Saturday 15 September 2018

We're pregnant!

We're pregnant! (again)

On Sunday April 29, 2018 we transferred our frozen embaby who survived the ice age! I began taking pregnancy tests right away and found out 4 days later, on May 3, 2018, that we were pregnant!

Of course, we were very happy that this FET worked and we were pregnant again. But anyone who has experienced infertility and multiple miscarriages understands that a pregnancy after loss can be filled with very complicated emotions. We were overjoyed it worked, but at the same time, we were anxiety-ridden for fear of losing yet another pregnancy. We wanted to be hopeful, but also wanted to be prepared for the worst (which is all we had known prior to this). And then we felt guilty and angry, for not being able to enjoy the beginning of this pregnancy like we wanted to. All this to say - its complicated.

Unlike our prior two pregnancies, we kept this one an ultimate secret between ourselves and our doctor at the Ottawa Fertility Centre (OFC). We were not ready to utter the words "we're pregnant" until we felt more confident and excited.

On May 13th and 15th I had blood work to monitor my hcg (the pregnancy hormone) and progesterone (I was on progesterone suppositories for the first 10 weeks to help this pregnancy thrive). Our hcg was high and was more than doubling. This had also been the case for our prior pregnancies, so was not as reassuring as one would think.

bruises from the blood work

On May 22, 2018 we had our first ultrasound. We were 6 weeks pregnant and everything was measuring right on schedule. The heart beat was seen but was still too small to measure the rate. We had asked for this early ultrasound, but because all of our prior pregnancies had been lost after 7 weeks, we were still very worried.

Finally our 7 week ultrasound happened on May 29, 2018! Everything was measuring perfectly and there was a strong heart beat of 124 bpm. We had never seen a 7 week ultrasound like this. I cried out of relief and happiness! We were still cautiously optimistic, but started thinking that this could work out!

There was also one interesting piece of news we found out at this ultrasound - this pregnancy had been an identical twin pregnancy. Of the one embryo we transferred, it had split into two - there was one gestational sac that had two yolk sacs. Unfortunately, one of those was not growing properly. We were worried that it would impact the healthy living pregnancy, but the doctor tried to reassure us that typically the second baby would just be consumed by the living one, with no negative impact. We were hoping this would be our case. We were surprised and sad for the other life that could have been, but worried and hopeful for the other that was still living.

We had another ultrasound at 8 and 9 weeks at OFC, until we finally "graduated"! This was one of the BEST feelings! We had never made it this far before! Our fertility doctor released us to our OBGYN who would continue to see us through the remainder of this pregnancy. It felt so good to say "see yah" to OFC, and take a break from a place where we had many difficult moments, but also a place where science had given us so much!

We met with our OB at 9 weeks, who made me cry she had such amazing bedside manner! She completely understood everything we had been through, and offered me weekly ultrasounds to help ease any anxiety I was having. I took her up on her offer, and we had ultrasounds at 9, 10, 11, 12, 14, 16 and 19 weeks.

7 week ultrasound
8 week ultrasound
9 week ultrasound

10 week ultrasound

11 week ultrasound

12 week ultrasound

16 week ultrasound

19 week ultrasound

Every ultrasound was more and more reassuring and finally after our 11 week ultrasound, we decided to tell our families! We told our families by putting a "big brother" bandana on Tobi.

Our 12 week ultrasound was particularly reassuring, where we were screened for genetic and chromosomal issues. Very fortunately, everything came back normal. At this point, we started to share the news with the most special people in our lives.

Our 19 week ultrasound was also extremely reassuring. This is the morphology ultrasound that took an hour to complete. All of the organs were measured and checked and everything was absolutely perfect. This is when we could have found out the gender, but we wanted to wait. We looked away and have asked all the ultrasound techs and doctors to keep it a surprise from us! We can't wait to find out what we're having when he or she is born!

Overall we had a total of 10 ultrasounds in the first 19 weeks of pregnancy.  I continued having ultrasounds for extra reassurance, until I started feeling the most AMAZING feeling ever - feeling our baby move!!!

We are now 22 weeks pregnant, due January 15, 2019, and OVERJOYED! It is still very surreal, but with every kick and punch from this active babe, we're reminded that we're FINALLY HAVING A BABY!!!!!

Our 12 week ultrasound photo, within a heart,
shaped from all the medication and injections I took to make this FET happen <3 

Our embryo survived the ice age!

In March 2018, we FINALLY got the go ahead to try again with a Frozen Embryo Transfer (FET). Based on our previous failed protocol, this protocol was different (and suggested my me).

