First Trimester

I love being pregnant. L*O*V*E it! I start feeling round ligament pain around week 7. I read online this is pretty early but not impossible and there is no mistake that is what I am feeling.

Close friends and family already know (have been in the loop since our first pregnancy) but I am bursting at the seams with excitement to share with my coworkers! Today is the day! After our weekly meeting I ask our partner, "Can I say something?"  Ahem:

"I am not sure if you guys have heard so I just wanted to let you know a new member will be joining our practice group. In June."

I stand and open my cardigan to reveal my shirt underneath:

Morning Sickness

I am glad I share when I do because the next week I begin morning sickness. Except it is all day sickness. Feeling sick 90% of each day, getting sick 4-5 times each day. I go on like this for a few weeks. I can count on two hands the number of times I have thrown up in my life. I hate it. I hate when I do it. I can't be around when others do it. I am not the friend holding your hair while you hover over the bowl I am the one yelling from the other room, with ears covered, "I hope you're ok!" The thing is most of my morning sickness is dry heaves. Terrible and violent dry heaves. And the times that matter does come up-also terrible and violent. I get small dots on my eyelids and around my eyes and hives immediately begin to appear on my face <--- though I've learned if I immediately splash my face with cold water for several minutes it minimizes this. Anyway re the dry heaves: I joke I have all this morning sickness but I don't even get to lose weight (; But really, dehydration is a real concern b/c everything makes me feel sick, even water. So I stock up on Gatorade which is not something I've ever enjoyed but Dr says good to take.

Some things I've noticed: I always get sick right after getting off the train (commute to work). A friend suggested it is motion sickness which I have never had before pregnancy but weirder things have happened? AND I did notice on weekends when we are out and about running errands I get sick between car rides. I can always feel mine coming up. It is never a situation where I am running to the bathroom with my hands over my mouth. And, it never passes. Once I feel it, it is imminent and just a matter of time. I can feel it build and can tell when I need to "look for a place" to take care of business. Like next to the light pole in the Giant parking lot (worker taking a smoke break calls out, "Are you ok?" I reply, "Thank you yes! I am pregnant!" He says, "I knew it!! Congratulations!") or the Trader Joe's bathroom in Center City (I walk in, calmly locate the bathrooms, two women, one with a child, are blocking the way. I say, "Excuse me," with a smile and nobody does a thing. The kid is right in my way. Excuse me sorry can I just squeeze by? Kid just stands there. I say, "I am pregnant and going to be sick" and finally the mom puts her phone down and slowly ushers Johnny out of the way. Only for me to learn the one bathroom is occupied and the other lady non/kid lady is waiting for the other one, which opens shortly after my statement and she goes in. Which!!! I guess I am just a nice person as I would've gladly offered my spot to a pregnant woman about to be sick! But really these are the only two a-holes I've encountered during pregnancy. Even a scammer tried to solicit me on Market St after I got off the train so I knew it was only a matter of time before "the motion sickness" kicked in. I said simply, "I am pregnant and I don't feel good" with a smile and he immediately left me alone).

Another thing I've noticed is I can sick "badly" after dinner. Like, eventually I start to pee a little bit during these violent episodes (despite my kegles)! Anyway, I link this to "overeating." And by overeating I don't mean Thanksgiving dinner I mean "an entire can of soup." So when you read "eat small frequent meals" they mean really small. For me at least. Each time Chris helps me stay stable while I am sick. He rubs my back and gives me tissue to wipe my watery eyes and runny nose. He gives me a cool cloth at the end of it all for my face. And he cleans up the tub while I brush my teeth. Then, inevitably, he says, "Sweetie why don't you take it easy I'll get a bath ready for you." What a guy <3

Morning Sickness-Miracle

People say ginger is the answer. I strongly dislike ginger. I buy the Trader Joes ginger chews anyway and they do work, they really do. They just are so gross I can't decide which is worse-the chews or the vomiting. I try half a Unisom with B6 and it does help a little. I still "felt sick" but get less dry heaves. So I go to Babies R Us to get "Preggie Pops," which I've been avoiding based on name alone. At this point though I will try anything. I would carry magic crystals in my pocket if someone said it helped them! So no surprise that when I see "pressure point wrist bands" sitting next to the pops and drops I pick these up also. We'd been in the car and I was already feeling sick. Standing in line I look through the window to the parking lot to "find a good spot." Right after checking out I eat a drop and put on the bands. Like, I am not even out of the store yet and I want to see if these things bring me relief. What do you know...they do! And quickly!! Some women these don't work at all and some women it takes time to take effect. Thank goodness it works well and works quickly for me! And it isn't just one or the other. Over time I test this and it is the combo of bands and pop/drop that do the trick (I read it is the citric acid in the candy that is what helps though in a pinch I tried sour patch kids and they did not help). I have not gotten sick after the train or car since-as long as I am utilizing both these items together (that is key, for me at least).

Heartburn

In additional to morning sickness I have terrible cases of "heart burn." Even from water. Nothing is off limits-everything makes me burny. This is not something I experienced before pregnancy and it is the worst. I would rather be throwing up. This burning fire in my throat is the pitts. And it is completely Tums-proof. I do find something that works for me though: raw almonds. Even just a small handful like 8. And trust me, the last thing I feel like doing when I have this burny feeling is eating or drinking anything else but the almonds actually help! So I throw some in my mouth and ugh crunch them up up up up, feels like sawdust, and swallow. Within minutes I have relief!

