And Then There Was One

A little over a week ago, I got the call I had been awaiting and dreading in equal measure.  “We’re thawing your embryos this morning,” the biologist at the IVF lab informed me.

Both embryos thawed, needed an assist with hatching, and then were watched overnight to see if they would grow enough for a biopsy (they had originally been frozen at a 2 stage for expansion, not quite enough to biopsy properly).  I found out the next morning that the blasts had expanded, samples had been dispatched to the genetics laboratory for testing, and both embryos refrozen with a newer vitrification technique.  The biologist stated that she estimated about a 75% chance for each embryo to thaw and re-expand properly for transfer in the future.  This was, essentially, the same chance we’d had before (since an earlier, less advanced form of vitrification had been used when the embryos were originally frozen in 2014), so despite the thaw and re-freeze, we really hadn’t lost anything in terms of the chances that the embryos would thaw properly later.

Then we waited.

Tuesday, I got the call from the RE.  We have one embryo that is genetically normal.  The other one had multiple chromosomal abnormalities, not ambiguous at all.  We chose to leave the sex off the report from the lab because personally, neither of us felt comfortable knowing.

I’m so glad we chose to do the test.  Interestingly, the genetically normal embryo is the one the lab had given a slight edge (though both technically scored the same in terms of grading) and would have thawed and attempted to transfer first even without the genetic testing.  However, if it didn’t thaw properly or simply hadn’t implanted, we would have probably attempted to transfer the other that turned out to be aneuploid.  We would have wound up with nothing to transfer or negative pregnancy test (at best) or a miscarriage/loss.  If the first one had implanted and resulted in a live birth, we would have been left in limbo, wondering what we should do with the final embryo.

There’s still a huge gulf between a genetically normal embryo and a baby.  There’s a chance the embryo won’t thaw correctly to even get to transfer since it’s been frozen, thawed, biopsied, and refrozen.  If we can transfer, even with a genetically normal embryo, not all implant.  Even if it implants, I know how easily the sh*t can hit the fan at any point in pregnancy.  There’s a lot of logistics and life and plenty that’s still up in the air or could change in a couple of years.

But, and this is the key point, the whole point of doing the test for us, we now know where we stand in terms of the health and potential of the embryos.  We can make whatever decisions we need to make with that knowledge in mind.

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The Loose Ends

Content note: I’m going to discuss our final two embryos and decisions related to them.  

Over the last few months, Arthur and I have an ongoing conversation that sounds something like this:

“If we were three or four years younger…”

“Yeah…”

“If we hadn’t had the infertility issues or the miscarriages or NICU…”

“Yeah…”

“But we did.”

“We did.”

“I’m tired.”

“Me too.”

It’s easy for me sometimes to focus on the good parts, those final easy months of my pregnancy with M that culminated in a term birth and a beautiful newborn and think, “oh, I could do that again”.  And if that was what was guaranteed, the answer would be easy.  Both of us had always assumed that if we hit the lottery (aka got pregnant and had a live birth on our own), we’d just be excited to try for a third child.  What – as the dust settles – we’re only now truly starting to account for in a meaningful way is how much the whole journey has taken out of us.

This isn’t a complaint.  We are fortunate beyond all belief in so many ways.  With some distance, all the infertility, IVF, miscarriage, and premature birth has ceased to be the constant it once was and has slowly begun to sublimate into the normal fabric of our life.  There are moments, of course, but there’s no doubt that it’s better.

Recently, however, I was reading a book where the miscarriage scene triggered a strong, painful memory of sitting in a darkened ultrasound room, pregnant, but not really any longer.  “I can’t keep putting myself through this,” I told my husband.  “I just can’t go through everything and then hold my breath for months.”

~*~

We met with the RE last week to discuss what to do with our final two embryos.  It’s truly a conversation I never thought we’d need to have.  When I went through the transfer that ultimately resulted in E, it was not a good day.  I’d had 22 mature eggs retrieved, 18 fertilized, and plenty of embryos growing beautifully on day 3, which pushed the transfer to day 5.  On the appointed day, we arrived at the clinic, got prepped and then handed a photo that I expected to contain our perfect blastocysts for transfer.  Instead, the photo showed two cavitating morulae.  Our best embryos out of 18 fertilized eggs were a full day behind.  Let’s just say there were a lot of tears that day.

