The Reveal

I did not want to know my numbers, but some way or another I ended up finding out. My first number was 47.

47              47                    47

47               47

47                                 47

It doesn’t really mean anything. But it was definitely in my thoughts after that. 47.

Three days later, I had my next blood draw and had to wait until Brian got home to listen to the voice mail message from the clinic. He would not even let me take the call! He had meetings that day and wanted to be there when we got the news. He was mostly concerned that if it was bad news, I would be all alone at home.

Message: Congratulations, you are beautifully pregnant! Your numbers went from 47 to 111. We will recheck them in ten days. At that point, we will be looking for them to be over 1,000. 

Pregnant!! 

But, oh, those blasted numbers. For ten long days, we waited to see if we were really pregnant. 111.

111

111

111

Message 2: Hi Amanda, congratulations! Your number went from 111 to 7,351.  We will see you in a couple of weeks for your first ultrasound!

Seven thousand???   Definitely pregnant!   Celebration!!

Pause.  Ultrasound… already?

Say what?? Oh, yeah. Our embryos were already older when they were transferred. Regular pregnancies are calculated from the date of the last missed period. 40 weeks gestation does not actually mean that there was conception 40 weeks ago. For me, they knew when the transfer took place and the age of the embryos. I was way more pregnant than we first realized! We were already five weeks along, maybe more.

Estimated due date: January 18, 2014.

Blood tests and more tests

The path to pregnancy after an embryo transfer involves a lot of blood. I had three blood draws total. One a week after transfer, one three days later, and one ten days after that. 

One morning as I was in the lab, I went to put my jacket back on and the tourniquet/bandage slipped off my arm. I bled everywhere! I had always thought those little gauze pads and stretchy tape were more for show than anything. 

Not so much. 

My open vein decided to leak everywhere.  It was kind of funny really. Their faces told me that they were used to seeing blood in vials instead of all over their floor. 

The blood draws were continuing to monitor my estrogen and progesterone levels, but were now looking for hCG, the hormone that tells us if there is a pregnancy. The first blood draw is a baseline and the second is to see if the starting number has doubled, which would be a sign of pregnancy. The third is to make sure that number has grown exponentially, which would indicate implantation and continued growth of the embryo.

One positive test does not necessarily mean you are pregnant. A chemical pregnancy registers some hCG at first, but the numbers do not continue to grow, which is an indication that something did not take.

Cellulitis

The injections that I need to have every day are intramuscular. Basically, I have to get a shot in the butt every morning and twice a week in the evenings as well.

Joy.

I don’t mind needles (which is a good thing considering how many of them I have been and will be seeing) and I would have given the shots to myself, but the angle makes it impossible. So, my lovely husband was roped into service.

Now, while I have nothing but good things to say and nothing but positive experiences with both our fertility clinic and with our fertility pharmacy, the injection training that we received is the one exception. Because we do not live in Boise, we were given some diagrams and some videos to watch on how to administer the daily shots. The one thing really lacking here was the location that they should be given.

We were giving them right in the center of the butt muscle- right over the sciatic nerve.  While we were lucky to not have that cause a problem, we ended up with a case of cellulitis- an infection at one of my injection sites characterized by severe pain, swelling, redness, and fever. I ended up in the ER early one morning to have it checked out. These infections can move very quickly and cause severe complications if not dealt with appropriately; when my temperature went up two and half degrees, we loaded up the car and set off for the hospital.

However, we were both terrified that whatever drugs they would give me to combat the infection would hurt our embryos and cause us to lose what we hoped would be a pregnancy so soon after our transfer. Brian was terrified I would end up having surgery and be in the ICU suffering and dying from complete and overwhelming sepsis.  (See, I am not the only one who worries about the worst-case scenario.)  He blamed himself because he gave the shot. The ER doc said that it could happen to anyone.

I must confess I was sorely disappointed when I entered the ER that early morning. Where were the screaming, wounded victims of horrific accidents? Where were the legions of surgeons waiting to catch a cool case? Where were the armies of doctors and nurses, coated in bodily fluids, yelling for help?

Okay, maybe I watch too much Grey’s Anatomy. 

There was just one lonely registration lady who promptly checked me in and transferred me to another room. The ER doc decided not to cut into my infection, much to my relief. He did put me on a battery of antibiotics to fight the bacterial infection, but he called Dr. Slater first. She assured us that the embryos would be just fine.

Sigh of relief. 

The drugs made me feel absolutely awful, but eventually the infection went away.

Transfer Day

I had to take three days off of work- one for the procedure and two for mandatory bed rest afterwards. Brian couldn’t come with me, and my mother-in-law offered to drive. That was very helpful because I was not allowed to drive afterwards.

The morning of the transfer I had another blood draw and was escorted to one of the procedure rooms.  They gave me a valium to relax. Dr. Slater said that my embryos had all grown and two of them were of excellent quality. We discussed the fact that Brian and I were only willing to try a transfer twice. So, we made the decision to transfer two embryos rather than one. This gave us a 50% chance of getting pregnant, a 10% chance of twins, and less than a 1% chance of triplets. 

Our embryos were inserted using a guiding ultrasound. It took all of 10 minutes. I joked with my mother-in-law about the fact that it is not every day one gets to be present at the conception of her grandchildren! 

We received pictures of our embryos and the ultrasound after transfer. Only the air bubbles are visible. Our other embryos were refrozen. 

Decked out in my squishy pants and well-medicated, I was driven home to my bed to be left alone with my worries. 

It would be a week before we would know if it worked.

Injections, Blood Draws, Medications, and Tales from the Stirrups

The first thing that they put me on to prepare my body for pregnancy was a prenatal vitamin, a baby aspirin, and a prescription dose of folic acid. They put me in touch with a fertility pharmacy and I ordered all the other drugs that I would be taking along with buckets of needles, syringes, etc. 

·         A daily shot of progesterone. It is a large amount of medication, suspended in oil. They are extremely painful.

·         A twice weekly shot of estrogen.

·         Six days before transfer, I would start a steroid and a prophylactic antibiotic.

·         Nightly progesterone suppositories. 

Once I started the medications and hormones, I had to do weekly and sometimes bi-weekly blood draws to monitor my levels. I also had two ultrasounds to measure the lining of my uterus.  All while school is still in session. I was very lucky to have supportive bosses and coworkers to help out during all my time gone.

My blood tests came back mostly good. I had to take more estrogen, but the level came up to where they wanted it after that. The ultrasounds revealed that my uterine lining was thickening properly and so all signs pointed to transfer day happening as scheduled. 

Each time I went to the hospital, one of the nurses, techs, or workers was one of the parents of one of my students. 

Every time. 

I really didn't want one of my student's fathers asking how I was doing while my feet were in the stirrups and he performed a trans-vaginal ultrasound. Really, really didn't. How do parent-teacher conferences go after that?? 

Strangest question asked while in the stirrups: "Do you want to insert this yourself?"

Uhmmm, no.  Thanks, you go right ahead.

Strangest question asked while out of the stirrups: "So, how is the lining of your uterus? Is it thickening properly?"

Best and strangest supportive statements: "Thinking thick thoughts!"        "I have pity for your butt right now."

A few days before transfer, they thawed six of our embryos. They thaw so many so that they have a good selection. Typically, not all embryos survive thaw, not all grow, and not all are of good quality. 

The embryologist called two days before transfer to give us the results of the thaw. They had all survived! They then let them grow to the blastocyst stage.

Oh, cellular division, how we pray for you to happen.