Friday, December 30, 2005


The rest of the (IVF) story

Yesterday, I told you the long and raw back-story to our infertility struggles. The good news is, today’s story is a lot less painful to read. And it has a happy ending!

Now that I’ve blown the suspense…

We started our first IVF cycle in May of 2001. In addition to ramping up the dose of follicle stimulating hormones, there was an additional week of self-injection to 'suppress' my own hormonal system, giving the clinic complete control over my body's reproductive cues.

When we first considered artificial reproductive technologies, the idea of the self-injections terrified me. I'm not afraid of needles per se, but I was very squeamish at the idea of doing the injections myself. I never could work up the courage to inject into my belly, but I did become a pro at finding the perfect spot on my thigh to inject. To this day, the smell of alcohol wipes brings me instantly back to our treatment days.

And let me interrupt myself to explain that even beyond the emotional turmoil that goes with infertility treatments, it is nearly impossible to have a normal life during an IVF cycle. You have to be at the clinic first thing in the morning to get blood work and an ultrasound done. (Finding a parking spot is hell. Getting to work even remotely close to on time is impossible.) Then you are on tenterhooks all day, waiting for the results. (The nurses used to laugh at me. They'd call and say, "It looks good, we'll see you in two days." And I'd say, "How many follicles? What were their measurements? What was the exact estradiol count?" And I'd obsessively chart everything on an Excel spreadsheet saved in the same file as all my temperature charting from the old days.) You have to be home every day around dinner time to do your injections, or take them with you. (Post for another day = funny places you've done your injections. My winner? Bathroom stall of Taco Bell.) And you have no idea when your retrieval will actually be. Maybe in six days, maybe in eight. We'll see. Probably in two days, but maybe three. As you can see, IVF is neither for the faint of heart nor for the control freak.

I figured that after two cycles of monitoring my response to injectible gonadotropins through the IUIs, the clinic would have a pretty good idea of what to expect from my ovaries. Apparently not. The ‘ideal’ cycle produces somewhere between four and eight high-quality eggs, according to our reproductive endocrinologist. As we got closer and closer to the date of egg retrieval, ultrasounds showed my ovaries filled to near-bursting with ten, then twenty, then thirty ova. I produced so many eggs that my estradiol (estrogen) levels skyrocketed and they had to ‘coast’ me for four days without stims, hoping the levels would drop a bit before retrieval.

When they finally did the retrieval in mid-June of 2001, I expected to be facing a surplus of embryos from my multitude of eggs. Due to the poor quality of Beloved’s sperm, the clinic employed the specialized technique known as ICSI, where one sperm is microinjected into an egg – which, of course, cost us an extra $1000 or two. I was badly shaken when we got the call later that day to tell us only ten eggs were viable and even more upset when we found out later only three embryos had survived to the end of the first day.

Three days later, we were back in the clinic to have the embryos transferred back to my uterus. Because of my relatively young age (almost 31) and fertility history, the clinic would only transfer two of the three embryos and agreed to cryo-preserve the third. With my two ‘babies’ tucked safely back where they belong, Beloved and I went out to lunch on our favourite patio and began the hellish time known in fertility circles as ‘the two week wait.’

In the time leading up to my cycle, I had become a regular on the IVF Connections bulletin boards. The mythology of the time advocated eating pineapple during the two-week wait, because the enzyme bromelain was supposed to improve the odds of implantation. (Other mythology revolved around the presence of bubbles in your urine, if I remember correctly. Only when you’ve been there can you imagine how desperate you become to find some order in the randomness that is infertility.) So, in those two weeks, I ate enough fresh pineapple to shred the inside of my mouth.

Ten days after my transfer, I woke up feeling loagy, like I had a flu. I ended up going back to bed, which was very rare for me. By late afternoon, I was feeling so bloated and uncomfortable that I was having trouble drawing a deep breath. I called the fertility clinic to check in and the doctor on call told me to meet him in the emergency room in half an hour.

I had developed ovarian hyperstimulation syndrome (OHSS), a common but potentially dangerous reaction to the extremely high levels of estradiol from the many follicles I produced. OHSS causes fluids from the bloodstream to leak into the abdominal cavity, which causes the bloating and breathing difficulties, and in severe cases can lead to kidney shut down and blood clotting. My case happened to be fairly mild (Nancy documented her hospital stay from OHSS on her blog) and I was told I could go home after a few hours, but would have to go back to the clinic every day for monitoring.

I was on my way out of the ER when the doctor stopped me and told me that in addition to the other blood tests he had ordered, he had requested a pregnancy test. He told me he was confident that the results would come back positive, but it may yet be several hours. Did we mind if the call came late in the evening to confirm? I'm surprised anybody but dogs could understand my supersonic squeal of assent.

Turns out not only was I pregnant, I was very pregnant. My levels of hCG, the 'pregnancy hormone', were very high for only nine days after transfer. So then came another hellish wait for the first ultrasound, populated by daily and then every-second-day visits to the clinic to monitor the OHSS. When we finally had our first ultrasound, I had been conditioned to expect more bad news. I was convinced the baby would either be lost, or ectopic. Turns out I was wrong.

Both babies were fine. Both. Both embryos had taken, and I was pregnant with twins.

I was in love with the idea of having twins. My father was a twin, his father was a twin, my mother's father was a twin. Two babies, an instant family. I loved the idea.

Our elation was short-lived. Two and a half weeks later, we went back for a follow-up ultrasound, and they couldn't find the heartbeat of the second baby. We had lost one of the babies at 9 1/2 weeks.

It was really a hellish ride. We still had one baby who seemed to be thriving and on target, and yet we had lost another. People didn't seem to understand why I mourned this lost baby almost as deeply as the one I had miscarried the previous year. And of course, I was sick with worry for the surviving baby.

But don't let me paint too morose a picture here. I was thrilled to be pregnant, and pregnancy treated me well. And through it all, I never really doubted that some way, some how, Beloved and I would be parents. I just knew it, in my soul, as I've never know anything before or since.

By the time we made it to our next ultrasound two weeks later, I was beyond anxious into the dark netherworld of neurotic. We saw a perfectly healthy baby growing right on schedule, and could actually see little arms and legs waving happily. I cried so long and so hard in sheer relief that the ultrasound technicians gave us free pictures and cried along with me. I was still crying when we got home nearly an hour later.

The final scare in that pregnancy was at the 18 week ultrasound. We found out beyond doubt that our little baby was a boy, and a healthy one, except for one concern. He had an echogenic cardiac foci , a bright spot of calcification on his heart that was thought at the time to be a possible indicator of Down's syndrome. An amniocentisis would have confirmed or ruled out Down's syndrome definitively, but the odds of miscarriage through amnio were the same as the odds of the baby having Down's, one in 100. In the end, after a few sessions of genetic counselling, we opted to wait it out and hope for the best.

Tristan Louis was born three days after his due date on March 7, 2002. He weighed nine pounds and was 22 inches long. He was, and continues to be, perfect in every way.

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