I didn’t even think about the last few embryos the clinic had decided to continue growing to day 6 and see if there was anything to freeze.  A day or so later, I got the call that the lab had frozen two day-6 blastocysts.  Truthfully, I was so disheartened by infertility and circumstances I just sighed.  It was too much at the time to get excited.  We were more or less broke, emotionally and financially.

As the infertility cliché goes, though, you only need one good one (and in our case, a bizarre, stressful, high risk pregnancy), and E came into our lives.  At the advice of the perinatologist and my OB, we decided to try on our own for a year when we were ready for a second child.  Much to our immense surprise and joy, M came to us.  Which left us having the conversation I recounted above.

Like I said, none of this is a complaint.  We’re lucky and I don’t discount that in any way.

Neither of us feel as though we can discard the embryos.  The embryos have a form of dual existence for me.  They are somehow both not fully human and also, simultaneously, my babies.  I’m aware other people have different feelings about embryos, and that’s absolutely their prerogative.  I’m certainly not going to judge anyone for their feelings or what they choose to do with their embryos – it is such a difficult, personal decision.  This is just what works for us.

We finally determined that our best course is to find out, as much as possible, what we have frozen.  We know we have two day-6 expanded blastocysts with a “b” grade inner cell mass and a “c” grade trophectoderm.  The biologist at the lab described them to us as “average” – certainly high enough quality to potentially create a baby, but not top rated.  Due to my high-risk pregnancy with E (and the increasing trend towards single embryo transfers regardless of pregnancy history), the embryos have to be transferred one at a time, meaning we would potentially need to go through two FETs.

We don’t have the energy (or finances) to put into treatment that we once did.  The idea of going through another miscarriage (or worse) scares me.  Doing two FETs means a good bit of logistics to make them work just in terms of getting to the clinic as required, not to mention the expense and the two week waits.

This led us to genetically testing the embryos, which is a little cheaper than a single FET at our clinic by the time we add in medications and everything else that goes into an FET.  It means thawing, growing the embryos out overnight, having them biopsied, and then refreezing.  It’s not without some risks, but in return, we’ll have some idea of whether or not the embryos are euploid, and the refreezing will be done with a newer, better form of vitrification.  If one or both of the embryos turns out to be euploid, we’ll have a higher chance of implantation and a lower risk of miscarriage once we transfer.  If one or both of the embryos turn out to be aneuploid, well, we’ll save ourselves the cost of one or two FET cycles, the two-week-wait, and potentially a miscarriage.

It’s not an easy decision.  I’m aware that there’s definitely some controversy right now in the world of embryo genetic testing.  A couple of days after Arthur and I made the decision to go ahead with genetic testing, this landed on our doorstep:

IMG_0486

Not the most helpful coincidence.  I mean, I’m glad doctors and scientists are considering these variables, just sort of strange timing for us…

I’d be lying if I said that the idea of a lab making a mistake about whether or not the embryos are good doesn’t scare me.  However, given all of our particular variables, genetic testing is still our best option going forward.  We’re working on getting the consents signed currently.

And then…we’ll see.

The Old Guard

microblog_mondays

Arthur and I went to see the RE today to talk about the two remaining embryos we have frozen.  The embryos are a discussion for another post, but as we stepped into the clinic, I had this odd sense that I no longer belonged there the way I once had.  It reminded me of going back to my alma mater, walking around the campus, seeing the current students going to classes, realizing I was an alumnus now and that era of my life was over.

We sat in the waiting room.  A couple came in.  They seemed happy, and I watched as they were ushered back in the direction of the ultrasound room and suspected they were here for a pregnancy check.  Unless the routine had vastly changed, I knew ultrasounds for follicle counts were done much earlier in the morning.  I hope that they got good news.