In April, I got my period and started injections again. Depending on where we were at in the cycle, I injected myself 1-3 times a day with the goal of thickening my uterine lining to 7mm. Although we only needed my uterus to thicken, this protocol was the same as my prior September 2018 IVF cycle and it meant that I was growing a gajillion follicles. I was essentially doing a second IVF cycle, without the egg retrieval. Instead, once my lining reached about 7.5mm thick, I "triggered" and ovulated all 20+ follicles (OUCH). We were instructed to abstain from all sex, for fear of getting pregnant with multiples (very doubtful, but we did not want to take any risks).

Finally the day came for our FET. We did not find out until we were at the Ottawa Fertility Centre (OFC) that morning, whether our embryo had survived being thawed or not. We were SO happy when we found out that our embaby survived the ice age! We got over that hurdle.

That morning, we transferred our embryo - the embryo that was created from our eggs and sperm which were retrieved and combined in our September 2018 IVF cycle, cryogenically frozen over the winter, thawed, and then transferred back into my uterus on April 29, 2018.

That day I was wearing what I deemed my "lucky fertility earrings" - these were pineapple earrings I bought for myself, for this FET. In the infertility world, pineapples are a sign of good luck and fertility.

And then we were to wait (again), to find out if this embryo decided to settle in and make a home in my uterus! We had very mixed emotions - we were very hopeful but also preparing ourselves for the worst.

A Failed Frozen Embryo Transfer (FET) Attempt

After our second devastating miscarriage and a few months of recovery and testing, we finally got the go ahead to do a Frozen Embryo Transfer (FET) in January 2018. Our plan was to transfer one of our two frozen embryos that had been retrieved and created thanks to our IVF cycle in September 2018.

After our second miscarriage, we felt that so much time over the past few years had been spent waiting with very few chances to actually "try", so we wanted to move ahead as quickly as possible.

I started the typical protocol which involved taking oral estrogen pills and eventually wearing estrogen patches. My bloodwork and lining was monitored at the Ottawa Fertility Centre (OFC). They needed my uterus lining to be at least 7mm thick; however, this seemed to be a struggle and they kept having to increase my estrogen dosage to try and get my lining to thicken. Unfortunately, the levels of estrogen in my body became so high that I ended up having bad reactions and side effects. One morning, I woke up feeling impaired - I could barely walk. I called OFC and they instructed me to go to the emergency unit immediately. They feared I was having a stoke.

The Ottawa General Hospital checked me out and very fortunately, there was nothing seriously wrong. However, I did not react well to the high doses of estrogen and my cycle was cancelled. This meant that there wasn't a chance to even try to get pregnant.

More waiting.

Well this was frusterating!

We were instructed by OFC to wait to try to get into a specialist at a dizzy clinic in Ottawa. They seemed to think this was required before I could do a FET again. However I had only ever had bad side effects while on estrogen, and once off of it, I felt completely normal. In my mind, there was absolutely no need to wait to see a different specialist. I was sick of waiting and pleaded with OFC to reconsider and help me proceed.

OFC ended up booking me in and I decided to take matters into my own hands. We knew that I reacted poorly to the high doses of estrogen that were typically used to prepare for a FET, but I knew I needed to avoid that protocol. I also knew that in my prior IUI and IVF cycles where I took injections, my lining always thickened nicely. I proposed to my doctor that I follow the same protocol I did for IVF, using injections to thicken my lining. We would avoid doing another egg retrieval, but take advantage of the thickened lining to do a FET. Apparently I was the first patient at OFC to do a protocol like this, but there had been cases in other clinics where this worked, and they agreed.

So finally, in March 2018 we got the go ahead (again) to do a FET.

Testing after our 2nd miscarriage

After our second miscarriage, we decided to undergo additional testing to try to understand if there was anything else that could be causing these miscarriages.

After having the pregnancy removed via Manual Vacuum Aspiration (MVA), we had the remains of pregnancy sent to a company in Montreal (called Ignenomix) for testing. This testing included a service where we could speak with a genetic counsellor. The doctor explained all of the results to us. We found out that it would have been a little girl; however, there was a chromosomal error known as Trisomy 16. This explained why the pregnancy stopped developing properly. We found out that this chromosomal error is the most common cause of first trimester miscarriages. We also found out that  it was not something we passed onto the baby - this was a common chromosomal error that happens in early pregnancy, which very devastatingly enough, happened to us (likely twice in a row).

We also did additional blood work to test for any clotting issues. Fortunately these were also normal.

After about a month of testing, and a another month waiting for results, we finally got the go ahead to attempt a Frozen Embryo Transfer (FET) using one of our remaining two frozen embryos from our September 2018 IVF cycle.

Tuesday 14 November 2017

A Successful 1st Round of IVF Ending in Another Missed Miscarriage...

