Ticket In Hand

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We had our RE consult today and it did not take me long to realize that in the fast-moving world of reproductive endocrinology, I’m definitely a blast from the past.

When I did my first FET cycle in early 2014, I used Lup.ron, oral estrogen, PIO, baby aspirin, a short burst of Medrol, and valium for the transfer.  Today, the FET we’ll undertake in September/October will involve injected estrogen every four days, PIO twice a day (!), dexamethasone, baby aspirin, medrol, and predisone.

My response: “I JUST got feeling back in all the areas of my butt and now PIO is TWICE A DAY?!”

Apparently, this protocol results in much higher implantation rates.  Dr. E explained that there’s too much variability with oral estrogen to be comfortable – apparently some women really struggle to get levels high enough even with high doses – but with the injections, it’s been much more consistent.  The steroids lower the immune system a bit to allow the embryo to implant and the different types plus longer dose periods than before seem to really help this process more effectively.  No more valium for transfer either.  Two days of taking it easy, like before.

I asked how likely the blastocyst we have in storage was to thaw properly and Dr. E told us since it’s frozen with the newer cryopreservation methods, it’s around 98% certain that we’ll have a transfer.

I am…a little overwhelmed, to be honest.  Not so much by the protocol itself (though it certainly is different than any other fertility protocol I’ve undertaken) but simply by the fact that this is it.  As weird and f—ed up as this sounds, the RE’s office and fertility treatments and reproduction (or lack thereof) have been this huge part of my life for about seven years.  Whether or not this FET or anything else results in a pregnancy, my reproductive years are coming to a close.

I won’t miss the worry, the miscarriages, the fertility treatments, the incredible sadness of failed cycles, the two-week wait, or any of that stuff.  Infertility, high-risk pregnancy, loss, and NICU inflicted real wounds that are still healing and scars that still ache at times.

But there were silver linings that I couldn’t appreciate in the trenches.  Dealing with infertility and the associated complications also moved me from being someone who looked over her shoulder for another person when someone asked for an adult to someone who says “here, me, I’m an adult”.  I can battle with a ferocity I didn’t know was possible and also know when it’s time to walk away from a fight.  I know how to talk to an insurance company, how to marshal my resources, and who to call.

It’s more that I’m letting go of something that consumed vast amounts of time, resources, emotions, and despite the fact that this is, inherently, not a bad thing, it’s a change and a door closing.  It’s moving into an entirely different landscape – where I won’t chart my cycle, pee on OPKs, alternately (depending on where I am in an attempt to get pregnant) hope for or dread my period, or take pregnancy tests.  I’ll get rid of the maternity clothes and the baby stuff.  Labor and Delivery will go back to being a department with no more significance to me than Endoscopy or Medical-Surgical.  I’ll change into whatever lies ahead and deal with it, hopefully gracefully.

It’s strange, though, being here.  It’s like waiting in an airport, ticket in hand, and not knowing exactly where I’m going next or how many transfers or bits of lost luggage, but knowing that my flight will depart soon for somewhere.

This post has been a part of Microblog Mondays.  If you want more, please visit Stirrup Queens‘ blog.  Thanks to Mel for originating and hosting.

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The Left Overs

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Last week I finally bit the bullet and made what I plan to be the first in the final series of appointments with my RE, hopefully culminating in a final embryo transfer around early-mid October 2019.  I mean, my RE is a good doctor and I like him, but I truly won’t be sorry to see the end of treatments and the clinic and all the attendant stuff.  I’m looking forward to moving on and coming to end of the infertility journey.

One part of infertility, however, isn’t going to be over anytime soon.  The reason I wound up at a fertility clinic in the first place, PCOS, still factors into my life, health, and daily living.

This is one of the parts of infertility that I really hadn’t considered much when I was in the trenches, mostly because in the trenches, it’s a day-to-day, minute-to-minute battle.  At this point, however, I’ve got a bit of breathing room to consider the future and that future continues to include PCOS.

And PCOS…sucks.