Eventually, we were ushered back to talk with Dr. E.  As we discussed the remaining embryos, it was clear that we were no longer there with that mixture of fear, anticipation, and hope that we had originally come into the clinic carrying four years ago.  Instead of trying to begin, we were bringing the journey to an end, working to figure out the last steps.

I’m not nostalgic about IVF or treatment.  A few days ago when I went write about a particular experience during my first IVF, I was surprised at how p*ssed I still felt when reliving that memory.  I don’t miss the uncertainty, the worry, and the torturous waits for everything from follicle checks to the infamous two-week wait.

I am slightly nostalgic for that nervous but hopeful person I was when I first walked into the clinic.

Many of the times I’ve gone to the clinic, there’s been the sense of doors opening.  Of possibilities and plans and fresh starts.

Today, we walked out with all but the last two doors closed behind us.

Want more Microblog Mondays posts?  Head over to Stirrup Queens and check them out!  Thanks to Mel for originating and hosting.

Odds and Ends

A couple of weeks ago, E knocked my laptop off the coffee table accidentally.  In a freak sort of moment, it hit the corner of a heavy basket I keep next to the table and cracked the screen.  Since the crack didn’t affect the LCD part of the screen (it was a very surface crack), I groaned and figured I’d keep using the laptop for a bit while researching potential replacements and saving.

A few days later, M spit up directly into the keypad.  I turned it off immediately, wiped up what I could, and waited.  The laptop is mostly working now, but has some sticky keys and is clearly running even more obviously on borrowed time than before.  Arthur is researching alternatives and hopefully we’ll get one ordered in the next week or so before this laptop dies entirely.  I’m backing up all my files to the external hard-drive and getting ready to move my bookmarks and such before that happens.

It is telling that upon seeing the screen crack, my first thought was: well, this will most likely be less expensive to replace than two vials of foll.istim and definitely less expensive than a single IUI.

Infertility has clearly skewed my view of the term “expensive”.

~*~

Life is in that busy but largely pleasant mode for the most part these days.  I’ve been back to work since mid-June, which is going well.  I enjoy what I do, so while I’m tired (trying to readjust to working nights is taking some time), it’s great to have a chance to interact with my coworkers and take on some projects.

Arthur and I got to go to a fundraiser for the local zoo on Friday with his parents and a couple of his siblings.  It’s a sort of local “taste and drink” deal, where many of the restaurants and catering companies in town set up booths with small portions and typically a signature drink or two.  Because I have a terrible sweet tooth, my favorite is the artisan chocolate company.  It was a lot of fun, made more so because the animals were far more active at night than they typically are during the day.

~*~

E is almost finished with speech therapy.  We have one last session in September just to make sure she hasn’t regressed.  I’m not too worried at this point.  The other day, she walked up to me and started talking about the “botanical garden”.  Yep, with the word ‘botanical’ clearly pronounced.  We’ve come a long way from the 18 month who had what the speech therapist termed a “moderate to severe” speech delay.

She’s doing extremely well overall.  Still doing some physical therapy for a few motor issues, but we see improvement and hope that soon enough the gymnastics class I’ve got her enrolled in at our local YMCA will be enough.  We’re gearing up for a minor procedure for E in September due to congenital partially blocked tear ducts, but hopefully that will be her final surgery for the foreseeable future.

M is growing so fast!  Having a term baby after a very premature one is a totally different game.  She’s a happy, giggly baby who smiles and babbles a lot.  It’s strange not to be in a doctor’s office on a regular basis and to watch her outgrow clothes at an absolutely (to me) extraordinary rate.

~*~

Arthur and I scheduled a consult with Dr. E to discuss our two remaining embryos.  We aren’t anywhere near ready to make a final decision, but we need information to make some of those decisions, time to potentially save up financially, and a discussion of what’s even possible or advisable at this point.

~*~

We’re starting to make appointments to prepare for a house purchase.  We’ve been looking at various neighborhoods, narrowed what we are looking for, and decided on a couple of financial institutions to talk to for the mortgage.  It’s both daunting and exciting to get to this point.

