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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Sometimes, You Can’t Run After Them

Content note: parenting, miscarriage

My older daughter loves books.  Upstairs, downstairs, board books and picture books abound.  I periodically go through and put them back in some semblance of order, only to have them joyfully pulled off the shelf a few minutes later for reading.  There are classics and newer titles and everything in between.

There is one board book, however, that doesn’t belong to the girls, that never is pulled from the shelf, that I have never read to either daughter.

I bought it nearly four years ago, one burst of optimism in a lot of nagging fear and doubt.  I never could get into buying baby clothes – that felt wholly overwhelming to me for something so tentative – but I did purchase a tiny set of board books.  The other two I threw away after it happened, I was so sad and so angry, but one I slipped into the box that held a positive pregnancy test, ultrasound photos, the embryo photo, some cards, and a few sprigs from the bouquets I received.

I don’t feel pregnant, I told my doctor at the time.  I’d never been pregnant before, but I knew, knew somewhere deep inside that something wasn’t quite right.  I found out that I’d miscarried the first one on a December morning when the ultrasound screen showed the pooling blackness of a gestational sac with something inside but no flickering sign of life.  The second one though.  The second one had a perfect heartbeat.

I hoped that the feeling of this is not right had been the first one passing, but I still didn’t feel good.  Or rather, I felt too good.  Not a wisp of nausea (but my mother had never really suffered from morning sickness and these things are often hereditary).  No breast tenderness (not everyone gets that).  No reaction to strong scents (well, it doesn’t usually set in right away).  Not overly tired (no more than usual).

But everyone told me that if you saw a heartbeat, your chance of miscarriage was drastically reduced.  I bought the books.  The Runaway Bunny seemed particularly apt.  If you run away, I will run after you, the mother bunny promises her little bunny.  I had run after this child, first with all the poking and prodding, then medications, and finally the IVF.  Right then, it seemed perhaps I had finally caught this baby.

Even then, I couldn’t quite shake the feeling.

I wasn’t surprised the day the ultrasound revealed the absolute stillness in my womb.  Devastated, but not surprised.  The babies were gone, but I could not run after them.  I could not turn into a fisherman or a mountain climber or anything else like in the story to bring either of them home where they belonged with me.

I let go in the end.  I had to.  Unlike the fictional mother bunny, I didn’t get that choice.

I tucked the book into the box a few days later.  A small gift, a book I wanted so badly to be true.

I could not bring them home.  The only thing I could do was send my love.

October is Pregnancy and Infant Loss Awareness Month. 

How Do You Say ‘Thank You’ to Someone You Never Met?

When I’d go for my daily run as I was going through infertility, I had one song on my i-pod that I generally slotted toward the end of my playlist.

Well, I won’t back down
No, I won’t back down
You can stand me up at the gates of hell
But I won’t back down

No, I’ll stand my ground
Won’t be turned around
And I’ll keep this world from draggin’ me down
Gonna stand my ground

I always knew I couldn’t control the outcomes of my cycles or whether or not we ultimately had a baby.  I couldn’t control the suckitude of cancelled cycles, BFNs, or the losses.  Most days, it felt like nothing was in my control.

Well I know what’s right
I got just one life
In a world that keeps on pushin’ me around
I’ll stand my ground

I never heard the song as a “don’t give up on treatment” but rather, not to give up on life when some days, it was hard to get up in the mornings.  The song always rallied me to remember that someday, somewhere, we would make it through.  There was a good life after infertility, whether or not we ultimately had children.

And I won’t back down
(I won’t back down)
Hey, baby, there ain’t no easy way out
(I won’t back down)
Hey, I will stand my ground
And I won’t back down

I listened to that song through so many bad moments – diagnoses, miscarriages, cycles, job losses, hospitalization, NICU, my brother’s death, post-NICU – and it always gave me just that little bit of strength I so often needed to say “I am struggling.  But I will find a way through.  Maybe not the way I envisioned or hoped.  Maybe a different way.  But a way”.  Still does, honestly.

As I was browsing news sites the other day, I heard that one of the song’s writers and singer – Tom Petty – had died.  I’m sad and sorry he’s gone.  But what do you say about someone you never met or actually knew?

I guess, just this:

Thank you for the song, Tom Petty.  Thank you.

Lyrics to “I Won’t Back Down” by Tom Petty/Jeff Lynne. 

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

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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.

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.

Clothing-Specific Memories

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Sorting through clothing is a funny thing.  I know people who do not become sentimentally attached to their sweaters or jeans, who cull their collections regularly and who don’t overstuff their drawers, but I am not one of them.  There’s some clothing I can get rid of pretty easily: things that are stained, that obviously don’t fit, basic tees or undershirts that have reached the end of their usefulness, but there’s a whole separate class of clothing that lives in my closet that presents a bigger challenge.

Apparently, I’m not the only one who has this issue, something I was reminded of when I ran across this article, poignantly titled “What Do We Do With the Clothing of Grief?”  As the author recounts the sweater she bought so hopefully during a lost pregnancy, I couldn’t help but think of my own “clothing of grief”.

In my case, it’s the brightly colored peplum boiled wool jacket I wore to the doctor’s office the day there was no more heartbeat.  The black fleece pants that I wore throughout my pregnancy with E and wore to the hospital the day my water broke at 21 weeks.  The olive-green dress with embroidered cranes I wore the day after my brother died.  I don’t know why it’s that dress, the day after, that I associate so strongly with that tragedy, but for some reason, the two are inextricably woven together in my memory.

Sometimes I wonder if I’m ever going to make a decision about those clothes.  I did sell one piece, the sweater I was wearing the day I was diagnosed with PCOS that lay crumpled in a drawer for years, never worn again.  The others, however, seem either too practical (the fleece pants) or too much difficult to reacquire pieces that I really like (the jacket and the dress).  What’s really strange is that I had memories in the jacket in particular that are fairly happy memories before that day.

Perhaps it’s too much to ask that the clothing of grief be repurposed into something truly neutral, but I do sometimes pull out the pieces and wonder if I can find the courage to start wearing them again, make enough memories in them to imbue them with both joy and sorrow.  Instead of the clothing of grief, make them something more akin to the clothing of memory.

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The jacket, on a much happier day (visiting the Hoover Dam in Nevada)

Thanks to Mel for hosting and originating Microblog Mondays!  If you want more posts, head over to Stirrup Queens to read.