GOTD: Beta to the MAX

Wow, that blog post title was an 80’s joke if there ever was one. 10/14 Google of the Day (GOTD) as follows:

“how did you get your beta test results ivf”

Today’s point of curiosity was that ultra-critical, ultra-binary moment: when you are, or you aren’t. Say you survive the 2WW (again), and it’s time for that beta blood test, and it’s a couple of hours later and the nurse has your results. How do you deal?!

I’m thinking back to my IUIs, and I recall the first and the last bad news phone call, but not the second, for some reason. Hmm.

IUI #1: I was working from my parents’ house; Joe and I were headed to Miami to see my sister for the weekend, and Katrina, my ACRM nurse, called to let me know the negative results. But the night before, I already felt Aunt Flo coming, so while it was upsetting, it wasn’t unexpected. I also knew that it sometimes took more than one try, so I felt okay about the fact that it was negative. (I mean, I still definitely cried while watching Hook in the basement.)

IUI #3: I was working from home, on a stupid training call about a stupid new tool. The nurse called me and I remember pacing my house, trying to get as far away as possible from the drone of the trainer’s voice, with the biggest pit in my stomach as I listened to the same news, for the third time. I think I sat on my stairs and cried. Pretty sure Aunt Flo came the following day.

Each time the nurse called with the news, I never considered alternatives to straight up picking up my phone and taking the call. But through Google, I found out a multitude of ways that this moment could play out:

  1. You hate hearing the bad news from a nurse. You’d rather hear it from “DH.” You ask the nurse to call DH instead, and he will give you any bad news in a better, gentler way.
  2. You don’t want to talk to a live person, and for them to hear you break down if it’s bad news. You ask the nurse to call you, and to leave a voicemail. You listen to it on your own, or you wait until you and DH are together in a safe place and listen then.
  3. You have a job where you physically can’t pick up the phone, or you don’t have a good place to sneak away for feelings. You ask the nurse to leave a voicemail, and listen to it at home.
  4. You want to film yourself and DH receiving the news. You ask the nurse to leave a VM, then listen to it at home, in front of the camera.
  5. You already know the answer, because you “tested out” your HCG trigger (so you know it’s not a false positive from the meds), and the nurse is just calling to confirm what you think you already know.
  6. You didn’t test HCG out, but you POAS (PdOAS? POASed? POAS’d?) the day of the beta test and you have an idea of what the verdict will be. But the clinical beta will double confirm your home test.

I learned about all of these options from a quick scan through one such forum. Honestly, I think it’s fantastic that women (and men) going through this HORRIBLE FUCKING TIME are figuring out ways to manage the anxiety and make these untenable situations as easy for them to deal with as possible.

But for me? I don’t know what I’ll do, come Oct 21. I know I don’t do home pregnancy tests. I didn’t even do them a lot when we were regularly TTC. As an overachiever and a pretty good test taker, I felt like the HPTs would lower my averages. I also figured, either I’ll have a period, or I won’t, and that will let me know what I need to know. And I was regular as clockwork, so being reliable helped, too. As far as the phone call goes? Will I change my ways and let the nurse leave a VM at the beep? Probably not. I’m too instant gratification for that. But at least I know I have the option, thanks to Google.

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The IVF Protocol (And Other Paperwork)

Protocol, such an official term. What’s a protocol, you ask? The actual format differs from clinic to clinic, but at ACRM it’s basically a very detailed, day-by-day task list to get you from the start of your IVF cycle, through stimulation meds to the egg retrieval phase of IVF. (After egg retrieval, you receive an additional set of protocols to get you through embryo transfer and the beta pregnancy test.)

The protocol includes things you should be doing (i.e. scheduling a financial consult, paying your fees), to things you should be taking (i.e. birth control, baby aspirin, stim meds, trigger shots, etc.). It’s immersive and overwhelming. It was my IVF Bible for the weeks before egg retrieval – I literally referred to it several times a day and had copies on both my phone and work computer, as well as the master in my IVF binder. (More on the binder in a later post!)

