This cycle was big because having done two before, it was THE determining factor with how we’d move forward. Our first cycle was ridiculously successful, although we never brought a baby home from it and it brought loss into our lives again. We had a false sense of confidence going into cycle 2. Cycle 2 tanked. So many eggs, so many fertilized, and it resulted in nothing but two 5 day poorly graded blasts which wouldn’t have made it to freezing. This cycle was the one to tip the scales. Was #1 lucky? Was #2 unlucky?

We threw the kitchen sink at our protocol. Saizen/Omnitrope, different priming, different meds, a different clinic, lab and doctor. I cleaned my diet up entirely for this determining cycle.

Well folks, the verdict is out. Cycle 1 was pure luck. Cycle 2 was unlucky, but not far off. Cycle 3….

We retrieved 14 eggs.
13 were usable/mature.
10 Fertilized
2 Embryos were frozen

We got two embryos. One day 6 4BB grade (picture perfect), and one less great embryo on day 7, a 3CB. Both usable. Not AMAZING or anything, but we have 2 shots we didn’t have before at having a bio child.

The stats (which I no longer trust, because I always end up on the wrong side of them) say that at my age (38, until tomorrow!), our 4BB has a 35% chance of live birth and our 3CB has a 25% chance. (source). I shared some info before, but here’s how it panned out in this study (it doesn’t note the day of the embryo, but day 7 tend to be less likely overall).

We haven’t decided whether we’d like to forge ahead as planned with a double transfer when the time comes, as the preparation is really extensive, but that’s a convo we will have with the doctor once we begin our priming for transfer #5.

So that’s where we’re at. We have a long-ish wait for transfer. Our clinic closes for the holidays so unless my cycle starts like yesterday, we will be looking at a 1.5-2 month transfer protocol prior on top of waiting another cycle to pass, so potentially 2-3 months to go before anything happens.

I truly hope year 39 brings more joy than sorrow. Today is my last day of 38, and I am more than ready to let this year be done, along with this stage in our journey.

In the meantime I’ll still be sharing here. Infertility doesn’t just cease to make you feel things when you’re in limbo. I also hope to share some more resources as the next month or so passes by (it also keeps me busy!).

Thanks to you all for continually checking in and following my journey. It has been the silver lining to this experience. Be sure to subscribe if you want a quick email when new posts drop!

The post Egg Retrieval #3 – The Results appeared first on .

During our last cycle the attrition went like this:

13 Retrieved -> 12 Mature -> 10 Fertilized -> 2 blasts on day 5/6.
(I have been saying 1 blast actually, because the second blast was not rated something they’d normally even keep – I think they transferred it just as a hail mary).

We did a double transfer and nothing stuck. I got my period promptly on the day of my beta, and I knew I was out of the game.

This cycle I have been flip flopping between hope and despair. I am so fucking afraid that the same thing is going to happen. Having a repeat of last time despite all the changes we’ve maid is absolutely terrifying. If it does, this is our last cycle using my eggs. We have already began the process of looking at donor eggs (I’ll share more on that process below), and reading into the complexities and ethics of gamete donation. It’s a lot. The emotions this time are massive as a result. It’s like standing on a fence post and the smallest gust of wind can throw you on one side of the fence or the other. It’s completely out of your control and has the ability to completely change the direction of your life. Scary. Ass. Shit.

So here we are. I got my fertilization results the morning after my retrieval.

14 Retrieved -> 13 Mature -> 10 Fertilized

If the number was 9, or 11, I’d probably feel good. The fact that the number was 10 just threw me for a loop. One was not mature, like last time. Fertilization rate was slightly less percentage wise. This time we used ICSI again, but my husband did a 12 hour abstinence, instead of 2-3 days as normally recommended. Lower abstinence can result in less sperm, but it can prevent DNA Fragmentation which can be a cause of embryos dying off by day 5/6 or not implanting/developing properly. We also did Zymot, which is a chip/cartridge like thing that they drop the sperm into, and the ones who make it through are deemed the most fit/normal. It is supposed to help a lot as well. Yet the fertilization rate was slightly less at 76% vs 83%. Nervvvvves. It’s small but it still gets me after all this emotional trauma of infertility. Logically, it’s fine. Emotionally, it’s scary.

I am trying to counter my emotions with logic but I just can’t this time around. I refuse to fiend toxic positivity and hope because it’s just not how I am feeling. I am readily preparing for a call tomorrow that breaks me, and also preparing to call my clinic to begin our application for donor eggs. I’ll also note my car broke down last week, and is in the shop, and I got sick after my retrieval so I am a grumpy sniffly mess over here. A grumpy, sniffly, poor mess.

The biggest thing I am grappling with right now is financials – we’re very very lucky that we can use my husband’s income to support us on a pared back lifestyle right now and use my entire income (my ENTIRE income) to support our IVF journey. However, I have used all of my income I made this year on this process, and as we stare the donor egg scenario in the face, we are left wondering when is enough, and how the hell we’re going to afford to go this route. Our mantra has been “You can always make more money”. It’s true. But it’s anxiety inducing nonetheless. If we move ahead in that direction, I’ll be borrowing from next year for the hope of a baby that isn’t even genetically mine.

I’ll update you all in the coming days whether we get anything from this cycle or not.

So let’s talk donors. A LOT of people go into donor conception as a last resort. They are so drunk on the idea of a BABY that they don’t bother looking at the complexities around donor conception. It is one effed up industry, first off. But it does allow infertile couples, LGBTQ couples, and single parents by choice the option to grow their families if adoption isn’t for them. I’ll preface by saying adoption is absolutely for me, but we’re not ready for that yet – it’s part of my long term plan though, likely regardless of the outcome of IVF – it has been since I was a child. I always said I wanted to adopt one and have one. But adoption isn’t always ethical either, nor easy, simple, best for the child. So we were faced with what path to take now at this period of our lives and the donor route is it if it comes to that. We will also do the work to prepare ourselves for adoption one day if life allows, but it’s not a cure for infertility and there’s a lot of self work that has to happen before we consider it.

Donor conception can come in a few forms. Egg donation (from a known donor, a fresh donor or a frozen donor, and either a non-ID donor or an open-ID donor), sperm donation (similarly from a known, fresh, frozen, non or open ID donor), or the even more complex embryo donation (often non-disclosure, but sometimes known/open).