A Long Time Coming

In the weeks and then months after E was born, we spent a lot of time at the hospital, first in NICU, then going back and forth to doctor’s appointments and tests.  Every time I made the trip to the hospital, the route took me through a nature preserve marsh area.  I’d often spot hawks, great blue herons, or swans.

One day, I saw a flock of white birds perched in the trees and logs.  At first, I wondered if they were seagulls or more swans.  They were quite a long way from the road, so hard to make out, but as I got a better look, I realized that a couple of them were wading in the water.  They were storks.  A whole friggin’ cloud of storks.  This realization elicited a rather dark-humored chuckle from me, given the association of storks with babies.

“Really?!”  I muttered incredulously to myself.  “This is where y’all have been hanging out all these years, huh?”

I continued to see the storks all summer, and the next spring, I kept an eye out for them.  Sure enough, the cloud of storks again descended on the marsh.  I would watch for them as I went back and forth to my OB appointments in those early, tenuous days of my pregnancy with M.  I saw them as I headed in with bleeding.  I saw them after good ultrasounds.  I got to the point where I was almost superstitious about it – if I saw the storks, everything was probably okay.

This summer, I waited to see the storks.  While I’ve seen a few of them on and off, it’s nothing like the last two years.  At most, I’ve seen three or four at a time, whereas in previous years, I’d see ten or fifteen easily.  I’m completely aware that this has something to do with changes in the migratory pattern of the birds, but it’s a sort of strange coincidence how it has almost perfectly dovetailed with the volume of my anxieties and feelings about infertility.

When I was first diagnosed with infertility, the one thing I wanted to know was whether or not the acute distress of not knowing and the horrible limbo of waiting would ever end.  I figured intellectually it would – and multiple bloggers/authors in this community with every manner of outcome testified to that – but there were days it felt emotionally like we might remain in the undecided, unresolved ether forever.  In some ways, that was one of the hardest parts of fertility treatment for me.  I could deal with the physical side effects, but the waits – waiting to start cycles, waiting for lab results, waiting for paychecks to pay for cycles, waiting for embryo reports, waiting for pregnancy tests, waiting for ultrasounds, waiting on those long weeks of hospital bedrest to see if E would survive – stressed me enormously.

For a long time, infertility has been a wound that has stubbornly refused to heal or even really scab over.  We still have two frozen embryos, and with my history of subchorionic hematomas and the concerns with whether or not something in the IVF process possibly exacerbated the first one with E, there are some loose ends yet.  Lately, though, I’ve noticed that while I’m not quite resolved, I’m starting to see that eventuality on the horizon.

One Project Finished

May and June comprised one of the busiest periods I’ve had in a long while.  As my BSN program drew to close and deadlines ticked down, I found myself running around completing a sixty-five hour practicum class that involved setting up and then interviewing community leaders on my chosen topic as well as doing the research for my classes to prepare for papers.  June finished out with an absolute orgy of writing as I wrote three major capstone projects totaling over seventy pages.  It was, to say the least, completely exhausting.

However, it was also rewarding as I got the notice on Monday that my final paper passed and my advisor recommended me to receive my diploma!

When I decided to go for the BSN, I initially rolled my eyes a little.  I already have a BA (in English) and I figured this degree would be more of the same.  However, with more and more push for RNs working in hospital settings to have BSNs, I knew I needed to go ahead and get the degree.  Otherwise, I risked a situation where, if I ever found a position I wanted to pursue in another hospital system or my system changed rules or ownership, I might find myself either unable to apply for a different position or told that I needed to complete the BSN within a certain number of years.

I was surprised at how much I learned.  While I definitely had a head start since my degree in English had taught me a good bit about research and writing, in my new coursework, I learned how to really evaluate scientific research.  I also learned about statistics and worked through the steps of problem-solving in a nursing setting.

In short, I know I’m better at what I do thanks to earning this degree.  Eventually, when I’m ready, it will also set me up much better to complete masters’ level coursework.

