And Thanksgiving Came

Obviously it's way past the point where we've found out the results of our November transfer. The transfer itself went perfectly. We got a picture of the embryo baby that got placed inside of me. Kind of cute, yeah? In a fascinating medical sort of way, anyway!



They take a picture before they do an assisted hatching so that it looks nice and spherical. After this, they shave one side of the shell off to make it easier to implant. But that wouldn't be as pretty of a picture!

I started testing via cheap internet HPTs 5 days after the transfer, and never got a positive. My beta test was "5" nine days after transfer, and the repeat test 2 days later had dropped into the negative range.

So... I'm not pregnant this time.

But, I'm also not terribly hurt. I feel so grateful that God has worked the timing this way, because we knew going into this that out of 5 embryos we would almost certainly not have 5 living children. The genetics of fertilization just aren't that perfect. Some of these babies just need a mommy to release them to Heaven, and only by chance did the embryologist choose a baby destined to make it to birth the first time we did a transfer.

If this baby had been chosen first, I would have been devastated. I probably would have had surgery before trying any others to see how bad my endometriosis is. I would have felt terribly guilty, wondering if we made a mistake and killed a child because my body just wasn't healthy enough. We may have begged the doctors to put me on more meds or change their protocol, and just generally stressed something that would have been totally unrelated to my ability to bear a child.

But that's not what happened. God allowed Hannah to be the first one. It was easy compared to what many of my infertility sisters go through. Then I had Ellie- once again, easily. I know my body works. I know the transfer protocol works fine. I know this isn't my fault. And so I was able to enter the Thanksgiving season grateful for the honor I had of serving this life for the few short days it was destined to grow.

I am happy we were able to use my body and my resources for this child that had nothing whatsoever to give back to us. I feel complete. I served as best I could, and it was good.

Now, we are getting ready for another one. January 6th is the schedule this time. I hope this one is one of those destined to make it. But God knows. Perhaps Hannah will be the only one of the group to be held by us. If that's the case, we'll know within a few months time. And if that happens, I will cry.  Either way, we will give these babies every chance we can and care for them every second of the lives they live.

How to get pregnant: Medication edition

I'm well on my way to transfer of embryo number 2. I am much more amused this time around at how this process works. First, I take birth control. High dose. No placebo pills. I also have to get on anti-diabetic meds (thanks PCOS!) and aspirin. Then, the Lupron shots start. Goal: chemical menopause. After about a week of this, I stop the birth control pills, keep giving myself shots every morning, and switch to estrogen. The estrogen dose increases incrementally as I get my lining checked, then decreases a bit and stays constant either until the cycle is over or until I'm out of my first trimester. Once my lining is sufficiently thick, I stop the Lupron and start progesterone shots. These are the ones that hurt like heck. 5 days later, we transfer, and the progesterone continues. In the couple of days leading up to transfer, I also add an antibiotic and an oral steroid to the regime. The day of transfer involves a muscle relaxer. Metformin and Aspirin can be dispensed with if I get a positive pregnancy test, otherwise they will probably continue through another transfer cycle.

Looks like this (not all meds are actually in this picture, just what arrived from the specialty pharmacy):

Ta-da! And this is just for a frozen embryo transfer. If I was doing full-blown IVF, the meds would be more numerous and significantly more expensive.

So far, I've made it to the end of the BCPs and through the first ultrasound. Apparently my PCOS induced "string of pearls" is very much intact and pronounced on the left side. Meh. Oh well. Next ultrasound is next week, estrogen starts Saturday. I've been pretty lucky in that I haven't had many side effects other than some nausea and cramping from the Metformin. No hot flashes or horrible mood swings from the hormones.

Hoping Again

I am having a major sense of Deja-vu. Well, no, I am actually past that point by a little bit. This week, we received, signed, notarized and mailed an update to our embryo adoption contract. We have a preliminary ok, and are waiting for the final word that everything is in order with Embryo Adoption Services of Cedar Park and our contract will be open for another 12 months. I weaned Ellie a week ago, and met with the Reproductive Endocrinologist this week to re-establish care.