In Canada, it is illegal to get paid to donate any of the above, but you can reimburse the donors expenses related to donation – this more so applies to egg donation since it entails a retrieval like I just did, down time from work, travel, etc. But it’s super hard to find donors in Canada as a result. Most of the fertility clinics work with US cryobanks, which offer Sperm, Eggs and Embryos which can be bought, essentially. They also don’t come cheap.

The purchase of donor products is complex because the banks are poorly regulated on the number of times a person can donate (guidelines exist, but I’ve seen many stories where guidelines have been ignored), it’s hard to track if a person goes to multiple banks to donate, and thus hard to control the number of offspring from a single donor (this is a negative when it comes to the donor conceived person’s opinion in many cases, as it is jarring for them to have 50+ siblings across the world with new ones popping up each time). It is also harmful for egg donation especially to do more than 6 retrievals. It can effect the person’s fertility down the road, whether they want to birth their own children or not, it can cause medical complications at a higher rate, such as OHSS, and the procedure itself comes with risks which are often downplayed. Lots of donors do so not due to altruism, but due to the financial gain so they can pay for school or their bills (many are young, around 20-25 and need the money). One bank I looked at that my clinic partners with had all donors of Russian and Ukranian descent, which I felt was not a simple coincidence given the state of affairs in those countries. I could not find any donors of other backgrounds that matched my own.

Another consideration when going the donor route is how your child will feel as they grow up, and learn of their conception story. Many children have no qualms about it (hell, I basically had a sperm donor), but some do, and you have to be prepared for this. Best practices for donor conceived people include having an open knowledge from birth of their conception (age appropriate), and it’s absolutely best if the child knows who their donor is and has the ability to find them as they grow older – much like adoption. This tends to be a challenging thing for some donor recipient parents to deal with – the possibility that their child may also see their donor as a parent, as their “bio parent” and may want to harbour that relationship. Many donor conceived children want to at least reach out for medical history (although for egg donors anyway, a detailed history is provided but of course things can change). They may inherently seek out the genetic mirroring that a bio relationship provides, and they are likely to want to know their bio siblings.

Something that comes up when you want more than one child from a donor egg or donor sperm is whether the same donor will be available for multiple cycles – if you want your child to have a full biological sibling. This is often complex as you don’t know how many batches of eggs, vials of sperm, or embryos it will take to result in a live birth. And once again, that shit is expensive!

How expensive?

Last I checked a cohort of eggs (6-7 eggs) runs around 18-21k USD. That often guarantees you either two good blastocysts or one euploid blastocyst. No guarantee they will work though. Many cryobanks offer a guaranteed plan which runs around 35k USD, but you need to qualify for this based on your medical history, lining thickness, sperm quality, etc.

Sperm is a lot cheaper, around 1100-2500 CAD depending on the bank.

Embyro donation varies, and I know less about it, but usually the embryos are leftover from other couples who did IVF to grow their families and who did not wish to discard the embryos. Your child would thus have a full biological family outside of your own, much like adoption. The complexities of adoption often apply to this form of donation or “adoption” as it can commonly be referred to.

If you have a known donor, it is important to ensure they are comfortable with the possibility of the child pursuing a relationship down the line. There would be no financial ties for the donor, but it’s absolutely possible the child may want contact. And it’s always recommended that the child knows as much about the donor as possible so they can create their own self-identity around their existence. Same goes for the donors current or potentially future children (the donor child’s siblings).

Not everyone cares about these complexities. It’s easy to shut your brain off to them when you have a dream for a family. But I urge anyone considering donor conception to sit with these things for a while, and understand that it’s not about you, it’s about the child and the donor. Always. Some questions to ask if you’re considering donor conception:

• Why did the donor donate?
• Who is benefiting from the donation?
• Are they open to a relationship/are they open ID? (realistically, with DNA testing it’s very likely even non-ID donors will eventually be found, but it’s better to know from the get go)
• What are the traits that are most important to you and why? (height, hair colour, eye colour, medical history, lineage, ethnicity, education, etc.). Do they truly matter? How will your child possibly feel looking different from you or your partner?
• How many times has the donor donated?
• How many known siblings exist?
• What is the max number of donations the clinic allows? How do they ensure this isn’t abused?
• Do you want a full bio sibling for your child?
• Do you possibly know someone who could altruistically donate to you instead of purchasing eggs, and are they fully aware of the possible ramifications of the donation? (many donors don’t want kids, so they donate their eggs, but end up having “children” who want to know them anyway).
• Will your child know other DC children or will they be the only one?
• How will you navigate things if your child feels bitterness or resentment due to donor conception? It’s hard to hear the tough stories sometimes, but listening to donor conceived people is crucial if you go down this path.

So there’s my TED talk on donor conception. We’ve grappled with all of the issues and I have sought out guidance from donor conceived people about best practices for choosing a donor, a cryobank and how to navigate this next step should it be part of our path. I’ve had a couple of close friends take this path, and it has been eye opening to say the least!

I’d love to hear of any other considerations or resources you’ve found in your own journey if donor gametes are a part of it! Here are some I have found:

Resources:
Donor Conception Canada: https://dccanada.org/
We Are Donor Conceived: https://www.wearedonorconceived.com/
Donor Sibling Registry: https://donorsiblingregistry.com/
Parents Via Egg Donation: https://www.pved.org/
Donor Conception Network UK: https://dcnetwork.org
Donor Conceived Community: https://donorconceivedcommunity.org

Some articles:
How Do Individuals Who Were Conceived Through the Use of Donor Technologies Feel About the Nature of their Conception?

Shifting to a model of donor conception that entails a communication agreement among the parents, donor, and offspring

Donor conception and children’s rights: “First, do no harm”

Starting Conversations: Donor Conception Resource List

Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3

The post Fertilization, Some Feels & Exploring Donor Conception appeared first on .

Last we left off, I had gone in for my monitoring appointment on stims day 8. Things were looking good, slow and steadily where they should be based on my previous cycles and my doctor’s expectations. The doctor had me scheduled to be back on Monday, November 20. In my previous cycles I stimmed for 11 days and 13 days, so I suspected I’d be in that range again, but with a new protocol and different meds, it was hard to say.