Peeing

I have not had to pee a lot and I know this is because I am not drinking enough. Hence, the Gatorade when I can take it. And fwiw, that doesn't make me burny. BUT I hate the idea of drinking all this sugar, essentially. Bur Dr said no artificial sweeteners so a substitute like Pedialyte is out.

Sleeping

A nurse told me during my first pregnancy to start getting used to sleeping not on my back. So I begin this now. I am a tummy sleeper that wakes up on her back so starting early sounds like a good idea! Here's the skinny re laying on your back in later pregnancy: http://www.whattoexpect.com/pregnancy/ask-heidi/week-27/sleep-positions.aspx

Food

Things I normally love, I can't even look at. Namely: greens. Salad is this girl's best friend but the sight of kale or spinach pushes me over the edge. Dr says you can essentially starve yourself the first trimester and baby still gets what it needs. You don't, necessarily, but baby does. So eat what can might actually appeal to you and what will not make you sick. One night we wander Trader Joe's for something, anything, that looks appealing. I go home with a two-pack of everything breadsticks.

Love

Not sex (but yes, we are doing that-Dr says no worries). I am talking the lovey dovey stuff. We start planning. Start feathering our nest. We visit  the book store and pick baby's first bible and cry over books called things like "I Prayed for You." And we learn so much-like what a "board book" is! We buy a little "soft book" of sewn material with lambs on the front b/c who could resist anything with lambs? I lay this in baby's crib and sometimes tear up in happiness when I see it and imagine us holding our little baby reading to him/her <3

Gender

Because we have our embryos tested we can learn the gender immediately. No chance. My entire life I have thought how amazing it would be to learn the gender at birth! Aside from the baby itself what a wonderful surprise to look forward to after labor <3 Then like in the movies Chris will run out to the waiting room and tear off his MJ mask and yell, "It's a *****!!!"

Results

I go back for bloodwork twelve days later. Chris and I meet so we are together for the phone call from Nurse Brigette We are waiting in his lobby literally staring at the phone in my hand. It is like counting down to the New Year! I check the ringer is on and UP all the way. Battery is nice and strong. We just sit and wait and look. Then, my voicemail icon pops up. What the!?!?!?!?! It went straight to voicemail! Grrr (turns out I had inadvertently set my phone to do not disturb)! Anyway, we play the message. They give HCG levels in this call and you are looking for some significant figures. Figures widely and wildly vary between women so I know low numbers "don't necessarily" mean it didn't take and that high numbers "don't necessarily" mean it took. We play the message: Beta is (drumroll) 515! We hug we kiss we cry!

I go back for bloodwork two days later which happens to be our 15 year wedding anniversary. We get the call as we are sitting on our favorite bench at Longwood Gardens. Nurse Brigette again. Beta is now 1,005. WE. ARE. PREGNANT! Thank you God!

Transfer Day!

Yesterday afternoon I got the call from a nurse laying out exactly what to do and what to expect. First item: drink lots and lots and lots of water starting now!  Fine, done.

The morning of the transfer
Chris and I sign in at the clinic and take a seat. I am so excited! In no time they call my name and the "rest of our lives" potential begins.

First off, I have acupuncture scheduled before the procedure. I'd read a study that said having acupuncture immediately before the transfer, even if you haven't had any prior and did not have any post, it increased the success rate (http://www.fertstert.org/article/S0015-0282(06)00212-3/abstract).

I am laying there with all my needles in and my acupuncturist says, "I will leave your water here next to you but you probably already have to pee!" I say, "Not yet! So I better drink more!" and she says, "Oh I bet you'll have to pee when I come back!" I take a couple of giant swallows and settle in to relaxation. I think of our journey to this point. My heart has a way of neatly packing everything that happens in life onto a path that leads to a particular moment. And that if any one of those things had been slightly different I might have ended at a different point. So I think about our loss and the indescribable and crushing sadness that came along with it. I think about the cycles of IVF and the countless needles and my tears of loss turned to laughter as I recall Chris so nervous to administer them (: And I think of lighter thoughts too like "maybe this is why we have this big empty "no man's land" extra bedroom that for years we have done nothing with-perhaps it has been waiting for its special tenant." Most of all I think though, "This might be it. This might lead to our baby!" I am all positive-just endless and unashamed excitement that this could really be it! I keep circling that thought in mind and for the first time EVER throughout this entire process, I give myself props. Props my mom had been giving me all along: that the road is a hard one-mentally, emotionally, physically. I'd say, "Mom I'm fine it's no big deal" but for some reason laying there with my pins before the transfer I finally got it. It was like I had to wear emotional armor throughout the process and I could finally take it off and place it on the ground. And as I did so I looked at it laying there-all the needle marks and the stained tears and the worry and the fear-and I think, "Yeah. I guess it was a tough road."

