no time like the present

I'm here to share some sneaks as well as some belly photos.


This layout was made using a Pinterest pin as my inspiration, just something fun all the designers are doing this month. I pin so much and so do the SC members, that we felt it was time to put some of that awesome inspiration to use! I used the Atlas add-on only on this layout.

This layout was made using the Narrative and Atlas add-ons. I was really at a loss on this one and stepped back several times before finally settling on this design. So glad I took breaks along the way because I do like the end result.

And, finally my favorite layout this month made with the main kit only - STORY HOUR. The pinwheel was a decoration I made for our gender-reveal party.

Kits go on sale at noon EST on the 27th for subscribers and midnight for everyone else. Happy shopping!

This was my 20-week belly with Claire and some of my thoughts at the time.

A couple things to note...

• There is no way i could fit into that hexagon shirt today.
• I already had a name picked out....and right now we got nuttin' for these boys.

Below, my current pics of my 20-week belly.

I think I'm at a 14lb weight gain. I didn't document it at this point in Claire's pregnancy, but I'm definitely bigger in the belly area this time around.

I have come to terms with the fact we're adding boys to our family. I have some ideas brewing for their room, but first on the list is moving Claire to the smaller room since the boys will share.

We had another appointment and ultrasound today. Everything looks great and the boys are progressing well. Thanks for all the well-wishes on my last post.

Double the thankfulness this year!

The short story: I'm pregnant again. And it's twins!

The long story: In September, Greg and I began another round of IVF. This time my protocol was changed, probably because the doctors thought my eggs were getting old as they gave me a test for ovarian reserve. That test came back fine, but nevertheless, they decided for a ganirelic cycle, which meant a month of birth control and other oral medications, but no shots, followed by a month of a crazy amount of shots.

By retrieval day, my cycle didn't appear any different than the two previous ones. I had a modest amount of eggs at each of my monitoring appointments, and the surgeon predicted less than 19 eggs, which was how many we got in our second cycle (Claire). Boy was I surprised when I woke up and heard the number "31." I was so loopy and asked Greg the whole way home if they had really said "31." He confirmed probably about 15 times before telling me to quit asking.

On transfer day, 5 days later, we had a few embryos to choose from. Always you want to put the best one in so you don't risk freezing and thawing to your best shot at pregnancy. Of the embryos, we had two A's. We've never gotten A's before and after talking with 3 nurses, the embryologist and the doctor, we finally decided to throw both of them in and see what happened.

On the day of my first beta (blood draw for pregnancy) nine days after transfer, my number was 479. Whoa! With Claire my beta # was about 170, and the pregnancy before that was 90. (Anything over 50 is considered positive for pregnancy). So, at that point we were fairly certain both embryos had implanted. That was a Friday. With betas, it's important that the number doubles every 48 hours. That signifies the pregnancy is progressing like it should. So, when I went back on Monday, we expected the number to have tripled over the weekend. It did not. Just shy at 1182. Immediate worry and panic ensued even though I was told that I wasn't in the "danger" category. Two days later was my 3rd beta, and once the number is over 1000, it doesn't necessarily follow the doubling rule. We were hoping for about 2200, and ended up with 2532!! Instant relief....at least for a few days until the ultrasound.

Last Wednesday, we learned that we had two good heartbeats and both babies are measuring at 6weeks 2days, the exact same that Claire measured at this point.

On Saturday, I started spotting, so we went back to the doctor on Sunday. We learned that both babies are still doing well, but there's a place where the placenta attaches to the uterus that is bleeding. So, I'm on bedrest until the bleeding stops and modified bedrest until my next ultrasound on December 5. My doctor has jury duty next week, and I really think the greater civic duty would be to let him give me an ultrasound this Wednesday instead of waiting another torturous 5 days. But, that's not what the state of Tennessee thinks, so I have to wait. In the meantime, I wouldn't mind if a prayer (or two, or twenty) were said on behalf of our babies.

It's a ton of trouble for us to get pregnant, but that hasn't stopped us. Really, I can't imagine it any other way! Plus, I won't have to answer any embarrassing "How did you get pregnant?" questions from my kiddos later on..... We're just beyond excited and anxious to welcome these two precious souls into our home. I'm due July 7, but full-term for twins is June 9, so that's the day I'm counting down to.

IVF questions, answered

It's been awhile since I've posted about IVF, so if you've happened upon my blog recently, you may not know all Greg and I have been through to get pregnant in the first place. Here's a link to my (almost) daily journal of my IVF process.

Recently, I've received some questions via email and would love to answer these for others that might have similar concerns. And, if you have any other questions (there's no dumb question) that you'd like me to answer, feel free to email me at the link to the left or leave a comment in the section below.

How did you tell your families that you were trying to have kids, and going through the IVF procedure?

