  A 5DT of one (other two cryopreserved) yielded a chemical pregnancy two weeks later.  I went through a round of hormonal suppression and then geared up for our first frozen embryo transfer in February.

And that is where I am today.  8DP5DT of FET#1.  More to come.

FET #1: 7DP5DT

I'm writing this blog to chronicle my current journey for my own family as well as shed light on the path we've taken.  To give another face to infertility, and to help show that we walk amongst everyone else.  That we come in all shapes, sizes and colors.

The title for this post is a whirlwind of acronyms that, without a connection to infertility struggles, would make no sense.  Wow.  To spell it out, today is 8 days following (8DP) the embryo transfer of a 5-day blastocyst (5DT) for a cryopreserved embryo transfer (FET).

Ummm...still unclear.

I went through an IVF cycle in November.  I was pregnant with that late-stage embryo, called a blastocyst, for around a week.  It's called anything from a failed implantation to a chemical pregnancy to an early miscarriage to an inconclusive pregnancy, depending on who you ask.

The cycle left us with two additional perfectly viable embryos.  Both were cryopreserved - frozen in dry ice. We started preparing for the first frozen cycle in January.  A blastocyst was transferred last week.  I'll find out next week if it successfully implanted.

The two-week wait is difficult enough.  Jacked up on hormones, as much estrogen and progesterone as your body can manage, makes it a downright joy.

8DP5DT, 13DPO in more simple layman's terms.  What are my symptoms?  I have utterly no idea.

1DP5DT - 5 DP5DT: increasing lethargy, vivid dreams, some queasiness 0DP-3DP.  I think I picked up a touch of food poisoning around the time of transfer.  Cats becoming increasingly cuddly.

2DP5DT - 5DP5DP: Intermittent & very light cramping.  Extreme dizziness (the if-I-look-down-I'll-fall-over type) at 3DP5DT.  Moodiness increasing.

6DP5DT: Severe cramps lasting around an hour mid-day, light cramps throughout much of rest of day.  Insomnia, less vivid dreams.  Ridiculously cuddly cats.

7DP5DT: Cramps continued throughout much of day, occasionally (but not often) severe.  Incredibly moody and irritable.  Cats still very cuddly.  Insomnia picks up again from pre-transfer, dreams less vivid (makes me less optimistic).

Every single one of these symptoms could be attributed to the heavy doses of progesterone running through my body.

My clinic waits until 12DP5DT to run the beta test.  That's Monday, still a whopping 5 days away.  Who knows what pseudo-symptoms will develop in the next few days?

With Bug's pregnancy, I had none (other than clingy cats).  Zero.  Zip.

Monday can't come soon enough.

The hidden face of infertility

Infertility has many faces.  Some hidden, some perhaps not so much.

It could be the childless couple down the road.  The ones whose house is always open for the neighbors' kids.  The ones who would make the perfect mom and dad, but who never seem to get there.

It could be the single lady you see at church.  Or, for that matter, the single guy.

Or the gay couple, male or female.

For all of that, it could even be the pregnant woman you encounter at the grocery store.  Or the mother chasing her little boy.

It could have been me.

It was me.

It is me.

I am a daughter, a friend, a wife and a mother.

I also am an infertility patient.  What an ironic term; infertility certainly forces patience.

My husband, son and I.  We are the family on the street that disappears under the hidden guises of infertility.  I'm sure that no one would assume our struggles upon first meeting us.  My 2-year-old son, Bug?  Below is his first picture.  I suspect that anyone who has done IVF will recognize it immediately.

Progesterone, estrogen, clomid, follistim, menopur, bravelle, trigger, IVF, ICSI, HSG, laparoscopy, endometriosis, FSH, LH, uterine checks, hypothyroid, ultrasound, cryopreservation, TSH checks, HCG, embryo, blastocyst, downgrading, stimulating, FET, beta tests, bloodwork, reproductive endocrinologist.

A hodgepodge of words of little significance to fertile couples.  Our family is unfortunately intimately associated with this terminology.

I don't claim to know what other women facing infertility have experienced.  Only that it sucks.  That I've felt the pain, and that while we all walk on this journey alone, we all walk together as well.

Welcome to my journey.