Next they move me to the OR. Nurse Jen is with me today which is so fitting as she gave us our IVF intro so many months before! She asks me if I have to pee I say "well yeah!" She said people have peed during the procedure so if my bladder is "too full" I should empty it but not all of it. Ok so (1) I should def empty some then so I don't pee everywhere but (2) how do I empty only "some" of it? My sister (a nurse) later told me the way to do this is my quick exhales midstream-I had NO IDEA! Anyway, in the bathroom I am able to stop but not when I want to. I am concerned. They kept saying how I needed to have a full bladder a full bladder a full bladder a full bladder. So I drink more water from the sink and return to the OR. I am laying here for quite a while. It is cold and sterile and plain which is exactly how an OR should be so I like it. The lighting is dim and cool. I laugh as I see the "little door" built into the wall by friend MR has told me about so many times (she has 5 beautiful children via IVF).

When the Dr comes in he relays for me again the statistics of success, saying "let's get you on the right side of those statistics!" There is no music on and he mentions this to Jen and says he'll just make his own and he starts softly singing Hush Little Baby which at that moment I think is the sweetest and most appropriate thing in the whole world <3 There is a screen and he narrates his actions so I can follow along. He says if you watch closely you can see the embryos exit the tube (inserted into me). I can't quite make it out but I'll take his word for it! And we are done! Well, not quite. I have to lay there for 10 minutes before I can get up. Gee I have to pee pretty badly but 10 minutes isn't bad. What I am about to say I mean with my entire heart and soul: that was *thee* hardest part of the entire IVF process. I had to pee so. badly. I can't even tell you. I was naming countries of Africa alphabetically. I was spelling cities in Europe backwards. I was doing anything and everything in my power to distract myself from this pee feeling. It has been 7 minutes. I can no longer concentrate on geography or anything else besides my bladder. I have never ever had to pee so badly in my life. I can't believe I am going to do this but I call out, "Jen?" I wait a bit then, "Jen?" I wait a bit then, "JEN!?" "JEN!?" Finally the door opens and I say, "Jen Jen I have to pee I can't hold it I can't hold it and she laughs and says ok you only have two minutes left go ahead." I havent moved so quickly since jumping out of bed in Iceland to see the Northern Lights for the first time. I swear I peed for like 5 minutes straight. They usher me back to the changing room and boom, that's it-they release me!

Progesterone In Oil (PIO) Shots

I have been *dreading* these shots as I have heard and read from others they are horrid and perhaps the worst part of the entire IVF process. And even when you google "progesterone in oil shots" the suggested searches are "tips" "side effects" and "pain." Yikes!

So I don't want to jinx myself here but we are having zero problems with the PIO shots.  I will share my "technique" in case it helps.

• Proper State of Mind

This is the same needle as the retreival trigger shot so we are all used to that by now. Or at least I am after having 5 rounds/5 shots. So really this is old hat. Or at least this is what we tell ourselves.

Carrie: My proper state of mind is zen. I am going to do everything in my power to make this as easy as I can. This is a needle I have had many times before. I know it is quick. I know it is for the baby/babies. The universe is not asking too much of me to endure this shot.

Chris: I need a beer to give this shot. It is getting better though. I hate the idea I am hurting Carrie. <--- This is so sweet. The shot for the recipient is just a quick jab. I really think it is harder for the person giving the shot!

• Set the Scene

Clean up your counter and nicely lay out everything you'll need. For me this includes a papertowel with sharps container in upper right, 3 alcohol wipe packets vertically along the left, PIO sitting at the top, and a cotton square.

• Location Location Location!

I popped into the clinic and Nurse Rachel drew happy face "targets" on me. It is important to administer the injection in the right place. Medically speaking, if you inject anywhere into your hiney the medicine still goes in which is the important thing-it will just be very uncomfortable sitting. So have your clinic draw targets, one on each side of you so you can rotate shots (one night on the left, the next night on the right, and so on).

• Injection

I warm* the target area with a heating pad while Chris fills the syringe with oil (it is pretty hard to draw up). He changes the needle tip then keeps the syringe enclosed in his first. I heat my target and he warms the oil for about 5 minutes. I swab the area, it's go time! I nook myself into where our countertops make a soft corner. I put the weight on the side of my body that *isn't* getting the shot. Sometimes even lifting my injection-side foot off the ground a bit. This helps to keep those muscles totally relaxed which helps afterwards. Chris talks me through the entire thing. I remind him always, "90 degree angle." He counts up to three, very occassionally having to restart the count like when you are young and learning to dive (;

*During injection training months ago before we began Round 1 Nurse Rachel told us icing the injection site beforehand actually causes the skin to tighten making it harder for the needle to break the surface thus potentially more painful. She is the expert. She does this for a living. I have not iced so can't speak to it.

• Post-Injection

He removes the needle and presses an acohol swab onto the injection site (the cotton square is there in case there is blood which there hasn't been since the first time). He kisses my lower back every single time which I find endlessly sweet. He gently massages the injection site for about a minute. We clean up the counter and go for a walk. Even just 20 minutes. Just like keeping the muscles relaxed during injection I read exercising them a bit after helps.

Maybe I am just lucky but the above has been a recipe for success and might be for you too!