Both Greg and I definitely didn't want a lot of attention brought into an already stressful situation, but we knew it was in our best interest to tell our parents, friends, and co-workers about the procedure we would be going through. The main reason we needed to tell was because the clinic was an hour away and there would be numerous trips there in a short period of time, not to mention the amount of pharmaceuticals that I would have had to hide. Several of the injectibles had to be refridgerated, so I would have been afraid to ask someone to get the butter if they didn't know I was using hormones! Also, there were a ton of syringes and containers for disposing of them in my bathroom that eventually took over the counter. Had we not told those close to us, they might have thought I was deathly ill with all the trips to the doctor. Better to tell the truth than them worry about me.

To make it easy on both of us, Greg and I each decided we would tell our respective families. I didn't feel the need to tell my parents the ins and outs and the whys and why nots and all the rationale behind our decision. After our second failed IUI, however I talked to my mom about my consult with the doctor. It was at that time Greg and I had debated whether to try a 3rd IUI (10% success rate on a procedure that cost $700) or bite the bullet and go with IVF (55% success rate, but much more expensive at $11k, not including pharmaceuticals). In my discussion with mom, I explained that Greg and I were going to proceed with IVF in order to become pregnant. I told her we didn't know why we weren't able to become pregnant, and through all the testing, everything seemed great in our favor for a successful IVF cycle. I also explained that there would be many doctors visits and drugs to take, but that I didn't know all the details yet. Even though infertility is a very personal issue, this was not a hard subject for me to discuss with her. Matter-of-fact, it opened a door and I knew I had her support. She even had to give me some of the injectibles when Greg was out of town, so it was nice that she knew in advance what was going on.

For Greg, it was easier for him to tell his dad, which he did around the same time. I wasn't listening in on that conversation, but both of us told our family and friends that what we were doing was not a secret. We were fine with other people knowing we would be doing a cycle of IVF and we were open to donations (ha!).

I thought letting that part of my life become public would be difficult, shameful and scary, but in the end, it wasn't any of those things. It was easy to open up because after much research I learned that 1 in 7 experience infertility. I wouldn't hide a diagnosis cancer, I would treat the problem. I viewed it no differently than that, so it wasn't shameful. And, as more and more people found out and I learned more at my clinic and from friends (both online and in real life), the scariness of it all just dissipated. Instead, I was left with throngs of supporters who were all wishing the best for me and praying every step of the way.

How many appointments did you have in a cycle of IVF?

In total, I went to the clinic for either blood work, ultrasound, or a procedure 14 times during the 2 month process. That's a lot of driving since our clinic was an hour away, but keep in mind you can count your mileage as part of your medical expenses on your taxes (hey, every little bit helps!). Those appointments do not include the initial consult, the pretesting or anything else, only the appointments related to our 2nd IVF cycle.


Did your husband go with you to every appointment?

In a word, "no."

I know many women would want their husband or a friend with them for their doctors' appointments, but in reality, it just wasn't feasible for Greg to take off that much work. Nor, was there a real reason to do so.

Many of the appointments were for a blood-draw and ultrasound to check follicle growth. Most of the time, I was in and out within 15 minutes. Other times, it took longer, but in all they were very quick and I'm thankful my clinic worked very efficiently.

Also, had Greg tagged along, I might have caught grief for my KrispyKreme reward that usually followed.

8 weeks 5 days

Sorry I've been MIA lately. Everything is okay, I've just been very nauseous in the afternoons and it gets worse the later it gets, so I've had to work as much as I can during my feel-good hours instead of blogging. I'm making a concerted effort this week to do better. I have ultrasound pics to show you, plus cow stories, and house photos, so a lot has been happening.

I went for my second ultrasound and my how our baby has grown since just 2 weeks ago. Here s/he is measuring 5.3mm and about 6w2d (I was actually 6w4d at this point.).

It's a tiny little thing in the right of the big black spot in between those little x's.


Then, at the most recent ultrasound, s/he has already tripled in size, measuring 19.3mm and 8w3d, so it's played a little catch-up, which I don't mind at all.


Here, it's turned sideways and the right x marks the hiney the left x marks the head. It never would show us anything but the hind end, so we couldn't get a good picture. I hope that stubbornness doesn't continue long, since if you recall I had placed an order for a baby that doesn't spit-up and a teenager that doesn't talk back.

So, I go back to the doctor in 2 weeks for another ultrasound and then I'll feel like I can breathe a bit easier. I miscarried at about 9 weeks last time and if I can make it past that point, I'll be relieved to say the least.

More blogging this week, I promise!

final IVF calendar + synopsis

I've posted before about how important calendars are in the IVF process. They keep you on track, help you remember what shots to give at what times, at what dosages, and on which butt-cheek. You laugh, but it's hard to remember if the shot the day before went on the right or left.

My calendar helps me to remember appointments, milestones, and most importantly, helps me in counting down the days to the pregnancy test, the ultimate end of the cycle.

I debated whether to make my calendars pretty, whether I'd want to keep them if my cycle didn't end the way I had planned. In the end, I decided making them pretty was important to me this time. If all went well, I'd have something to look back on that would fit in my scrapbook, and if not, they wad up and fit in the trash just as well as an Office Depot planner.

This is the final version of my pages. I may go back and add photos later, but for now, all the important information that I would otherwise forget is here. Enjoy!