My protocol was delivered through email by Katrina, my ACRM nurse, along with about 10,000 other documents to read, review, and sign. Just kidding, only 7. Here’s a list:

  1. My IVF protocol
  2. My medication list (the fertility drug list: Follistim, Menopur, Cetrotide, Novarel, Lupron, Progesterone… and the list goes on)
  3. Injection training instructions – 15 pages!! I videotaped myself scrolling through it to Snapchat a friend… maybe I’ll post it someday!
  4. More injection training instructions
  5. Injection training consent form – just to say you’ve read the instructions and all is crystal clear (ha, ha)
  6. “One Baby at a Time is Best” consent form – this is to agree to transfer in only one embryo at a time to minimize risks that come from a multiple pregnancy
  7. Disposition of embryos consent form – this one was very interesting, and deserves its own post. The question was, should we be able to freeze any embryos during the IVF process, what do we plan to do with them in the event of divorce or one/both of our deaths?
  8. IVF process and risks informed consent form

Did I already mention that this was overwhelming, AND exciting!? I remember being in a work meeting when I received these eight attachments in two emails, back-to-back… and it felt like the world stopped for a second. I thought, “Ahh! This is it!” … and proceeded to end the meeting as quickly as possible so that I could peruse the documents to my heart’s content.

IVF For Beginners

I walked into IVF knowing the bare minimum about how the treatment process worked. I hardly Googled it. I’m not sure if I was depressed, overwhelmed, or just over it… probably some of each. But I put one foot in front of the other and followed ACRM’s instructions to call on Day 1 of my next cycle.

Day 1 was over a weekend, so the following Monday, I received an email from Katrina, my ACRM nurse, letting me know next steps:

  1. I was to start back on birth control pills for 11 days. (This quiets the hormone-makers in the brain so that your cycle can be fully controlled by the clinic/IVF meds)
  2. I was to set up a financial consultation to discuss IVF costs and payment. (ACRM expects upfront payment for the balance not covered by insurance)
  3. I was to schedule an HSG and trial transfer appointment, and initial bloodwork. Joe had an initial bloodwork appointment as well. (This HSG/trial transfer deal deserves a post of its own, but essentially the point is to 1) look at your uterus and ovaries with a small camera to make sure everything is good, no blockages or lining troubles and 2) make sure that there’s no funny zigs or zags on the way to your uterus that could cause issues during embryo transfer time)
  4. I was to sit tight and wait until the full IVF “protocol” was sent over in a few days. (Ah, the protocol. More on that later.)

After getting these initial instructions, I was definitely excited. It felt like things were happening. Like we were moving forward with a really good option, and a great medical support team. (I also like instructions and to-do lists, so that helped :-)) I couldn’t wait to get started for real.

Making the Leap from IUI to IVF

Somewhere in the middle of the 2WW for my 3rd IUI, Joe and I were in the car together when I tearfully turned to him and said, “I’ve decided something. If this current IUI doesn’t work, I don’t think I’m ready for IVF. I’m young, we have a lot of time to have children, and I don’t think I’m ready to subject my body to the invasiveness of an IVF treatment cycle at this point.” I was having a bad day. But I did somewhat mean it.

A few days later, I got my period. Failed IUI, #3. I wasn’t so surprised… but that didn’t mean it didn’t hurt in every way. It was harder than ever not to know what was “wrong,” after so many tries. Still unexplained, this infertility. Was it timing? Was it an undiscovered medical condition? What. Was. The. Problem?!

Back in the 2nd IUI cycle, we had a catch-up meeting with Dr. Fogle to talk through next options past IUI and so I had a general understanding of the physical and financial commitments of IVF, as well as the 6-week time commitment required. I can’t remember the moment I changed my mind and decided to move forward, but our reasons for jumping into IVF were pretty practical:

  1. We weren’t getting any younger, at 32 and 31. Egg reserve and health only diminish with time.
  2. Perhaps the IVF process would help us understand why our bodies hadn’t been working to produce a baby over the last year and a half.
  3. We had already met our insurance deductible for the year, and it was to our benefit to continue with IVF treatment in the same calendar year.
  4. We had also been saving money for a new car, and had money in the bank to write the upfront checks that IVF treatment required (insurance only covered about 70% of costs in our case).
  5. We were ready to see this adventure through…and ready to be parents! We’d come this far… so, we asked ourselves, why not? We didn’t want to live with the regret that we didn’t do all we could.

