Retrieval

Our retrieval was over two weeks ago.  It's taken that long for me to have the want to to blog.  I needed a break.  A break from talking about our infertility.  A break from thinking about our infertility.  Just a break.  I have made the choice to be very public and transparent about our journey.  But sometimes it's exhausting.  And people who have never walked this road just don't know what to say or how to respond.  I get that, and I know people mean well.  But when someone asks about our retrieval and I tell them we have half of the embryos we really should have, it's frustrating when someone responds with, "Well, it's better than nothing" as they walk down the hall with their three kids in tow.  Because, while it is better than nothing, I just went through over 100 injections, dozens of blood draws and dozens of transvaginal sonograms.  (If you don't know what a transvaginal ultrasound is, do a google image search.  They're not the most pleasant things in the world.)  We have lost embryos, and now have babies in heaven.  It is a very real possibility that by the time our transfer rolls around, we won't have enough embryos to transfer.  Those kinds of comments do nothing but frustrate me.

So, I needed a break.  (I really do appreciate everyone's outpouring of love and support.  And I understand that if you've not gone through infertility yourself or with a close loved one, it's hard to know what to say.  My goal is not to be critical, but to share my heart and my frustration.)

Vent session over.  Here are the details from our retrieval:

We got to Colorado on a Saturday night, just in time for the Alabama football game.  ;-)  Sunday morning we headed to CCRM for what became a daily visit for blood draw and ultrasound.  Each day we measured the growth of my follicles and monitored specific hormone levels in my blood.

Inside a woman's ovaries are follicles, which you can think of as little water balloons.  Inside each follicle, we would expect there to be an egg.  As the follicles grow, the eggs inside are maturing.  On average, the follicles (and eggs) will grow 1-2mm per day.  The goal is to grow the follicles to around 20-22mm.  The picture below is not my ultrasound, but it gives you an idea of what it looks like.

Source: http://www.fssc.com.au/treatment-options/ivf-procedure/

Most women will have several follicles begin to develop at the beginning of her cycle.  However, one follicle will become the dominant follicle and the other follicles will be absorbed back into the body (or just disappear or the follicle fairy comes and takes them away). The bottom line is that there ends up being only one follicle, and on the rare occasion, two. 

 One of the purposes of the injections I was taking was to block the communication from my brain to my ovaries so that all of my follicles would continue to grow and mature, thereby giving us lots of eggs to retrieve.  Each day we had a report on the size of each of the follicles in my ovaries.  You can see the progression of growth from Sunday to Tuesday.  

Because I had some follicles so large on Tuesday, my doctor decided to trigger me early.  If we waited too long for the other guys to grow, we would lose my mature eggs.  So, on Wednesday morning at 3:15am Michael and I got up so he could administer my trigger shot.  This shot basically tells my body to ovulate and for the follicles to release the eggs.  It has to be administered at a very specific time based on when the retrieval will occur.  If you've ever done IUI, you've also had to have a trigger shot.  However, this shot was much bigger and scarier than the others I've done.  It went in my tush, the needle was nearly 2 inches long, and if Michael missed the spot he could his my sciatic nerve which would be very painful for me.  Luckily, all went well....even at 3:00 in the morning!

Wednesday morning we went back in for another blood draw and a genetics class for the Comprehensive Chromosomal Screening that we are having done on our embryos.  It was incredibly informative, and I loved every minute of it!  I learned so much!!

Thursday was the day of the retrieval.  I wasn't allowed to drink or eat anything after midnight Wednesday, and our retrieval was at 2:15pm. I was starving!!!  I started the day with a quick IVF physical, and then Michael and I sat around and waited for 2:15 to roll around.

Eventually they called me back and prepped me for surgery.  The doctors and nurses here are amazing.  They were so sweet to just sit and talk with us, and calm my nerves.  The anesthesiologist even went to school at UMKC, and knew all about Kansas City!  It was fun to have a little connection to home.

Surgery was only about 20 minutes.  The doctor goes through the vaginal wall with an aspiration needle, and sucks out the contents of every follicle, no matter the size. Surgery prep and recovery was longer than the actual procedure.  I woke up easier after this surgery than any other time, which was a huge blessing!  The wake up part is the hardest part of surgery for me.  My "sweet" surgical nurse defaced my shirt, though, while I was out!  Naughty, naughty, naughty!!  (Although we all got a really good laugh out of it.)

Unfortunately, we learned after our retrieval that not all of a woman's follicles necessarily have an egg.  (Makes me wonder if that's a part of our infertility, too, if I'm not producing an egg each month.)  We were anticipating retrieving 12 (or more) total eggs.  We were told several times that the ultrasounds are an estimate of how many follicles a woman has because often some follicles are hiding behind others and are difficult to see on ultrasound.  We only retrieved, however, 8 eggs.  Out of those 8 eggs, only 6 of them were mature.  We anticipated not having 12 mature eggs due to the small size of a couple of the follicles.  

After the retrieval the embryologists wait a few hours for the extra cells to fall off of the eggs before they fertilize them.  So, after we were back at the hotel, they took individual sperm and injected them into each of my eggs.  We left the next day, and received a phone call on our way home telling us that only 4 of our 6 mature eggs fertilized.  There's really  no explanation to why they don't all fertilize.  Even with injecting the sperm directly into the egg, some just don't do what they're supposed to do.

At that point, we had 4 embryos.  Michael and I believe that life starts at conception, so even though it was difficult to hear that we didn't have as many embryos as we expected, we rejoiced in the fact that we had four babies.  We are technically a mom and a dad, and have never been able to say that before.  Now we had to wait 5-6 more days to see which of the embryos grow and divide at the right rate.  

This is a picture of a blastocyst, which is the stage we needed our embryos to grow to.  This happens at about day 5 or 6 in the life of the embryo.  We had 3 of our 4 embryos survive to this stage.  At this point, the embryologist biopsied 3-4 cells off the outside of the embryo and then froze the embryos.  

Source: https://creatingafamily.org/infertility-category/chromosomal-testing-pgd-blastocyst-embryos-w-fresh-transfer/

The cells from the biopsy will go through what we call CCS, or Comprehensive Chromosomal Screening.  This screening will tell us which embryos are chromosomally normal.  The embryologists will use this screening to make sure our embryos have 46 chromosomes and that there are 2 of each chromosome.  Embryos that aren't chromosomally normal will either miscarry or potentially produce very sick babies.  We want to be able to transfer the embryos that will give us the greatest chance of having a successful pregnancy.

So, now we wait.  We still have three embryos, and are waiting to see how many we will have after the CCS testing.  Statistically, 70% of the embryos are chromosomally normal for women in my age range (under 35).  My nurses keep telling us that we have my age on our side.  In reality, my age hasn't proven helpful to this point.  Based on my age, we should have twice as many embryos at this point.  If we had anticipated this outcome, the doctor would have suggested us to have gone through a "banking" process where I go through multiple cycles of meds and retrieval surgeries to "bank" our embryos and test them all at once.  So, if I'm honest about it, I'm nervous about how many embryos we will end up with to transfer.

But that's where we are.  During this process I was worried I would have too many embryos, so I prayed that the Lord would give us the perfect number of embryos.  Unfortunately for me, three was not the perfect number I had in mind.  :-)  The Lord continues to test my trust in Him and in His plan for us.  We are waiting anxiously to hear our CCS results.  Until then, we wait.