I thought it would be helpful to link all my previous IVF posts in one place. Nice for me to reference, and nice for you, too, if you've come in mid-story.

My posting began back on day 20 of my IVF cycle, but this was my second experience with IVF. Because of this, I was better educated, more determined, and poorer. Nevertheless, it's a story with a happy ending (so far) so here's the links to read about the process of us getting pregnant. If you're expecting a romance novel, you're looking in the wrong place. This story is less about candles and rose petals and more about needles and doctors' appointments.

• IVF Day 20 - The saga begins. Here, I discuss the reasons why I'm sharing this personal process and the basics of IVF.
• IVF Day 21 - One of my favorite posts for anyone, fertile or infertile. This post is all about vitamins. Is it weird that I get excited talking about vitamins?
• IVF Day 23 - Another exciting post...this one about Folate versus Folic Acid. It's riveting!
• IVF Day 30 - Want to see a self-administered injection right in the gut? This is the place for you. A simple Lupron injection.
• IVF Day 34 - The importance of a calendar in the IVF process.
• IVF Day 37 - This post explains egg follicles, how they're measured and why they're vital in the IVF process.
• IVF Day 39 - My meds are explained in great detail...down to the opening of the box. The Pioneer Woman may take the best food-in-process photos, but my skills at photographing syringes and meds is second-to-none.
• IVF Day 42 - How I fit all these shots into my daily routine.
• IVF Day 44 - Confessions. This was my most read/commented post thus far. If you haven't read it yet, you might find this one interesting.
• IVF Day 45 - Trigger day. My follicles/eggs are close to being ready for retrieval.
• IVF Day 46 - Egg Retrieval Day = Surgery. Lots of good photos here...heehee
  
• IVF Day 47 - Fertilization Report.
• IVF Day 48 - Another Embryo report.
• IVF Day 51 - Transfer Day. This is the day we see our embryos for the first time and decide how many to transfer.
• IVF Day 52 - Good news! An unexpected totsicle.
• IVF Day 58 - Nasty progesterone shots.
• IVF Day 59 - Needle comparison. Clearly I've run out of things to discuss and the wait for my pregnancy test has become unbearable.
• IVF Day 60 - Pregnancy Test!!! Should I give away the ending?
• IVF Day 64 - Ethics discussion. Not the best essay, but I'm writing with pregnancy brain...so just coming up with the word "ethics" is a big deal.

And, that my dears, is the IVF synopsis. Hopefully I won't be writing about it again for a long time.

I'm alive and kicking

Sorry for the absence from my blog this past week.
I've felt pretty blech lately, which is a good thing, but counterproductive to blogging.

Ready for my beta numbers?

• Friday, March 12: 157
• Monday, March 15: 684
• Wednesday, March 17: 1444

Before the numbers reach 1000, it's imperative that they at least triple over a 3 day period and double in a two day period. As you can see, mine did just that, with a doubling rate of 1.4 days between Friday and Monday, and 1.7 days between Monday and Wednesday.

These numbers show that everything is going as it should.
And if I needed any more proof, I just get a whiff of any food and instantly become nauseous. Actually, I don't even need a sniff. During the Kansas (ahem, Northern Iowa) game I caught a glance at a Gordon's fish commercial and that was enough to do me in. Gag.

Back to beta numbers. On the 9th day post day 5 transfer (also considered the 14th day after ovulation), if the beta is above 50, there's an 80% chance of having a healthy baby. Last year, my beta on this day was a 91, and albeit good, I fell in that sad 20%. This time, I'm hoping I'm in the 80%.

I'll be back with a summary post on my IVF experience as well as my final calendar. Greg is also threatening to talk about IVF from his perspective.

ivf - day 64 - ethics

The title says IVF day 64, and technically it is, but it's also "pregnancy day 32." I'm a little over 4 weeks with a due date of November 19 and so happy to be saying that. So, in discussing the ethics behind IVF, I must admit I'm biased. Without IVF, my chances of becoming pregnant are slim to none.

But, I don't think I'm different than any other woman. No matter how well your career is going, how much your social life is booming, it's in a woman's nature to have the desire get pregnant and have a child.

My basic premise is this: if it's "natural" to want to have children why is it unnatural to seek treatment to do so?

By definition:
Natural: existing in or formed by nature

It's interesting to me that critics of IVF lean on the argument that it's "unnatural." Sure, at first glance, it's odd to give daily shots, have almost-daily ultrasounds and bloodwork, and fertilize eggs in a petri dish. But, the entire process of IVF mimics the way the body should work. Hormones have to be at certain levels to produce mature eggs. The uterine lining has to be at a certain thickness and quality to support growth of an embryo. Fertilization still occurs. IVF ensures the body does what it should do in the "natural" way.

IVF doesn't change the way babies are made. All one has to do to see this is watch an IVF pregnancy and you'll see it progresses the same as a non-IVF pregnancy. The success/failure of pregnancy is almost identical. And, the difference in the statistics could be attributed to the fact that many women undergo miscarriages and never knew they were pregnant under normal conditions. They might just assume their period is a little late. This is unlikely in the case of the IVF patient since they're so closely monitored in the early stages.

