Frozen

How do you begin to tell a story when you know it doesn’t end well? Well, I guess, having just revealed the ending, there is no better place to start than the beginning…

F.E.T

Prepping for a frozen embryo transfer is a joy compared to what one must endure in a fresh IVF cycle.  There are no needles.  Yes, you heard that right. No needles are involved.  Well, except for a blood draw to check serum progesterone and estrogen levels and another to check for HCG to confirm or deny pregnancy.  It is really quite easy and made me wish all over again for more than two frosties. Dang my aging eggs!

My FET cycles went something like this:

• Baseline ultrasound on cycle day 1, 2 or 3 to ensure there were no cysts that would prevent moving forward with the cycle
• Start 2 mg oral Estradiol on cycle day three 2x/day
• Increase estradiol to 3x/day 1 wk later
• Day 14 lining check to make sure lining is adequate for transfer
• Progesterone blood draw on day 16 to ensure no spontaneous ovulation. If ok, drop estradiol to 2x/day and start crinone vaginal gel 2x/day
• Embryo transfer of day 5 blastocyst on day 21
• Quantitative HCG test 9 days later

To elaborate on the above:  estradiol is a little green pill. It’s the same pill that postmenopausal women use to combat the adverse side effects of menopause. It’s job, in the case of a FET, is to build the uterine lining to entice one of those thawed embryos to implant and grow a baby. It has a few possible side effects:  headache, stomach ache, nausea, vomiting, possible hair loss. I noticed a thinning of my already fine hair. My heart also felt like it was racing immediately after my evening dose. It came with a $0 copay, which in the world of fertility meds is amazing.

Crinone is progesterone in gel form taken vaginally. It is easy to use, but a little messy. I recommend investing in some panty liners. Also -TMI warning- it is recommended that you manually clear out the extra Crinone every few days while showering. If you do not, it may irritate the cervix and you will end up with discharge that looks like coffee grounds. This is actually old blood mixed with crinone, and will freak the heck out of you while you are in your nine day wait. Just suck it up and clear out the crinone. Crinone has similar side effects to rising progesterone in early pregnancy: headache, fatigue, nausea, bloating and mood changes. Husbands should really not mess with you while on Crinone. Crinone is responsible for supporting the lining along with estradiol. It is critical in supporting the pregnancy if implantation is successful. In a natural cycle, the corpus luteum would produce the progesterone needed to maintain a pregnancy. Since this is a hormonally-induced cycle, there is no corpus luteum and progesterone supplementation will need to continue until the fetus can take over at 10 wks. Crinone may or may not be covered by insurance. In my case, it was, but the copay was high. Luckily, there is usually a manufacturer coupon available, or you can join a savings program like the one featured here. Actavis also has a drug assistance program for several medications including Crinone.

In addition to the above meds, I took my usual supplements including a prenatal vitamin, B-50, CoQ10, fish oil, turmeric and baby aspirin. I also went to acupuncture 1x/wk leading up to the embryo transfer and twice on the day of transfer (immediately before and after transfer).

On the day of transfer, I was prescribed an oral antibiotic to take approximately 1 hr prior to my procedure. When I arrived at the fertility surgery center, I was given a Valium in order to relax my body for the transfer. Then, they start pushing liquids as the procedure works best with a full bladder.  This was probably the worst part for me as my RE is nearly always late! There is no anesthesia. You and your significant other walk to the surgical suite, and you are placed in stirrups (if you have ever given birth, it is exactly the same set-up). The embryo(s) are then loaded into a thin catheter, which is passed through the cervix into the uterus. Ahead of time, you are asked to confirm that the identifying information on the embryo(s) matches yours, which OF COURSE, is a good idea. After a period of brief cramping passes, the RE carefully confirms the placement of the embryo(s) in the optimal position, which is the midpoint of the uterine cavity. The catheter is withdrawn, and the procedure is finished.  Some clinics make you lie on the table for a specific amount of time and then send you home on bed rest. My clinic feels that studies have proven that FET has the highest success rate when women resume their normal activities. I, therefore, walked out of there on my own two feet with only two restrictions: no vigorous physical activity and pelvic rest (code word for no orgasms of any kind).

#1

Our first embryo transfer was such a lovely experience. We were in the middle of a whole house renovation, so I had to trade breakfast in bed and a tranquil bubble bath for a whole lot of hammering, drilling and sheetrock dust. Nonetheless, it was nice to start my day off with acupuncture followed by a rare middle of the week lunch with the hubby. We had chosen to put back only one embryo at a time given my fear of multiples and the fact that we only had two embryos available. Everyone at the fertility center was thrilled with the quality of embryo #1. We were given several pictures, and everyone complimented us on our perfect little embryo. Isn’t he/she beautiful?

Post-transfer relaxing consisted of acupuncture followed by going to the rock yard to pick out granite for our kitchen. The nine day wait flew by. I was given strict instructions by the staff not to pee on any sticks (POAS). DH also pleaded with me to resist the urge. Alas, he was out of town in the few days leading up to the blood test, and I just could not wait any longer. After doing a lot of online research, I picked up a box of First Response Pregnancy tests. On day #8, I POAS, looked hard and long at it, squinted and saw a faint second line. Interesting. It was so faint that it was difficult to tell if it was a positive or an evaporation line, so I just stuck it back in the box. The next morning, I took another and got a similar result. I was pretty sure by now that I HAD to be pregnant, but I was going in for my labs that morning so would have my confirmation soon enough.

