Episode 5: ABCs of IVF (Part 3) - Embryo Testing & Transfer(s)

Small Batch Sound: Hey everyone and welcome back to Confessions of a Slow Cooker. I'm Ashlyn Bluh and today is the third and final episode in the mini-series I call the ABCs of IVF. Last time we went over the priming and the stem cycle, all leading up to the first IVF procedure known as the egg retrieval. How many eggs you get matters, which is why they spend all that time stimulating egg growth in the days before your retrieval. However many you get, they will attempt to fertilize them with your partner's sperm or donor sperm and then see how many of them turn into embryos. So you usually find out how many eggs they retrieved while you're still at the facility. But then the next day you get calls and then over the next week you'll keep getting calls. Per my journal entry from that day, the day after my retrieval, out of the 15 eggs I had, only four were successfully fertilized overnight. There were apparently three that they didn't even attempt to fertilize because they weren't mature enough at the time. But the embryologist told me the following day, well, maybe they had matured and so they would attempt. So 15 eggs to four embryos to maybe seven embryos. And then two days later, I got another call that said two of the three that they were hoping to fertilize had successfully been fertilized. So now our total is six fertilized embryos. Are you confused yet? And then during that They said that they were also monitoring five more eggs that they were slow growers. And since I'd been a slow grower this whole process, they weren't just going to give up on them yet. Three days later, I got the call that four had made it to the next step, genetic testing. So it was 15 to four to maybe seven to six back to four. I remember being somewhat relieved and also bummed. Just four chances to get a strong enough one to implant. That didn't seem like a lot. And the worst part, the testing would take two to three weeks. Waiting during any part of the IVF process is excruciating. It just sucks. There's no way around it. Embrace the suck. We got lucky that it only took nine days to get our results. So they scheduled a telehealth appointment with our doctor to go over them. There we sat in front of my laptop at the counter in our Aspen condo waiting. to hear if we would A, have any embryos that made it through the process, or B, if I would have to consider doing the whole egg retrieval part all over again. I have friends who got embryos. I have friends who never even made it to the genetic testing part and had to make that decision even earlier. As for us, our doctors said we ended up with two strong embryos and one they categorized as low mosaic. And the term low was actually good news. Low level mosaics have mostly normal cells and a lower percentage of abnormal cells. So technically we had three, but mentally we decided to operate and make decisions as if we only had two, since we weren't sure if we would ever even try to implant the mosaic. Our doctor gave us the option to find out the sex of the embryos. Marcus and I looked at each other and nodded in agreement. Not exactly the gender reveal I'd envisioned in my younger years, but it was just as special. And as it turned out, all four of the embryos they sent out for genetic testing were boys. Marcus grew, Marcus threw up his arms and said, yes. It was cute. The doctor told us we had two options. We could go ahead and go back to the egg retrieval step and try to bank more embryos, or we could try a transfer or two. And if they didn't take, we could go back to the egg retrieval step then. Thankfully, Marcus and I were on the same page here as well. We decided to do the transfer. I was going to be 38 in a few months at that point. So I figured I was still young enough to go through this whole process, as long as I didn't take like a gap year. And even then actually, I would have been technically young enough. I have friends who were over 40 when they started the whole thing. We had heard throughout the process that it's good to have twice as many embryos as the number of children you want. So with two embryos to transfer, the odds were that maybe one would take. I had always wanted more than one child. I'm the oldest of three. But these numbers suggested unless we were successful with the first embryo transfer and then again with the second down the line, there was a good chance that we would only have one kid. Again, that's if one of these embryos even took. We ended up calling a friend of Marcus's who has one son and asking him about having an only child. And that conversation was all I needed to be a hundred percent okay with the idea. Fast forward, I am still okay with the idea. I'd like to remind anyone listening or watching that this is not the quote, right thing to do. It's just what my husband and I decided after hearing what the doctor had to say. If you end up in the same situation and choose the alternate option, I'll cheer you on just the same. Since we decided on the transfer option, our next step was to wait for my period to come. At that point, I would receive my transfer calendar and we would keep tracking along. For reference, I started my period on April 26th, which meant that the earliest transfer date would be June 9th, 2023. Remember, everything is around your cycle. Here's my transfer calendar for those of you watching. They put me on birth control pills for three weeks. I started doing Lupron injections every day to essentially halt my body's natural hormone cycle so that my doctor could basically control my ovarian simulation and give me the necessary doses of estrogen and progesterone needed for the embryo to stick. All these meds are meant to give your body the best shot at doing what it needs to do. I started doing Vival estrogen patches. And here's a look at what that ended up looking like on my belly. I got up to four patches a day. and you weren't supposed to put them in the same place on consecutive days. So I don't know about you, but I don't exactly have a lot of real estate in my belly area, and