Even the fertilization process of IVF mimics the body's selection process. The strongest, best sperm make it the long pathway to the egg and are able to break through the outer barrier for fertilization to occur. In the lab, similar techniques are used. Sperm are examined for quality and motility and the best are used for fertilization purposes. Still, there is nothing artificial in this process. Even in the lab, one sperm and one egg are needed to create one embryo. Same as in the human body.

After the sperm and egg come together, fertilization isn't a sure thing. If it does happen, it's up to that embryo to properly divide. Many stop growing as they should. There are many chromosome issues that just cause the embryo to arrest. But, there are a few that survive, that hatch and implant in the uterine wall, which is when pregnancy occurs.

What many people don't realize is that your body makes decisions every month during a cycle. It makes the decision which egg is the frontrunner, which will ovulate. Once sperm enters the picture, and fertilization occurs, the embryo has to divide at the proper rate or it will miss the opportunity to implant, because it needs perfect uterine conditions to do so. Many times an embryo is formed and passed and a pregnancy never occurs, whether a chromosome issue is to blame or the uterine conditions aren't conducive. Most of the time, a woman never knows this decision making process is occurring in her body month after month. We go on blissfully unaware because it's not us making the decision, it's our bodies. We don't feel guilty if a pregnancy doesn't occur, because we don't know why the pregnancy didn't occur. We don't know if an embryo was formed or not.

Just because the IVF patient and doctors are making decisions throughout the process doesn't necessarily infer they are "playing God." God set in order the natural process of how a baby is formed. One sperm and one egg are needed, fertilization must occur, the chromosomes have to be just right, the uterus has to be ready, and the hormones have to sustain the pregnancy. Researchers have worked to understand God's process in order to give a couple the chance of becoming a parent. It's a chance, that's all it is. The researchers can't create an egg or a sperm. They can't wave a wand and form an embryo. They work within God's parameters and laws of nature to treat a condition.

When a researcher studies anything they look at the normal process and how it *should* be. Think about a cancer researcher. They look at normal cellular processes and try to understand what goes wrong in a cancer patient. They treat the medical problem, but they don't work miracles. They work with the natural processes of the body, administer drugs to regulate the body, and even do surgery to remove the problem.

An infertile couple is no different. They are infertile for a medical reason. They seek medical treatment for their condition.

What many outsiders fail to realize is that infertile couples seeking treatment aren't looking for a blond-haired-blue-eyed baby. They are looking for the opportunity to become parents. Me, on the other hand...I put in my request for a baby that doesn't spit up and a teenager that doesn't talk back. What's wrong with that? I'm practical.

(kidding)

Of course, there are lots more issues related to IVF I could discuss (ie. PGD, when an embryo has rights, stem cell research), but frankly I don't feel adept to do so. If you're struggling with these issues, I highly recommend A Case For Life by Bo Kirkwood. The cover isn't the prettiest, but it's a quick-read, and makes complicated material simple for us non-scientists, all while keeping a God-centered view. One aspect of this book that I found particularly interesting was the discussion of "conception", which is a non-scientific term and difficult to pinpoint. Something I had never thought of before, but am now keenly aware.

As an update, my bloodwork is doing well. I go back tomorrow for my final beta and will report here when I get my test results. Still on those progesterone shots, too :)

ivf - day 60 - pregnancy test

Let me start this post by saying I'm so thankful for this news. I feel lots of things: blessed, surprised, relieved, excited, nervous, happy....and I could add another 50 adjectives to this list, I'm sure.

Greg and I knew going into this that it could go either way. Actually we were coming home from church Wednesday night and I looked at Greg and said, "Do you think I'm pregnant?"

He said, "What do you think?"

I said very seriously, "Well it could go either way."

Why yes it could April. Very profound!!!! I'll blame that on pregnancy brain, too.

But seriously, it really could have gone either way. The stats weren't as much in our favor this time. What you might not know is that every IVF clinic has to report their stats to the government and publicly, which usually means on their website. These stats are published by age group, they show pregnancies, births, singles, twins, triplets. They show lots of criteria. And, if you're considering IVF, you definitely need to investigate every clinic you can (within reason).

In our age group, about 55% become pregnant and 53% carry to term. So, basically our chances of getting pregnant were 50/50. Like I said, it could go either way :)

But, when you look at embryo quality, you can further delineate who has a better chance of pregnancy. Our first round of IVF in 2009, we were sitting at about 70% likelihood, but this time, we were closer to 40%.

I was scared, nervous, I couldn't sleep.

I can't even begin to explain the thoughts that went through my head during the 9-day waiting period. Lots of talk about what to do with our frozen embryo in the case this round didn't pan out. On that same car ride, Greg even brought up selling his car and being a "one-car-family." But, that really would only net us about $3000, so that wasn't the best idea. And, he can't blame that on pregnancy brain.

Anyway, there's a point of no return with IVF and pursuing infertility. It's a fine line and one we didn't want to cross, but found ourselves on the verge of making a decision we didn't want to make.