At the end of the work day, my IVF nurse called to let me know that I was indeed pregnant. That was the good news. The bad news was that my HCG level was only 21. They like it to be at least 50, and upon further reading [obsessing], it would ideally be >100 to be a good indicator of a viable pregnancy. It was possible that my embryo was a late implanter or that this would turn out to be a chemical pregnancy.

I did not take this news well. In fact, in confronting DH with it, I completely fell apart. It was an ugly sight, complete with lip quiver, a fair amount of hysterics and lots of feeling sorry for myself. It was a rough two days until I retested and HCG fell to 10. Chemical pregnancy was confirmed- an early miscarriage in which the embryo implants and stops growing shortly thereafter, presumably due to  chromosomal abnormality. There was nothing to do but pick up the pieces and carry on.

#2

FET#2 was a different story. DH and I tried to recreate our romantic lunch-time experience, but were running short on time and settled on take-out.  I did not carefully read the label on my antibiotic and accidentally consumed it with dairy, which made me feel like I would hurl in the moments prior to my procedure. No one complimented us on our beautiful embryo. In fact, the embryologist told us not to worry about the apparent debris around it. What! Do you mean our embryo is ugly? It was such a striking difference that we mentioned it to the team in the surgical suite. They laughed and laughed saying many an ugly embryo made a perfectly healthy and attractive baby.

The nine days ticked by, and it was once more time for my blood test. This time when the IVF nurse called me, she had better news. Not only did I have a BFP but HCG was 178. A strong positive.  I was thrilled! My estradiol was a little low at 189, so they increased my estradiol to 3x/day. I then began the torture known as beta hell. This meant at regular intervals, I went to the lab to draw levels for HCG, Progesterone and Estradiol. During the first four weeks of pregnancy, HCG should double every 48-72 hrs. By 6-7 wks, it takes an average of 84 hrs (3.5 days) for HCG to double. HCG levels reach a peak around 8-10 wks of pregnancy and then decline and level off for the rest of pregnancy. My levels were as follows (I obsessively used betabase to interpret the finding):

• 5/23: 4 wks: HCG 179, Progesterone 11.3, Estradiol 189
• 5/26: HCG 387, Progesterone 15.5, Estradiol 244 (doubling= 64 hrs)
• 6/2:  5w3: HCG 3154, Progesterone 13, Estradiol 212 (doubling= 56 hrs)
• 6/9:  6w3 : HCG 13,172, Progesterone 17, Estradiol 224 (doubling= 81 hrs)
• 6/16: 7w3: HCG >39,000

A gestational sac can be visualized on ultrasound once HCG > 1200. I had my first ultrasound at 6w3. At this time, a gestational sac and fetal pole should be visualized. Most of the time, a tiny flickering heartbeat can also be seen.  At my ultrasound, we saw an appropriately sized gestational sac and what we think was a fetal pole. No heartbeat was seen. DH and I were very disappointed as we had been down the road of blighted ovum before. Our RE told us that blighted ovum was a possibility, but that it was too early to make presumptions. I was scheduled for another ultrasound 1 wk later at 7w4.

This time, it was clear. There was only a large gestational sac. No fetal pole was seen and no heartbeat. Our baby dreams had been dashed again. This time there were a few tears and a brief nap before picking  J up at school. We had told the RE that we would take no further action at this time. I would go home and wait out miscarriage. For two weeks, I walked around wearing the most super-sized maxi pad I could find and black spandex shorts under my clothes in case, god-forbid, my miscarriage started while I was out and about. I work in a swimming pool for 1/2 of my working hours as a Physical Therapist, so I had to pull myself out of the pool for obvious reasons. I really, really wanted this miscarriage to be over quickly. But my body seems to be oblivious to lack of development of a fetus. Initially, I think my HCG was continuing to rise. I say this because at 8 wks, I started to experience morning sickness. The smell of bacon cooking would send me scurrying off to my patio, gagging all the way.

It was also around this time, that DH decided we needed to go on vacation. Either that, or I needed to see a shrink. I chose vacation (duh), and we started to plan a last minute trip to Hawaii. My BIL lives in Kauai, and DH has a client in Honolulu that had been asking him to come onsite for a while. Of course, this messed with my timeline for a natural miscarriage because if I eventually required a D&C, I needed a two week buffer between my surgery and flight to ensure there were no post-op complications.  In the end, we decided it would be best to schedule me for a D&C at the two week cut-off and hope I wouldn’t need it. Except I did. Guess my body is as reluctant to become un-pregnant as it is to be pregnant. The good thing that arose out of having a D&C is that the genetic testing could be done on the fetal tissue.

The test results came in about a week later. I had miscarried a chromosomally normal boy. The significance of that is this. If the test results come back “normal female,” the lab automatically assumes they accidentally tested your own tissue. After all, the majority of miscarriages are attributed to chromosomal abnormalities of the fetus. My result, however, could not be a mistake, and it was heartbreaking. Difficulty getting pregnant. Repeated pregnancy loss. And now miscarriage of a presumably normal embryo. This was clearly not good for my prognosis. My RE recommended I consult with a repeated pregnancy loss specialist in Tennessee to get to the bottom of this. But I could not worry about that now. I was going on my dream vacation with my family, and I was determined to have a good time.  And guess what? We did.  The time of our lives.