It’s sad but it’s true, and a hard lesson to learn for those who experience it. A positive pregnancy test does not always end with a happy, healthy baby 9 months later. In fact, 1 in 4 pregnancies in Canada end in miscarriage and 1 in 6 Canadian couples experience infertility.

Here we go again (or at least this is what we're thinking), with this being our 2nd miscarriage this year... 

But how did we get here? Here's a bit of our story, before we get to the present day sentiments:

  • In 2015, we tried for a year on our own, with no success. We were referred by our family doctor to the Ottawa Fertility Centre (OFC) where I was eventually diagnosed with Polycystic Ovarian Syndrome (PCOS) and hypothyroidism. 1 in 10 women in Canada have PCOS. It can prevent women from ovulating naturally, among having many other difficult side effects (weight gain, acne, the list goes on...).
  • During 2016, while under treatment with OFC, I took ovulation-inducing medication for 12 months. Unfortunately, all that those medications came with was a year of crappy side effects.
  • In January 2017, after 2+ years of trying to conceive, we had our first attempt at Intrauterine Insemination (IUI) with super-ovulation (SO). It worked and we FINALLY got pregnant! We were ELATED, to say the least. Unfortunately, during our 7 week early dating ultrasound, we found out that the pregnancy was not progressing normally. It took 3 more ultrasounds and by 10 weeks, the doctor confirmed that we had a "missed miscarriage". We were obviously devastated and we were given options of what to do next. Initially I tried taking misoprostol to medically induce a miscarriage, however after 2 failed rounds of misoprostol and another 2 months passing by, we realized there were still retained products of conception and I needed a medical procedure to finalize the miscarriage. Finally, in May of 2017 (after 5 months of the worst roller coaster ride yet) I had a Manual Vacuum Aspiration (MVA). As our fortune would have it, this didn't work either, and I ended up having a D&C which was finally successful to terminate the non-viable pregnancy.
  • Needless to say, we needed to take a break during the summer of 2017.
  • In August 2017, we received a call from OFC that we were next in line for the Ontario government-funded In-Vitro Fertilization (IVF) program. This meant that most of the costs of the procedure were covered under OHIP (things like medication were not covered). We did IVF in September and it worked, and we were pregnant, again! After all that effort and pain, it was initially reassuring to know IVF seemed to have worked. We were cautiously optimistic and thought that after all our troubles, this pregnancy was sure to work out. However, all that reassurance came crashing down when we experienced déjà-vu and were diagnosed with our 2nd missed miscarriage of 2017. It took about a month of repeat ultrasounds to receive the official diagnosis, but we ended up having a MVA at 9 weeks and 4 days (of pregnancy) to treat the missed miscarriage in November 2017.
  • Both of these missed miscarriages (or "silent miscarriages") were first-trimester “early” losses, but still heartbreaking nonetheless, especially following all of our struggles with infertility.

So this brings us to present day...

This current miscarriage might sting a little more than our last one because it follows an initially successful In-Vitro Fertilization (IVF) treatment. We were SO excited to start getting positive pregnancy tests before Thanksgiving (just 6 days after our 5 day fresh embryo transfer). We received confirmation of our pregnancy just after Thanksgiving with OFC. Our bloodwork was looking so strong that they didn't even want to repeat it!

However, we received an initial warning at our first viability ultrasound on October 27th, 2017. We should have been 6 weeks and 6 days pregnant, but we were measuring only 6 weeks. It took about a month of repeat ultrasounds (3 ultrasounds over 3 weeks) to receive the official diagnosis of another missed miscarriage. By November 10th 2017, we should have been 8 weeks 6 days, but we were still only measuring 6 weeks 4 days and there was no longer a heart beat.

We ended up having a Manual Vacuum Aspiration (MVA) at 9 weeks and 4 days on November 14th 2017 to treat the missed miscarriage. If you want to rant with me about our Canadian health care system, ask me about ironically-enough having to go to an abortion clinic to get the health care I need and deserve. This loss is considered a first-trimester “early” loss, but still heartbreaking nonetheless.

Going through 3 years of infertility, with only 2 pregnancies and 2 missed miscarriages, is not an easy road. Being pregnant or experiencing a miscarriage for 80% of 2017 is not fun, especially when you have no baby to show for it. Life isn’t always fair and not every infertility road has a happy ending - at least that's how we're feeling at the moment. IVF is not always a miracle solution as miscarriages are just as likely as they are with a natural pregnancy. This is the unfortunate reality that I’m trying to accept right now.

