Here We Go Again

It has been a while since I last wrote. It is partly because I decided to take our forced break in the PGD process as an opportunity to take a long overdue trip home to Canada to see my family and friends. I had been putting off traveling because of my hysteroscopy last November that marked the end one pregnancy, then trying to conceive again, then another pregnancy, then another miscarriage and finally our decision to move forward with IVF and PGD. It just didn’t seem like a good time to travel or even think about being away in another country. So when Dr J told me we would need to wait a cycle and go another round, I didn’t even hesitate. I booked the flight a few days later and flew out the week after.

I thought going home would rejuvenate me, and certainly seeing my family and friends did help boost my spirit, but I came back feeling depressed and lonely. I spend the week with my nieces and nephew, held my best friend’s new baby girl, played with her other daughter and other friends’ children. It was amazing, I missed them so much and was so happy to see them, but it was also very emotional and painful. When will I get to hold my own baby? 3 years ago, I had a baby boy and I only got to hold him 5 times in 3 1/2 months. The last time I held him, he died in my arms. He was too small and too sick to move out of his incubator. It shouldn’t have happened that way. I should have been able to hold him every day. My son Holdon is always on my mind, but lately I’m feeling haunted by him again, like I felt in those first few months after he passed away. All the painful memories of that time have been flooding back to me and I feel like there’s a weight pressing down on me. Maybe it’s the pressure of so much weighing on us with our upcoming procedures or maybe it’s the fact that my husband’s brother just had a baby boy and there were a few complications that are keeping him in the NICU. My fear and anxiety over my new nephew, were echoing so painfully, all the emotions I went through 3 years ago with my own child. But this time it’s different. Thankfully, my nephew is recovering quickly and will be going home soon. I’m so relieved. My brother and sister in-law have gone through enough of their own heartache on the road to having the family they wanted. It has finally come together for them and I’m overjoyed for them and already so much in love with my new nephew and I haven’t even met him yet. He’s such a blessing.

So the question is, why am I an emotional wreck right now? Nothing has changed and yet I’m in a terrible funk.  This is not a good place to be when we’re about to start our second round of IVF, but even that has me in a bad mood. I should be excited to be proceeding again, but I’m not.

Wednesday, two days after my new nephew was born, we sat across from our fertility doctor and listened to him talk about the plan for our next round. The entire time, I sat there with a bad attitude. For weeks I’ve had a feeling of dread weighing down on me that it wasn’t going to happen for us this month. Well Dr J confirmed this for me. We’re looking at another 2 to 3 cycles before we even think about doing a transfer, and that’s assuming we have a healthy embryo at the end of the PGD testing to transfer. With all our siblings and friends having children around us, I can’t help feeling like a failure. It’s not quite a setback so I shouldn’t feel this disappointed, but I really hoped I would be pregnant again in November. I was counting on it to get me through the holidays and my upcoming birthday in January. I’ll be 37. Not exactly overly advanced maternal age, but not a spring chicken either. And I have low ovarian reserve so time really isn’t on my side.

To summarize, we met with Dr J to determine the next protocol for my meds going into our next round of IVF. We already have 5 fertilized eggs, frozen and ready to be grown to 5-day blast for PGD, but Dr J wants us to have at least 8, if not more, to start out with in order to give us the best odds of having a viable embryo after PGD. So we took a cycle off and are now ready to go for another egg retrieval. My options were to do a lower stim cycle, what Dr J called a mini IVF cycle, where I would only take an oral FSH hormone, Clomid. The benefits of this are, no birth control pills first so we’d start right away, less hormones and less stress on my body, and possibly yield better quality eggs though there’s no evidence to prove this. The con, I probably would only get 2 or 3 eggs in one cycle. So if we don’t fertilize at least 3 eggs, we’d have to take a cycle off and do another mini IVF to get more. So I’d be batching eggs for possibly up to 3 or more months before we could even begin the testing phase. The second option was to go for a full IVF cycle again with stronger meds. The pros of this are that I will likely get more eggs in one cycle. Hopefully we’ll get about the same as I did last time or even more, and then we can proceed with PGD with a really good starting number of eggs. The con, I  have to go on the pill again for a few weeks first to prepare my ovaries for the hormones ahead, then have another period, and then start the IVF cycle. The other con is that the meds are going to be stronger so this might not be as good for egg quality, but again, there’s very little evidence to prove this one way or the other so it’s just speculation.