At this point, I’m looking forward to catching up with reading blogs, commenting, and writing here a bit more often.  I’m hoping to watch the documentary “Vegas Baby” about the Sh.er Inst.itutes IVF contest when it comes to Net.flix and read Belle Boggs’ The Art of Waiting.  I recently finished Kate Hopper’s memoir Ready for Air about the premature birth of her daughter and D. Knight Smith’s Letters to Ellie.  I’ve been thinking about infertility and NICU quite a bit.  It’s as though suddenly I’m really starting to process some parts of the experience that perhaps I couldn’t when I was going through them.

Returning Home

Big time spoilers for The Lord of the Rings – especially the ending – ahead.  

It’s no secret that I am a huge fan of The Lord of the Rings.  There aren’t too many things in my life that have stayed constant since age 14, but these books continue to inspire, motivate, and comfort me.  As I’ve grown, aged, and lived, the meanings have changed, the understandings deepened, but every time I pick them up, I find something new.  When I first read the books, I was thrilled by the exciting adventure, the battles, and, oh yeah, Aragorn.  These days, it’s a different part that I keep turning to read.

One of the things I love about The Lord of the Rings now is the ending.  The movie version leaves out part of the original ending, and I understand that choice at some level.  The original ending is messy, hard, and complicated in a way that’s difficult to translate to the screen.

For those who aren’t familiar with the book ending, it looks initially like a very traditional storybook ending wrap-up.  Then the movie and book part ways: there is evil waiting in the Shire for the returning hobbits.  They have to fight yet another battle to get the Shire back – their home is ugly and changed by that evil.  The book and the movie return to sync when Frodo departs Middle Earth.

When I initially read The Return of the King, the scouring of the Shire irritated me a bit.  It seemed…unnecessary.  The major task was fulfilled, the ring destroyed, the epic showdown at the gates of Mordor fought, and the hobbits returned home triumphantly.  Then Tolkien throws in this seemingly discordant sadness and destruction.  It’s no wonder Peter Jackson left it out of the movie.  It feels unfair that after everything the hobbits have done and the horror they’ve been through they don’t come home to a hero’s welcome, that there’s still more to do.  This isn’t a Harry Potter ending.

Now, though, I get it.  Tolkien has captured the reality of life after being touched by struggle and tragedy, in whatever form that comes to particular people.  You don’t walk through Mordor and remain untouched.  Even once the main event is over and evil seemingly vanquished or at least survived, it’s coming home to find more work to do and reminder after reminder sitting in your front yard.

We walked through Mordor the days my daughter nearly died.  We walked through Mordor when my brother so inexplicably left us.  The days when nothing made sense.

I hoped when we finally came back, naively, it would still be mostly the same.  I knew better.  But I hoped.

Instead, it’s been the weariness of battling back what those journeys took from us.

It’s no longer the epic battles of life and death.  It’s the bitterness at the bottom of the glass, the sh*ttier stuff, but battles that are no less for their smallness.  It’s fighting those unwelcome triggers and reclaiming home.

It’s knowing when to lay down the swords and begin the peaceful work of planting and bringing green life back to damaged land.  It’s showing mercy.  In some ways, this is almost harder.  It requires vulnerability, patience, honesty, kindness, and diligence.  Qualities that some days are tough to muster.

Tolkien doesn’t give Frodo a beautiful happy ending in his beloved Shire.  The wounds simply go too deep.  I take a lot of heart, though, from Sam’s ending.  Sam, who also bore the Ring, touched evil, who also walked through Mordor.  Sam, who “planted saplings in all the places where specially beautiful or beloved trees had been destroyed and he put a grain of the precious dust in the soil at the root of each.  He went up and down the Shire in this labour…”  Sam, who receives these words at the last, painful farewell: “Do not be too sad, Sam.  You cannot be always torn in two.  You will have to be one and whole, for many years.  You have so much to enjoy and to be, and to do.”

That is an ending – or perhaps another beginning – worth all of the work.