The Endometrial Receptivity Test Can Suck It

Playing catch-up here – busy with a mess of work lately, which is awfully nice. I’m writing you from Phoenix where I’ve got some work tomorrow….it’s warm, and that’s like a reboot to the system after the Chicago winter we’ve had.

Last Thursday I had 2 biopsies taken for an Endometrial Receptivity Array (ERA).

As the name indicates the Endometrial Receptivity Array tests to see if the endometrial lining is receptive to implantation. (I encourage you to Google a more technical description to fully define the tests). Dr. Hail Mary wanted to run these two biopsies to see if anything was afoot in there since I’ve had three embryo transfers and no permanent residents. The test is done in the implantation window of your cycle (mine was done Day 23) following at least 5 days of progesterone (which I started taking back on February 14…..how romantic).

What’s the procedure like, you ask? Well, a speculum is put into place just like for a Pap, the cervix is cleaned off with a bit of iodine on what looks like a Q-tip on steroids, and then a pipette is snaked in. Once the pipette’s in place it’s moved around the lining and with a bit of a suction it gathers tissue for the biopsy.

It. Was. Not. A. Walk. In. The. Park.

Since I was having tissue drawn for two different test I had to go through this twice. (I’m not asking for your sympothy, just stating the facts….but it was a fucking crappy test). During the first one the nurse kept saying, “you are doing really great.” Now….I know that something likely needs to be said during these things, but perhaps me “doing really great” simply sprung from not swearing out loud like a men’s rugby coach or using my fists to punch at the table….likely “doing really great” mostly had to do with my ability to just lie still. I did get my deep breathing on – that was super helpful. If you ever have to do one of these just breath as deeply and as much as you can, it does make a difference – if not, you’re just…clenching, and that’s not going to do anyone any good.

It’s hard to explain exactly how it feels…..it’s loads of heavy cramping, for about 45 or so seconds, maybe a minute. Now I know that’s not a long time but if somebody had a pipette up your business and it was suctioning out bits of your endometrial tissue, 45 seconds is 45 seconds LONGER than you want that to be done.

The only ray of sunshine I can add is that 45 seconds really isn’t THAT long and when it’s over it’s over – instant relief. I think some Tylenol or ibruprofen would have helped if I’d thought of taking it beforehand….and afterwards I just had some lingering mild cramps (like a mild period) so I was fine. The tissue’s being sent off to a lab so it’ll be a few weeks before we know anything. We are of course aiming at a diagnosis of: Receptive. Though Not Receptive isn’t a deal breaker, it gives them info to work with and likely treat….so we’ll see when we see.

I’ll keep taking progesterone shots through the 25th – 1ml in the morning (right cheek) and 1ml at night (left cheek) – and then I’m to call them when my period ensues. Then it’s on the birth control pills, and if all these tests are fine then we’ll get started with IVF4 for reals.

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PIO leads to Knotbutt and Progesterboobs

We’re just about halfway through our 2ww wait here and as the double-edged sword would have it, I find myself without much work and with alot of free time. On one hand it’s time to fill within a period of time that I want to pass quickly…and work would certainly be a distraction. But, on the other hand, lots of free time has allowed me to knit a few last minute Christmas gifts and to watch a mess of stuff on Netflix.

It’s also been a week of progesterone shots (PIO)…(PIO = Progesterone in Oil) which are going fine. I do wonder if something has changed with the constitution of my butt cheeks as the shots are taking a little more of their sweet time to sink in. I mean, they’re sinking in, but I feel like I’m having to apply a bit more pressure and it takes a few more seconds until the needle slides in. It’s still fairly low on the discomfort scale (my apologies to anyone who thinks I’m a fucking BRAGGART) so I’m thankful for that.

One thing I’ve done, based on reading the suggestions of other people, is to warm the oil slightly before drawing it into the needle and plunging it into my butt.  How am I warming it you may ask? Why…..I’m putting that little bottle in my brassiere and letting it warm up with the help of my natural 98.6 degrees. It definitely works….though that bottle’s pretty cold, causing a bit of squirming the first second or two it’s on my mammary.

However, I don’t know what’s changed, but after at least 35-40 PIO shots thus far (spread across 1 IUI and 3 IVFs) I have my first two knots….conveniently located one in each cheek. It’s my understanding that knots form with the progesterone pools in one place.  My knots aren’t necessarily uncomfortable unless you press on them but it’s super weird to just feel a knotty mass in there. I do massage the injection site afterwards for awhile so I’m guessing I just finally fell prey to the dreaded knot. I used to sit on a heating pad after the shots….maybe I’ll go back to that tonight.

