TTC - Hurry Up And Wait

IVF injection training at Mt. Sinai  © Shutterbug

And so it begins again, the 2ww (two-week wait) that all of us on this journey dread, and dream of, and suffer through, and bargain with. It's been five months since I've stood in these shoes. I'm certainly older, definitely wiser, and struggling with both regret and doubt.

We crawled back to Mt. Sinai in March with our tails between our legs after our negative experiences at Create, and met with Dr. Liu again. It was shocking to discover she was nearly nine months pregnant and about to go on leave any day. There is something just unfair about going to a pregnant doctor for fertility treatments. She and an assistant (which was awkward) kindly spent a long time discussing our options with my wife and I. If we wanted to proceed with an IVF cycle, she stressed the importance of us attending an IVF "class", held bi-weekly, before going that route, and we resigned ourselves to more time away from work, and more feelings of isolation as likely the only lesbians in the room. 

We arrived just before the class started, on a weekday in late March. We could hardly believe it when the rest of the attendees continued to trickle in every few minutes until the class was actually half over. It was disruptive, and disrespectful to the doctor leading the class. It was, by the way, Dr. Ellen Greenblatt, who is the head of the entire program. Much of the information was common sense or we already knew from doing our own research, but there were a few surprises.

I was under the impression that the whole reason for taking fertility drugs, which I had purposely avoided up until now, was to increase the number of follicles I produced each month. This is not the case: they are designed to increase the number of mature eggs the follicles produce, but that number is still limited to the number of follicles I start with (called the "antral follicle count"). They cannot change that. If my body at my age is only producing 4 follicles, then the maximum number of eggs you can hope to grow, even with drug intervention, is 4. OMG. The antral follicle count can change each month, however it's unlikely to vary by much.

The other important things I learned were about the IVF process itself - how eggs are retrieved, scary statistics on fertilization or lack thereof, how the embryos are grown (could be 3 days in a petri dish, or could be 5), grading embryo quality and fragmentation (!), futuristic procedures like helping the embryo to "hatch" (do you know what a zona pellucida is? I didn't.)…the whole thing seemed surreal and clinical and cerebral to discuss growing your future child in a lab.

Despite the scary financial number-crunching (most insurance plans, mine included, have zero coverage for fertility drugs), we decided it was time to bring out the big guns and attempt a round of IVF in May. Likely the only attempt, given that the total cost for treatment including the donor sample, drugs, and various procedures could run close to $15,000. We were already closing in on that figure with what we'd spent on our 7 IUI procedures in the last year.

I nervously counted down the days to cycle day 3, when I would go in for the usual b/w and ultrasound, and would begin drug injections. Time seemed to move in slow motion as we tried to evaluate all of the possibilities in advance. This is what the IVF class makes you realize as well; you have to prepare for making absolutely critical decisions, so that if and when the time comes, there is no hemming and hawing. For instance, we even have to sign forms to designate what should be done with our embryos should something happen to me in the middle of the process. Happy thoughts.

The u/s news was not good. I had three follicles in my left ovary, and one follicle plus a cyst in my right ovary. A cyst?! Yet another thing I was unprepared to hear and hadn't researched. My mother had required surgery for an ovarian cyst at a very young age, so this panicked me. A helpful nurse named Donna asked us to wait for my blood results, explaining that my estrogen levels would indicate whether this cycle could be salvaged. We had decided that IVF would be off the table for this month now, since 4 follicles were not enough (4 follicles would likely mean a max of 3 good eggs, of which only one or two might fertilize - a lot of money to gamble on such a low number), but hoped to proceed with another IUI and not waste the cycle. Donna explained that sometimes an ovarian cyst can trick your body into thinking it's a mature follicle, you to ovulate too early and release immature eggs. A level of around 200 might mean a usable cycle, but anything higher and we would have to cancel. And so we waited in one of the exam rooms we knew so well.

The sympathetic look on Donna's face when she returned said it all, even before she announced "640". We were so dejected, and so tired of the process being out of our hands, and now were worrying about the cyst. Donna, bless her, spent half an hour counselling us and said my body would likely reabsorb it. After some discussion, we came to the conclusion that we may have jumped the gun with going to IVF at this point. If I had been afraid of taking fertility drugs because of the chance of multiple births (and side effects), yet I was only producing four follicles and willing to subject my body to IVF now, then perhaps it was worth trying a medicated IUI cycle for the first time instead. The (oral) drug they would put me on is Clomid, and if I did happen to produce too many eggs for an IUI (not likely), we could choose to abandon the cycle and try again another month. Nothing to do but wait for my next day 1.