Mostly, it raises my risk of diabetes along with a number of other conditions, which means monitoring and care to ensure that I remain as healthy as possible.  For me, this means a daily dose of met.formin.  While it doesn’t work for all PCOS women, for me, it’s a miracle drug.  When my second RE put me on it prior to my second fresh IVF cycle because at that point, we were throwing everything reasonably possible at the infertility, I noticed my cycles regulated a bit and we got better egg retrieval and embryos.  After I gave birth to my first daughter, I went back on it to attempt to control the PCOS and boost my milk production, then continued on it and was surprised when, over several months, my acne abated and my cycles regulated.  Because PCOS is one of the big wild card conditions of infertility (some PCOS women have a terrible time conceiving while others, surprisingly, don’t have much issue at all), we were overjoyed when this led to our second daughter.

I managed without met.formin until I stopped nursing/pumping for my second daughter, but at that point, the PCOS symptoms returned with a vengeance – acne, wonky cycles, the whole nine yards.  I called my OB/GYN who was fine with putting me back on the met.formin and things have calmed down since.

I’m fortunate when it comes to PCOS because I have a fairly reliable external indicator about whether or not the PCOS is under control: acne.  If I’m breaking out massively, generally, I have cysts on my ovaries and the attendant issues.  I’m also fortunate that (so far) I’ve been able to find treatments that abate the symptoms considerably.

Despite the fact that my OB/GYN is good and I can somewhat see how well controlled my PCOS is, I know that I need a good primary care provider, especially since I’ll be able to stop seeing my RE (who has helped with managing my PCOS and been my back-up with that for years now).  At the moment, I’m starting to work on searching for the right doctor.  PCOS isn’t ending just because my infertility is resolving.

This post is a part of Microblog Mondays.  If you want more, head over to Stirrup Queens’ blog!  Thanks to Mel for originating and hosting.

Thinking Through My IVF/RE Experiences: Part 1

Over the years, I’ve sat down more than once to try to write about my experience with my first RE and IVF in general.  It’s proved trickier than I thought.  Some of it, I’m sure, is that women are socialized not to express certain (negative) emotions.  Some of it is that it seems like something I should be over.  A big part of it is survivor’s guilt.  I mean, I have kids at this point, so it seems sort of ridiculous to complain.

And yet, parts of this story still bother me because they should not have happened.  In real time, I was so deeply invested in the process, I couldn’t really dig into considering them, even in my own head.  I was all about acknowledging that something had happened, but also sort of glossing over at the same time.  At this point, it’s not so much about my personal stuff as entering a conversation about how to improve care for infertility patients in fertility clinics.

I’ve written in a Q&A format, mostly because that seemed easier than trying to form this as one narrative piece.

What went wrong with the first RE?

I’ve mentioned before on the blog that at the first consult with him, I expressed that I understood with PCOS that wasn’t responding incredibly well to drugs like Clo.mid and Fem.ara, it could take some time to get to the point where I was pregnant and that I had a wedding in June (this was in March) that we’d need to work around.  He sort of smiled and went “Oh, I think I can have you drinking water at that wedding instead of wine.”

I hate to say this, but while the rational part of my brain was going nope, nope, nope, the sad, worried, fearful part of me really wanted to hear that.  Because here was a guy who was confident and felt good about the whole situation.  He brushed away my concerns about being able to come in for ultrasounds during cycles because of my work schedule (“We deal with that all the time”).

Things escalated a little when I got a cyst after my first cycle on injected fertility medications, which I hadn’t realized could happen.  So I had a cancelled cycle and had to rest on birth control for a month.  The next cycle resulted in a huge overstimulation for TI/IUI and was cancelled as well.  I was getting concerned because I was going in for ultrasounds quite a bit – which hugely negatively impacted my work schedule, contrary to my doctor’s reassurances at the initial visit.  I then did a cycle with Fem.ara + injected meds, which was cancelled by a different doctor in the practice due to under-response (my doctor was on vacation) and told to consult with my doctor when he got back.  It was late June by this time.

My doctor was hard to schedule with because he was “so busy” according to the clinic.  We agreed to a phone consult.  My doctor told me he wouldn’t have cancelled that cycle, would rebate my clinic fees (which we appreciated) and would personally supervise my next cycle.  “Good,” I told him, “because my period is starting.”  We booked the next cycle and I started shortly thereafter.  A week later, I was told by the nurse at the clinic that one of the other doctors would review my lab/ultrasound results because my doctor was on vacation.  I was furious.