On the plus side the PIO shots have yet again caused a recurrence of Progesterboobs (boobs made bigger by progesterone supplementation). It’s actually just a subtle difference but hey, I’ll take it.

So far so good with the waiting, and only another week to go.

 

 

 

My Due Date and What I Got Instead

On Sunday, March 3, 2013 I got my first positive pregnancy test. There was joy. There was apprehension. A natural pregnancy after trying for over a year and just 2 weeks after our first meeting with a reproductive endocrinologist. Read about all that.  I went to see my doctor, she agreed I was in fact pregnant, patted me on the head and sent me on my way with a piece of paper indicating that my due date was somewhere around November 9-11, 2013.

November 10-11, 2013. So…..now.

Nearing the end of March I started spotting and the pregnancy ended in miscarriage. I wrote about it here and afterwards we embarked on the quest that brings us to present day.

My husband and I talked this past weekend and I told him that when I woke up Saturday it occurred to me that we would have been due this weekend.  He said, “wow, things sure would have been alot different.”

And it dawned on me: Things ARE alot different.

While we aren’t sitting here with a baby (which yeah, wouldn’t that be nice), alot of good has come:

1) I started blogging and the act of writing has been hugely cathartic. It’s been an amazing way to process my feelings during what could be an overwhelming time.

2) I started tweeting under my blog’s name. Between the blog and the tweets, I’ve found a supportive and vast online community of ladies going through exactly what I’m going through. I can reach out to folks and ask questions, seek advice, compare experiences, etc. I am so thankful for these ladies (and a few gents) who I will likely never meet.

3) I’ve learned that I can give myself lots and lots of shots (to date it’s in the area of 118, one IUI with follistim and 2 IVFs with follistim/menopur,lupron/progesterone). I feel pretty kickass about this and very empowered. Read about my thoughts on needles. I mean, you want me to give myself a shot right now? Name it: where you want me to do it, I’ll do it. Want me to give you a shot? I’ll do it.

4) My husband and I have gotten through all of this. Period. And I’d bet money on the fact that we’re better.

5) We’re now serious about adoption, which while it seems über daunting, also excites me. Even if I do get pregnant this current IVF, adoption could still be a likely scenario for us: we both have siblings and feel they’re pretty important. If our little one’s to have a sibling, it could very likely end up that adoption’s our route.

6) I learned that IVF can be a positive experience. It can be. For me it is not at all the horror story I’ve read about for years in the media. I know IVF isn’t nice to everyone. Some ladies have a terrible time with the hormones, there can be alot of expectations and emotions, doctors can be brusk, nurses can say things or look at you in ways you don’t like. HOWEVER, it’s different for everyone and you don’t know what it’ll be like for you until you start – try to go in expecting the best instead of the worst.

7) I now know more about what it takes to make a baby than friends I know who’ve actually HAD babies. For real. It’s an effing miracle ANYONE EVER gets pregnant with all the stuff that needs to happen for eggs and sperm to come together in a perfect chemical mix in the perfect uterine environment during a tiny narrow window of monthly fertility that the little egg’s even viable.  FUCKING MIRACLE.

8) I’ve learned alot about supplements and foods that are good for fertility. I’ve found people who are knowledgable about supplements and are good enough to write about them: InfertileChemist, I’m looking at you http://infertilechemist.wordpress.com/2013/07/04/supplements-part-i-dhea/#comment-1173   The CCRM website is also good for this:http://www.colocrm.com/FertilitySupplements.aspx   (There’s also alot of bullshit out there so you really just have to do the best you can with all of it).  Me? I took wheatgrass for a long time (my RE asked me to let that one go once we started IVF), but I still take: CoQ10, Royal Jelly, PreNatals…recently I’ve added Pycnogenol and a little extra Vitamin C.  As for food, I try to eat plenty of protein, vegetables, whole grains…..in particular lots of blueberries, chia seeds, avocado, yams if you can find them…..watch your caffeine and booze (some REs say absolutely none and others say moderation) and I’ve tried to cut out processed foods and am watching sugar….which is my kryptonite.

9) I’ve joined a support group and get to look into the eyes of other ladies who are struggling. We share stories and there are knowing nods. We learn from each other. It took a long time for me to take this step, but I did when the time was right and I’m very happy I did. We’re all in different places, trying different things, but we help each other.

10) I still have my hope.