So far, we're pregnant and focused on that. No, we're not out of the woods.

My beta today was 157, which tests for HCG (human chorionic gonadotropin). It needed to be above 50, so we're on our way.

I'll be checked again on Monday and Wednesday to make sure it's multiplying like it should, which would indicate a normal pregnancy. I'll continue the progesterone for several more weeks, provided the pregnancy continues.

Just because I'm pregnant, doesn't mean I'm done talking IVF. I plan to discuss some of the ethics next week (hoping not to stir up too much controversy) and anything else that comes to mind. Please let me know if you have any questions. I'd be happy to devote a post entirely to questions as well. I'm open to anything, which you should know by now. If you don't feel comfortable leaving a question in the comments section, feel free to email me april@studiocalico.com

Thanks so much for all your prayers, well-wishes, support, following my story. It means so much to know there are others out there who are interested in our struggle and were hoping for a wonderful outcome along with us. I can't say enough about the support you've shown.

ivf - day 59 - big needles

Just look at that progesterone.

That's P-R-O-G-E-S-T-E-R-O-N-E with a "G"

Definitely not a "J." Why would anyone think such a thing.

These are some of the needles I've used over the course of this process. The one on the right was for my Follistim, and it's the same size as the ones for my Lupron (I used insulin syringes for those) and for my Ovidrel (which is HCG to trigger ovulation before my egg retrieval).

The needle on the left is for drawing up the progesterone. It's pink. PINK = PAIN. That's my way to remember to not use it for injection. That and the fact that it's the size of my pinky.

The middle needle is for my progesterone. It's gray. GRAY = GIVE.

Just to give you another shot, look at the size of that opening!

So, I draw up the PIO (progesterone in oil), and it really looks like vegetable oil, with the pink needle.

Then, I switch out the top to the gray needle for injection.

Tomorrow's my big day...the day of my beta test to see if I'm pregnant.

ivf - day 58 - progesterone

IVF begins with the easy shots. The tiny little needles that you can barely feel.

Truly, you can barely feel them, and other than sometimes bruising, they're not a big deal.

Now, progesterone-in-oil shots are a big deal. Literally.

Big needle. Big syringe. Big deal.

I'll show you the size comparison in another post, but for now, I'll discuss how this drug is administered and why it's important.

First, the how-to's, because let's face it, if the doctor says to do it, I'm going to do it whether I understand it fully or not.

After loading the syringe with the oil, I call Greg out of bed to give me the injection. He's not a morning person, so I use this to get him out of bed. It works beautifully because he doesn't want anything to compromise my IVF cycle.

I've already cleaned off a spot on my backside and he holds the skin tight (aka spreads the fat out) and shoves the needle in. At this point, I'm usually saying something like, "Quit hesitating" or "Do it ALREADY!!!" The anticipation is worse than the shot.


Once it's in, he holds the injection site still so he can pull back on the syringe.

He pulls back to make sure there's no blood entering the syringe. If there is, that means he's hit a vein (very rare, never happened to me) and he'll have to re-inject in a different spot.

Once confirmed that he's in the muscle and not a vein, he slowly injects 1cc of progesterone in.

We do this once each day and will continue to do so if my pregnancy test is positive on Friday.

So, you want to know why? I did, so I asked.

Progesterone is normally produced by the body and it sustains a pregnancy. It originates from the ovaries, after ovulation. I figured, since I ovulated 19 eggs, I'm producing a lot of progesterone, so I shouldn't have to take a shot. (This makes sense in my brain.)

It's true, my body *should* produce the progesterone, but I've been hopped up on all the other hormones (both suppression and stimulation) that interfere with my body's natural way of doing things, that it might interfere with my ability to produce progesterone correctly as well. So, we do these shots as a safety measure.

Progesterone works in the body in these ways:

• Helps to regulate the menstrual cycle.
• Prepares the lining of the uterus for implantation.
• Keeps the lining of the uterus thick which is necessary for a successful pregnancy.
• Produces a rise in temperature after ovulation, which remains until menstruation occurs.
• Creates a nutrient rich environment for the baby by increasing glycogen and arterial blood to the lining of the uterus.
• Keeps the uterus from having contractions.
• Causes the cervix to thicken and create a mucous plug which prevents bacteria from entering the uterus.

(taken from this source)

After ovulation, my progesterone needs to be at least 30 ng/mL to sustain a pregnancy. So, last Friday, I went in for bloodwork and it came back at 81 ng/mL. Perfect! No increase in dose.

And, other than showing you the size of the needles, which I'll do tomorrow, I don't have anything else to say about progesterone. It's a pretty straight-forward little booger.

ETA: In my original post, I misspelled "progesterone" 10 times including the title. Misspelling is SOOOOOOOOOOO unlike me, so let's hope it's pregnancy brain. And, if you're out there and noticed an untrue fact or misspelled word, please know I'd rather be corrected and be right, than go uncorrected and be wrong. Unless you're my husband, you can correct me anytime. ;)

One last thing, if you haven't already, please read the post below and comment to win one of the fabulous eBooks from Ella Publishing.

ivf- day 52 - snowbaby

Have I mentioned that I love my IVF nurse?

