Amanda's Battle Against Infertility (Part II)

IUI Round 1

IUI, or Intrauterine Insemination, is the gateway assisted reproductive technology (ART) treatment for many people dealing with infertility.  It is also rarely covered by insurance as only 13 states have infertility mandates, and at the time we were not in one of those states.  However we knew that if we didn't give it a go we would regret it, and so we placed our prescription order and put in our requests for time off.  The medication was the same, and so were the side effects leading to the wonderful "Chloe" nickname to explain the oh-so-lovely personality change I had.  When it came time for our IUI we headed over the river to Maryland, with my husbands contribution cup under my shirt in order to keep the swimmers as close to body temperature as possible.  As with HSG, IUI treatments require a catheter being inserted thru the cervix but in place of the dye, "washed" sperm are sent down the tube cutting their journey time in half while reducing the chances of chemical damage from cervical mucus (yes, they check the pH and yes it's as awkward as you think).  The washing process basically insures that only the best of the best sperm are allowed to attempt to fertilize the egg, no weak/deformed swimmers allowed in this gene pool!  Once again my hubby produced Super Sperm with post-wash numbers that were graded by the nurse as A+++.   Again I started the progesterone supplements and again dealt with swelling and bloating, and again we received a big fat negative (BFN) when it came time for our BETA. 

Cancelled Cycle

At this point we had already decided to go forward with the recommended 3 IUIs, and it was during this time frame we decided it would be in our best interest to jump the Potomac in to Maryland - one of the states with an infertility mandate.  Meanwhile we paid for IUI #2 and I went for my baseline CD 3 apt, which was disastrous.  Even though Polycystic Ovarian Syndrome had been ruled out pre-RE, the nurse doing my transvaginal ultrasound found 4 cysts, 2 on each ovary, and blood tests confirmed that they were estrogen producing - cancelling IUI #2.  This settled our resolve to move to a state with infertility coverage, for while it wouldn't stop the emotional roller coaster at least we could start controlling the financial aspects.  Within a few weeks my husband was offered his dream position, and while at my annual gaming convention, we sold our house for more than asking in under a week!  For the first time in a long time things were starting to look up, we had infertility coverage on the way and the selling price of our house gave us a great nest egg to use on treaments.  When I returned from the trip I was sick as a dog and chalked it up to the "ConBug", until my fertility app sent me a reminder that I was Late.  A (male) coworker even asked me if I was pregnant after noting that my boobs were huge (his words, not mine), something I had been chalking up to all the fertility treatments and associated hormones.  A quick test confirmed it, with two lines popping up before I could fully get the lid on. I shot an email to my boss that I would be late for work, and went to my RE for a blood test.  That afternoon I got the call we had been longing for - a doctor was confirming that YES we were pregnant.  I did a happy dance in my cubicle and started planning fun ways to tell my husband that it was really happening, all of which went out the door when he got home from work as I just blurted it out.  That weekend we continued our house search, laughing at how one of the reasons for the move was no longer valid.  I went for a blood test on Monday morning, and that afternoon set up a meeting to talk to my boss about my upcoming move and what kind of role I could have in the company.  During that meeting my RE's office called and my world fell apart - my pregnancy hormones had dropped to a non-viable level leading to chemical pregnancy #3.  

Back to IUI

After taking a month off to recover, physically and emotionally, we were ready to try again.  By this point I was working and living in VA while my husband was in MD, starting his new job and finalizing everything on our new house.  I started the medication for IUI #2 the day before giving my notice at work, and while I was sad to be leaving my coworkers I was thrilled to be leaving a place that had become filled with painful memories.  IUI #2 ended with another BFN, and IUI #3 followed the next month with the same results.  By this point the holidays were fast approaching and we decided to take at least a month off before embarking on IVF.  The plan was to start IVF #1 at the end of December, taking advantage of our new insurance before a few of the medications would no longer be covered.  Yet that was not to be, as my period decided to arrive three days early, during the time in which my RE's office was closed for annual inspection.  Another month off it was, which allowed us time to relax and just enjoy being together without the stress of needles, pills, and catheters.    

