If you missed the first two parts of this series, you can readThe Beginning...Infertility, my cross to bearandInfertility, my cross to bear (continued)to find out how it all began.
My phone consultation with Dr Sher went amazingly well. I just knew he was our answer to prayer. Even though he was based in Las Vegas, he had several clinics around the country and he suggested we do our cycle with one of his local RE's so we wouldn't have to incur the cost of traveling (our insurance covered absolutely NOTHING). So we met with Dr S at the local clinic and we felt comfortable enough with her to move forward.
For the sake of brevity, I'm leaving out a lot of the little details about all the pre-cycle testing we endured, learning how to give myself injections and my embarrassing meltdown in the nurse's office when she handed me my IVF protocol, which was basically a calendar with the color of the rainbow all over it, indicating which med to take at what time. I was on the most aggressive protocol possible, taking up to 10 different meds at one time. On some days, I would be giving myself up to 6 injections. I have to admit that as soon as we got home after receiving my cycle calendar, I locked myself in the bathroom and sobbed on the floor for a good 30 minutes, wondering what I ever did in my life that was so horrible that I deserved this.
I remember the very first injection was Lupron, given with a relatively small needle in my belly. Then I started dexamethazone (an oral corticosteroid), which was a drug created by Satan himself. Not only did the dex make me all bloated and constantly craving any food that could be smothered in cheese and greasy fried chicken, but the Lupron turned me into a complete raving hormonal bitch. Tim stayed out of my way on most days, often volunteering to go on business trips just to get the hell away from me.
During all this, we had a vacation to Hawaii with some friends already planned before we had committed to the IVF cycle. Dr S assured me that it would be fine for us to still go on vacation and that I could bring all the meds with me and that my nurse was available by pager 24/7 should I have any questions or concerns. Due to airport security being extra strict since 9/11, I was worried about being able to bring all my needles and syringes with me on the plane but Dr S said, "don't worry...I'll write a letter for you". Fine....cool. Until I saw the letter, in which the first line stated "this patient is undergoing treatment for infertility"....there was that word again. Infertility. I kept imagining the airport security people reading that letter and knowing all my private business.....I kept whining to Tim, "why couldn't she have just written 'medical treatment'. She didn't have to mention infertility!!". Tim just shook his head, as I sat there whining, then shrieking, then sobbing and then ultimately just going limp as I sat next to him on our bed, completely drained of all emotion.
My first experience with an intra-muscular injection was when I had to start taking the estrogen injections. I didn't think I could do those myself, not only because I didn't think I could contort my body enough to stab myself in my own ass with a huge needle but I didn't think I'd have the guts to actually do it. So Tim got stuck with that responsibility, which I think he was secretly happy about, as he would say, "Sweetie, this is harder for me than it is for you"....yeah, just like my mom when she would smack me and say "this hurts me more than it hurts you" and I would catch a glimpse of a subtle smile on her face.
Then I started the estrogen suppositories, which I referred to as "crotch rockets" (if you've seen them, you know what I mean). Tim was always confused as to why there was a wet spot on my side of the bed every morning when I would wake up. He'd say, "sexy dream?" and I'd say "um, no....that's the result of the suppository melting....jerk".
Next we were off to Hawaii....our dream vacation....the one we kept referring to as our "last hurrah as a family of two" because we were SO gonna get knocked up on this cycle with twins. That's what I had asked God for and I felt like He pretty much owed me at this point. I started my first round of stimulant meds while in fantasy land....I'll never forget the first injection. We were scheduled to go for a boat ride around Diamond Head with our friends but we had to do my injection first. We told them to start heading downstairs to the car and we'd follow in a few minutes.
We were in our hotel room, mixing up our drug cocktail between the 10 vials of Follistim (yes, I did say 10 vials).....because it was such a high dose, it had to be given in 2 separate shots. Tim did the first injection....in my belly.....and it burned like an SOB. It literally took my breath away....he thought he did something wrong, as I stood there with tears welling up in my eyes, flapping my arms around as if I was about to take off in flight. He asked, "are you okay?" and I started to cry....oh man, how I started to cry....he gave me my second injection, which burned just as badly and then started to bleed as he pulled the needle out. I cried the whole way to the elevator and into the parking garage until we saw our friends...then I wiped away my tears, smiled and said, "so who's ready to party?". God seriously owed me BIG time. By now, I was demanding triplets...