The July cycle went wonderfully, a really good stim, but I didn’t get pregnant.  I asked to talk to my doctor again, was able to get another phone consult, and expressed that I was a bit upset he hadn’t personally monitored my cycle as he had promised.  He basically told me that he got to go on vacation and implied that my expectation that he would personally monitor my cycle was expecting far too much.  He was so convincing, I remember doubting my memory and asking my husband if he too had heard the doctor promise to monitor the cycle personally.  My husband was certain he’d heard the doctor say that too.

We decided to move to IVF because we were losing a *lot* of money on drugs, fees, and lost work for cycles that were being cancelled.  It was obvious that my ovaries were super touchy and didn’t necessarily respond predictably.  I was going in a lot for monitoring.  We figured that if we did IVF, we’d be able to do one cycle with all the monitoring and have a higher chance of pregnancy.  I again phone consulted with my doctor in late August, explained to him that I had started a new job, and that we were thinking IVF.  I had planned to possibly do the IVF in February or March of the next year and settle into my new job.  “We could get you in this fall,” my doctor told me.  Because I really, really wanted to be pregnant, I agreed.  I explained what I did at work and asked if there was anything I should know about IVF that would affect my job differently than any other TI/IUI cycle with injected meds.  He told me to plan to take one day off for egg retrieval and two days for transfer.

A couple weeks later, I called the clinic to finalize some details and the nurse mentioned in passing that I would have a 25 lb lifting restriction and restrictions on bending.  My job involves a lot of lifting and bending.  I just about hit the roof.  But my doctor was out of the country on a 3-week mission trip and I had to make decisions right then or delay the cycle.  We had already scraped together the money and I was desperate.  I made a poor choice and went ahead.

The cycle proceeded, I was very anxious, and 15 eggs were retrieved.  The day after my egg retrieval I went back to my job, where I would be on my feet for 8 busy hours.  I had to leave partway through the shift because I was in so much pain.  Two 3-day embryos were transferred, 2 were frozen, and I went home to wait.  I had my beta a day early because my husband and I were both off work that day.  Though the clinic nurses called me to tell me I had a positive beta and was pregnant, my doctor also called me personally to congratulate me.  I appreciated that enormously.

Of course, I got googling (ugh) and realized that even for the day it had been done, my beta seemed…low.  But it doubled appropriately, then exploded.  Even so, I could not shake a nagging feeling that I didn’t “feel” pregnant at all.  Nothing.  No tender breasts, no nausea, nothing.  When I went for my first ultrasound with a different practice doctor, the doctor found that I had 2 gestational sacs, both with something inside but only one with a heartbeat.  The next week I went for another ultrasound with my doctor to check on the one with no heartbeat to see what was going on.  Still no heartbeat in the one, but a beautiful, perfect heartbeat in the other.  He was effusive, excited, and told me to send him photos.

The bad feeling never went away.  Finally one weekend, I found myself almost hysterical with anxiety.  I knew something was wrong.  I called the clinic Monday and they scheduled me for a scan to reassure me (with one of the other doctors in the practice, my doctor wasn’t at my location that day).  I remember feeling the cold wash over when I saw the baby come into view.  I knew there was no flickering of a heartbeat, and the ultrasound tech’s immediate “I need to go get the doctor” told me everything I needed to know.

My doctor never called.  Never said a word.  Never told me how sorry he was that I’d miscarried.

Do you blame your first RE for the miscarriage?

Not at all.  I had known in my gut something wasn’t quite right from the start and unfortunately, miscarriages aren’t particularly uncommon.

In hindsight, are there some things you would have done differently?

I would have changed doctors after the situation where he told me he would personally monitor my cycle and then didn’t – particularly after he tried to play it up like he never would have said such a thing.  I work in healthcare.  It is totally good for healthcare workers to take breaks, vacations, etc.  I absolutely support that need.  I also totally understand that emergencies happen, but based on what the nurses said at the time, they specifically said vacation and he later confirmed that.  There is absolutely nothing wrong with taking vacation.  But I had/have a huge problem with the dishonesty.  The truth is, I suspect that he just completely forgot what he said to me and really didn’t care.