I went back to the clinic on Monday and things had progressed nicely.

Day 10 Follicles: 18mm, 17mm, 16mm, 15mm, 14mm, 14mm, 13mm, 13mm, 12mm, 12mm, 11mm, 11mm, 11mm, 7mm

The doctor wanted me back on Tuesday, and said it was now time to monitor me daily for progression and timing my trigger shot to mature the eggs. The next morning I had another ultrasound and measured as follows:

Day 11 Follicles: 19mm, 14mm, 14mm, 9mm, 17mm, 12mm, 15mm, 14mm, 13mm, 14mm, 15mm, 14mm, 11mm, 9mm (measurements seemed a bit funky on this day, but it’s all an estimate anyhow)

Annnd again on Wednesday Nov 22:

Day 12 Follicles: 21mm, 19mm, 19mm, 16mm, 15mm, 12mm, 13mm,, 15mm, 15mm, 16mm, 17mm, 11mm, 13mm, 18mm, 16mm, 10mm, 6mm, 5mm

On Day 12 of stims, my doctor let me know it was go time. I’d be finishing my stim meds that day, and taking my trigger shot that evening. They’d call me later in the day with a time for my shot, and I picked it up from my clinic dispensary.

A challenging part of living on an island is having to get off it to go to these big appointments like the retrieval of transfer. Especially on short notice. We booked a ferry and hotel for that following day, for our retrieval on Friday November 24.

I got my instructions for my trigger shot around 3pm in the afternoon. I was to take 3 injections (totally different from my previous protocol of 1 shot), consisting of a GnRHa and hCG. The kicker, I had to take it at 1:30am! My retrieval appointment would be Friday at 12pm approximately. Staying up that night after my 7:45am appointment that morning was no cake walk. I am normally a night owl, but when I am up earlier than normal it throws me for a loop. I did everything I could to stay awake, and finally 1:30am arrived and I took my shots.

Similar to my previous cycles, I tested the next morning to see if the trigger took, using a pregnancy test. There is was, that double pink line indicating it had worked. I packed my bags, packed up the dog for boarding, and we were off for the ferry.

When we have retrievals on the mainland, it’s recommended to book 1-2 nights in hotel, at the very minimum the night before the retrieval since it’s such a time sensitive thing. We decided to YOLO and we stayed for three nights.

My husband’s appointment for his sperm collection was at 8:30am, so he went solo and did his thing, and came back to get me. We went together to the clinic for my appointment and I went in right away to start prep for my procedure. I had never been to this particular clinic before, so it was all new to me – the processes, environment, nurses, etc. Some people had their partners there to accompany them, but I tend to want to just get it over with and not make a fuss about it, so I went in solo. My husband waited in the lobby and eventually went for a walk around the area while he waited for me.

Things were running a little behind, but I got placed in my little room, separated by a curtain, which had a chair, blanket, and my outfit for the day (this clinic lets you keep your top/socks on, and you just remove the bottoms and put on a skirt of sorts and booties for your feet). I got an Ativan, tylenol and gravol, juice and cookies, and the nurse eventually placed my IV. I waited for about an hour in a bit of a daze before they called me to head into the OR. I walked with my IV stand, and they got me in position for the procedure.

The biggest difference this time around was that the sedation was different. Quite different. It was the same meds, but a lower dosage. They warned me in advance that my previous clinic’s dosage was quite high and not the norm for them. This sedation would be more mild, I’d be more conscious and I’d feel a bit more. They prepared me for what to expect and started my medication drip.

I felt a bit woozy immediately, like I was seeing double. They placed the speculum, did what I assume was local freezing in my hooha (this hurt like a bad pinch), and then they gave it a moment and started the retrieval. Unlike my previous two cycles, I remember the whole thing and I felt it, albeit in a dull and subdued way. I experienced a few very intense cramps, similar to my biopsy the month prior (with no meds). Similar intensity, which tells me the meds took some of the edge off as I expected this procedure to hurt a lot more (it definitely does if not sedated). I remember the girl in the room next to me came back from her retrieval before I went in for mine and she was sobbing, wimpering and crying in pain. This freaked me out a bit but it did make me prepare for the worst.

The procedure wasn’t a dreamy sleep land like I felt before, it sucked frankly. But it was fast, and before I knew it the doctor was finished and I was walking back to my little curtained room. They placed what looked like a puppy pad below me when I sat down, and I experienced some spotting which I noticed after. I sat for about 30 minutes while they monitored me to make sure all was well, and waited for the results of the retrieval. For some reason they tipped me back in my chair with my feet in the air (no idea why) and I texted my husband to come meet me shortly, and they brought him back to walk out with me when I was ready to go.

Drum roll please….

My third retrieval yielded 14 eggs. This is more than my first two cycles where I got 13 each (more isn’t always better necessarily, the more you have the lower the quality can be in women of a certain age). I was pleased to hear this and was told that I’d receive a call the next day to update me on maturity and fertilization. The hunger games have now begun.

I went back to the hotel and rested for a bit, but not after gorging myself on A&W which was conveniently located in the building that my clinic was in. I took it easy for a bit, and then we decided to go for a walk since I got a surge of energy. The meds had worn off by this point and I popped a couple of tylenol in case pain started up. I felt some mild discomfort, but ended up being okay. We walked about 2km (probably not my best idea ever), went to a few record stores and grabbed a coffee before heading back to the hotel. I then proceeded to eat an entire big bag of kettle chips before nodding off to sleep. The bloating was a bit bad overnight, and I was definitely uncomfortable, but I survived and was ready to hear our results.

The post The Third IVF Egg Retrieval appeared first on .

After about a year of trying to conceive, a failed IVF transfer and a few embryos on ice, I decided to call in the experts, and by experts I mean a really reputable naturopath dealing with fertility patients. Why a naturopath and not my GP you ask? Because in my part of the universe (British Columbia, Canada), there is a health care and housing crisis and you may wait for years for a family doctor. So, Naturopath it was. Not to mention, most GPs will not support the use of supplements because they aren’t FDA or Health Canada approved or monitored for quality control – I learned this recently, apparently supplements can completely lie about what’s in them (within reason) and get away with it. Shop at your own risk.