After arriving back to reality from vacation, I went in for my ultrasound and I was pleased to learn that the stims were doing their job. My uterine lining looked beautiful and I had 8 little follicles brewing. Dr S burst my bubble as she said, "remember, it's not quantity that's important....having 8 follicles means absolutely nothing if they're not good quality". She smiled apologetically....I cried.
Oh and I started acupuncture right about this time. As if I didn't already have enough needles being shoved into my skin, I had to go do acupuncture because I had read plenty of information showing that showed many IVF patients having successful IVF cycles after undergoing acupuncture treatments. I figure I was already going for broke....what's a few more needles gonna do? The acupuncturist diagnosed me with "spleen Xi deficiency" and gave me a list of foods to eat and foods to avoid. One of the foods to avoid was ice cream. He smiled apologetically....I cried.
I was also doing heparin injections twice a day because, as if high FSH wasn't enough, I was also diagnosed with antiphosphilipid antibodies (APA), which is a blood clotting disorder. It is believed to have the potential to cause tiny blood clots which could interrupt the blood flow to the placenta during a pregnancy, resulting in miscarriage, or interfere with the body's ability to allow an embryo to implant, resulting in repeat failed cycles. The heparin injections left horrible bruising all over my belly. At certain points, I had to start giving myself injections in my upper thigh when my belly was too bruised for shots there.
Oh, wait....the fun doesn't stop there. Along with the high FSH and the positive APA's, there was more....behind door #3, we had a significantly elevated level of natural killer cells, which for the price of $4,000 per IVIg infusion, I could be rid of those nasty cells and on my way to achieving my dream of motherhood.
Natural killer cells....sounds wierd, right? Who ever heard of such a thing? I certainly never had until I talked to Dr Sher, who is a firm believer that certain immunological disorders can contribute significantly to infertility. Probably the simplest way of explaining what these cells are is this: every one of us has these cells. They are actually very important in fighting off infections and certain life-threatening diseases, such as cancer. However, sometimes, in pregnant women, these cells can go into overdrive, in which the embryo is seen as a foreign invader and is destroyed by the cells...the end result is a miscarriage.
So wouldn't you know....if anyone was going to test positive for elevated NK cells, it would be me. Fortunately, there was a treatment available....a very expensive treatment, called IVIg (intravenous immunoglobulin), which is made out of human antibodies derived from donor blood. The drug is given intravenously and it's purpose to suppress the immune system enough to where an embryo will be able to implant without the NK cells going haywire and attacking it.
My first infusion went well and took about 3 hours to administer. The day afterwards I felt like I had been hit by a semi-truck but no worries....wasn't I once the girl who said she'd eat pig poop if it was proven to be helpful in getting me pregnant? I think at one point I had also mentioned I'd let my acupuncturist stick needles in my nipples if I thought that might help, too.
I would continue to go into the clinic to have ultrasounds and bloodwork every other day to see how everything was coming along. What I did not expect was to have to continue the stim injections for 14 days. TWO WEEKS. Most women are on them for maybe 5-7 days, give or take a day. By day 14, I was beginning to lose my grip on reality. My belly was so sore from all the injections....my ovaries hurt....I was so bloated that I couldn't fit into any of my pants....and if Tim thought I was bitchy before all this, he hadn't seen anything compared to what I had become by day 14 on stims. That night, he made a smart-ass remark to me about something and I got up suddenly and started rummaging through my "drug box" and he asked, "What are you doing?" and I said, "I'm getting a 22-gauge needle to stab you in the eyes with". He quickly walked out of the room...a very wise decision on his part.
Finally, we got the thumbs-up to do our HCG trigger shot. This was an intra-muscular injection given to me at a very specific time in the upper arm muscle, which was supposed to make the follicles release their eggs within 36 hours time. The nurse told me that Tim needed to give me the shot at 12:45 am, on the dot. I forced myself to stay awake, out of fear that I'd fall asleep and miss our "deadline". And, of course, there is no part of this story without drama because it is my story, after all. Tim and I got into a huge argument about the amount of HCG in the syringe....I panicked because there was a tiny bit left in the bottle after he had already given me the injection. He kept insisting it was fine. I kept insisting it was NOT fine. I paged our nurse....who called me back almost immediately and said, "Do not worry....it's fine....now let me go back to sleep, you irrational, uncontrollable, pitiful drama queen". Okay, so she didn't say that last part but I was imagining that she was thinking it so in my mind it's as if she said it outloud.