UPDATE: After becoming pregnant from my successful embryo transfer I continued PIO shots for a few weeks. Those weeks I was exhausted. I come home from work and fall asleep. Chris would wake me up to take the shot and then I would fall right back asleep. "Going for a walk" was not an option (: And I did not suffer any consequences aside from a very occasional sore hip injection-site rolling over in bed.

Trigger Shot!

The clinic calls this afternoon.

Trigger shot is tonight!

Transfer is one week from today!

And that means they will administer my pregnancy test two weeks from that day, which happens to be our wedding anniversary! I can't think of a more perfect celebration! (says prayer)

I let work know I will be out and unavailable-the clinic says no work and zero stress for 3 days. Sounds like I'm in the for the princess treatment!

I schedule an acupuncture appointment for this afternoon and let them know my transfer date.

I think I want to schedule a massage for the night before.

From here on out I want nothing but zen, kumba ya. Bamboo flutes and incense (courtesy of MRT).

After the thrill settles a bit my insides sink. I totally didn't think to have the clinic draw the circles for my trigger shot! Plus all the PIO shots that will be coming. Crap! Crapcrapcrapcrapcrap.

Fine. Tonight we are on our own. Tomorrow morning I will swing by the clinic and ask if they can mark me up (:

FET (Frozen Embryo Transfer) Preparation...

Appointment 3

They like to see a lining of 8 and I am at 7.7 so Nurse Bridget is pleased.

She thinks HCG trigger will be coming soon with transfer likely next weekend.

FET (Frozen Embryo Transfer) Preparation...

Appointment 2

Lining today is 4ish.

Still watching that dominant folly.

Today we sign official paperwork for the transfer.

The form is for the lab and asks how many embryos we want to thaw. Two!

I know vitrification nearly eliminates negative thawing effects but I confirm with Nurse Nikki. She has never seen a fremby not survive a thaw.

The form asks us whether we want to know the gender. NO!

Have I said this before? I can't think of a better reward for labor and delivery than to learn if I have a little boy or a little girl. That moment is something I want to think about any time I am feeling sick or tired or moody or angry during pregnancy.

Since we all sound alike on the phone my mom and sister threaten to call the lab saying, "I have changed my mind, tell me!"

Next appointment in two days.

At work I think, "I will be pregnant next week." <--- cool thought!

FET (Frozen Embryo Transfer) Preparation

Appointment 1

As I have said many times, this process to me is like building a house of cards. And because I know at any moment it could collapse and start over I am careful not to look too far ahead. I never ask "what's next" until we are in the position to move to what's next. So I have no idea what preparation is involved with transfer. I know I have pills and suppositories and creams and shots I picked up from the pharmacy waaaaay back during Round 1. But the how and when is a mystery.

Just like stimming I was to call the clinic the first full flow day. So I do and go in two days later for my baselines.

Lining is 6ish which is expected during menstruation. It will get thinner then build back up again. I have a dominate folly hanging out with some buddies on my right and then a couple of smallies on my left. Today I start my doxycycline and 75 of Follistim, continuing my baby aspirin and prenatals.

Nurse Peg gives us our protocol and potential trigger and transfer dates!

Next appoinment is in five days.

PGS Results

The clinic said the PGS results would take about two weeks, generally within 10 days. It has been 13.

My mom asks, "How can you be so patient!?" I say, "Going through IVF, you can't be any other way." And really, with 5 rounds patience by now comes naturally. So while I was prepared to wait until day 14 I give into my mom and sister and call the clinic. It's my mom's birthday and we all agree what a great present good news would be.

I leave a message, "It hasn't quite been 14 days but my mom and sister are making me call. Please let me know if we have results."

A short time later I see the clinic number light up on my phone. I am prepared for them to tell me the results aren't in yet. Because I know they aren't. Because if they were, someone would've called me. But the embryologyst begins with: I have some good news.

My eyes well.

Before she says anything else I know this means we have at least one. WE HAVE ONE. I tell friends and family "it's nothing" when they say how hard the last 7 months have been on me. And until this moment I have been wearing such a coat of emotional armor I don't think I even realized it. Because once I learn I have one healthy baby the armor disintegrates. And only then do I realize I have been brave. I have been patient. I have been strong. And this is my sweet reward.

We have two healthy embryos <3

PGS Testing

PGS v. PGD

Some confusion exists between these two.

PGD tests for genetic issues.

PGS tests for chromosomal abnormalities.

Websites and even my clinic use the terms interchangeably so just make sure you make clear what/why you are testing and you should be fine.

Here is some helpful information from my clinic's website:

What is PGS?

PGS is preimplantation genetic screening (PGS) of embryos after IVF.  PGS can identify which embryo are chromosomally normal.  Embryos with the correct number of chromosomes can be transferred to uterus (womb) or can be frozen for future use. PGS can improve the chance of getting pregnant and carrying to term, and it can reduce the chance of having a baby with a condition like Down syndrome. It can also decrease the chance miscarriage due to aneuploidy.

What are Chromosomes?

Chromosomes are string-like structures found in the center of every cell (the nucleus). Chromosomes contain genes that are made of DNA. Therefore, our inherited information is housed on the chromosomes. Normal human cells (embryo, fetus, baby or adult) contain 46 Chromosomes or 23 pairs. We receive 23 chromosomes from each parent. The first 22 pairs  are the same for men and women and labeled largest to smallest: 1 through 22. The 23-rd pair determines our gender. To test for a chromosome abnormality such as Down syndrome, the chromosomes are studied.