Not everyone believes in supplements, and that’s totally fine. I don’t in a lot of cases, however in the case of my infertility, I am of the mind that it cannot harm my odds. Especially those backed by science. So here I’ll do my best (as a person who failed science in high school) to break down what science I found around taking these mysterious pills.

Currently my IVF supplement list is as follows and has come from a few sources – I have found scholarly articles and studies on some of them, my naturopath suggested others, and the book “It Starts with the Egg”, which is highly controversial, recommended a few others. I didn’t take this book as gospel by any means but it has helped break down some of the science for me.

Also note, some of these are good for pregnancy as is, or trying to conceive, while others benefit blastocyst production and the endometrium for IVF/Assisted Reproductive Technology patients.

• Daily Prenatal Vitamin (not brand specific, although I am currently taking Materna because it also contains a small amount of Iron and I need as much Iron as I can get without taking a hefty supplement (IBS be damned).
• Fish Oil/Omega 3-6-9 – I am taking 1000mg of this a day. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9308390/, https://www.fertstert.org/article/S0015-0282(19)30810-6/fulltext)
• CoQ10 in the form of the readily absorbed Ubiquinol – a very large dose during egg retrievals of 600 mg a day, split into 3 doses a day of 200mg each. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870379/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210096/)
• Active Folate – Methylated Folic Acid 1mg (also more readily absorbed than regular Folic Acid) (more so for regular pregnancy should it occur, but it could also help IVF https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172634/)
• L-Arginine – MASSIVE dose of this for egg retrieval – 6000 mg a day. It can get costly. I find the capsules to be the easiest to stomach, but you can also consider a powder supplement mixed in liquid, but it is BITTER. I mix with a ton of lemon or lime juice and water when I do the powder. I try to do capsules whenever possible though. I also try to mix this throughout the day to make it easier to handle. (https://academic.oup.com/humrep/article/14/7/1690/2913125, https://pubmed.ncbi.nlm.nih.gov/32977253/)
• Vitamin E – 400 mg (https://www.imrpress.com/journal/CEOG/48/2/10.31083/j.ceog.2021.02.2207/htm, it is also good for sperm quality (https://pubmed.ncbi.nlm.nih.gov/34671676/)
• Zinc 15-25 mg (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599883/, also good for male fertility and immune response)
• Vitamin C 1000 mg (Great for post FET https://www.longdom.org/open-access-pdfs/effect-of-post-embryo-transfer-vitamin-c-supplementation-on-the-outcome-of-invitro-fertilization.pdf, https://egyfs.journals.ekb.eg/article_170463_2d039f08729155c6101049ea92985f35.pdf)
• Women’s Probiotic – I take Renew Life Ultimate Flora Women’s Extra Care Probiotic because it has a really good mix of the flora you want for your lady bits, and it is a large dose at 50 billion. (the studies are mixed on this, but I take it as a just in case, and for my IBS and gut health. Some doctors will actually recommend a vaginal suppository of probiotics specific to the vaginal flora to help balance bacteria, mine included. This dose is a ten day of FloraSAP and it is taken before FET).
• NAC (n-acetyl-l-cysteine) 600 mg (https://egyfs.journals.ekb.eg/article_170463_2d039f08729155c6101049ea92985f35.pdf, https://www.fertstert.org/article/S0015-0282%2804%2901904-1/fulltext)
• Vitamin B12 200 mcg (https://raf.bioscientifica.com/view/journals/raf/4/3/RAF-23-0015.xml)
• Vitamin D3 2500 IU (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8969598/)
• 81mg Aspirin (low dose – NOTE – check with your doctor before taking this, and absolutely advise any medical professionals that you’re taking it as it can effect your procedures (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604627/,
  
  This is also a really good article on a number of supplements and their uses for fertility: https://academic.oup.com/humupd/article/13/2/163/661418

A caution for those taking supplements for egg retrieval and FET – consult your fertility doctor because some of these supplements should not be taken during pregnancy or in preparation for it. Some may simply have no effect, and there’s no need to take them once retrieval has been completed (or IUI!).

So there we have it, the 700 pills I take a day. I recommend doing the research yourself to decide if any of these are right for you or not. At this stage in our IVF journey I’ll take any help I can get so I was willing to use the kitchen sink approach.

The post IVF Supplements – What I am taking appeared first on .

When you go an IVF cycle, as you may know by now, Wanda becomes your friend (as in the intravaginal ultrasound wand). What people don’t always know is how often you go, what happens when you get there, and the etiquette around being in your birthday suit in a doctors office.

Today was my first monitoring appointment for cycle 3. I am at my new clinic so things are a little different, so I thought I’d share.

So far in cycle 3, I have felt a LOT of different things physically. On about day 3 of stims (I am now on day 8), I started feeling a lot of ‘movement’ in my ovaries. When I say movement, some people may have not felt this sensation before, but since my very first miscarriage, I have always felt my ovaries doing every little thing. During a normal unmedicated cycle, during IVF especially, and as the follicles grow I can feel them almost pulsating in my abdomen. It’s super bizarre. It’s like a pressure and a twinge all at once.

So the movement began. I also started getting beyond exhausted from just about nothing at all, and any sort of sudden movement or compression/twisting of my torso felt super uncomfortable. This is perfectly normal, and the clinics generally ask that you avoid any strenuous activity during stims as a result. Doing so can risk ovarian torsion, which I can’t attest to, but I does not sound like something I’d like to feel for myself.

The ovaries can reach sizes of 4-5 inches each when you stimulate them via IVF, which is why your stomach expands, your bowels decide to stop working properly, and you are sometimes in discomfort as you lead up to the retrieval.

So monitoring appointment one. I went in today on day 8. I knew my body was responding to the meds simply from how I was feeling, but you go into these appointments so blindly regardless. It’s probably best that way, because you can speculate and fixate on so much during IVF. The appointments are always super early, and today on a Saturday it was at 8am. I am NOT a morning person, so these are always painful for me.

I arrived, got called into the changing area (at my clinic it is separate from the ultrasound room), and then once I was ready got called into the monitoring room. When you do these monitoring appointments you have to undress from the waist down, and a sheet is provided to cover up with, as well as booties at this clinic so you aren’t walking around in bare feet. I laid down on a bed next to the ultrasound machine, like any other ultrasound. The only difference is the stirrups you use, and well – you can picture the rest. Hello Wanda my old friend.