IVF 

When most people think of infertility treatments, IVF is generally where their minds go.  Even if they are saying artificial insemination (IUI), the process they describe is more often than not invitro fertilization (IVF) and this the BIG MOMMY of fertility treatments.  Nothing is simple about this process and it makes holding down a full time job a pain in the rear as there are apts almost every day for a week or more plus it requires multiple days off and the ability to administer medication at work.  For IUI everything is done either first thing in the morning, or post-dinner, while with IVF portions of it are smack in the middle of the day.  Since our move I hadn't found full time work, so I decided to starting subbing in the local county as it offered the flexibility I needed along with some extra money to put towards our treatment.  Our first Box o'Drugs arrived in the middle of January and it was massive, requiring our full dining room table with an inserted leaf to hold everything.  I was going to be taking at least two shots a day for up to two weeks plus a variety of pills and suppositories after the transfer.  Unlike TI and IUI, IVF is a complete override of your natural system and for many women it begins with birth control pills (oh the irony) in order to reset the clock.  My clotting issue meant we would skip the pills and begin with my next cycle, which resulted in my first appointment happening on January 24th.  This baseline apt began like all the others, starting with blood work and then followed by a transvaginal ultrasound to insure no cysts.  However the ending was vastly different as I was given a quick shot class, to include a how-to guide on mixing medications and finding the right spot.   I was officially cleared that afternoon and got my first two shots after dinner.  I went for my follow-up apt on CD7, and was told all was looking good!  The follow-up call in the afternoon confirmed what the ultrasound tech had told me, and I was told to add my third daily shot in the morning.  This morning shot was the first hiccup in my IVF journey as unlike the other ones it was time sensitive, so I had to pick a time that I was 100% certain would work which resulted in waking up way earlier than I desired in order to get the shots in before my 7AM apts.  I had additional apts on days 9 and 10 - before getting the go ahead to trigger at 915PM on February 2nd. Unlike the other shots and triggers this one required my husband's assistance as it needed to hit a target not easily reached.  After a good 5 minute panic attack, the shot was finished and I waddled off to bed.  Another LARGE difference between IUI and IVF is that once the trigger shot is administered there is to be NO sex until the transfer - and that includes what my mom still refers to as "Bill Clinton sex".  The next day was an "off day" - no apts, no medications, just instructions to drink lots of water and attempt to relax.  The following morning started early with nerves and excitement, and off we went to get our eggs harvested.  Sedatives were given and I awoke to my husband's smiling face and a happy nurse telling us that 18 eggs had been retrieved!  15 eggs had been our goal number so we were elated to hear that my ovaries had gone over that, however we found out the next day that while 18 had been collected only 15 were mature and of those mature eggs only 7 had been successfully fertilized.  With IVF each egg is given its own petri dish and then a few hundred thousand sperm are added to the dish, and generally 80% of eggs are fertilized.  In our case, I was producing eggs with hard shells which resulted in a 40% fertilization rate and being told that if there was a next time we would be using ICSI which injected a single (tail-less) sperm in to each egg.  I was praying hard there wouldn't be a next time as my body was not enjoying the after effects of the retrieval.   I was a tired, sore, cranky, swollen, constipated mess - and my stress levels just kept going up as we continued to get the results.  Of our 7 fertilized embryos all 7 were still growing the morning of day 2, giving us hope of a day 5 transfer which is the ideal transfer day.  However late that same afternoon we got a call telling us that 4 of our embryos had stopped growing and that I was going to need to do a day 3 transfer.  Within 24hrs I was back in the stirrups and 2 little embryos were being inserted in to my waiting uterus.  We were told that we had a 70% chance of implantation and around a 25% chance of twins, all based on the grades of the embryos - and I was told that while my husband was now open to "release" I was still in the land of no sex and would be for 72hrs.  I started taking my pills and suppositories - figuring out which schools in Baltimore had the largest faculty bathrooms in order to administer the post lunch dose. After 14 anxious days I decided to take a home pregnancy test and was once again delighted to see two lines pop up - which I confirmed by taking two more tests.  I had a blood draw the next day but the afternoon phone call was full of doom and gloom in that my pregnancy hormones were not high enough to suggest a viable pregnancy.  A second blood draw was scheduled and I knew as soon as I heard the voice of my RE, and not the nurse, that I was having another CP.  We were told to schedule a recurrent loss panel (RLP) apt when we were ready, and that we would need to take off at least month.  A few days later my IVF pregnancy was officially over, and I was scheduling more tests to see if something unusual was at play for while I was tested at the start of the journey some problems are so rare - and the tests so expensive - that they are only administered as part of a RLP.   While one test did come back positive, on its own it was not enough to explain why we had suffered three official chemical pregnancies.  

Now

So where does that leave us?  We just finished what became a mini-IVF cycle (medication & retrieval but no transfer) and hope to begin another IVF round within the week.  The only option we have left is getting our embryos genetically screened, which is a lot easier said than done.  The test can only be done on a blastocyst, which is where an embryo should be on day 5 - a milestone we didn't reach on IVF #1.  With our first mini-IVF we only got 1 viable blastocyst (17 retrieved, 12 mature, 10 fertilized, 3 blasts, 1 viable) and the statistics/costs involved with the genetic testing are such that sending less than 4 isn't advisable.  We are also reaching the end of our infertility prescription coverage, but I have been offered a FT job that does provide infertility benefits (thank you again Maryland!).  However we are reaching the end of our medical options.  If none of our blasts pass the genetic screening then this is the end of our infertility journey.  If the genetic screening shows a chromosome problem then we can explore donor eggs, but we have no insurance coverage for that and the costs are well north of $20k for what is a 40% chance of success.  If our blasts do come back "normal", and one is transferred, and we have another miscarriage than the most likely answer is for some unknown reason my body can't handle a pregnancy which leaves gestational surrogacy - something that costs around $80k with similar odds of success. We have started contacting adoption agencies, something that I had been drawn to pre-infertility days and it's possible that our child is currently being carried by another woman.  I still have faith that we'll become parents, and while the journey is taking much longer than we ever could have imagined and filled with more heartbreak than we ever thought possible I know that one day I will hold my child in my arms.

Fellow HeartBEATS

Reading this and reflecting back to when she first informed me her infertility battle I can’t imagine the amount of courage it took for Amanda share that with me. I’m beyond grateful that she not only shared it with me but also choose to share it here with you all.  Please wish her and her hubby all the best in becoming future parents. Their journey hasn’t been easy but I’m truly hopeful it will be worth it in due time.

As always this is a communal space so if there is anyone else battling against infertility, and would like to share your story please feel free to email me at externalheartbeat@gmail.com