Gender Selection or Sex Selection

The PGS report will indicate which embryos are males and which ones are females. If an embryo has one X chromosome and one Y chromosome, the gender is male.  If there are two X chromosomes, then the gender is female.

Many Embryos have an abnormal number of chromosomes

Studies from many different IVF clinics have shown that even embryos with good physical appearance or “morphology” can have chromosome problems. Even in women younger than 35, at least one third of the embryos have abnormal numbers of chromosomes. The number of embryos that have abnormal chromosomes increases each year as a women ages.

Chromosomal Aneuploidy

Spermatozoa or eggs that have extra or missing chromosomes will pass this problem on to the embryo after fertilization. This situation is known as aneuploidy. There can be extra (trisomy) or missing (monosomy) chromosomes. Both conditions are a problem. If the aneuploidy involves the larger chromosomes, the embryo may not attach to the wall of the uterus or may stop developing soon after and miscarry. In some cases, however, the aneuploidy may cause the fetus to be abnormal but carry to birth. Down syndrome is an example of this, but there are several other types. The features of the chromosome condition depend upon which chromosome is extra or missing, but can include physical abnormalities and mental retardation.

Risk of Aneuploidy and Maternal Age

As a woman advances in age, the chance of aneuploidy in her pregnancies increases. This association is due to the fact that a woman’s eggs are as old as she is. Females have all of their eggs from the fetal stage on, therefore they are born with all the eggs they will have in their lifetime. As such, the theory regarding aneuploidy risk and advancing maternal age is that, over time, the chromosomes in the egg are less likely to divide properly leading to the egg having an extra or missing chromosome. The risk of conceiving an abnormal baby increases with maternal age, but the frequency of aneuploidy in embryos is much higher than at delivery. This difference in percentages of affected embryos versus live born is due to the fact that a pregnancy with aneuploidy is less likely to attach to the uterus or go to term. Most will not implant or will be miscarried. The percentage of affected pregnancies is reduced over the course of the pregnancy. The lack of implantation and loss rate of aneuploid embryos are believed to be the main reasons why pregnancy rates decrease with advancing maternal age.

Avoiding Transfer of Chromosomally Abnormal Embryos

Aneuploid embryos are mostly indistinguishable morphologically and developmentally from chromosomally normal ones.  The PGS report will indicate which embryos have the correct number of chromosomes for transfer.

The PGS Procedure

PGS has been developed to test embryos prior to the embryo transfer. This technique involves removing (biopsy)  one or more cells from each embryo, followed by a very fast genetic analysis using a technique called array CGH (aCGH) for fresh transfers or Next Generation Sequencing (NGS) for embryos that will be frozen for a subsequent cycle.  Embryos with a normal number of chromosomes can be transferred back to the uterus. Euploid embryos (those having the correct number of chromosomes) have a higher chance of implanting and resulting in a healthy pregnancy.

Blastocyst Biopsy on Day 5 or 6 of Culture

Main Line Fertility is one of the few centers in the USA that has the specialized equipment and trained embryologists to perform biopsy of blastocysts.  Blastocysts are embryos that have hundreds of cells that have differentiated into an inner cell mass (that will become the fetus) and the trophectoderm (that will become the placenta).  During blastocyst biopsy, a hole is made in the shell of the embryo and several cells are removed from the trophectoderm.    Chromosomally normal blastocysts can be frozen for future attempts at pregnancy.

In addition, it is possible to thaw cryopreserved embryos, perform PGS or PGD, and then transfer the healthy embryo/s in a frozen embryo transfer (FET) cycle.

Advantages of the PGS

Most chromosomally abnormal embryos either do not implant or spontaneously abort shortly after implantation. Thus, if only normal embryos are replaced, which have higher chances of implanting and reaching term, the probability of delivering a healthy child may increase if PGS is applied.

PGS of aneuploidy has been proven to double implantation rates in several studies, reduce the rate of pregnancy loss by half, and increase take-home baby rates.

Advantages of Freezing Embryos after PGS or PGD

Embryos can be frozen after biopsy and then later transferred in a frozen embryo transfer (FET) cycle.  An advantage of this is the best embryo can be selected from day 5 and day 6 blastocysts.  Moreover, NGS testing can be performed which provides more detailed genetic information through complete genome sequencing.  In addition, the uterus may be more receptive.

Banking or Batching

Patients have the opportunity to freeze and bank (or batch) multiple biopsied embryos from several IVF cycles.  When patients have the desired number of biopsied blastocysts, they can “run” (or analyze) the frozen biopsied cells at the genetics lab, and pay for testing only once.  One or two tested embryo/s can be transferred back to the uterus in a frozen embryo transfer (FET) cycle.

Risks of the PGS Procedure

While PSS is a relatively new procedure in IVF, the micromanipulation or biopsy techniques required to perform the procedure have been in use for many years. The risk of accidental damage to an embryo during the removal of the cell(s) is less than 1% in experienced fertility centers. Additionally, no part of the future fetus will be compromised or missing because of the removal of a cells.