At this clinic I like it a lot because they don’t keep you in the dark about what is happening and what everything looks like. There’s a giant TV on the wall and you can observe exactly what the doctor is doing as they measure your follicles. Here’s what the screen might look like:

Each of those big black orbs are follicles, and in those follicles is where your eggs hopefully reside and grow. At each monitoring appointment they take precise measurements of each follicle. Sometimes clinics will do a preliminary count of these before you begin stims. Some don’t. Mine did not.

Today things looked really really good. We found a similar number of follicles to what I am used to getting, around 16 this time (normally I have had 14, but it’s possible some duplicates exist in there due to the challenges of identifying the individual ones. The doctor measured them as I watched.

In IVF it’s imperative that you don’t develop a ‘lead’ follicle. During a regular cycle outside of IVF, your body produces many follicles, but the largest wins. The rest don’t stand a chance, and the largest becomes the egg that gets released that cycle. The rest of the follicles change after ovulation to produce hormones to support a potential pregnancy. When we do IVF, we want all of the follicles to grow at a similar rate for ideal retrieval of similarly sized mature eggs. Usually one tries to take over but certain meds keep them growing steadily. Sometimes it takes a few tries to avoid a lead follicle. In the past, my lead follicles haven’t jumped too far ahead and haven’t hindered the overall collection of eggs. But what they can do is hinder egg quality. So slow and steady wins the race with IVF.

Today on day 8 of stims my follicle count was 16, and my follicles ranged in these sizes (in mm): 14, 13, 13, 13, 11, 11, 10, 10, 10, 9, 9, 9, 9, 8, 8, 8

In previous cycles by now I have had follicles 16-18mm with others as low as 5-6mm. My doctor seemed super pleased with this result today, as it showed I am responding to the meds in the way he had hoped, and they are slow and steady. Our hope is that keeping things even keel will help in our egg quality.

When I go in for these appointments I try to remind myself to hold back on talking too much during the measurements, because I can imagine keeping track of all the follicles – if you have more than a few growing (and it’s not always a numbers game, sometimes fewer follicles and eggs is better for quality) – can be frustrating for the doctors and nurses. Our doctor luckily gives us the time and space to ask questions once we finish up.

I got dressed and picked up my additional meds at the dispensary within the clinic. Ours dispenses enough medications for 9 days of stims, then goes from there day by day so you don’t over purchase medications. They aren’t cheap, averaging about $700+ Canadian Dollars a day (and of course most insurance does not cover fertility meds).

I skipped back to my car, happy that the different meds and protocol still yielded some good looking follicles. So much is still unknown, and that’s the hardest part of the journey. Whether they will continue to grow on track, whether they will be mature once retrieved, whether they will fertilize and whether they will reach blastocyst stage. Each step gets you closer to your baby, but the waits feel excruciating and the lack of control can be discouraging.

I head back on Monday for my next monitoring appointment, usually spaced just 1-2 days apart in case any big jumps in growth occur. Fingers crossed we stay on course!

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I started my stims on Saturday Nov 11th for our third egg retrieval. I joked last cycle that I could do egg retrieval stims forever, I just hated transfers. But then we had a cycle failure, and now it all feels a lot more stressful to endure with the knowledge that it very well could fail again.

“Think positive thoughts!” they say. I have tried my friends, oh have I tried. I do have hope, but it’s not blind. It’s realism with a sprinkle of hope. Annnd maybe a sprinkle of pessimism at times. But I swear I try to keep it skewed towards hope.

The thing that surprises me about this attempt is that I am in it, but it doesn’t feel like I am in it. I guess I have gotten slightly desensitized to the act of injecting myself multiple times a day, and I have gotten so used to being on this rollercoaster that it all just feels normal to me. That is a bit sad to think about. I never wanted this to be my normal.

So far the medications this cycle have been tolerable. My priming meds had zero side effects, which is WONDERFUL, because I had primed with birth control previously (this time testosterone and estrogen), and birth control is my nemesis. It did such a number on my mood and thoughts. I felt depressed and moody constantly. I felt normal, maybe even better than normal on this new combo. I stopped my priming meds on November 7 and began my stims on Nov 11.

Stims so far have been… okay. This time I have to take injections in the AM and PM (diff meds). Right now, one injection in the morning, along with 5 pills, and then supplements (19) mid day, and another two injections and 2 pills before bed. I felt great day 1-2. Day 3 I started to get fatigued and also got really stomach sick (could have been IBS, but it hasn’t been bad lately so not totally sure). It sure beats constipation though, which I know is on its way. Day 4 (today) I have been wiped of energy entirely. Just tanked. Walking the dog was a feat and I was yawning all day.

There are a few things/rituals I am doing this cycle. I figured I’d share my routine here in case it helps anyone on their own journey.

– I am taking 8 million supplements (I’ll do a deep dive into these in my next post). I will mention that my doctor has me on CoQ10 (Ubiquinol 600mg a day, taken 3x daily, and 2x 81mg Aspirin – not recommended unless your doctor directs you)
– I have been doing acupuncture with a fertility specific practitioner who also did IVF herself, initially weekly during priming, and now twice weekly during my stim protocol. Some people doubt the effectiveness of acupuncture since it doesn’t give super immediate or visible results, but studies have shown it can help with blood flow to the uterus, and it has benefited those doing embryo transfers (some studies below).
– Exercise – I have been *trying* to do a minimum of 20-30 mins of low intensity exercise daily. Whether I am working my butt off at a photo session, or walking the dog on a brisk walk, having the goal helps. This also gets the blood flowing.
– My acupuncturist (actually, her alternate who I booked during her time away) suggested doing a hot foot bath in the evening, covering up to your lower calf with hot water for 10-15 mins, then laying down and elevating the legs above the chest/head for 10-15 mins. Apparently in Chinese medicine this can be shown to help with blood flow and getting fluids moving through your body/liver. It also helps with sleep!
– Fluids – Lots of them. I am notorious for not getting thirsty but during stims I have to be careful with my liquid intake, or I’ll get suuuuuper constipated. More on the in the next point.
– Fibre. So much fibre. I try to add things that are bulking agents to my diet during stims, whether its psyllium husk, or more nutritionally dense things like chia seeds, hemp seeds (this combo always gets things moving along), peas, etc. It’s better to have soluble fibre or bulking nutrient rich foods than things like colace, restoralax or similar. Pro tip – start fibre long before you *need* it. Even with my regimen I still get painfully backed up by retrieval time.
– Sleep – Sleep as much as humanly possible. I sleep a lot anyway. I have always been this way, requiring 8-9 hours minimum a night – during stims I sleep 9-10 ideally.

