In Vitro.
This is still not widely communicated to everyone, so I assume it may be a surprise to any who read this. The following is what we went through last year.
After Zach and I got married, we pretty much instantly agreed to attempt to start a family. I knew it could be up to a year before anything happened, but I still wanted to obtain fertility testing just to have peace of mind that we actually could get pregnant.
Thank goodness I tested early.
I had inquired before I had even met Zach on fertility testing, but all my previous doctors had just brushed off the request and stated the general guidance is to try for 12 months and then get tested. This was told to me even if I had presented reasons to be concerned.
I met with a doctor in early 2022 that had basically told me the same. I remember she even told me I was "normal" without having any data to back that up. It was not enough for me. My GP actually suggested I try a specific doctor in the area, so I eventually made an appointment. Honestly I thought I would just get my blood drawn, maybe do a more invasive scan, and finally be told everything looked good and I should expect to get pregnant soon.
Unfortunately that's not how it worked.
In March I underwent a few blood tests. One test was to confirm I was actually ovulating. I was! But that meant the next step was to schedule a HSG x-ray.
At the end of March, I had the exam done. If you're not familiar, it's basically a test where dye is inserted into the uterine cavity and x-rays are taken to determine if the fallopian tubes (which is where the egg and sperm met) are open. If they're not open, it's considered impossible to get pregnant naturally. The test is usually described as uncomfortable or extremely painful. For me, I had no pain at all. I thought maybe this was a good sign.
A couple days later though, the doctor called to inform me that both of my tubes were unfortunately closed. I had the type of closure that could not typically be operated on to open the tubes either. It was instead suggested that I remove the tubes altogether. Which would really mean that I could never get pregnant naturally.
It was horrible news. The worst I've ever received. I felt like my life was over.
HSG exams are also theorized to potentially open up closed tubes. This didn't work for me.
Zach and I researched our options. We tried a few different strategies. I had been going to acupuncture, so they gave me a herbal "fertility tea" to drink three times a day. I started taking serrapeptase pills since they allegedly can remove scar tissue from your tubes. We saw many other doctors for their opinions and advice. I underwent a lot more blood tests to rule out PCOS and other hormonal imbalances. Zach underwent fertility testing as well just to be sure everything was fine on his side. We even saw one doctor that offered surgery to open up my tubes, but the odds of getting pregnant after that would have only been 30% by her estimation. (Other doctors also discouraged surgery as there is a risk of the tubes just closing up again.)
Eventually we decided to go ahead with the fallopian tube removal surgery. I was scheduled for mid-June.
The worst part of the surgery process was that in order to have my insurance cover the surgery, I had to state that I was willingly sterilizing myself and I could not indicate anything about future IVF treatment. A lot of trust was put in my doctor since we basically had a verbal agreement that the purpose of the surgery was so I could undergo IVF. I was very worried that something might go wrong.
I also had to coordinate short-term disability in order to get the time needed off of work. I realize that's ultimately a privilege, but this honestly added to the stress of my surgery. The company I was told to work with was disorganized and unhelpful. I was sent "warnings" that my claim would be rejected because of paperwork that was beyond my control was not yet received. In the end, it all worked out, but it was not without great stress on my part. Eventually Zach advised me to just not show up to work even if the paperwork was not completed or rejected.
The surgery was not necessarily a prerequisite to IVF, but it greatly increased our odds of success. Without the surgery, there was a very high change the pregnancy would terminate itself. It didn't make sense to move forward without the surgery.
The surgery I underwent was essentially the same as an endometriosis diagnosis surgery (laparoscopy). The day of my surgery, Zach could not accompany me due to COVID restrictions that were still in place. I had to sit in the waiting room without him and when I was brought back to the preparation room, I had to sign more paperwork acknowledging the purpose of the surgery and agreeing to anesthesia which I had to consent to the risk of death. It truly was a horrible experience. Eventually I started sobbing and the nurses asked if this was something I really wanted to do. It wasn't that I wanted to do it, I felt like I had to. But it still didn't make it easier.
The surgery took less than an hour and eventually I was waking up from the anesthesia. Everything went really well. The doctor confirmed that my fallopian tubes were no longer functioning. Zach took me home and I spent most of the day groggy from the medication.
The recovery time was surprisingly much faster than I anticipated. I was even cleaning my apartment a little a few hours after my surgery. In hindsight, I don't think this was a great idea since eventually I did feel pain from recovery. Overall though, I didn't need the pain medication that was given to me afterwards. That part is very fortunate.
I figured the recovery time would not be that extensive due to the research I had done beforehand, so we decided to continue with our Hawaii honeymoon that I had planned before my surgery was scheduled. It was a fantastic way to recover.