I really regret not putting the brakes on that first IVF cycle.  It made things much more stressful at work (even though I had an extremely supportive boss and coworkers, thankfully) and once I realized that my doctor (again) hadn’t been 100% forthcoming with me, I wish I had insisted on waiting until I saw him to talk about the situation to do something as major and expensive as IVF.

I wish I had listened to the part of my brain that threw up the red flag in our first consult instead of playing it off as a bit of a misspeak and proceeded with more caution.

One other thing that, in hindsight, would have been good would have been getting a second opinion from a different RE before going for IVF (it’s worth noting that my first RE did not push IVF for us – we were spending so much on TI/IUI cycles that by the time we’d gone through a few, we were getting to the point where we couldn’t keep doing those for the lower chance of pregnancy, so we brought it up).  I was really intimidated by the idea of finding someone (the clinic I went to was the only one that had a local satellite office).  But even if I’d needed to go to the city where the main office was located or somewhere else entirely, I wish I had had someone review my chart/tests/treatments to that point just to sort of double-check things.

What are some things you would have wanted to see from your first RE?

The other day, Mel at Stirrup Queens posted a link to a project about the worst things people said to women who miscarried or had stillbirths.  I know, unfortunately, exactly what my chalkboard would say:

“Not one %$#%& thing.  Absolute silence.”

It still makes me really angry that my doctor could take the time out of his “busy” schedule to call me and congratulate me on being pregnant but when I miscarried, he couldn’t be bothered to take three minutes to say “I heard.  I’m so sorry for your loss.”  This is basic.  It’s not an onerous request, and I would argue that it’s an essential part of reproductive healthcare.

I also would have appreciated it if he had been much more careful when he was advising me what to expect from IVF.  He did not tell me about the lifting/bending restrictions, which were incredibly relevant to my job that I had told him about (I think he figured the nurses would go over IVF instructions and didn’t think it was his job).  I am also really frustrated that he didn’t encourage me to take a day off after the egg retrieval, especially since he knew I didn’t/don’t work a desk job where I might be able to take time to sit down.  I was in a lot of pain as a result.

Confidence can be a good thing, but I felt like his statement about water at the wedding instead of wine wasn’t a helpful thing to say.  It gave me some unrealistic expectations for the process/timeline and honestly, I felt horrible – like I had done something wrong – when I wasn’t pregnant by the time of that wedding.

He also came across as pretty dismissive when I would ask about how the various treatments would affect work or my life.  These were reasonable questions on my part and should have been treated/answered seriously.

 

Planning to have Part 2 coming soon…

Flipping The Script: Solidarity, not Pressure

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When I was actively going through infertility and treatment, I heard a lot of stories.  I think everyone who goes through any sort of medical or social crisis hears stuff like this, you know, the “the doctors told them they’d never get pregnant/recover/etc., but they did!”  Sometimes this was helpful, particularly when related firsthand by the person the story had happened to, and often, those storytellers (whether in person or on blogs) would point out that while it had worked for them, they knew it wasn’t necessarily going to work that way for others.  It was solidarity, not inspiration.

Unfortunately, this wasn’t always the case.  Sometimes the stories were told more prescriptively (often by people that they hadn’t happened to), in the “if you just hang on, it will happen!” or “if you do _______, you’ll have a baby!”  Often, it occurred when I was already beating myself up and wondering what I could have done differently or when we were making painful decisions whether or not to continue treatment.  Those stories made me feel guilty, my decisions unaccepted, and left me second-guessing whether or not I’d done “enough”.

I’ve lurked this year for National Infertility Awareness Week, mostly because reading everyone else’s blog posts proved interesting and the topic – “Flip the Script” – is one I’ve had to mull over a bit.  Finally, though, I’ve realized the script I want to flip: be careful with stories.

A couple of years ago, I realized I’d become that cliché, walking urban legend of infertility stories: IVF works on the third embryo transfer after losses, rare, tragic complications, and out of that, a beautiful, healthy child.  Getting spontaneously pregnant with my second with no interventions or treatments only added to it.