So my schedule has basically been monopolized with all of these tasks each day. If I am lucky I have time to go to the bathroom or get some work done (jokes, but it feels this way some days). It makes me wonder how so many people do it. I am grateful I make my own schedule and have nobody to answer to but myself and my clients (who are the best for the record).

What are your rituals/habits for Egg Retrieval in IVF? I’d love to hear them!

Acupuncture studies for IVF and FET:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458185/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142313/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918533/

The post Deja Vu: Egg Retrieval Prep #3 appeared first on .

What did you decide to do if you’ve gone this route? How did you make that decision?

Many important convos will be had this week as we make this choice for the third time. Last time we didn’t have any embryos to freeze, so the choice turned out to be correct for us (saved us some money this way, as you have to pay up front for the PGT cycle vs not, on top of the fee per embryo at our clinic). This time, on a different protocol I really have no idea what the right choice will be.

Here’s some of the info I have found which I’ll dump on you all so you can make informed choices. For every study for, there’s a study against. (actually for every “for, there were 2+ against, despite PGT-A being so popular in North American clinics).

Studies against:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607878/
https://www.statnews.com/2021/11/26/ivf-pregnancy-pgta-genetic-testing/
https://academic.oup.com/humupd/article-pdf/29/3/291/50276439/dmad001.pdf
https://brieflands.com/articles/zjrms-121265

According to an analysis by Kemper, Wang, Rolnik, Mol:

“The biopsy may inflict direct damage on the embryo; the results of the biopsy, namely false positives and negatives, may be an indirect avenue of ‘damage’ to the embryo, or may reflect differences in the molecular technique utilized. Furthermore, examination of the results of only the first embryo transfer is likely to cover both indirect and direct forms of harm, as there is likely to be an increase in pregnancy rates due to the better selection of embryos. If the first embryo transferred is successful, then perhaps these harms are mitigated for the patient, but this relies on a relatively small first transfer success rate.

Mosaicism (the presence of two or more different sets of genetic material within the same embryo) may lead to potentially good quality embryos being discarded; by this mechanism, PGT-A actually removes these potentially viable embryos, whereas morphological assessment alone would allow these embryos the chance to produce an ongoing pregnancy. The reporting of embryos with a PGT-A plot falling in the mosaic range continues to be an issue, not because of the mosaicism per se, but due to the absence of solid unbiased evidence to counsel couples on the nature and destiny of these embryos. A mosaic result may be irrelevant, being confined to the placenta, or may represent true foetal mosaicism, with various degrees of clinical manifestations and significance (Kemper et al., 2019b; Popovic et al., 2020). This nuance is missed when analysing only the first embryo transfer; the first embryo will likely have the highest ‘purity’ and may well not be mosaic; it is only when cumulative rates are analysed that the potential impact of mosaicism is revealed.”

Studies for: (I’ll admit these were harder to find… if anyone has any to share, feel free in the comments)
This one shows no benefit for younger IVF patients, but positive benefits for older patients:
https://jamanetwork.com/journals/jama/article-abstract/2790646
https://www.frontiersin.org/articles/10.3389/fendo.2023.1020055/full

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We decided after our biopsy cycle to move ahead as soon as possible. On Oct 3 we began to plan for a new Egg Retrieval with our new clinic. One hail Mary to see if we can create embryos again, this time on a different protocol altogether.

So far we have sank tens of thousands of dollars into this endeavour. It’s like playing the lottery, but not knowing if there’s actually a prize to be won or not. I have counted many things I could have spend my money on, but didn’t. Many experiences I have not had or had to forgo because of treatment and the dream of bringing home a baby of our own one day. It puts me in a bit of an ethical dilemma every time we forge ahead and put more investment into this. This money could be spent in a lot of ways, either on our future or by using it to help others. For now, we have made the decision that this is still important to us, and although sometimes we feel guilty about using our funds this way, I know people who toss their money out the window in worse ways, so that gives me a bit of peace in the decision. (for those wondering, 3 cycles will put us at about 70k CAD without any transfers – bye to my salary for a year).

Egg Retrieval 3.

As soon as I got a bleed from my mock cycle, about 3 days before I stopped the medication, I called the clinic for my cycle day 1 (CD1). Just like that I was on another adventure. The nurse immediately faxed my prescription to my pharmacy and we were off to the races.

This time I am set to do priming for 35 days. A mix of Androgel (testosterone) and Estradiol, followed by a week of provera to induce a period. I am currently on day 26 of this priming.

On October 31 I head into the clinic for injection training (not that I need it at this point, but it’s protocol), and to pick up my stim medications. I’m scheduled to start those on November 11, the day I begin my Christmas mini sessions of all things (hah!). Last year I also had to do stims during my mini sessions. I was SO bloated and so exhausted. This time it’s just day one of stims so hopefully I’ll feel fine for a few days before the side effects kick in full force and the bloating begins.

My protocol for Egg Retrieval #3 is as follows:

Day 1-5

• Aspirin 81mg mg, Take two tablets of Asprin 81mg daily, for a total of 162mg.
  Saizen Inject 0.5 mL (1 mg) subcutaneously
• Rekovelle 12.00 mcg subcutaneously
• Menopur 225 IU subcutaneously

Day 6+

• Cetrotide 0.25 mg subcutaneously
• Rekovelle 12.00 mcg subcutaneously

Trigger day (TBD)

• Dual trigger TBD dosage

The medication types are similar to retrieval 1 & 2 but the priming, constitutions and dosage differs quite a bit.