There’s likely much more that I haven’t put my finger on, but one newish friend gave me advice a few months ago that I now carry with me every day:

We now live in a time that if you really want a family, there are so many ways that it can happen: pregnancy, IUI/IVF, donor eggs, surrogacy, fostering, adoption, etc. You may not know right now how your child will come to you, but you have to believe that they will come to you somehow.

So while I didn’t get my due date, and I am still waiting for our little bundle to show up, I really did get a whole lot more.

(But little peanut for reals, you can show up any old time now).

10dp3dt Another Wait Almost Over

So here we are, deep into the two week wait….2ww if you’re in the know. Specifically we’re 10dp3dt (10 days past 3 day transfer if you’re not in the know).  The time has passed pretty well, some days pass slowly, some quickly and I’ve kept myself busy with distractions: plenty of movies (Go see Gravity in 3D already!), some delicious home cookin’ and lots of knitting.

Hey look! Pictures:

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Yes, I could take a home pregnancy test, but why do that to myself? The blood test at the doctor’s office is much more definitive and for me, that’s a safer bet for my emotional well-being.  If you’re one of those folks who start peeing on a stick right after the transfer or as soon as the test “might” detect pregnancy hormones – good for you! For me, that would make me crazy and these days (especially these days) I’m all about what’s best for me. Keep peeing on your sticks ladies, but I won’t be joining you.

As for symptoms I’m not reading into anything, as I’ve been giving myself shots of progesterone in oil (PIO for anyone who cares) since the night of the retrieval and added estradiol/estrogen pills nightly since the 8th….so really, ANYTHING I’m feeling could easily be attributed to DRUGS not normally in my person.  However, just to put it out there, the last few days I’ve felt short periods of mild cramping and today extended periods (like since I woke up) of mild cramping, some odd gastrointestinal mischief, some slight overall “blahness” and maybe some additional sleepiness.

But again – symptomatic of what we’re hoping for or just side effects of meds?

Who’s to say?

On a plus note, I have my Progesterboobs back. Progesterboobs are boobs you get as a result of progesterone. It’s like magic. They’re just noticeably a bit….fuller. I’ll take ’em.

And I’ll say it again with these progesterone shots: LET THE NEEDLE DO THE WORK. None of this jabbing and sticking and running start business. I quite literally rest the needle on my fanny cheek, gently (GENTLY!!!) push and wait…..and wait a little more…..after a few seconds, it just sinks in and there’s barely any discomfort. I in no way think I have an exceedingly high pain threshold – I just think I’ve found a pretty efficient fairly pain-free scenario. Also, no men in the bathroom during shot time – it just prolongs the issue and adds to the tension and discomfort. I know it’s all “for better and for worse” but if there’s ANY chance you can get yourself to the point of doing your own shots: DO IT. YOU ARE ALREADY A ROCKSTAR FOR GOING THROUGH IVF. Once you can give yourself shots YOU ARE UNSTOPPABLE!

Needle rant finished. Sorry.

Monday morning I’ve got a blood test that’ll give us our “move forward” information:  1) yay we’re pregnant and we move forward as pregnant people or 2) we’re not pregnant and we talk to The Russian about what to do next…..stay with her, see someone else she recommends, try something different, try the same thing.  Our insurance allows us up to 4 tries (bless that Illinois mandate) so we’ll try again right away if need be.

2 more sleeps until we know which way we’re headed.

The 2WW: The Beatles Were Right

So we’re about halfway through our slightly abridged 2ww and are 6dp3dt. For any of you not in the acronym know, 6dp3dt = 6 Days Past 3 Day Transfer – and we’ll blood test on Day 12.

I’m having a much easier time with this wait than I did with other periods of waiting in the process: waiting to stop birth control, waiting for meds, waiting between scans, etc. It’s an odd thing to know that right now, as we speak, I am either pregnant or not pregnant….it’s simply too early to tell.

Throughout the time I’ve been trying to get pregnant I’ve read a lot about the 2ww (and have been in it many many times) and mostly I find myself shaking my head at people.

You just have to wait!

Time has to pass – there’s no changing it.

So for me, I’m NOT going on the internet to read too many opinions by too many people without any medical knowledge, I’m not reading into every little thing my body’s doing, I’m not over-thinking every little moment, and I’m not going out to buy pregnancy tests before there’s any chance of them registering anything accurate.

You know why?

Because I’ve done some of that before and it got me nowhere. I also hate to pull the age-card, but I am 42….at this point there’s some life experience to lean on. I know that to do any of the above things is pretty much like punching myself in the face, running around the house with a scissor, or like covering myself in peanut butter and then taunting a bear.