After that, most of our time was filled attempting to distract me from the next step. We scheduled our IVF protocol for August. Prior to moving forward, I had to undergo more testing. I felt like I was getting "approved" to conceive. It's a very frustrating process sometimes.
I started birth control a few weeks prior. This is usually the first step for starting IVF.
In August, we traveled east to our IVF clinic. I hadn't realized prior, but IVF is broken out into a few different stages:
- Initial stimulation of the eggs / Instead of a natural cycle, all of the eggs released that month are matured for fertilization
- Egg retrieval / All the matured eggs are extracted from the body
- Embryo transfer / One of the eggs that were fertilized and developed is inserted back into the uterus in hopes that is will implant
- Progesterone injections / If successful, progesterone is supplemented up to week 10 of pregnancy. In my case, I had injections each day
So August was the first stage up until the egg retrieval. We had chosen to proceed with a frozen embryo transfer rather than a fresh transfer which required waiting at least a month until we could reach the next stage.
We also chose to do individual genetic testing for Zach and me, just in case we may possibly carry the same genetic abnormalities. Luckily, we don't.
My protocol for the egg retrieval was as follows:
- Day 1 - 4:
225 mg injection of Gonal F
25 mg injection of HCG
Oral medications (keflex, aspirin) - Day 5: Morning labs to check hormone levels
- Day 5 - 7:
200 mg injection of Gonal F
20 mg injection of HCG
Oral medications (keflex, aspirin, start Provera on Day 6) - Day 8: Morning labs to check hormone levels
- Day 8 - 9:
150 mg injection of Gonal F
15 mg injection of HCG
Oral medications (keflex, aspirin, provera) - Day 10:
40 mg injection of Lupron Trigger at 8:30PM exactly
20 mg injection of Novarel HCG at 8:30PM exactly
Oral medications (keflex, aspirin, provera) - Day 11:
40 mg injection of Lupron Trigger at 8:30AM exactly
Oral medications (keflex, aspirin) - Day 12: 8AM Egg retrieval (more anesthesia) and semen specimen!
Results: 16 eggs extracted, 10 were mature, 7 were fertilized, 5 reached blastocyst stage, and 4 came back genetically normal. 4 embryos frozen!
TOTAL: 23 subcutaneous stomach shots
The injections were ok. Although they were subcutaneous, I did not find them to be painless. My sister came for moral support for the entire protocol and it really made the experience so much better.
After our egg retrieval, we went back home until October. I continued birth control. Finally late October we were scheduled for the embryo transfer.
Once again I had to undergo testing in order for the approval to move forward.
About 3 weeks before our transfer, I stopped birth control. Three days later, I started estradiol (1 tablet twice per day, then 2 tablets twice per day, then 3 tablets twice per day plus 1 vaginally at night).
Six days before the transfer, I started 75 mg intramuscular progesterone injections. This is done everyday in the evening.
Two days before our transfer, I had labs once again to determine if I was responding to the progesterone.
My protocol eventually consisted of:
- Estradiol (3 in the morning, 3 in the evening)
- Progesterone injection (75 mg at 7pm)
- 5 days before transfer until day after transfer - Medrol oral medication (steroid, taken before bed) Medrol is the WORST. It made me cry. It tastes awful.
The day of our transfer, we arrived at the clinic about 30 minutes early. The clinic instructed me to bring socks and have a full bladder. No more anesthesia! This process I was able to be awake since it only takes a few minutes. Our clinic did not prepare us for the fact that other people would also be in the room with us as they were undergoing the same procedure. I was quite unhappy about this. It just would have been nice to know what to expect and it made me feel like I was on a conveyor belt of fertility treatments.
The transfer went well. The nerves and emotions caught up with me so much so that the doctor asked if I was excited. I'm not sure if I was, honestly. I didn't want to get my hopes up.
I took the rest of the week off work which may have helped keep me relaxed. I think taking the week after would have helped as well.
12 days after the transfer, we had an appointment to confirm pregnancy. We tested at home beforehand though. I was pregnant! All the effort has finally paid off. I had to go back to the clinic in two days to again confirm the pregnancy. Then a week later, I had to confirm again. So much poking!
About a month later, I had my first ultrasound (6 weeks). My first doctor visit took place around 8 weeks.
Progesterone injections took place every night from October 20 - December 16. Estradiol was also consumed twice a day until December 16.
TOTAL: 58 intramuscular gluteal shots
And now here I am, nearly 13 weeks pregnant. What an exhausting journey this has been. Thank God it all paid off. I really do feel very lucky and thankful and I am still processing everything that happened. Finally some relief. Finally some hope.
Can't wait to meet you, baby zachloe!