I’m grateful for how things worked out.  But it is by the most bizarre circumstances and strange, against-the-odds events that I am where I am in life right now.  There is absolutely nothing that is able to be generalized to someone else struggling with infertility.

It’s not because of my hard work.  It’s not because of my persistence.  It’s not because I’m somehow “special”.  It’s not because of my good attitude or positive thinking (please, ask anyone in my life – I did not accept infertility/PCOS with any grace whatsoever, still dislike many pregnancy announcements/going to other people’s baby showers except under special circumstances, and hated pretty much every moment of treatment).  It’s not because of “baby dust”.  It’s not because I deserved it more than anyone else.

Truthfully, I have no idea why things worked out the way they did.  I’m grateful, but I really don’t have an answer to the “why/how”.  And I resent the idea that if things had not worked, I would have been any less worthy.

Basically, what I’m saying is this: I hope no one (including me) ever uses my story as a cudgel or as a prescription or as a “this could be you too if you just keep trying!”  Because anyone who is struggling with infertility, needs to take a break, or needs to consider their options (including resolving without children), does not need that pressure or guilt.  It’s great to tell our stories and truths.  But there’s a way to do it without generalizing out-of-the-ordinary happenings to others or giving false hope.

Let’s flip that script, straight up.

This post is a part of Microblog Mondays.  If you want to read more, please head over to Stirrup Queens!  Thanks to Mel for originating and hosting.  

That Thing With Feathers

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Hope is the thing with feathers

That perches in the soul,

And sings the tune without words,

And never stops at all…

– Emily Dickinson

 

We never really did much natural cycling when we first started trying to conceive in 2012.  My cycles were so incredibly abnormal right from the start that we had done our initial testing, gotten the PCOS diagnosis, and started seeing an RE before the one-year mark.  Even when we’d do a few months between medicated cycles and then ART cycles, I didn’t have normal natural cycles.

Once I quit breastfeeding (or, more accurately, attempting to breastfeed), the spot-bleed-spot-bleed-no-normal-periods came roaring back for several months.  Since that was my normal before my daughter was born, I wasn’t particularly surprised, just frustrated.  In some deep, dark recess of my mind, I’d genuinely hoped that giving birth would “fix” my reproductive system.  I tried a bunch of supplements, stayed on met.formin, lost weight, and nothing changed.  I saw my OB/GYN, got a prescription for birth control pills, picked up a pack, declared myself done with natural cycles, and then in a fit of pique, decided to pull a Scarlett O’Hara: “I’ll think about that tomorrow”.

Every day thereafter, I reprised.  I kept up with the supplements and met.formin.  Until one day, the bleeding stopped.  I marked the date as cycle day 1 and shrugged.  I wasn’t too hopeful.  I had an ultrasound in December because I was having pelvic pain and wondered if I had a cyst.  My ovaries had the classic “string of pearls” appearance of PCOS.

I started spotting on day 21, but then on day 28, had an actual round of bleeding that was easily identifiable as a real period.  I marked the cycle again and waited.  The bleeding stopped in a timely manner.  Again, I had a period on day 28.  The acne also started to let up a bit.

Well, this is new.

In late February, we decided to see what would happen if we ditched any form of preventing pregnancy.  In April, unsure if my body was even making the right hormones or trying to ovulate despite having cycles, I ordered some cheap OPKs.  They’ve come up positive each month for an LH surge and are appropriately negative otherwise.  I have a basal body temperature thermometer, but with my odd hours (I work nights twice a week) temping has not clarified anything.

A couple of weeks ago, I realized my met.formin prescription was going to run out, so I called the RE’s office to get that prescribed.  Since I was on the phone with them, I figured that I’d go ahead and schedule my saline sonogram.  It’s a bit on the early side since we’re not planning to transfer until next spring, but I reasoned that if anything showed up as an issue, then we’d have some time to figure out next steps.