Well, I do.

As I was laying here on bedrest hoping beyond hope one of these little B's would take hold, my phone chimed.



I can still hardly believe it! One of those embryos held on long enough to be considered viable, and so it was frozen today, on day 6 post egg-retrieval.

On my transfer day, I had asked the embryologist if we'd have any left over to freeze. He looked back at our last cycle and we had none. Then, he looked at the current embryos and just shook his head. So, even though my discharge papers said to call my voicemail box to see if any were frozen, that thought wasn't even in my head. I had already written it off. After all, only about a third of couples end up with some to freeze, and I had already been given the proverbial head-shake.

You see, my IVF lab only freezes grade A or B blastocysts that haven't stopped growing on day 5 or 6.

Another piece of information is that they ALWAYS transfer the best embryos first, on the fresh cycle. So, if I had 3 of the best transferred yesterday, and the one ranked fourth made it to the cryopreservation stage, what does that say about the possibility of pregnancy with these "better" embryos?

That's my rationale anyway.

Greg is a self-proclaimed late-bloomer and my grandfather said I looked like a spider till I was about 8 (I weighed a whopping 32 lbs in 1st grade), so I guess it's no surprise that our embryos might be "delayed" a bit. Just not too much. That's all I ask.

• Down to one injection per day: 1cc PIO (will show you this process next week)
  
• Progesterone check tomorrow.
• Beta (aka pregnancy test) next Friday.
  

ivf - day 51 - embryo transfer

Today began early, like all my previous trips to Nashville. The whole way down (an hour drive, but it takes 30 minutes longer in traffic), Greg and I talked A's and B's and what our final decision would be regarding the number of embryos to transfer.

It's such a difficult decision to make and one that fertile couples never have to discuss. Can you just imagine, "Honey, I think you should ovulate 3 eggs this month." "Why of course, sweetie, then we'll have one implant." Um, no.

And, like I've said numerous times before, IVF is a numbers game or statistics game if you like that fancy word better.

Our 2009 round of IVF, we transferred 2 embryos. One was almost an A and the other was definitely a B and we ended up with a singleton which we later miscarried at 10 weeks. So, the dilemma this time was whether we should transfer 2 or 3, but we knew all along the decision would be made that morning (after my Valium) when the embryologist brought in photos of our embryos with letter grades beside them.

So, on the drive down, we were still discussing A's and B's and the risks involved, as I was drinking Gatorade so I'd have a full bladder for the procedure, even though we had no clue how many of the 5 stand-out embryos would be presented to us this morning.

We were supposed to arrive by 9:00am, but of course, we were there by 8:45 because in my family, if you're not 15 minutes early, you're late.

So, we waited for 15 minutes until we were called back to the surgery center. Like always name-bands were checked about 53 times from point A to point B.

When we got to the room, Greg changed into his lint-free outfit, or purple-people-eater-outfit, whichever you prefer.


And, I disrobed waist down except for my awesome socks (knee-high socks are a must in these cold rooms).

I'm digging my outfit here. The mix of patterns is fantastic. Not particularly happy about my level of Gatorade consumption at this point, though.


We talked with the nurses, signed papers, got my discharge instructions, and then, most importantly, took my Valium.

And, I'm glad I did, because when the embryologist came in with our embryo photos, I was a tad disappointed.

3 blastocysts, all grade B.

I was so hoping for at least one A, and that the doctor would try to talk us out of transferring all 3, but we had no such luck.

Our embryos had done great up until day 3, when they slowed a bit, so they are about 6 hours behind this stage here:

Isn't this one beautiful?

But, that's okay....ours may be ugly ducklings at first, but we're hoping for one beautiful swan.

After discussing our decision of transferring three with our doctor, I was wheeled back into a dark room. It's dark because embryos are normally kept out of the light. At that point, the embryologist showed Greg the embryos one last time (hence the lint-free-garb). The embryologist loaded the embryos into a catheter and the doctor inserted that tiny tube through my cervix and into my uterus.

Now, this isn't my uterus, but see the white line that looks like a feather? That's where the embryos go, because that's where they attach. During the transfer procedure, my bladder has to be full because it presses down on the uterus making it easier to get the embryos in the exact right spot. So, my ultrasound monitor had a big black spot on the top 1/3, which was my gatorade sitting there, and even warranted a complimentary comment by the embryologist: "That's a great view!"

Me: "Why thank you."

I pride myself on being able to hold my bladder, so I'm the perfect patient for this procedure.

So, using an ultrasound the doctor guided the catheter to that very spot and pushed the embryos out of the tube. Once removed, the embryologist examined the tube under his microscope to ensure all 3 had left the tube, then I was wheeled back into my room to lay flat for an hour.

With my still-full bladder.

Thankfully, Jennifer my IVF nurse came in to check on me and help pass about 15 minutes of time encouraging me about my chances of pregnancy.

With grade B embryos our chances aren't as good as we'd like. We're at about 50% chance at best for pregnancy, but Jennifer said I'm pregnant until proven otherwise.