The test may occasionally classify an abnormal embryo as normal. Very few of such pregnancies have occurred. The reverse may happen, too – a normal embryo that is tested may be classified as abnormal by mistake, though the chance of this is also small. Again, due to the small chance of misdiagnosis as well as the presence of conditions not tested for via PGD, prenatal testing is still recommended.

Not all genes or chromosomes can be studied by PGS and one cannot test for both genes and chromosomes from the single cells concurrently. Neither test is 100% accurate because we can only biopsy a single cell from the embryo, thus follow-up prenatal testing via chorionic villous sampling (CVS) or amniocentesis is highly recommended.

Which Patients Benefit the Most

• Women 37 and older: Any IVF patient 37 years of age or older may benefit from PGS, provided that they produce 5 or more embryos.

• Women with a prior history of multiple miscarriage or aneuploid pregnancies: Regardless of age, these patients could benefit from PGS. In all these patients, higher implantation rates, reduced pregnancy loss and reduced risk of chromosomally abnormal conceptions are expected after PGS. It is not clear yet if patients with repeated IVF failure benefit from PGS.

• Patients with a chromosome condition: Individuals with certain chromosome conditions can reduce their chance of passing the condition to their child via PGS.

• Severe male infertility: A high rate of chromosome abnormalities has been seen in embryos from men with non-obstructive azoospermia. PGS may also be indicated for other cases of very severe male infertility.

• Couples who are interested in family balancing

What About Cost?

This procedure may add several thousand dollars to the cost of IVF. Few insurance policies cover the expense.

Round 5

During my forced month off I started thinking "How many rounds should I do? How many rounds are typical? How many rounds before my Dr sits me down and says this is a losing battle?" I read online the average is 6. Six rounds for one healthy baby. For all we know our fremby is "one healthy baby" and hey it only took 3 rounds! So keeping fingers crossed we are due for another soon!

This morning at my baseline appointment I have a cyst. 100% of women get cysts, Nurse says. My blood work will determine whether I can began stimming tonight. If the cyst is producing estrogen I will not begin and they will see me again tomorrow to recheck things. (Estrogen has to be below 100 to begin the stimultation medicine). If my level still hasn't gone down I will have to wait until my period next month. And then if it *still* hasn't gone down they will put me on birth control to suppress it, "but with your AMH level being so low we really don't want to have to do that."

So crossing fingers "and toes," she said. The clinic will call me this afternoon to let me know which path.

***

Yay! bloodwork was all clear!

Medicine

2 Menopur morning and night

150 900 Follistim morning and night

20 microdose Lupron morning and night

--> The only thing "different" I've done this round is drink protein shakes. I know despite my efforts I am not likely getting the requisite amounts of protein.

Final Follow-Up Appointment Stats

Lining: 9.0

Right: 16, 12

Left: 20, 12, 17, 13, 20, 15

Retrieval

Dr. retrieves 7 eggs! We haven't had this many since round 1!

Day 1 Update

5 have fertilized! We have never had this many fertilize! My mom has been saying since before I even started stimming "I feel good about this round." And me, the eternal optimist, feels good about every round but maybe she is on to something! Hoping our embies are safe and warm and dividing as they should be the next day or so!! Very exciting!

Day 3 Update

The embryologist called. We are so so excited: 4 of our embryos are in good shape! 3 are 8-cell, 1 is 6-cell, and the one lagging behind is 3-cell. things can go either way. We don't have cell counts for each round but for the ones we do we have seen 8-cells make it to day 5 (and beyond! our one in the bank is an 8) and not make it to day 5. For today though we are happy and thankful and excited! Trying to be patient until our day 5 update but I can't help but think ahead to next steps of PGS testing and possible frozen transfer <3

Day 5/6 Update

!!! Two of our embryos make it to Day 5! This gives us a total of 3 Day 5 embryos for testing.

---> Even though for months we had nothing to test we talked about this scenario often.

We are going to go for it!!!!

Round 4

Medicine

300 Folistim nightly

1 Menopure nightly

Clomid: 5 pills a day (2 in the morning, 1 midday, 2 at night)

Letrizole: 2 pills a day (1 in the morning, 1 at night)

ICSI v. Natural/Standard Fertilization

I talk to the clinic about ICSI v. natural/standard fertilization. ICSI is when the lab cracks the shell of the egg and manually injects a single good looking sperm from the male's semen sample. Natural/standard is when the lab adds a drop of semen to the egg and allows fertilization to happen on its own. ICSI is the go-to when there are male fertility issues (slow or misformed sperm, for example).

There are pros and cons of the ICSI approach. The con, and what concerns me and prompts me to discuss with the clinic, is the cracking of the shell. Once the shell is cracked for ICSI the egg maturation is arrested. This means if the egg isn't fully mature at the time of retrieval it is game over for any potential embryo development. Conversely, with natural/standard fertilization even if the egg isn't fully mature its shell, left in place, provides additional time to grow and can still become a viable embryo. Almost like it gets a second chance.