Once I hung up with her, Tim said, "I hope I did the shot in the right place" and I asked, "What do you mean? You were supposed to do it in my upper arm and that's where we did it". He shrugged and said, "It's just that I felt like I was pushing the needle into bone, rather than muscle". Oh good God....I just wanted to go to sleep at that point and dream that none of this was even happening.
Egg Retrieval Day = All I remember is being wheeled into the OR and as the anesthesiologist asks me to count backwards from 10, I said, "I feel totally drunk....the lights on the ceiling are SO cool".
After, Dr S called us on my cell phone as we were driving home. She said, "I have some good news and some bad news....which do you want first?". My heart sank....and I told her to just break it down for me. She explained that she was able to retrieve 9 eggs and of those eggs, 5 were mature and 3 were intermediate (that was the good news). The bad news was that all the eggs were described by the embryologist as "dark and grainy". "What does that mean?", I asked her. She said, "It means they're not very good quality and I'm not sure they'll be workable at this point but sometimes we're surprised so don't write the cycle off just yet". The embryologist would do ICSI (where they inject the strongest sperm directly into the egg) on those 8 embryos and hope for the best. And then, with that, she said she'd call me back in 2 days with a fertilization report.
Two long, anxious days later, she called and said that 4 eggs had fertilized normally. Now we just had to hope that they continued to grow. We wouldn't know exactly how they were doing until a few minutes before the egg transfer the next day. I thought God was trying to teach me a lesson in patience....I vascillated between extreme anger and a oddly calm sensation of peace.
Egg Transfer Day: Dr S gave us a picture of our 4 beautiful surviving embryos and she recommended we transfer them all. Two of them were "excellent" quality and the other two were not so excellent but she said they had a better chance of surviving inside me than in the lab. She gave us a 40% chance for a singleton pregnancy and a 35% chance for a twin pregnancy. I quickly envisioned myself 8 months later with wild unkept hair, bags under my eyes, pouring heavily caffeinated coffee down my throat every hour and perfecting my football hold as I nursed twins....and it made me smile. Bring it on...
8 days past tranfer = I went into the clinic to have my beta HCG levels checked. To say I was a nervous wreck is seriously downplaying it. I had to go back in 2 days later for another beta and then I would learn the results....was I pregnant or not? Now I suppose I could've just peed on a home pregnant test stick and found out for myself but I felt like that would be cheating, somehow.
10 days past transfer = I had a nervous breakdown in the "blood chair". The nurse had to bring me a freakin brown bag to breathe into. I just knew God was up there having the time of His life watching all this go down. I asked her who I needed to bribe to get my results as soon as possible...she assured me they would call me within a couple hours.
As promised, our home phone rang within 2 hours and we heard the nurse and Dr S say together, "Congratulations.....you're pregnant!" I started crying, of course....I think Tim even cried. I honestly couldn't believe it....the whole cycle had been one huge, scary roller coaster ride and now we were finally at the end of it. Or, should I say, the end of that chapter and onto the beginning of another....
Finally, two weeks later, it was the day of our first pregnancy ultrasound. As we waited in the waiting room to be called back, I honestly thought I'd puke right there all over the floor from the amount of anxiety I was feeling. I was a nervous wreck, to say the least.
Dr S came in and started the ultrasound. She was able to spot the gestational sac right away and she said, "Looks like there is just ONE baby". While I was thrilled, there was also a little part of me that was somewhat disappointed that it wasn't twins. After all, that was the deal I had made with God ahead of time. Then she was quiet for a few minutes as she tried to locate the heartbeat....my heart dropped as she asked the nurse, "Tell me again what day the transfer was....how far along exactly are we?". The nurse said, "6 weeks, 6 days"....Dr S said, "we should be able to see the heartbeat by this point but the baby is only measuring 6 weeks, 1 day so we'll have to wait maybe another 10 days and have you come back and see how much growth there's been...and of course to ensure there is a heartbeat".