It's just a mixture of emotions today. Disappointment, but potential excitement.

Today and tomorrow are bedrest, then a progesterone check on Friday.

ivf - day 48 - dividing

I'll be quick with today's update since it's late.




Most parents have empty-nest syndrome when their kids go off to school, but my separation comes much earlier, like before I even know if they are my kids.

It is a strange feeling to turn your future child over to the hands of a lab for 5 days.

During my first IVF cycle in June/July 2009 my favorite part of the cycle was when my embryos were outside my body. I thought that as long as they weren't with me, I couldn't mess anything up.

But this cycle is much different. I miss my embryos. Maybe it's the hormones that are pulsing through my veins, but I miss them.

Day 2 of the embryos being in the lab (egg retrieval day is counted as day 0), I get my last report before transfer on day 5. The embryologist leaves me a voice message letting me know whether I'll be a day 3 or day 5 transfer. I'll talk more about transfer days later. If we don't have any embryos at the 4-cell stage, I would be scheduled for a day 3 transfer. The lab really wants to see at least a few at the 4-cell stage and all of them need to cleave by then.

Normally, my lab doesn't give the exact number of embryos that are at each stage, but I wanted to know. I've found that if you want something, it's best to ask for it. So, today our report came in and it was very good news. All of the embryos had cleaved, 5 were at the 4-cell stage and all of those were graded very high.

For the next two days, I won't get a report and anything could happen. It's up to the embryo to grow from there and if there's any genetic mishap, they will "arrest" or stop growing. This happens quite frequently, so we need even more division.

Today my meds were:

• 1cc PIO (injection)
  
• 1 Medrol (oral)
  
• 4 Tetracycline (oral)
  

day 47 - fertilization report

The same day of my egg retrieval a procedure called Intracytoplasmic Sperm Injection is performed. This is commonly know as ICSI (pronounced: ICK-see). The idea is simple and I can only imagine how this procedure came about. Probably two teenagers in labcoats in their parents/ basement were playing around with mice eggs and said, "I wonder what would happen if we took a small needle, put a sperm in it and injected it into an egg [insert teenage giggle]." That's really all the procedure is. Of course you need a REALLY tiny needle and a REALLY powerful microscope.

First, the sperm is washed and the andrologist (sperm-handler) gives the strongest and best sperm the chance to swim up, against gravity. Those sperm are then inspected for quality (ie, not swimming in circles, not having 2 heads, etc) and then one sperm is drawn into the needle. The head of the sperm is closest to the opening of the needle, as it would normally enter the egg, head-first.

The embryologist takes an eggs, holds it with a pipette....all of this is done under a microscope, obviously....takes the needle and pokes through the outer layer of the egg and inserts the sperm inside.

I found a funny video on this. There's lots of these on YouTube, but I chose this one on humor factor alone:



After the egg and sperm meet, it's all up to the embryo whether it will become fertilized. I should mention that ICSI is done on day 0 and fertilization occurs on day 1. If fertilization happens, and we hope that it does, the egg/embryo will look like this:


See the two circles in the middle of the egg? Those are called polar bodies. Still, the cells have not begun to divide, so it looks kind of boring at this point.

Now, to make it a bit more personal. Of my 19 eggs, 16 were ICSI'ed. I'm not sure what rationale is given as to whether or not an egg is ICSI'ed, but I would presume it has to do with maturity of the egg.

The fertilization rate at my clinic is 50%, so I would expect 8 of my eggs to fertilize. Lucky for us, my eggs + G's sperm are already over-achievers, because we have 10 fertilized eggs!

Now we wait till tomorrow when we learn if any of those have begun cell-division. We're wanting 4-cell embryos tomorrow, and lots of them.

ivf - day 46 - egg retrieval

Our egg retrieval day began very early.

Actually, I woke up at 12:30, 3:30, and ultimately 5:00am. Worse than a kid on Christmas morning, I tell you!

Greg, on the other hand slept like a baby.

We left at 6:09, although I wanted to leave at 6:00. I'm always nervous about a wreck or traffic in Nashville and missing my appointment. And, for this, if I miss my appointment, my eggs could ovulate and that would mean my cycle was worthless.

When we got to the office, they weren't even open yet (7:15), so we checked our iPhones for emails and I looked at some of the comments on my blog (thanks!).

I brought something unique to the clinic today. I was worried about hyperstimulating at my appointment yesterday, and asked my IVF nurse, Jennifer about Gatorade since I had read somewhere that it helps. She said, "The nurses in California swear by coconut milk."

Number 1: I HATE coconut with a passion. It's the reason I don't think I could survive on Survivor.

There is no number 2.

I went to the store when I got home yesterday and bought an 8-pack of Gatorade and a can of coconut milk and took it to the office where I was going to open the can and drink it. A few minute after I arrived, Jennifer called with my bloodwork results and I told her I bought coconut milk. She asked where I found it.

me: "Kroger." (duh)

Jennifer: "April, I don't think you can get it at Kroger. What does it look like?"

me: "It's in a can and it's thick, I really don't know how I'll get it down. Maybe I should dilute it."