I’d be knowingly setting myself up for confusion, discouragement and frustration.

And frankly, I like none of those things.

In other news, I’ve been doing progesterone shots since last Saturday’s egg retrieval and so far so good. The nurse was kind enough to draw a circle on each fanny so that I’d have a target – and I’ve been retracing her lines every few days. Man I hope I’m not in an accident or anything, though I’m sure it would give the EMTs a good giggle to see a grown lady with circles on her butt cheeks.

A note on these shots: the needle is intimidating, because it’s an inch-and-a-half long and you know it’s all gotta go in. Honestly though, it’s so sharp that by simply resting it on my skin and pressing a bit the needle does all the work and after the initial sting from the tip of the needle it really hasn’t hurt at all. I shit you not. Perhaps I’m lucky and have a high threshold for pain, but after reading so many things on the interwebs about how awful they are, I really have thankfully not had that experience. I’m able to do them myself and they go pretty quickly.

I put a bag of frozen vegetables on first, do the shot, rub it around and then sit on a heating pad for a few minutes afterwards to help the oil work its way in. This is what works for me.

The progesterone’s another reason it’s easy not to read into every symptom, because likely it’s the progesterone’s fault. I’m a little sleepy, yesterday had a teensy bit of nausea and I suddenly have a decent set of knockers. They’ve grown enough that I really don’t need to wear my “smoke-and-mirrors” bra unless I really want to vavavoom it.

So alas, we’re in a good place: lots of movies, books, cooking and general chilling out. Time’s actually passing fairly quickly, we’ve been laughing a lot and life kind of plods on as usual.

Soon enough we’ll know which road we’re taking next and in the meantime, in the words of the great Paul McCartney, we’ll Let It  Be.  

Wow, that was super cornballs, even for me.

IVF Meds for Smarties and Dummies

So….What’s in the Box? (my day-to-day protocol coming once I have it)

IMG_20130607_111344_832 (1)

First, for the smarties:

Androderm – testosterone patches, potentially helps low responders or gals with high FSH (i.e. low ovarian reserve) to respond better to stimulating meds (taken for 2 weeks before starting all the stimulating hormones).

Estradiol – helps maintain the endometrial lining of the uterus, making a nice home for an embryo to implant

Follistim – mimics FSH (follicle stimulating hormone) in the body.  FSH tells the oocytes in your ovaries to grow and mature. (subcutaneous injection)

Menopur –  This hormone is responsible for ovarian stimulation for the development of egg-containing follicles. (subcutaneous injection)

Pregnyl – mimics the hormone LH (Luteinizing hormone) in the body.  LH is the hormone that triggers ovulation. (subcutaneous injection)

Ganirelix – prevents the usual hormone exchange that causes follicle production and ovulation by suppressing the pituatary stimulation to the ovaries.  This lets the Follistim stimulate a more uniform development of multiple follicles.  (subcutaneous injection)

Leuprolide – suppresses the hormones LH and FSH to keep a woman from releasing immature follicles and eggs. (surprise, also a shot)

Progesterone (in oil) – stimulates the uterine lining (endometrium) to continue to develop so that an embryo that implants will have a thick, supportive environment to nourish it.(intramuscular injection) – I’ll start this a few days before egg retrieval

Doxycycline – antibiotic, reduces the risk of infection following egg retrieval.

And,

a metric crap-ton of syringes and needles.

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Now for anyone whose head is exploding (like mine), look at it this way:

Some things help you make eggs, some things keep you from ovulating those eggs, and other things help you ovulate the eggs when The Russian deems them ready.

My REs assistant explained it like this:

In a typical month there’s a race where a number of follicles run, but a “lead” follicle gets ahead.  That follicle matures an egg which (hopefully) will ovulate. One egg. Per month. Some ladies might pop a few. Who knows.

Anywho, with fertility meds you get a number of follicles lined up in the blocks. They start running but instead of one getting way ahead and winning, a whole mess of follicles all join hands, sing Kumbaya, run the race in the spirit of fairness and good sportsmanship, and all cross the finish line together.  Meaning, many follicles produce many eggs that the RE, in my case The Russian, can retrieve.

At least that’s what you hope.

And then you hope that just one of those little suckers fertilizes, implants and then grows into something you will be terrified of birthing through part of your body that doesn’t seem like it will allow for those circumstances.

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Here are some websites I used in compiling this list.

http://www.conceiveonline.com/articles/7-most-common-fertility-drugs

http://infertility.about.com/od/infertilitytreatments/a/fertility_drugs.htm

http://www.ivf.com/ivf_meds.html