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.

The Beginning

Things happened very quickly from there. When we notified the clinic that we would like the donor profile and the 14 embryos it contained placed on hold for us, they immediately set up a medication regiment and tentative transfer day. 

We were shocked! From the time we chose our profile, it would only be six weeks until the transfer of our embryos. 

Barring any complications, of course.

Genetic and Adoptive Counseling

The counseling appointment was by far the biggest fear that we had in getting started. After solving a number of scheduling difficulties and taking time off of work, we set out for Boise to meet with a counselor. We needed her approval in order to proceed with our transfer.  We felt nervous because we did not know what to expect and were prepared for a very evaluative session. 

In reality, she was very nice and very helpful. It was far more informative than evaluative. She herself had two donor children, which put me at ease. I felt more comfortable talking to someone that I felt had a platform of actual experience. She asked about our infertility and our journey to get there. I cried. Brian didn’t. Of course. 

She asked about our profile choice. On this issue, she was the most aggressive and I felt uncomfortable at first. I felt that I had to justify our choice and explain the medical realities to her. Wasn’t she a doctor? Why would she make us feel bad about this? There wasn’t a problem that no one told us about, right?

I realized later that she just really needed to make sure that we understood our choice, and that no one had lied or pressured us into it.

She gave us a packet of information and explained that the issues of raising donor children are very different than the issues with raising adopted children. We explained that we will have the policy of full disclosure with our children- they will know they are adopted. Secrets are not something we approve of, especially not in regards to where you come from. She agreed and said that this is the preference in the adoptive world now. 

She explained that adopted children struggle with identity. They wonder who they are and why their birth parents did not want them. Donor children differ because they were not given up after birth and do not struggle with wondering how their birth parents could give them away when they carried them, birthed them, knew them. Donor children struggle with genetic identity. Who are they genetically? Are there siblings out there somewhere?

This was one factor that had escaped our preparations. While we both figured it would have occurred to us as some point, it was the one new thing that we took from our meeting with the counselor. Our children will have full siblings somewhere in the world. 

This takes on a complicated reality.

What happens when our kids go to get married and/or have sex? They could unknowingly be in a relationship with a blood relative of some sort. And asking is not enough. Some people lie. Some parents will never tell their IVF kids that they donated embryos. Our children's partners could have no idea.

Our children will need to undergo genetic screening with sexual partners. Wow. We were not quite prepared for that one.