So, in mid-September, I started back on birth control pills for the first time in almost two years… the beginning of our next adventure.

Embryo Transfer Day!

I popped my Estrace, Xanax, and Advil, I grabbed my water bottle, and we headed to the doctor’s office. After the requisite bloodwork, Joe and I made our way to the OR. The nurse greeted us, walked us through the post-transfer do’s and don’ts, and asked us to change into our his-and-hers OR clothes. After waiting a few minutes, I was led into the back for a quick ultrasound to check if my bladder was full. (A full bladder pushes the uterus down for better visibility on ultrasound, and also helps the doctor insert the catheter more easily for embryo transfer.) Even though I had already guzzled about 60 ounces of water, my bladder was nowhere near full. So, back to the pre-op room for more water, and waiting. They tried again. Still not ready. I felt like a failure! I apologized profusely to the nurse, and she kindly said, “Don’t worry – bladders can be funny! We just need to wait a little longer.”

So we waited. Finally, around 11am, we were both led back to the OR to get the party started. I definitely had to pee by then. 🙂

It all happened so fast, but here’s what I remember. I was in the same room for the egg retrieval. Dr. Keenan, who was on deck for my transfer, had previously did my trial transfer (and several ultrasounds/at least one IUI), which reassured me a lot. The nurse placed my legs in the maximum security straps, and the team started to get the equipment ready. Joe took a seat to my left, next to my head. Dr. Keenan called the embryologist over, whose name is Dr. Steven Johnson but introduced himself as Steve. Nicest guy ever. He gave us the embryo update:

Retrieved: 10
Fertilized: 8
Arrested: 2
Transferring today: 1
Still in development for potential freezing: 5

5! Wow!! I was ecstatic to hear that news. I felt so good, and so hopeful that our cycle had produced at least 6 embryos. Six pre-babies! I was happy.

Dr. Johnson then showed us a photo of the embryo that they were transferring in that day. He said it was a perfect embryo… “textbook.” He went back to the adjoining lab and started to get the embryo prepared for transfer, while Dr. Keenan placed the speculum and catheter in position. After a few minutes, I heard Dr. Keenan say, “Steve, we’re ready,” and then the transfer process began. Joe put his hand on my shoulder. Though I couldn’t see much of the transfer on-screen, I watched the doctors watch the screen intently to place the embryo in the exact right place in my uterus.

It’s hard to describe what I was thinking in these 5 minutes. It was stunning. It felt like the miracles of science and love, coming together. I listened to the classical music faintly playing. I sent good vibes to the little embryo making its way to its home. I prayed that this was our baby. Tears slid down the corners of my eyes at the weight of the moment.

All at once, it was complete. The next part was a blur. The nurse sat me up gently, and showed me an ultrasound capture of the embryo. It’s just a little flash of light that wasn’t there before. But it’s almost a baby.

 

 

IUIUIUI: Turkey Baster Time

IUI stands for intra-uterine insemination. I had literally never heard of this word before my ob-gyn brought it up, somewhere in the Clomid months. I didn’t know there was a step (multiple steps) in between “can’t get pregnant” and IVF. But! I was glad to hear of this seemingly low-key treatment option. So we agreed to start with IUI right away under the watchful eye of Dr. Fogle and the wonderful nurses at ACRM.

How IUI works: well, the specific protocol probably differs person to person, but at my clinic, here’s how it generally worked on each of my 3 cycles.

Cycle Day 1: On the first full flow day of my period, I was to call the office and let them know that it had started. They would then schedule my Day 3 ultrasound and bloodwork to start the treatment cycle.

