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.

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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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We tried ‘naturally’ for 11 months with one chemical pregnancy. When it came time for us to start IVF the feelings were bittersweet. On one hand we both felt so defeated and mad that we had waited so long to make the decision we had to try at all, and then angry that what other people get for free was going to cost us 20k+. On the other hand it felt very much like go time. We felt a bit more productive, but we still really had no clue what IVF entailed and what to expect.

I started out with a clinic that had a local office where I live. I didn’t know much about anything to be honest, and I trusted that my doctors and my nurses would guide me through the process.

I learned really fast that there would be no hand holding.

I got a phone consult with my doctor, and super quick monitoring appointments in the clinic. A crash course on meds and injections via zoom, and was left to my own devices.

I didn’t know what I didn’t know.

There were some things I wish had been explained to me in more detail. A few questions that arose were:

• What do each of the meds actually do?
• What are the stages of an IVF cycle?
• How long does a cycle actually take?
• Why did my doctor choose the protocol they did for me specifically?
• Should I be doing anything else to improve my chances?
• What are the risks?

None of this was provided by my clinic, so I started to seek out online forums on social platforms to ask these questions and get the lay of the land. I used Reddit, Facebook, Instagram and a few popular baby making apps. Soon, I realized there was a lot more to IVF that I wasn’t aware of. What I thought was an exact science was far from it. I’ll do my best as I write here to explain this stuff in case anyone new to IVF needs some insight.

There are a few stages of an IVF cycle.

• Birth control pills, estrogen or other hormones. Before you start IVF treatment, your doctor prescribes meds for ‘priming’. This can be anywhere from a couple of weeks to over a month or more.
• Ovarian stimulation, which this includes the dreaded injections (this lasts 8-15 days on average). During this stage your ovaries over produce eggs with the help of very strong hormones.
• Egg retrieval. This is where they extract the eggs you’ve grown, using a transvaginal ultrasound with a long needle attached. You’ll usually be sedated for this, but the type of sedation varies depending on where your clinic is located. You’ll find out the number of eggs retrieved that day.
• Fertilization is when they take your sperm sample and create the embryos. This can happen via standard IVF where they put a bunch of sperm into a petri dish with sperm and let them have at it. ICSI is another common form of fertilization where they inject the eggs with one individual sperm. You’ll usually be told the day after your retrieval how many fertilized. It’s common for not all eggs to fertilize.
• Embryo development happens over the course of 5-7 days after fertilization. It occurs in the lab, and usually no updates are given until day 5-6. The wait is painful.
• Embryo transfer occurs either on day 5 after retrieval if you have embryos that have met the blastocyst stage (a certain number of cells, shape, etc., or for others, all the embryos are frozen during a process called vitrification. Some may be biopsied before freezing for genetic testing for abnormalities. The transfer would then occur at a later date after thawing the embryos in the lab.
• Pregnancy…. that’s the goal anyway.
• Pregnancy Support is often needed with IVF, which includes taking progesterone and sometimes estrogen up to 10-12 weeks of pregnancy.

You’d think the clinic would tell us this, but they did not. We took it day by day learning as we went.

We started with a Saline Sonogram – a process where they insert a catheter through your cervix into your uterus, then pump saline solution into the uterine cavity to investigate it’s structure and rule out abnormalities. We then began our medications in November – beginning with birth control priming (more so to time the cycle to the clinic’s schedule). I started my stimulation meds (from here on referred to as Stims) on November 22.

I forgot to add that I am terrified of needles. Bloodwork makes me cringe, I fainted during an IV placement years ago, and am forever paranoid it will happen again.

Some couples have the partner do the injections, because it includes them in the process and they can look away. I am too much of a control freak to allow someone else to poke me if I can help it, so I did the injections myself. You do these injections generally in your belly, in a ring around your belly button while pinching the skin/fat.

I started on what is referred to as an Antagonist Protocol (never did learn why!), and was put on a dose of Gonal-F 300 IU, Menopur 150 IU, and Orgalutran .25mg. This is considered a fairly high dose due to my age. A few things I learned after starting stims:

• Stims are effing expensive (with no insurance coverage my Stims meds cost approx $10k CAD on top of my cycle cost for 11 days).
• Ice packs are your friend. 10 mins before and 5 mins after.
• Giving injections to yourself is scarier looking than it is in practice. I was TERRIFIED. After 3 days I was fine and could do it like a pro.
• When you start stims, giving an extra 30 minutes to prepare everything helps. Watching an injection video while doing the injections initially also helps (youtube is fine). It helps you follow along with the steps, including jabbing yourself.
• Some meds go in the fridge and some don’t. Making a list of steps helps you make sure you don’t mess up dosing or accidentally refrigerating something that isn’t meant to be cold.
• The timing is really specific. If you’re considering doing IVF and have a busy life with many obligations, it can be a big adjustment. Some meds happen in the AM while others happen mid day or at night. I did all of my first cycle of meds around 5:30pm because it worked for me at the time.

At the end of stims they make you take what is called a “Trigger Shot”. It’s one final shot which is timed exactly (!!!) 36 hours before your retrieval appointment.

With an antagonist protocol, here’s what the meds actually do:

Gonal-F (Rekovelle works the same), Menopur: Stimulate the ovaries and follicles to produce more than one egg at a time.
Orgalutran/ganirelix: Prevents ovulation of those eggs. If they ovulate, your cycle can be cancelled.
Trigger: Causes the eggs to “mature” in preparation to be retrieved. Mature eggs are the only eggs used for fertilization.

One thing they didn’t tell us is that if you have a hCG trigger, you can do a pregnancy test to confirm the trigger took. The trigger will show up the same as the pregnancy hormone will on the tests, so this provided a little bit of added peace of mind. This will only work with this type of trigger though, so caution against doing it with other types.

So we did our trigger at 8:00pm on December 3, one day after my 38th birthday and awaited the egg retrieval to follow on December 5 at 8am. I triggered and had one day reprieve from my injections in between as I prepared myself for the egg retrieval.

Our retrieval was to take place in a different city, since our clinic was a small satellite clinic of the main location, so we hopped on a ferry that next day, checked into our hotel and binged bad cable TV. I was bloated, uncomfortable, but so ready to get this part over with.

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