Jennifer: "DON'T DRINK THAT!!! Bring it to me and I'll use it to cook with."

So, there's the coconut milk (aka cream) I thankfully didn't try to drink.

All the nurses had a good laugh over this one.

We were called back at 8:30 and I donned my lingerie.

Sexy, isn't it?

And, with the socks, even better.

We read some magazines while we waited...

Greg has the better lighting here. I should have insisted we move the bed closer to the window.

The nurses talked with us a bit. I was the only egg retrieval today.



Then, I drifted off to sleep so they could perform this procedure:




Basically, my feet go up in stirrups again. The doctor uses a vaginal ultrasound to locate the follicles. Then she guides a needle and small tube up through my abdomen and into each follicle. Then sucks out all the fluid. They may even add extra fluid in and suck it out again, just to make sure they get the egg. The egg is microscopic, but the follicle isn't, so they have to trust that an egg is in there and will come out. After they did that to each one of my follicles, they wheeled me out.

ACK! This procedure isn't pretty, I tell you!

And a little while later, I was awake and snug as a bug under my warm blankets. And a piece of advice to all you ladies out there who stay cold: If you're ever having surgery, the hospital most likely has a blanket warmer. They may or may not tell you about it, but you've already paid for it, so you might as well use it. Heaven on earth!

After I was fully awake, Jennifer came back to talk to us and to wait for the egg count. We waited and waited...and I got more and more nauseous (from the anesthesia).

Jennifer guessed 15 eggs and Greg (forever the optimist) guessed 16.

Finally, Annette, the lab tech came in and told us we had 19!!! Significantly higher than last time.

So, I bounced out of bed and went home, skipping along the way:

um, no.

Once I was cleared to go, I was wheeled out with my saltine crackers and Gatorade and came home to sleep for a bit.

Today, I started the following meds:

• Tetracycline (antibiotic) 4 times daily and I'll continue that for 4 days
  
• Medrol (steroid) 1 time a day for the next 4 days
• Progesterone in Oil (PIO) via injection once daily until my pregnancy test and with any luck, I'll continue this for a bit longer than that.

Tomorrow is a big day, too. I will receive my fertilization report. Keep your fingers crossed for some polar bodies.

ivf - day 45 - my follicles are ready + another new calf

I got up the nerve to get a photo of the monitor at my visit on Wednesday. This was my last E2 and ultrasound (yay!). I don't know why I felt it was a covert operation because I could have gotten a print out if I had just asked.

At each of my monitoring visits, the ultrasound tech, Patty, looks at my right and left ovaries and measures each follicle one by one. She calls out numbers like 11x15 or 12x13. I write them all down and then I meet with my IVF nurse, Jennifer to discuss it. She adds the two numbers and divides by 2 to get something like 13 and 12.5 for each follicle. When I have several that are at 18 or above, it's time to trigger ovulation. So, tonight, I took two shots of Ovidrel at 9:30pm. That medication induces ovulation exactly 36 hours after injection. So, my egg retrieval is scheduled 35 hours post-injection at 8:30am on Friday. In order to retrieve the eggs, they have to still be in the follicles.

Normal ovulation is very similar to this process. The body develops lots of eggs at the beginning of a cycle (actually, eggs are recruited for development about 3 months out), then somewhere along the way, one surpasses the others and that's the one that is ovulated at about 18mm. I've read that it's rare for an egg less than 15mm to produce a pregnancy. So, whether it's the IVF process developing lots of eggs or the body in a natural process, the egg has to be to a certain level of maturity before pregnancy can occur.

Today, I go back for E2 but not monitoring. And, the best news of all, NO INJECTIONS TOMORROW!!! I get a free day before diving headfirst into progesterone injections later this week.

Considering we have a busy week already, our cows haven't exactly been helping us any. Saturday, #1 had a cow. Then, yesterday about 1:00, Greg ran down the barn steps with binoculars in hand saying, "You need to come look at this! You may never see something like this again!" So up I ran and looked out the front window into the wooded area where #7 (the cow we thought would have a calf first) was standing. Obviously in labor.

Well, that went on and on and on.

Jared, a college kid from church, was helping me with some Studio Calico work, but quickly diverted his attention to helping Greg with the cow. He was in nursing scrubs from his clinical rotation, so he donned my dad's carhart overalls, coat and hat and headed out.

Then, around 5:00 we decided to call the vet and get her up.

If you're not used to farm-speak, you might think "get her up" means to make her stand up, but you'd be wrong. "Get her up" means to get her up in the pen and in the chute, where we can pull a calf if need be.

The vet came at 6:00 but it took awhile to get her up.

So, it was around 8:00 before she was in the chute and he could palpate her. If you don't know what that means, I'm not explaining that one.

She was fully dilated and tired, so they made the decision to pull the calf.

Thankfully, it all worked out, momma and baby are fine and resting in some hay because it's cold tonight.

We'll check on them this morning and hopefully the calf will be on the boob-tube as Jared would say. I plan to take photos, but it was dark last night, so not the best opportunity.