My very regular cycle, however, became uncooperative. Day 30 came and went. Then day 35. I called the clinic, concerned this was related to the cyst, and was told to come in on a Sunday, my period now nearly two weeks late. We had a very unfriendly doctor we'd had once before, who was quick and businesslike. She said everything looked normal. I explained I had never been this late before in my life, and asked what could cause a period to be two weeks late. She looked me in the eye and said sarcastically, "Uh, pregnancy?" What a bitch. Thanks for that, after all the disappointment and emotions we'd been through, all the procedures we'd endured; thanks for calming our fears and helping us to understand the current situation a little better. It was three weeks of debilitating PMS symptoms before my period arrived on day 45.

Cycle day 3 we were back at the clinic for b/w and u/s, and again I felt rushed through the process. The doctor simply confirmed there was no cyst and everything looked normal, then said I should begin taking the 100mg Clomid pills that evening for 5 days and come back in on day 12. She did not tell me my antral follicle count, so I didn't know if the Clomid would produce 2 eggs or 10.

I took the 5 days' worth of pills, then suffered through another four days of waiting before we went back in to hear what the effect had been. The side effects were bloating and headaches that Tylenol couldn't touch, but everything was bearable because this time we felt in control. We were finally doing something to affect the outcome of this cycle.

Silly me, I am 41 years old. There were never going to be 10 eggs. The answer was 2. 2 follicles measuring 2.05mm and 2.15mm, perfect for a Clomid cycle (larger than normal). Uterine lining perfect. You will learn all of the numbers, all of the abbreviations, all of their meanings, all of their odds. The doctor doing the u/s was the same bitchy one from last cycle with the "uh, pregnancy" comment, but she was in a better mood. She reassured me this cycle was good to go, and I only needed to do b/w the next day.

The b/w technician was none too swift. She asked me my name, I gave her my health card, she asked me to confirm my name, and then she pointed to the computer screen and asked me a third time if that was me. Overkill! I sat down, rolled up my left sleeve and held out my arm, and she sat across from me and asked which arm I wanted to use. Seriously? As usual, when she saw the absence of veins she didn't believe this was the arm they would normally use, and I explained the right arm was worse. She asked, "Have you ever used the other arm?". I feel like I'm on Candid Camera.

As fate would have it, our IUI day fell smack into the middle of a long-planned cottage weekend with friends. We had no choice but to drive the 5-hour round trip back to the city and leave our friends to fend for themselves for the day. It was bizarre, terrifying, and exciting to know that this time there would be two eggs coming down the pipes. After months and months of emphatically stating, "I don't want twins", the thought of never getting pregnant now seemed a much worse fate. Suddenly, the very real possibility of ending up with twins felt like it could be a blessing as much as I'd thought it could be a curse. 

There is no way not to obsess, not to have all of this invade your every waking and sleeping thought. It is hard to focus at work, hard to have banal conversation with friends and family, and hard to not get your hopes up. We just resign ourselves to the process, sing a little Que Sera Sera, and hope for the best. Tiny nurse Bernadette did the IUI this time, and it was just as difficult and excruciatingly painful as always. Poor Bernadette apologized profusely for hurting me and for struggling for so long, and I apologized for my crooked cervix, and my wife apologized for me having to go through all this.

It is now 4dpo (days past ovulation), or 4 dpiui. I have obsessively checked the Internet for stories of early pregnancy symptoms, for percentages of twin pregnancies with Clomid, and for statistics of women over 40 with fertility treatment. It is not productive, and if I had one piece of advice for other women starting this process, it would be step away from Google. Step away from the forums, too. Although they can be a great source of support, there will always be someone with a good outcome, someone with a bad outcome, someone with an outcome you didn't even consider. It's not going to tell you how your story will end. You will spend precious hours looking for answers you can't actually find there, and in the end what you read will probably compound your stress levels. It certainly won't help you sleep better. 

I get overwhelmed with the number of stories that mention miscarriages, often multiple lost pregnancies, and often late in the game (10 weeks or even further along). At this point I can't even imagine getting a positive pregnancy test, let alone getting used to the idea of expecting a baby and then having the rug pulled out from under us. I know the chance of miscarriage at my age is high, and I know the chance of genetic abnormalities is also high, but it's impossible not to get our hopes up. This has to work.

I want to believe a happy ending is possible.

And so we wait. And we hope that we can add our photo(s?) to the baby board...