Today, I saw Dr. E, my RE, for the sonogram.  When Dr. E checked my ovaries, he noted that they don’t look polycystic the way they usually do.  I looked at the screen.  I know the appearance of my ovaries well, and the usual bunch of immature follicles was definitely missing.  Dr. E asked about my cycles, and I told him about the positive OPKs, regularity, and the supplements.  “Well, keep it up,” he said.  “It seems to be doing something good.”  He told me that it was hard to say given my history if I’d get pregnant naturally, but it was worth continuing and he hoped it would work out for us.

It’s somewhat promising as infertility situations go.  Definitely an improvement in many ways, but is it enough to actually get pregnant? Even with ICSI and a surfeit of eggs, we really don’t make a lot of embryos – and the ones we do make tend to be about a day behind.

I really want to be hopeful.  I really want to think that even after all this, the “old fashioned way” might be truly possible.  I really want to think that even if this doesn’t work out, one of the embryos will work next spring.  There’s no doubt I have seen (and had) longer odds and stranger things work out.

At the same time, I also know all too well the painful wounds that appear when hope flits away and reality unwelcome rushes back.  As I told Arthur recently, “Everyone keeps saying you need hope to live.  But in my case, it usually just f*cks me over.”

That’s where we stay for now in terms of infertility.  In the gray area between hope and not, possible and not, that unsatisfying non-answer.  What I keep reminding myself is that this is a season, not forever – and much of the rest of life is good right now.  Today, though, definitely lightens that gray a little and causes the ‘thing with feathers’ to stir.

Want to read more Microblog Mondays or participate yourself?  Please head over to Stirrup Queens and enjoy!  Thanks to Mel for originating and hosting.  

Oh, Right…Infertility

I like to think I’m not particularly superstitious, but when Arthur and I got down to talking about the nuts and bolts of transferring one of our two remaining embryos in the fall, I couldn’t help it.  I used to love fall.  My birthday is in late October and I’m a huge fan of pumpkin spice everything, jack-o-lanterns, the beautiful days with crisp evenings, and the leaves turning brilliant colors.  However, the last few years have gone something like this:

A few days before my 30th birthday – Diagnosed with PCOS and told that it was “not impossible, but unlikely” that we’d be able to conceive on our own.

31st birthday – In the middle of ovarian stimulation/egg retrieval for the first IVF cycle that ended in miscarrying twins.

Shortly after my 32nd birthday – Arthur unexpectedly lost his job and I started bleeding with the SCH (both on the same day!).

33rd birthday – My brother shot himself.

SO…while I can intellectually accept that all of this is unrelated and probably coincidence, fall just doesn’t seem to hold the good sort of surprises for me.

We looked at each other when I brought this up and I knew as soon as I said it that we probably needed to put the transfer off a couple of months.  Not only did it give us some much needed financial breathing room, it gave me some emotional breathing room.

I don’t know how I’ll handle that first anniversary of my brother’s death.  I do know that the stress inherent in a transfer cycle, mega-doses of progesterone and, if I was lucky, HCG in my system won’t make it easier emotionally.  I also know that it’s not the time to deliberately set myself up for the terrible disappointment of a negative beta, the anxiety of an early pregnancy, or the devastating loss of miscarriage.  If we got pregnant on our own around that time, well, we’ll cross that bridge if we ever come to it, but making a choice to throw a transfer in there is a whole other situation.

I have such mixed feelings surrounding putting transfer(s) off until early 2017.  Relieved because I just don’t know how much more stress/loss I can take right now, and it’s a wonderful chance to get to simply enjoy parenting E (who has become a great deal of fun to interact with).  Hopeful because we have two frozen embryos and some time for natural cycles.  Frustrated because at some level, I’m tired of infertility.  I’m tired of knowing that we likely have about $7,000 – 10,000 in RE bills coming to complete the transfers.  I’m tired of waiting and just want to be finished with the process.

Regardless, I know it’s the right decision.

In a month or two when my met.formin prescription runs out, I’ll probably make an appointment to re-up that and do the saline sonogram to check my uterus for scar tissue or other problems.  I’m hoping sonogram comes back okay, but at least if there are issues, we have some time to mull over options before next spring.