I wasn't satisfied with that though....I asked her, "What exactly does this mean?" and she said, "Well, either 1 of 2 things are happening....either the embryo implanted later than we thought which would explain why the baby is measuring a few days behind, which by the way, sometimes happens because there is room for error by a day or two OR the baby has stopped growing and the pregnancy isn't viable". I was stunned....and Tim and I drove home in complete silence.
I spent the next 10 days trying my best to convince myself that everything would be fine. I even began to joke about the situation, by telling a co-worker, "this baby is SO slow that I'm having to repeat my 6th week of pregnancy again because of it". During the day, I threw myself into my work and did my best to focus on everything BUT the pregnancy. At night, however, I was left with nothing but my thoughts and my worries. I laid awake at night, wondering what the outcome would be. Tim refused to talk to me about it anymore because I was driving him crazy. I just felt so alone...so isolated....like no one in the world could possibly understand how I was feeling. While I thought the 10 days waiting to find out if I was pregnant was extremely difficult, the wait for the 2nd ultrasound was downright gut-wrenching.
Then the day finally came....September 12, 2003....where we would learn the fate of our little bean. Part of me honestly didn't want to know....I just wanted to believe that everything was fine. I wanted to live in the little fantasy land I had created for myself for just a little while longer. But that wasn't exactly how God had it planned. Almost immediately, Dr S could tell the pregnancy had ended. The baby had grown since my last ultrasound but not enough to be significant and there was no heartbeat.
I felt as though I had been punched in the gut and even that isn't a good enough description of what I was feeling right then. I couldn't believe this was really happening. After everything we had been through with this cycle, not just physically but also emotionally and financially, it just seemed like God's idea of a cruel joke. I sat on the end of the exam table in a daze as Dr S explained the process of what would happen next....either a natural miscarriage or a D&C. I was afraid to open my mouth....Tim told her we'd get back to her and let her know what we wanted to do.
As we drove home, Tim asked me what I was thinking and I couldn't answer. I sat there in silence, looking out the window and into the heavens, cursing God for this outcome. Once home, it was as if I was on auto-pilot. I just went about everything so mechanically, void of emotion. Tim asked if I wanted to call our friends and family and let them know what had happened but I told him I couldn't bear to do that, so I left the job to him. It ripped my heart out listening to him making phone call after phone call so I retreated upstairs to our bedroom, where I laid on our bed, praying that any minute I would wake up and realize that all this had just been a bad dream.
Unfortunately, it was really happening. I waited a week to see if my body would naturally expel the pregnancy and when it didn't, I called my ob/gyn who recommended using Cytotec to force my body into labor. If you are ever offered Cytotec, I highly recommend you refuse it (key words here being "forced" and "labor"). I'll give more detailed reasons in my upcoming post about miscarriage #3.
The miscarriage itself was horrendous. It's one thing when you know someone close to you who has experienced a pregnancy loss...you can empathize with her, you can let her cry on your shoulder, you can hug her until she has no more tears left to cry. But when it's YOU going through it...well, there simply are no words to explain it. I have never cried so much in my life. Not only from the physical pain but also from the emotional pain...there was just no more hope left. All I felt was despair and grief...there was no light at the end of the tunnel anymore. I was angry at every other woman who was pregnant...I was angry that for all I had been through, I still had nothing to show for it but a broken heart....I was angry with God.
I stayed angry and grief-stricken for quite awhile...much longer than I anticipated. It took me a good few months to get past it all and even when I did think I was past it...just when I thought I was beginning to move forward, something would happen and I would find myself back at square one again with the grief, with tears that never seemed to stop and a stabbing pain in my heart that literally took my breath away at times.
Finally, I had to dig deep within and remind myself that the only way I was going to achieve that dream of motherhood was to pick myself back up again, dust myself off and start over.....it was hard. I won't lie. It was painfully hard. But, somehow, I found the strength I needed to start to make plans for IVF #2, only this time we were going straight to Dr Sher himself in Vegas.
If we wanted the odds on our side this next time, it HAD to be Vegas....