I ran out of room pretty quickly. During this time, I was also scheduled to have electroacupuncture twice a week. And that was, remember, in the first episode of this mini-series when I talked about the blood flow that they discovered in my workup. This is that. About six days before my transfer, we did another ultrasound and blood draw to determine the rest of the medication protocol. They had me stop the Lupron and begin endometrium, which is progesterone administered via vaginal tablet. So fun. I started MedDraw, which is a steroid, and doxycycline, which is an antibiotic. And then I added more progesterone to the mix via injection. ⁓ A friend of ours took a photo of my sweet husband giving me this. particular injection because I had to be in the upper buttocks. This one stung. Patches, shot bruises, changing your underwear multiple times a day because of the progesterone tablet residue? IVF is not cute. We drove down to Denver for the transfer itself and we took our dogs with us since it was a finite trip. Remember the previous episode when I said I was told to tell the hotel I might need more days? Well, that's not the case for your embryo transfer. We knew we would come in the day before and that we were supposed to stay in Denver for at least a day after the transfer before jumping in the car to drive back through the mountains to get home. Less jostling of the uterus. I arrived the morning of the transfer at the clinic and had a blood draw. for my estrogen and progesterone levels. Then I went up to the surgical area and got ready for the transfer. They don't put you under for this one. ⁓ It's really just like an IUI. They put the embryo into the catheter and then place it into your uterus. They did give me a volume so I could relax, but I don't think that was for the actual procedure itself. I think it was more so I'd relax after I left. Once the doctors and nurses left, Marcus and I balled. We were so hopeful. We went back to our friend's house where we were staying and I went straight up to the guest room to nap and lie around. While we were still in Denver, the clinic called and said my estrogen and progesterone levels were fine. And so all I had to do was wait for nine more days to be tested. No big deal, right? Just nine days. The waiting is the worst part of the transfer. There's nothing you can do, but try to relax so that your body will do its thing. And so wait, you must. And by the way, I know some clinics make you wait longer than nine days before the pregnancy test. Whatever the days, it's brutal. I'm a little type A if you can't tell. So as soon as I could, I submitted my lab order to Aspen Valley Hospital and I made an appointment. for as early as I possibly could the day that I was going to be tested. On the morning of June 18th, I got my blood test and waited to hear from a nurse. It was a Sunday, so I knew there would be fewer people at the clinic and it probably wasn't gonna be my nurse who called me. The phone rang and a voice I did not know said, I'm so sorry. It was earth shattering. I thought I was pregnant. I had felt symptoms that I thought meant I was pregnant, but I wasn't. And now we only had one more embryo left. I recall being a hot mess for the days after that. I wrote in my journal that since I was off all the hormones, my body was coming down from that change. And just emotional loss of the embryo felt like just too much to handle. I also wrote, I was an absolute bitch to my parents. Sorry. My doctor called us two days after to discuss next steps. According to her, there was no known reason the first one didn't take. She said it could be a genetic issue that wouldn't show up on a chromosome test, meaning it could look strong, but still be abnormal. Or it could have been that my body's first attempt at keeping it just failed. Either way, she didn't see a reason why we shouldn't try a second transfer. She did suggest one change for the next transfer though, that we do what's called a natural cycle instead of the medically assisted one. They are a little less calendar friendly because it would wholly rely on my body cycle and we know how that goes. And then she said she'd add in some other things to see if it would help, like Claritin and Pepsid. I don't really know how that helped, but I was willing to try anything. And she suggested we skip a cycle because my ovaries were, quote, sleeping from all the drugs I'd been on, and they really needed time to reset. Something else she said we would do in the meantime is test for a blood clotting issue. There was no evidence I had an issue, but just in case. Plus, we had the time. And if there wasn't an issue to be found, they would put me on blood thinners during the next transfer cycle. So we had a plan. We didn't get what we wanted the first time, but a plan with a proactive doctor felt like the next best thing. Also, right after that conversation, my cousin Jillian texted me and said she would be willing to be my surrogate should we ever get to that point. It was overwhelming to think about at the time, but also a mental cushion. I wanted to carry my own child. I wanted to be pregnant. But if I couldn't, I had options. And that was nice. During the time I was waiting to get started again, I did a lot of soul searching. I talked to two women I knew who had had first transfers fail as well, and they both told me, the baby you have will be the baby you were supposed to have. I held tightly to those words and put them on a post-it in our kitchen. I even wrote to myself in my journal, Dear future Ashlyn, you will be a mom. You will get a positive pregnancy test. You will get to hold a baby in your arms and it will be yours. Somehow, someway. My next transfer was ultimately scheduled for August 17th, 11 days before my 38th birthday. I don't know where you grew up, but I grew up in the South, in Nashville, Tennessee, to be exact. And my parents had me when they were 23, 24 years old, albeit I was born in Los Angeles. I did not foresee this. Not at all. I've said this before in another episode, but I felt ancient. I had been considered geriatric for