In the meantime, we’re informally seeing if something breaks loose in a natural cycle.  Truthfully, I don’t see this happening.  We needed a lot of medical intervention to get pregnant, have no idea at this point if my left fallopian tube is open, and while I am having surprisingly regular cycles, we never made lots of great quality embryos during the IVF cycles.  I know what the deck looks like, and it’s not stacked in our favor.  At some level though, it’s almost as if I need to try this for a while – if just to satisfy my curiosity and answer the “what if” in my head.

In Which We Have A Conversation With The RE

Right around the time I went to see my OB/GYN in September because my PCOS was causing weird bleeding and fierce acne, I also found myself unable to quit thinking about the two embryos we still have in storage. I had/currently have zero desire to be pregnant right now. At the same time, I kept wondering what the real possibility of a second pregnancy would look like or if there even was a reasonably good possibility of that happening.

Part of the issue is that out of three pregnancies, I’ve had zero normal, term deliveries. Each subsequent pregnancy has required more and more medical intervention. My first miscarriage was sad but routine. My ectopic required follow-up blood draws and monitoring for over a month, and even then I was really pretty lucky when it comes to ectopic pregnancies as I miscarried “naturally” without needing metho.trexate or surgery. The third pregnancy, of course, required a total of 4 ER visits, 2 brief admissions to L & D, innumerable office visits and ultrasounds, 17P shots, specialists, a 55 day hospital stay for me, a c-section and a D&E for retained placental fragments (not to mention the lengthy NICU stay for E).

In other words, it’s not prudent to do things that require actual planning and serious time/financial/emotional commitment such as applying to start my master’s degree until I’m truly done with pregnancy. So after talking with my OB/GYN, I went over to the RE’s office, which happened to be in the same campus and made an appointment to see Dr. E. We had questions about the quality of the embryos, the possibility of scar tissue in my uterus, and what came next. I also needed to know how the embryos were frozen and whether we would do one transfer or two. There’s obviously a financial difference and we needed to know ahead of time so we could plan savings.

We met with Dr. E a few weeks ago and set up the outlines of a plan. Much to my surprise, the quality of the two embryos is quite good. “These are the two best embryos you’ve made,” Dr. E told us. He also told us that the embryos were frozen as individuals, not as a pair.

Dr. E concurred with both the perinatologist and my OB/GYN that while I’m always going to be a high risk pregnancy because of my history, the subchorionic hematoma (SCH) was most likely a one-time thing. There’s no reason to think that another pregnancy necessarily would be dangerous or that I’d wind up hospitalized with a premature birth again. Then we got down to the details of what a transfer would look like for us. “Definitely one at a time,” Dr. E said. “I’d even go so far as to say that given your OB history, this is a medical necessity.”

“Because I’m already high risk and twins are an even higher risk?” I asked.

“That’s part of it,” Dr. E said. He had a theory about my SCH. The causes of SCHs are mysterious and not well studied. There’s some thought that blood clotting disorders can be a factor, but due to my infertility and miscarriage history, I’ve had a number of the work-ups for blood clotting issues and we’re reasonably certain that wasn’t my problem.

I’ve had a total of five embryos transferred. We know for a fact that four of the five implanted (blighted ovum, the baby I lost at 9 weeks, the ectopic, and, of course, E). Dr. E told me that it is somewhat unusual to have such a high implantation rate in IVF. When we did the ultrasound with E and saw only one gestational sac, we all figured that the embryo we’d transferred with E had just stopped developing and not implanted.

Dr. E thinks it’s a possibility with my track record of implantation that that embryo did implant and try to grow briefly, there was a vanishing twin that never got far enough to see on the ultrasound, and that this may have caused the SCH to develop. Dr. E stressed to us this was merely a theory, but when he said it, it made a lot of sense.

We also talked about the state of my uterus. While Dr. E said he couldn’t be certain until he actually did the imaging, he’s reasonably confident that I won’t have extensive scar tissue. Apparently having the D&C or D&E shortly after giving birth makes the risk much higher for scarring but mine was far enough out from my daughter’s birth that the risk was lower.

All in all, it was a good conversation. The current plan is to consider transferring sometime in the fall of 2016, but that depends on how E is doing and how Arthur and I feel about it at that point. We’re done with fresh IVF cycles. At least we have answers to our questions and can make fully informed decisions going forward.