Technicalities aside, I am somehow feeling hope again. I think nearly a year of trying to conceive naturally and coping with the ups and downs of testing, to be let down again and again, has set me up to be able to handle the emotions of IVF – it isn’t the case for everyone, but I somehow have been able to compartmentalize this part of my life and hold my grief and frustration simultaneously with hope. One day, maybe that won’t be the case. It does get harder each time we have a loss or a failure, but over time our path becomes more clear and as we get more answers and results (or lack thereof), I think we will begin to feel confident in the directions we are taking.

IVF has been a very reactionary process. As much as I’d love to plan ahead and say “I will only do X number of retrievals, put $X into this”, you truly don’t know until you’re faced with that very moment and the emotions that come with it. As logical as you want to be, the hope for your future, the vision you have for your life, the person you become through the process (and god has this process changed me) will dictate those next steps as you reach those individual markers or decisions in your journey.

Today, the way I feel is that if this cycle fails we may try the donor egg route, which is a whole other path and life for us if that’s where we end up. But that’s something we will only know when the time comes to make the call. It will also be a hard route, knowing I’ll have to grieve the loss of my own fertility (if it was ever there to begin with, who knows). The loss of a biological connection, the loss of a stage of my life. But I am so damn ready to enter the next stage. A stage that doesn’t involve endless limbo with my body failing me.

So for now I’ll stay in the realm of hope. I’ll do everything in my power to make this cycle count and to give it my best shot, because that’s all we can do when these things are so very out of our control.

The post A new plan appeared first on .

I went into stims with enthusiasm and I brought that same vibe to my second egg retrieval. I basically hopped and skipped into that procedure, knowing what to expect now. I had the same number of follicles as last time, similar sizes and I was on a so-called miracle drug called saizen/omnitrope which I was sure would bode well for us given our previous outcome). We just needed a bit better quality and we’d be golden.

As before, my husband dropped me off, waiting with me until it was my turn to go into the procedure area. He stuck around for his part, did the job and left. I took my ativan since I’d be having another IV placed. I was in a nice daze as I awaited the okay to head into the operating room. Things were light and easy this time. My nerves were low, and we chatted about the hoopla of the Taylor Swift Eras tour, even getting the doctor in on the chatter. It was another doctor I hadn’t met before. But all was well. I was ready to do the damn thing.

I faded out a bit – didn’t quite fall asleep, but remember time warping slightly and we were done (thanks meds!). They walked me out and the embryologist came shortly after to give me my news.

We had 13 eggs retrieved (same as last time!), 12 were mature and would be fertilized using ICSI. I was over the moon.

I received a call the next day at 8am sharp. Out of the 12 mature eggs, 10 fertilized normally.

Looking back, I felt a little sad about this. Our first cycle just 9 months earlier was:

13 retrieved, 13 mature, 13 fertilized, 7 made it to blast on day 5/6. I was still super hopeful. Quality over quantity I kept saying! Our first cycle yielded just the two normal embryos after testing, so I wanted this cycle to be better quality even if it meant fewer embryos.

The wait until day 4 after transfer was painful, but we had friends visiting and I took every opportunity to enjoy myself. We went to a music festival two days after my retrieval. We celebrated my best friends birthday. We came home and I caught up on work. Doing a retrieval mid wedding season is no joke!

Day 4 I got a call. We had embryos!!! I’d be heading back for a fresh transfer that next day. I booked the ferry, we left at 6am and we’re ready to meet our embryos! This time we had planned to transfer two, in lieu of testing. Due to the added cost, we didn’t want to bother and discard anything. We decided each untested transfer would be a double transfer.

I arrived at the clinic with so much excitement. I was so damn ready. So damn positive. My husband donned his hazmat suit and I changed into my hospital attire. We were sent to the little waiting room we’d been in countless times before and we sat for a bit and waited for the embryologist to come give us a report before we did the transfer.

After about ten minutes she entered. She was so hard to understand, with a very thick Eastern European accent. I had to clarify a few things because it was hard to hear every word. She told us we were ready to go, and we’d be transferring 2 embryos – a 3BA and a 2AB….

Say what? I was confused. Last time we had a myriad of 4-5s (further along basically I’m growth with more cells), and some AAs. These were the two they wanted to transfer? She said yes, and proceeded to tell us how the others were doing. I barely understood her, but from what I gathered, a few were growing normally, just behind, and the others were trying to catch up.

Okay… so we had two, and that’s all we knew so far. Last time we had 6 full on blastocysts by this stage on day 5. I was worried.

While my legs were splayed and my drapery open, I asked the doctor if we should transfer two after all given this news. What if they were our only shot? She assured me that embryos do much better in our bodies than in the lab, so yes we should! (I found out later that the 2BA was something they wouldn’t even normally freeze, so this is likely why she urged us to transfer).

We went ahead with the transfer but the mood had changed. I was scared. Another 20 thousand dollars was on the line. I was told to stay hopeful, to keep positive. We had two embryos on board and that’s all that mattered. We travelled home immediately after the transfer – went to the ferry early and waited. I had a slice of pizza and an egg salad sandwich for dinner.

The next morning at around 9am I got the final call. Day 6 report. None of our embryos had made it. None. Not one. It was the same embryologist who delivered the news the day before. Her bedside manner was lacking, the way the news that we lost everything except the two embryos in me came across was appalling to be honest. She said “they are all discarded, ok? Anything else?” when I asked for clarification. I held back tears.

I hung up the phone and texted my husband from bed. I couldn’t handle speaking the words out loud. He came rushing into the bedroom and found me sobbing in a puddle of tears. I was hysterical. I couldn’t stop crying. My world stopped in that moment. Hearing every single embryo had either arrested or was such poor quality that they couldn’t be frozen was one of the most upsetting moments in my life to date. This moment was harder than the miscarriage news. It was almost as hard as hearing my little sister died in a car crash, over the phone nearly ten years prior (that one takes the cake). It broke me in some deep way. All the hope. All the positivity. All the parts of my that had convinced myself that I deserved a family of my own were fractured into a million shards. I began to spiral, and I wondered why me. Why the hell couldn’t I just have anything without fighting so damn hard for it and suffering so much over it.

I’d love to say this had some silver lining, but for once it just didn’t. Maybe that’s why it hurt so unimaginably.

People kept saying “but you still have two!”, “be positive for those embryos inside you!”. I couldn’t. I was convinced it was over.

