Part 7: Testing + IVF #2

We were back to square one.

I met with the OBGYN for my D&C follow-up, and he suggested some testing to look for thrombophilia. It came back with some positive marks, showing I was super good at clotting (hence the SCH from my first pregnancy). We met with our RE to discuss another IVF cycle to create more embryos, and he said I had to get cleared by an immunologist first to confirm how to treat the blood clot risk in the IVF process.

I also started working with a reproductive immunologist in California (there are only like, 3 in the whole country). My results came back:

• MTHFR - C677T homozygous
• PAI-1 - 4G/4G homozygous
• Factor XIII - V34L heterozygous
• Vitamin D deficiency
• High insulin
• Native Killing 8.5-10% (50:1)
• Unconfirmed Asherman's Syndrome from the D&C

That's a lot to go up against. I felt so defeated, but we kept moving forward because it was all we knew how to do.

Part 6: My Second Pregnancy

About two months after my first miscarriage, we went back for a fourth embryo transfer. And it WORKED. Again!

We made the difficult decision to transfer the last two embryos together. Our reasoning was that these were our two lowest quality embryos, so they had lower chances of sticking, and we wanted the best chance for success.

The transfer itself was really unique. Another doctor from the clinic performed the transfer, and we clicked really well with him. After it was completed, he asked if he could pray with us, and offered an incredibly beautiful, sincere prayer on behalf of our two perfect boys.

I am really good at waiting until 7 days after transfer to take a test, but absolutely no later. 

At our first ultrasound at 5w6d, we had TWO heartbeats! Baby A was our little rockstar, right on track and giving us a show with an audible heartbeat. Baby B was growing a little bit behind schedule, but looked healthy and happy.

At our second ultrasound at 7w6d, we saw that Baby B was measuring at 6w0d, so he had stopped growing shortly after the first ultrasound. Baby A, however, was starting to look like a REAL BABY. 

After this appointment, we "graduated" from the IVF clinic and scheduled an appointment with a regular OBGYN (was I finally "normal"?). We waited 3 weeks for that appointment, and in those 3 weeks, something started feeling off.

I was instructed to continue taking the progesterone injections through week 10. My appointment was scheduled for week 11. About 2 or 3 days after I stopped the progesterone, all of my pregnancy symptoms went away. The nausea, the headaches, the cramping - all gone. I bought a home doppler and couldn't find the heartbeat, but I also knew it was difficult to find so early on. I just didn't have much hope that things were still going well.

At the OB appointment, I was 11w0d. The doctor hooked me up to the abdominal ultrasound and said he could see the baby, but couldn't pick up the heartbeat well enough, so he was going to switch to a transvaginal ultrasound. I waited on the table foreverrr for them to come in with a new machine. They were completely silent while conducting the exam, and he was intently watching the screen, and then finally he turned to me and said "I'm not finding a heartbeat."

We discussed our options, and chose to do a D&C two days later. It was miserable. We had to arrive at the hospital at 5:00 am, and there was a huge family with rambunctious kids in the waiting room with us. I wanted to sink through the floor and just die. The nurse made sure to ask TWICE if I'd already had a pregnancy test done to prep for my anesthesia...like...girl, read the room.

These were our LAST embryos. How did we start with 15 and end up with zero? We thought we had our whole family (and then some) waiting on ice, but we walked away with nothing.

Part 5: My First Pregnancy

Our third transfer...worked. Against all odds, but also after a lot of hard work, it worked.

LOOK AT THAT PERFECT LITTLE CUTIE.

LOOK AT THOSE PERFECT LITTLE LINES.

One thing to remember: When the embryo transfer happens, the embryo is already 5 days old, which means you're already about 3 weeks pregnant. The numbers on the tests above are the number of days after the transfer, so the top test is 4 weeks along.

I had a problem with my progesterone injections. We switched to a new type of oil and I had a bad reaction in my hip, so my clinic told me to switch to my thigh. Then this happened:

Ok it's kind of hard to see, but I got a huge lump in my leg MUSCLE and I couldn't walk for like 4 days.

We went to get an ultrasound at 5 weeks & 4 days along. It was perfect and magical and amazing. Still too early to see a heartbeat, but we had a SAC and GROWTH!

Two days after this ultrasound was done, I had a huge blood clot. We jumped in the car and headed down to the ER. I called my RE on the way and asked what we should do, and they confirmed that we should go to the ER. 