I sat there in the clinic and weighed the options, but in the end I decided that since there’s no actual clinical evidence that Clomid yields better eggs than the injectable meds, we would proceed with the full IVF cycle. I just don’t think I can keep doing retrieval after retrieval for the next 3 to 4 months just to get the amount of starting embryos that Dr J wants when I can hopefully do it in one cycle, albeit longer, with the full IVF option.

This brings me to today. Today is cycle day one and I go in on Monday for a baseline ultrasound and to check my estradiol levels. If all is good, then I’ll start birth control pills again. I’ll take them for a few weeks and then I’ll stop and get a period. Once I get the next period, we’ll begin the injectible meds and have another egg retrieval. If all goes well and we fertilize enough eggs, then we’ll thaw the 5 we already have and grow all the embryos together to 5-day blast and then send a biopsy of each embryo to the PGD lab for chromosomal testing.

This brings me to the second part of our conversation with Dr J and why we’re looking at January before doing a possible transfer…

The protocol for PGD is now to test on day 5. It used to be day 3, but the research showed that it is better to wait until 5-day blastocyst for the embryo to develop more and have more cells. It was thought before that the embryos may not survive to day 5 so they sent the embryos for testing on day 3, but now the labs are better and the thought is, if the embryos don’t survive to day 5 in the lab, they likely wouldn’t survive in the uterus either and wouldn’t be viable anyway, so the mainstream protocol is to do PGD on day 5 now. The added bonus is that the embryo has hundreds of cells by 5-day blastocyst so the biopsy is done from the part of the embryo that will make up the placenta and there’s little risk of damage to the embryo. This is the protocol that Dr J presented to us a few months back when we first met with him and we all agree it’s the best way to go, hence the need to get as many starting embryos as we can as they may not all survive to 5-day blast for testing. The transfer day protocol is the part that is changing. Dr J, initially told us that we were at an advantage because the PGD lab is nearby and we could transfer a fresh embryo the day after the testing on day 6. However, he is no longer recommending this protocol. He has been finding that the success rate of direct transfer of a fresh embryo on day 6 has a lower success rate of implantation even when the embryos are found to have normal chromosomes after PGD because the survival rate of the embryo diminishes greatly after 5-day blast in the lab. There are too many cells at that point and the embryo needs more support than the lab can offer, so their survival rate isn’t as high when they continue to grow in the lab after day 5. Also, the hormones we are given to have a strong ovulation can make the uterus inhospitable for implantation. So these are two major problems that can cause an unsuccessful transfer. Furthermore, Dr J just attended a big fertility conference and was presented with evidence that supported his findings. So he now recommends freezing any viable embryos after chromosomal testing on day 5 and waiting a cycle or two before transferring.

A set back or just good sense?

This all makes sense and I’m glad Dr J is staying on top of the research and offering us the best options in order to give us a better chance. All in all, I think this isn’t so much a setback as just the better way to go, but I would be lying if I said I wasn’t disappointed. I left the appointment crying and feeling rather hopeless. Right now, we don’t even know if we’ll have any healthy embryos and now he’s telling me that if by some miracle we do, that I’ll have to wait another cycle or two to do anything with them. I’m going to have another birthday before that happens. It just sucks. I’m just so tired of all of this and want to move forward. I don’t want to be on hold anymore. We don’t plan anything, just in case. We hope. We pray. We get good news. We get really bad news. More good news. More bad. And through it all, inexplicable turmoil on my body and emotions. It’s exhausting. The only consolation as Dr J put it, is that at least my eggs will be retrieved when I’m still 36. Small consolation. I’ll still be closer to 38 before I possibly have another baby. I was 33 when I delivered my son, Holdon. And that’s the other fear weighing down on me. Before all the miscarriages and the label of recurrent pregnancy loss and infertility, I was pregnant and made it to 27 weeks and then got really sick with a life threatening condition of pregnancy called preeclampsia. I delivered my baby at 28 weeks and lost him 3 1/2 months later. The fear of this happening again hasn’t gone away. I’m at high risk for getting preeclampsia again and now I’m older, which doesn’t help my odds. What if we finally succeed in having a viable pregnancy and make it past the first trimester again, only to get really sick again with preeclampsia and possibly lose another baby anyway, not to mention the risk to my own life. I sometimes ask myself what I’m doing even trying to have another baby. Am I crazy? I must be because, a small voice always answers back to keep trying. It says “this will work out”… I sure hope that little voice is right.