In our case, male fertility isn't a major factor. Round 1 Chris's morphology (shape) was a little below standard so the lab opted for ICSI. Round 3 his morphology was borderline and they said they could have gotten away with either method but chose ICSI. Round 2 however there were no issues yet they used ICSI. So my request to the lab for this round was to please default to natural/standard unless there are clear morphology issues.

Final Follow-Up Appointment Stats

Lining: 7.9

Right: 18, 10

Left: 15, 13, 10, 10, 9, 4

Retrieval

Dr. retrieves 5 eggs.

Day 1 Update

3 have fertilized.

Day 3 Update

One embryo is dividing nicely and is where they want to see it at this stage. The second embryo is lagging behind. The third has more fragmentation than they'd like to see at this stage but is dividing on time. So sounds like maybe 1 and 2 maybes!!

I ask the embyologist how many they like to see banked before testing and she says, "Six is the sweet spot" but really it is a financial decision. Six? At the rate I'm going I'll hit monopause before I get to six.

Day 5/6 Update

One didn't make it. The other two were kept incubated and checked again on Day 6 but were still not formed enough for biopsy.

The clinic is closed in June (closes twice a year for cleaning and inspection-June and December) so I will have a forced month off.

Maybe take a little getaway....

Round 3

Acupunture

I stopped this. While certainly relaxing it didn't seem to make a bit of difference in my failed Round 2. The study I read where this was proven to help was based on treatment immediately pre and post transfer. Which if I get to that step, I will do.

Medicine

Days one through four:

225 900 Follistim each night

1 Menopur each night

4 Clomid pills each night (two at dinner, two at bed)

Day five onward:

225 900 Follistim each morning and night

1 Menopur each morning and night

No Clomid

Add Ganorelix
HCG Trigger (last stim dose is no Follistim, 4 Menopur)

Clomid causes the lining to thin. This isn't a concern in my case because we know we are not doing a fresh transfer (transer of unfrozen embryos shortly after retrieval).

The Great Ganorelix Incident of 2016

Morning shots before work. I have mixed the Follistim and Menopur and am preparing the Garorelix. How does this even happen-it falls out of my hand. Drops a few inches to the counter top and bounces on the paper towel I have laid out. What I *should have done* is open and use my last Ganorelix and just get a new one that night from the pharmacy for the next morning. But of course good ideas have a way of hiding amid a crisis. So I inspect the needle tip, decide it looks the same, wipe it with an alcohol swab, and have Chris inject me. I never look as he gives me shots. I prepare the area, point to where I want it, then look away. So I know it isn't good when I hear, "Oh God oh God oh God." I look down and I have this tiny fluidy welt. The needle didn't go all the way in and while he did inject all the medicine this is definitley not right. I immediately call the clinic, which I know doesn't open until 7am. I leave a calm message, pack up my additional Ganorelix, and head to the train. Chris and I ride to work in silence. I am so angry it is hard to hold in the tears. Like, hormonal/not like me angry. I am angry at myself for dropping the needle. I am angry at Chris for not pushing the needle in all the way. Ultimately I am angry that we may have just effed this entire cycle because everything is about timing. It turns out all is fine. The medicine went in, it dissolved. No harm done.

Trigger

Today's follow-up Nurse Rachel draws us a happy face target (: We trigger tonight, Sunday. It is the first time Chris is with me to receive the Pre-Retrieval Instructions and feel that emotional jolt-that high where you are like ok here it is, this is what we've been working for! Let's do this! (high five, chest bump)

Plus, I don't have to give myself my last round of shots!

Last Follow-Up Appointment Stats
Lining: 8.5
Right: 8, 18, 10
Left: 12, 15, 16, 18

Retrieval
Dr. retrieves 4 eggs.

Day 1 Update

Of the 4 eggs retrieved, 3 were successfully ICSI. Of the 3, one fertilized normally. They will keep their eye on the other two.

Day 3 Update

Embryologist tells us we have one "really nice" Grade A, 8-cell embryo.

Day 5 Update

Today is Mother's Day and what a gift: Our embryo made it! He/She has been biopsied and frozen. One in the bank!

Let's move to round 4!

Waiting for my period.

Round 2

I continue with acupuncture.

Medicine

150 900 Follistim each morning and night

2 Menopur each morning and night

1 Micro-dose Lupron each morning and night

1 Omnitrope (human growth hormone) each day

This round the focus is on quality rather than quantity.

Last Follow-Up Appointment Stats
Lining: 10.5 trilaminer
Right: 13, 9, 7
Left: 21, 20, 12, 11

Trigger

Nurse draws injection circle for us on my hip/behind area. Tonight's trigger shot process goes perfectly!

Retrieval

Dr retrieves 3 eggs.

Day 1 Update
One egg is mature and has fertilized

Day 3 Update
Embryo has three nuclei (extra set of chromosomes, there should only be two) and embryologist explains this is usually due to an abnormal egg. So this to me again reinforces the value of this process.

I tell them: Let's move right into Round 3.

Waiting for my period.

Round 1

Protocol

You can read here about different approaches to IVF.