three years at this point. My age plus the unsuccessful first transfer made me feel very nervous about the second one. But it didn't really matter how I felt about it. I still had to chill out as much as possible. So I read, I watched Harry Potter, my go-to. I crocheted, I took leisurely walks. But this time I took zero stock in anything I felt or for that matter didn't feel. Symptoms, whatever. No symptoms, whatever. I sailed through this time without trying to feel much at all. or at least not have a foregone conclusion about it. I am not saying it was easy, I just didn't lean into anything. I guess I was sort of seasoned in a way. And while I was hopeful, I was not nearly as optimistic the second time. There was one difference in this transfer that I want to point out. I went in just like the first one, got a blood draw, got the transfer, and then we went back to the same extended stay hotel I'd stayed in during my egg retrieval. The clinic called a few hours after to say my estrogen levels were off. They would send in a new prescription and I needed to not only get on it right away, but also need to get a follow-up blood draw and Aspen two days later to see if it righted the levels. Cool, whatever. So here's the interesting part, and it's something I tell everyone I know who's about to go through the transfer process, just in case. I sent my lab order to the same lab I've gone to this whole time. They are great. They were great. But they mixed up one thing. So I have two lab orders, one for the nine-day and one for this follow-up estrogen level test. They accidentally ran the nine-day test when they were supposed to just test for my estrogen. And so it's... you know, it tested for my progesterone, my HCG, and my estrogen. And then they sent the results to my clinic and my clinic found out that my estrogen's fine now, but my progesterone plummeted. So they dubbed my dosage right then. I wonder, my husband and I both wonder if maybe that had happened the first time as well, because progesterone is what you need for it to stick. Thank goodness they mix up the order. Thank goodness. After this test, there's still like six or seven more days to wait. And as the days tick by, I remember feeling less and less able to function in any normal way. I'm there, but I'm not really there, you know? I couldn't think of anything else. And so on my birthday, August 28th, I was like a zombie. Time stood still. I was afraid to hope this time. And I mentally prepared myself or tried to, to have to text the same people those two words all over again, not pregnant. I tried to wrap my brain around another retrieval and I started worrying about the implications of what a second failure could mean. I had never had a positive test before, never had a miscarriage, just never had been pregnant. And if I lost the second one, did that mean I couldn't get pregnant? I was 38 now. What if my ex would be demonstrably worse quality than ex retrieval? These thoughts were invading every breath I took. Usually when I'd be in a time of mental anguish, it just helped to move. Go to a really hard yoga class, get on the Peloton, something like that. Can't do that when you're in this time. You just have to sit with it and try your best to deal. Somehow I made it to the next day. The day. I got my blood drawn and went back home. Marcus had taken the day off to be with me when I got the call. We assumed we'd get it earlier this time since the weekday, but as the time went on, I got more and more nervous. We went on a walk around Aspen. It was a beautiful day. I didn't care. We saw a friend on a run or on her way to Pilates class. can't remember, but I was comatose. I ended up telling her what was going on before she left because I realized this was the most unlike me she'd probably ever encountered. We walked home and I tried to crochet a little. And by the way, I learned to crochet little animals during IVF, and by the time we were at this point, I was quite good. It was the best way to feel productive and also make something I could just give away. My goal was to get good enough that I could make my child a stuffed animal, and I'd achieved it. But was I going to have a child to give it to? My phone. It sat there taunting me, sitting so still and keeping so quiet. I just wanted to chuck it across the room. Before I did, I handed it to Marcus and said, I can't do it. I'm going to watch Harry Potter. Enter the phone when it rings. I closed the door to the bedroom area. Then I closed the bedroom door and I slunk into our bed, turned on Prime Video where all my Harry Potter movies live. And I would have sworn it was Order of the Phoenix, but my journal said it was Prisoner of Azkaban. Journals don't lie, so Azkaban it was. I don't know how much of the movie I even got to watch, because all of a sudden, Marcus burst through the door saying, I'm gonna be a father. The phone in his hand, or Nurse Ellie on the other end. He gave me the phone and she confirmed the news. I was in absolute shock. My HCG levels were 272.38. All they needed to confirm pregnancy was five. So I was like super pregnant. Holy moly. I mean, I couldn't believe it. For the first time since we started trying in 2020, all the journal entries each month with Not Pregnant, the IVF Saga, I was able to write in all caps. I'm pregnant. I did not mean to get... Whew, I did not mean to get emotional. Have a baby, I know how this story ends. Anyway, that's my IVF journey. I told you so many details because I wanted to humanize the process. I hope it helps anyone understand the possible timelines and how I can feel going through it. Stories always helped me. And if you have questions about anything I talked about today, please reach out, whether that be via social media or email or YouTube. Sorry, there's a link in the show notes for all of it. I say this every time, but going through IVF, even contemplating it can be so overwhelming and you don't have to go it alone. If you know of someone else going through this and you think it would help them, please share it. I'll see you next time. Until then, take care.