I was 5w6d.

They got the bleeding under control, and then did another ultrasound.

We saw the heartbeat. It was perfect. Then they gave me this paper.

They told me I had a subchorionic hematoma, but it was at the bottom of the uterus so it would likely continue to bleed and then resolve on its own. SCHs are common in IVF pregnancies, but I was very unprepared for the amount of blood.

They told me that as long as I didn't have any pain, it was probably fine.

I had no pain. A lot of bleeding, but no pain.

A week later, I went in to my RE for a follow-up ultrasound. There was no sac. No growth. He was already gone.

I miscarried my baby without even realizing it.

Part 4: Embryo Transfers + PGS Testing

We immediately turned around and began preparing for a frozen transfer. This involves taking estrogen pills for a few weeks, then adding in progesterone in oil injections. Those injections go into your hip muscle, and they suck.

The first transfer was absolutely magical.

I was not prepared for how emotional it would be, but it was one of the most incredible moments of my life. Our embryo was super active and was moving all around the petri dish.

And...negative.

WHAT.

I hadn't even considered the possibility that it might not work.

I felt hopeless, confused, and abandoned.

It sucked.

But, we decided to keep moving on. So we turned around and did another frozen transfer.

Part 3: IVF #1

August 2018. A backyard barbecue. A chance meeting.

I chatted for probably an hour with a new friend who was in her second trimester with an IVF baby. She told me about a third clinic where the pricing was much more affordable. We made an appointment for 8 days later.

At that appointment, we met with doctor number four. He made us feel at ease and that IVF was the right next step for us. I started birth control that night.

September 2018.

This photo is worth $2,460.

I took shots for 11 days. Then I had surgery to get those lil eggies outta me. They were able to get 30 eggs!
Of those 30, 25 were mature enough to be fertilized.
Of those 25, 19 were fertilized normally.
Of those 19, 15 continued growing to day 5 and were able to be frozen.

15 embryos. 15 potential babies. 15 little children.

We were in heaven. That was SUCH a magical time, full of so much hope and planning. We were certain we'd have more than enough for our entire family, and talked frequently about what we would do with all of the leftover embryos (we were excited, but not about to try to have 15 kids). Even if I could go back and tell myself what was about to happen, I hope I would still feel the tangible joy of that moment and allow myself to revel in it.

Now, the not-so-pretty side: egg retrieval recovery. We opted not to do a fresh transfer because of the large number of eggs retrieved, and the very real risk for developing OHSS (which super happened).

OHSS stands for ovarian hyper-stimulation syndrome. It happens when you retrieve a relatively large number of eggs. It causes fluid to spill into your abdomen, and can cause a bunch of problems. I had to live on pure salt (Gatorade and top ramen) for a week to dehydrate myself. It sucked.

The worst part, though, was my now top-heavy ovaries. One night, one of them...flipped. It's called ovarian torsion and it's the worst thing ever. We went to the ER and waited in agony for hourssss while they struggled to understand what I'd just put my body through. When you do an egg retrieval, sometimes you have to take a shot of HCG (the pregnancy hormone). So when they drew my blood at the ER, my pregnancy test came back positive, and they couldn't be convinced otherwise. The ultrasound tech kept seeing my ovaries when she was trying to look for my kidneys, and she told us "I usually try to keep a poker face, but this is insane." Anyway, my left ovary had flipped and it was excruciating, but still had minimal blood flow so I didn't lose it. A little Percocet and 24 hours later, it had reversed and all was good.

Part 2: Four IUIs

When we got back from Italy, I took a couple months to just let my body recover from the intense barrage of hormones. So, so necessary.

I felt stagnant, but confused that none of the medicated cycles had worked yet. I was ready to move to something more aggressive, even though I didn't think I really needed it.

We moved forward with two IUI cycles. IUI stands for intrauterine insemination, and it involves inserting a catheter into the uterus and placing the sperm directly into the uterus, hoping to catch one of my lazy eggs on its way down.

The first one was totally painless and over in a flash. The second one was very painful and the nurse commented that I had a retroverted (tilted) uterus, which makes me think the first one was not thorough enough.

After two unsuccessful IUIs, my doctor announced she was leaving UCRM and moving to UFC. I decided to follow her to UFC, but she wasn't covered by my insurance at the new clinic, so I switched to a new doctor at a new clinic.