Medicine

1 Menopur each morning and each night

225 of Folistim 900 each morning and each night

Add Ganorelix

HCG Trigger

First Injections

The first night of administration after laying out all our vials and needles and swabs and gauzes it takes us an hour before we actually give the first injection! In the weeks leading up to this point we had watched videos about injections. I *love* the series on youtube by Nurse Linda of the Sher Institute for Reproductive Medicine (SIRM). The drug manufacturer offers videos as well however they begin by detailed explanations of side effects which is not how I want to start this process!

I am not "good with needles." I was the one that would cradle my babied arm for a week after getting a shot. I would lie in bed awake the night before a physical worrying about the blood draw process. Like, as an adult. Getting several shots for world travel helped a bit but really it was mentally and emotionally preparing myself for IVF like, "Lady, if you're gonna pussy out over a few shots you have no business giving birth." And thus while it may seem harsh I don't have sympathy for women who complain about shots. Or frankly complain about anything in this process. Lots of blood draws, countless needles, bruising, pain, burning, endless appointments, vaginal ultrasounds-all without question bearable. Everyone is fully aware what this process entails when they begin.

(Steps off soapbox.)

So, back to the needles. A cinch (: Really and truly! I choose the belly. Chris is more nervous than I and it is adorable. After each needle he touches an alcohol pad gently to the injection site and looks up at me to make sure I'm ok. It's so sweet I can't take it <3

The first night we do not mix the Menoupur and Follistim as the nurse said give them a few times on their own to get used to it. We started mixing the next day. It looks like Gargamel's lab (: But it is a simple process and one the clinic laid out nicely for us. Why give myself an additional/unnecessary injection?

Here is how I set myself up each time. Wash hands. Two paper towels. One on the left is clean, one on the right becomes the dirty (trash at top, recycle at bottom) and I keep my sharps container right there in the corner of the dirty.

I use a new alcohol swab each to clean the top of each bottle and the tip of the Follistim pen (twice if I need to add a new cartridge). I mix the Follistim with the Menopur with the mixing needle, draw up the solution, change needle tips, remove air bubbles (I can't flick them out like Chris and the pros can it hurts my finger tips so I make my pointer finger flat and use the inside to smack it), and rest the syringe on the needle tip lid. I prepare any other medications (this photo is actually from round two which required additional meds) and similarly set them up then summon Chris. At first I used to have him next to me to cuckoo check my work as I mixed but eventually I begin to trust myself and mix alone.

Follow-ups

We go back to the clinic roughly every other day. We make our appointments as early as possible and can generally get to work without having to provide much explanation. (He has shared with his work, I have not shared with mine.) Each afternoon after the morning follow-up the clinic calls and based on the day's ultrasound and blood results says whether to adjust medication. My calls were always, "Keep on keepin on." I don't pour over the online forums but I did see some nurses will ask, when they look at the ultrasound "are you sure you are administering the shots properly?" Hahahaha so at least we didn't get that comment! 

Acupuncture

Chris points out an acupuncture brochure in the waiting room and...I make an appointment. You'd think my concern would be "does it hurt" but really I'm like hmm what should I wear? Sane and reasonable people I know swear by it and legit actual sciencey studies show it increases IVF success. Who knew!?!? They also offer on-site sessions immediately before and after transfer. Love that. I'll feel like a v.i.p. ha. If I can ever make it to that stage.

Last Follow-Up Appointment Stats
Lining:7.3 trilaminar (this means 3 layers, that is good)
Right: 8, 5
Left: 6, 14, 11, 4, maybe another 10

Trigger Shot

March 8. Based on this morning's ultrasound and bloodwork the clinic calls me gives me the news-trigger shot tonight! I am at work. I don't have any papers with me and I write down every word the nurse says. First and foremost I am to get home and administer my final set of stim shots. I am overcome by emotion when I hang up the phone and feel a combination of excitement and anxiety and I have to fight back tears. When I arrive home I facetime my mom who is my moral support for giving mySELF my last round of shots! Afterwards I feel if I can do that I can do anything!

Tonight at 10:00 pm we are to administer trigger shot. So this is the long scary no-joke needle compared to the dinky things we've been dealing with until now. Despite the clear directions from the clinic on where to inject we spend a solid 30 minutes discussing. I have everything laid out nice and organized. We pull up atomic clock on the ipad and watch the last few minutes count down. Me, waistband pulled down, leaning over the counter. Chris, needle in hand, looking, well, basically terrified.

Ok final 10 seconds. Things are growing tense ha. He is so much more worried than I and I feel badly for him! "I just don't want to hurt you," he keeps saying.

3! 2! 1! Injection!

I smell panic. I hear his hands frantically grabbing at things and little packets being ripped open. I look over my shoulder to the counter and see this haha:

Retrieval

March 10. My friend surprises me at the clinic with a bag of perfectly on-point goodies! I am beyond touched. Love you EGS sista!

Dr retrieves 7 eggs.

Day 1 Update

Five are mature and ICSI. Two fertilize.

Day 3 Update
Both are "thriving" on day 3; we have a 6-cell and an 8-cell.

Day 5 Update
Neither is viable for biopsy day 5; one is "compacting" so has not reached blastocyst stage and the other is still at the cellular stage and did not move much since day 3.

I am ok. I shed a couple of tears just because damn! I felt so good about it! God has different plans I guess.

I tell them: Let's move right into Round 2.

Waiting for my period.