We waited 8 more days until our beta test. To be honest though, I tested every damn day from my transfer onward. I did a HCG trigger again, like the first retrieval. So my tests were positive for many days. I wanted to test that trigger out. The tests got lighter almost every day, until they didn’t. They kind of went stagnant, with a faint little pink line for about 4 days straight. It was beta time and I actually thought, despite my pessimism that I might be pregnant. That they were slow to grow and probably slow to implant. I went for my beta and I got my results.

<1. I was not pregnant.

20k. 8 weeks of my life. Pain. Bloating. Excruciating waiting. For nothing. Absolutely nothing.

It was September 2. We had been trying for 1 year and 9 months with nothing but heartache and loss.

I called my clinic to make a follow up appointment with my doctor to find out how, why… they couldn’t get me in for a phone call for 6 weeks. 6 WEEKS. 6 weeks to ponder my failure, 6 weeks in the dark. 6 weeks of doing nothing to move forward. They didn’t seem to see the problem with this. They had made their money and that’s all that mattered to them.

I made a very crucial decision that day. I decided to leave my clinic. The clinic where I only ever spoke to my doctor 4 times in over a year. The clinic that screwed up and gave me someone else’s PGTA results and all their personal information. The clinic who I had to babysit at every damn turn. We only have two clinics regionally where we live, and I decided I was burning the bridge and jumping ship. Nothing can change if you do the same old things over and over. I wasn’t about to risk more money down the drain, it was mother effing go time. I wasn’t getting any younger.

Exactly 3 months before my 39th birthday I got my period and I got myself a new doctor.

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Now, imagine doing that with a day job, trying to hide the procedure and diagnosis or fact that you’re even trying to conceive from your judgy employer. Nope nope nope.

I booked my last transfer and NYC trip around my 3 month probation at my day job. That job I got so I could get maternity leave like any other normal human Canadian being. Those of you who don’t know me personally, I’m a wedding and portrait photographer. Self employment isn’t kind to pregnancy or leave.

I arrived in NYC and stewed in my thoughts for a few days, while trying to be peppy and make the most of my trip at the same time. IVF has taught me that it’s entirely possible to feel multiple conflicting emotions at the same time. Excitement and disappointment. Happiness and bitterness. Joy and sorrow. You almost start to compartmentalize it in a way. Observing the feelings from the outside. Like when your best friends get pregnant with twins on their first cycle while you’ve had losses upon losses. You feel ecstatic for them. But you also love hate them a little bit too. It’s entirely possible to feel the emotions at the same time and to genuinely be happy for others while grieving yourself.

A few days into my trip I decided that dealing with an incompetent boss who pushed professional boundaries about asking about medical stuff wasn’t worth the stress it was bringing to my situation. Maternity leave or not. Who the hell knew when we’d have success again. I couldn’t stick it out with no end in sight. What seemed like a hopeful career path and dream job for working my way up in a new field turned into feeling stuck, stagnant and bitter. I emailed my boss and told him I wouldn’t be returning. I emailed his bosses and told them why. I felt free for the first time in a long time. Free from the burdens of IVF and from the burdens of a job I hated. Free to live in the moment for the first time in ages.

This trip rejuvenated me in a way. It gave me the space and time to decide on our next steps.

When we started IVF we said we’d only do one cycle. Whatever we got, we got. Then we’d look at alternate options. Like many things in life, we didn’t know how we’d feel until we were faced with the decision of what came next. It wasn’t our last cycle.

We got home and due to my job as a wedding photographer I looked at the calendar. My job is one that I can’t just call in sick to, or allow life to just happen around. I plan my life 12-18 months in advance, down to the day. It was June and if we did another cycle, and another transfer (always the “what if this time it sticks?!”) it would put me being due in May – the beginning of my summer season the following year. I had already booked a few gigs for 2024 and I needed to do what I could to pay the bills – keeping my age in mind.

I assumed we’d have the same success the second time as the first. We’d have a few embryos to work with, so if we waited until August (when I had a lull in my schedule) for our cycle start, we’d surely be set up for a 2024 baby that wouldn’t interfere with my job. So we decided. We’d wait until my July cycle start to begin our protocol again. Same clinic, same protocol as cycle 1 with the addition of Saizen/Omnitrope as a primer alongside birth control.

We tried naturally that in between cycle with timed intercourse but alas it did not work. My cycle came and we were once again on our way. This time with no burden of a day job, with a month and a half break under our belt, some relaxation (see guys, I relaxed, it didn’t work!), and with fresh hope.

On August 3rd, 2023 I started my stim injections once again. I had a AFC (Amtrak follicle count, a pre count of your follicles before stims) taken prior, with 6-7 follicles visible (the same as last cycle). I started taking Gonal F 300, Menopur 150, Orgalutran .25, plus Saizen .1ml a day. Daily injections, taken around 10pm at night. This time, there was no fear of the needles. Every part of my being wanted to get shit done. I was ready for this. Readier than I have ever been. Each night I eagerly did my stims awaiting the day of our next ultrasound.

After 3 ultrasounds I was told my follicles were slow growing. My first cycle, I stimmed for 11 days total. When 11 days neared. They kept pushing me further. My follicles were growing, steadily, but slowly. This meant more meds, more money (about $650 a day per extra day), and more appointments. On day 13 they finally told me I was ready. I’d trigger on day 14, and my retrieval would be on August 18.

I took my HCG trigger at 8:30pm, 36 hours before my retrieval, this time 10,000 IU instead of the 7500 IU last cycle. I scrambled to book ferries and hotels. We had planned for every possible date within the 3-4 dates they quoted originally, booking countless ferry reservations and hotels, but with my delay we had to cancel them all and struggled to find a ferry that would get us there in time. Summer ferries are no joke. We had friends in town so had to shift accommodations as well to fit us all. This stuff just never goes as planned.

I waddled my way into the Airbnb around 10pm the night before the retrieval, the earliest we could get there. I tucked myself into the hardest bed I’ve ever slept on and tried to rest up for my procedure the next day. I could barely roll over I was so bloated. I didn’t know, but during stimulation your ovaries can grow to the size of grapefruits and beyond. I didn’t even have a large number of follicles – pretty average actually around 14. I couldn’t wait to get these eggies out and fertilized and to get back to being able to wear actual pants and not just leggings.

The things we do for love.

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