It was approximately at this point in 2013 that I did *not* wean Hannah or sign a contract or go back to the RE's office. At that point in time I was nervous about proceeding with another embryo transfer (when  I thought we were going to do one). Right now, I am excited and hopeful. Other than the whole medicated cycle deal, I feel emotionally like I did when we were hoping to conceive 7 odd years ago. I have every reason to believe things will go well, and am looking forward to the process, and it's really hard for me to fathom that I am in this place again. Talk about restoring the time the locusts had stolen!

I am not the person who normally would post this sort of thing. With my previous pregnancies, I barely mentioned them online at all. That was largely because I was coming from a place of loss and self-protectiveness, which was absolutely what I needed at the time. Right now though, I am not in that cocoon mode. I feel very whole, and I am not afraid to chronicle this process as it unfolds, whatever the outcome.

That being said, here's what I know is coming up:

1.) I have to wait until my next period to put 1 full cycle between nursing and transfer prepping.
2.) I am waiting for the final word that the paperwork is complete, and that should come within a month; I'm not expecting any delays on that front.
3.) Once my next cycle starts, I have a script for continuous-dose birth control to start shutting down my ovaries. Last time I was on that for 6 weeks prior to transfer.
4.) I will need to have a hysteroscopy before I'll be cleared by the RE to be placed on a transfer timeline. (This is new, last time it was a sonohysterogram).

After that all clears, I'll get meds ordered and get a schedule for monitoring and transfer! Also, to my great relief, I learned that my RE's office has a satelite 20 minutes from my house so I won't have to make the 5 hour round trip again until the actual embryo transfer.

The girls went with me to the appointment and Hannah got to meet the doctor who put her in my tummy. He was so glad to see them, and I got to be properly mortified that all Hannah wanted to do was flip upside down in the chair and show her bottom side. *sigh* They even had her birth announcement in my chart- what an amazing experience to be in that office without the anxiety and sense of dread I remember from before.

The other highlight of the week was getting Ellie's next clothing size unpacked and discovering that one of the little dresses matches one of Hannah's. It must have been a really popular style, both of them are hand me downs! Here are the little darlings the morning of my RE appointment.

Mythbuster: A single embryo transfer

Under Inspection:

A couple must transfer at least 2 embryos in order to have any hope for a pregnancy, especially if the embryos have been frozen.

Background:

Many people think they must accept a multiple embryo transfer, and for some, that is their best option. The fact is though, that it highly depends on several factors, such as:

• The age and fertility status of the genetic mother. (Ours was young)
• The age and fertility status of the receiving mother. (I was in my late 20s, with no uterine deformities)
• The method of freezing and the age of the embryo(s). (Ours were frozen about 4 years before our first transfer, at 5 days of age- blastocyst stage)
• The skill and experience of the embryologist doing the thawing. (Our clinic has, I think, an excellent embryology team)
• How many embryo babies are in each "straw." (We received 4 straws- 3 of which had 1 embryo each, and one of which had 2)

I already knew I wanted to try a Single Embryo Transfer (SET), and my doctor recommended either 1 or 2 embryos, so it was an easy decision for us. I did realize that this might mean less of a likelihood of pregnancy on our first try. On the other hand, I was only risking one life at a time, and giving that one baby the best chance possible to be born full-term and healthy. We plan to do the same with the other single-embryo straws in the future.

Factual Experience:

For our first transfer, we chose to thaw and transfer only one embryo out of the five that we received from the donating family. She survived, and is taking a nap right now! 

So we went from this (embryo picture magnified times about a zillion)

To this:

To this:

Conclusion that SET never works, especially not on the first try: Myth!