I did one IUI with my new doctor, which was unsuccessful, and he tried to push me to move on to IVF. I wasn't ready for something so drastic. If Clomid hadn't worked, an IUI deeefinitely should have worked, so IVF was not even on my radar.

We took a year off from treatments and used that time to try to improve our overall health. We did the keto diet for about 4ish months, and moved in to my mother-in-law's basement to try to save up for IVF - just in case.

After I'd lost about 20 lbs on keto, I decided to give IUI one more shot. We went back to a different doctor at the second clinic, and she is my soulmate. I love her, but that clinic is more expensive. More on how "you get what you pay for" later. Anyway, that IUI was unsuccessful, and after 3-4 IUIs, the success rate decreases dramatically, so that was it for me.

Part 1: Clomid + Femara

PCOS manifests as a lack of ovulation, so the treatment involves inducing ovulation by synthesizing your hormone levels. There are 2 types of drugs taken to do this - Clomid (clomiphene citrate) and Femara (letrozole). I tried Clomid for a few months in increasing dosages, sometimes adding in letrozole as well. Each cycle would basically look like this:

• Take Clomid on cycle days 3-7 (or 5-9)
• Take ovulation predictor kits from day 10 forward
• Get blood drawn on cycle day 21 to check progesterone levels
• Wait 10-12 days and take a pregnancy test
• If day 21 bloodwork AND pregnancy test are negative, start 10 day progesterone regimen to induce a new cycle

If you're doing the math here, that is a minimum of 6 weeks for a negative cycle. That means I was able to do 4 cycles in just over 6 months. I was frustrated.

The OB eventually told me there was nothing more they could do for me, as an OB cannot prescribe stronger dosages of Clomid and/or letrozole, so I made an appointment with a reproductive endocrinologist (RE). I was nervous because technically we had been trying for 11 months, not a full year, and I thought I wouldn't be allowed to get full-on infertility treatments until it had been 12 full months. Looking back, I realize how ridiculous that was, because I'd already been getting treatments from the 6 month point on.

Advice to my younger self: don't be afraid to go to an RE before the 12 month mark if there is something obviously wrong.

We started working with UCRM, and I was so impressed with their team. I loved them all and had a great experience there. The RE was able to check my lining and say "let's just call today day 3" instead of making me take progesterone for 10 days first. IT WAS AWESOME.

My first cycle was unsuccessful, so at only 14 days after I'd started taking Clomid, I was able to start taking Clomid + letrozole and started a brand new cycle. The pace at which REs can move, compared to OBs, is night and day.

At UCRM, we did 5 medicated cycles of Clomid/letrozole combos in 4 months, and had successful ovulation on 3 of those. At that point I'd been taking Clomid for 10 months straight, and we had a trip to Italy planned, so we took a break for a few months. When we returned, we decided to move to the next treatment plan: IUIs.

Before Infertility

Sometimes I feel like my story started when we decided to start trying to get pregnant. I forget that I was a person before all of this.

We met at 18. We got married at 22. It was winter 2013, and it was perfect.

We are now 29, and although our family size hasn't changed in 7 years, our love has grown into the most beautiful partnership, and even if we never graduate to parents, our relationship is worth the adventure. I know not everyone is so lucky, but we honestly count each other as our greatest blessings.

I was ready for kids from day one, but the timing wasn't right. I was starting grad school, and Spencer needed more time to wrap his mind around the idea. I started birth control when we got married, and tried several different methods (depo shot, the pill, and a copper IUD), but all of them created different problems for me. I got the IUD taken out in February 2015, and was never regular after that. (A consult years later told me that I had developed birth control-induced PCOS, which is actually very common.)

Over the summer we decided to start actively trying, as opposed to just "not preventing". I worked with an OBGYN to regulate my cycle, and it worked for a little bit, but then went back to irregular. We bought a house (fully anticipating to fill it with children) and I visited a new OBGYN after I was still experiencing irregularity for a few months. I am so grateful for her forward-thinking diagnostic mindset, because she was able to diagnose me with PCOS during my first visit. On average, it takes 2 years and 3 doctors to be diagnosed, but that wasn't the case for me. It may be because I have extremely classic signs and symptoms.

That doctor's visit, which was about a week before my 25th birthday, signaled the start of our infertility experience.