Cycle Day 3: Ultrasound and bloodwork. The vaginal ultrasound (via dildo-cam, as others have called it) is really not a big deal. It didn’t hurt me personally. The doc goes in and checks out the uterus and ovaries to make sure that everything looks good to start. Bloodwork checks estrogen and progesterone levels to make sure all levels also look good.

Cycle Day 5-9: Clomid, my old friend.

Cycle Day 11-ish: This is the mid-cycle check up, pre-trigger and ovulation. Same deal as Cycle Day 3, ultrasound and bloodwork. The doc checks to make sure that everything in the uterus and ovaries still looks good, and that the follicles are growing as desired. Depending on how the follicles are doing, the doc prescribes the medication to trigger ovulation.

Cycle Day 13: Trigger time! It’s an HCG shot given by a nurse in the office. Funny – I remember thinking, there’s no way they expect ME to mix this up myself?! I clearly did not know the IVF drill yet.

Cycle Day 14: IUI day! Joe’s appointment to produce a ~*sample*~ happens early in the morning. The lab washes the semen, distills the most qualified sperm, and then gets it ready for the short catheter trip directly into my uterus. Then I’d come in and the doc would insert the swimmers up the chute, hoping that more sperm in the uterus = a better chance of fertilization. I’d lay still on the bed for 5 minutes, then I would be able to continue my day as usual.

SEE? JUST LIKE SEX!

No. But hey, SCIENCE! What a time to be alive.

 

Our New Best Friend, the RE

I remember being so nervous for that first phone call to ACRM, our fertility clinic. Driving in the car on the way to work, I stuttered over my explanation of my reason for calling (trying to get pregnant… nothing happening… help) and was pleasantly surprised when they scheduled my first consult for later in the week with Dr. Robin Fogle, a reproductive endocrinologist (RE) at the practice. Before the appointment, the office had us download and fill out a bunch of entry paperwork, including our individual and combined medical history and insurance documentation. I also had to call my regular doc to send in paperwork on previous tests, including the HSG (dye test) results and semen analysis (I told you we were going to get into the details!).

Insurance sidebar: We were lucky enough to have insurance cover a significant portion of our infertility treatment (there’s a lifetime cap amount). I hope to do a post someday breaking down the costs we entailed throughout this process, including with IUI, IVF, and meds. I’ll need Joe for that one – he really took care of all the financial details so that I could focus on staying calm throughout our treatments. I was extremely thankful.

Back to the story. We got to the office (Perimeter location, for Atlanta-based readers). I had some more forms to fill out while waiting, then our names were called. Dr. Fogle herself greeted us at the door. She was nice as could be, and led us to her spacious office with a beautiful view of the surrounding scenery. We talked through medical history, she asked a few questions along the way, then we got down to the business of infertility. Dr. Fogle described the physical and chemical details of a regular cycle, and then pointed out the areas where we could run into issues: Egg quality. Ovulation. Physical blockage. Male Factors. And so on. She reminded us again that all tests had come back just fine… so at the moment, our infertility was unexplained. Or as she put it, “You’re unexplained.” Then, we moved on to treatment possibilities: Clomid. IUI. IVF. Chances of success by age group. (Since we’re in the youngest bracket, time is on our side.) All the while, she sketched the information she was telling us on a plain piece of paper, to illustrate the points. As a lifelong doodler myself, I mentally gave her bonus points for the visuals.

At the end of the conversation, we discussed immediate next steps: more Clomid, or direct to IUI. We decided to go home and think it through, rather than make a decision on the spot. It just so happened that we were there on a convenient cycle day for some bloodwork, so after saying our goodbyes and thanks to Dr. Fogle, I was shuffled off to The Blood Room (as I call it in my head), for a quick draw.

I liked Dr. Fogle right away. She was warm, friendly, completely sympathetic, but also straightforward with the details of our treatment options and chances. She made me feel comfortable. Her doodles felt like a map to somewhere hopeful. I didn’t feel like crying. I felt like everything was going to be ok.

We went home, and pretty quickly decided to jump into the IUI process. Dun-dun-dun!!!