Transfer of Property, or, Adoption of the Heart

The process of contract to transferring an embryo is very medical and seems very sterile on paper. While I have never been Catholic, their criticism of assistive reproductive therapy as "clinical" and "unloving (their term, not mine)" has its place in the experience, for sure. What they seem to miss is the emotional aspect that nobody wants to go to the doctor to get pregnant. And for us, getting pregnant clinically was the *only* way we would ever have the chance to meet these babies and welcome them into our lives. As I stared at the paper outlining the medication and procedure calendar, I realized I was understanding how parents become willing to do anything for their children, without reservation, without second thought, no matter how far removed a decision had seemed from them previously.

To start with, I had to start taking hormonal birth control in mid-February 2011, something I had never done before in my life (I realize that some women have been able to do natural cycles without medication and hormones, but this wasn't possible for my body). Then I had to start giving myself shots of Lupron (a hormone suppressant) in the stomach starting early March. To that, we added a "baby" Aspirin per day, and then started mimicking a the early phase of a natural cycle by taking estrogen in increasing doses after about a week on the Lupron. Half-way through March, I had an ultrasound to check my lining and make sure I wasn't trying to ovulate through all those meds trying to stop me from doing so.

A week later I had another ultrasound, and when it was determined that I had built a sufficiently thick lining with the Estrogen pills, I started taking intramuscular shots of Progesterone. Lucky Mr. Myth got to give them to me, and yes, I can assure you, if this had been a dream, those shots would have woken me up. It wasn't a dream though, and I also started taking an antibiotic and an oral steroid to make sure no infection or immune system flare could hinder implantation. Prednisone, I discovered, tastes like gasoline, no matter how you attempt to take it, but even that failed to jolt me out of any sort of delusion. This was real.

The morning of March 29th, 2011, we drove the 4 hours to our clinic (have I mentioned we live in the middle of nowhere?) and signed into our clinic for our transfer. The only choice we had made prior to the transfer was to only thaw and place 1 embryo, since the babies were all frozen individually. I have no idea what "grade" had been assigned, and the staff didn't volunteer the information. All I know is that when we were pulled back to the room, we were told that 1 thaw had been attempted, and the embryo had survived. I wanted to express some emotion- laugh, cry, but the truth is that I had a very full bladder for the procedure to come, and couldn't really breath deeply for fear of losing it and having to wait while it refilled. I just remember smiling, nervous as all get-out, feeling relieved, and sitting very, very still.

Unsurprisingly, my bladder was actually too full, and they sent me to relieve *some* of the pressure, which was its own special form of torture, but made me much more comfortable and able to focus on what was going on. Placing the embryo was very quick- maybe 10 minutes? Maybe less? The doctor came in and reviewed my chart. They asked me my name and date of birth for the umpteenth time, just to make sure, and then brought in a very normal looking catheter. Sam and I could watch the ultrasound on a very big screen right above the obstetric table. They put a very small bubble of air in the catheter where the embryo was, so that the first time we saw our daughter (not that we knew she was a girl then), we saw this:

It's rather surreal, when it's all over in just a couple of minutes, and you're lying there, holding your husband's hand, thinking, "That's it?  Now I'm pregnant?" The doctor wished us luck and left the room. Them embryologist came in next, and handed us a picture of the embryo right after the thaw. I remember looking at it and saying "Hi baby!" She was 120-something cells, just expanding after being rehydrated and warmed, (and yes, there is a thin spot where assisted hatching had been performed, for those who are interested), and looked like this:

In our contract, to protect the embryos from abandonment by the adoptive parents, the adoption isn't actually finalized until the baby is thawed and transferred. The law calls agreements regarding unborn lives a "transfer of property." It is abundantly clear, however, that we had not just become the *owners* of this little life, we had become parents for however long its life continued. We just stared at the picture, marveling at the details of the tiny speck of white in the ultrasound, and prayed that God would be the sustainer of life, acknowledging that any and all ownership rights belonged to Him alone.

And we were very, very happy.