No matter how hard we work, we cannot control our life when it comes to fertility. This has been a hard lesson to learn, since my husband and I have been people who have been told and who’ve learned that when you work hard, and if you work hard enough and for long enough, you can achieve your dreams. Unfortunately it seems that this is rarely this case with infertility and recurrent miscarriages. Or maybe we are just jaded and in a negative space at the moment... But these are our current sentiments. Unfortunately, words of hope and prayers get wasted on us at the moment - we feel we are more resilient and prepared when we are realistic and prepared for the worst. All we need is for people to say “that really sucks”. At this point in our lives, words of encouragement or hopefulness are more hurtful than they are helpful because we feel that we can not realistically live up to those hopes and prayers. Sometimes I miss our past happy-go lucky, everything is sunshine and butterflies, younger selves...

Other than the physical challenges of pregnancy and missed miscarriages, the emotional rollercoaster can be rough. Due dates like October 22nd and June 16th will always be difficult for us. Pregnancy announcements, baby showers, and even socializing with our peer group often surrounded by their babies is very difficult. We often feel left alone or left behind to fend for ourselves. And thinking about trying again is not as easy as it might initially seem. This will likely involve more testing from our fertility clinic in hopes to ensure I don’t have scar tissue or complications from the procedures I’ve needed to treat our missed miscarriages, forking out thousands of dollars to do genetic testing to see if these two back-to-back miscarriages are just bad luck or if there is another problem going on, a frozen embryo transfer (we only have 2 frozen embabies and there are no guarantees that those could de-thaw successfully, implant successfully, or go on to become a healthy baby), and the stress and anxiety of another embryo transfer working or not working - all of these processes and scenarios are equally stressful for different reasons and this process can take months.

Although this miscarriage this time might have stung a little more because it was after IVF, at the same time, it was a tiny bit easier because I was empowered. I knew what resources existed in my community to help me get through this and I knew what to expect. I was not alone and I had knowledge. Knowledge really is power. This was the exact opposite experience I had with our 1st miscarriage. At that time, I felt like I was in the dark and our medical professionals didn’t provide us with any information to support us.

I have been volunteering for the Butterfly Run Ottawa/Gatineau this year. I can truly thank the Butterfly Run Ottawa/Gatineau for arming me with this power of knowledge, this sense of pride, and this feeling of community. Without the Butterfly Run, I would not feel as strong as I do under these circumstances. It is for this reason that I’m choosing to share our story. I hope that by sharing our story, another person might feel less alone in their journey.

If you're interested in reading more about my journey, here are some other stories/snipits I've shared during our journey (writing and sharing has also been helpful for me):

Also, I wanted to caveat this post, or end this post rather, with saying I’m sorry if I share my feelings bluntly or if they are not the most positive thoughts at the moment... I don't mean to share these negative sentiments to offer the cruel realities of infertility and miscarriage (perhaps the first half of my post was a little dark and dreary). If you are going through this, or something like this, and feeling hopeful or positive, I do not want to take that away from you. Please continue to feel anything you are feeling! Every journey is different, and our feelings can change throughout this journey. Unfortunately, my personal feelings are not as positive at the moment, but I still feel they are important to share. By sharing these feelings, I do not want to take away your hope, but if by chance you are also feeling something similar to me, I would like you to know that there is someone who you can relate to.

XO Thanks for listening! And hugs to you if you’ve been through or are currently experiencing infertility and/or miscarriage. It’s not an easy road but hopefully we can make it a smoother and clearer road together.

Thursday 28 September 2017

Embryo Transfer

On Day 3 post Embryo Retrieval, we received an update from OFC. This was either going to be good news or bad news - a lot can happen to the fertilized eggs in just a few days, so we were anxious to know how they were doing.

We were told that they were doing well, and that we could plan to do an embryo transfer on Day 5 which was Thursday September 28th. This is the ideal scenario because it gives the embryos a chance to turn into blastocysts (typically by day 5) and be better assessed by the embryologist.

Jake and I both took the Thursday off work. We were scheduled to have a consult with the IVF doctor-on-call at 9:30 and our transfer was tentatively scheduled for 10:30. Because we still weren't sure if there was fluid remaining in my uterus, the transfer was only tentative.

OFC was running behind schedule that day. There had been a big storm in Ottawa the day before, so many patients were late or running behind because of road and traffic issues due to the storm. So that meant everything was pushed back that day. We got called in around 10:15. Jake changed into scrubs and I changed into that awesome hospital gown again.

We finally met with the IVF doctor and we were given all the info about how our embryos were doing. We had a total of 4 viable embryos plus an additional 2 non-viable embryos. Each embryo was evaluated by an embryologist and graded.

Of the 4 viable embryos, we had 2 excellent quality (the highest quality), 1 good quality, and 1 fair quality. The other 2 non-viable embryos would be destroyed.

Based on our discussion with the doctor, we agreed that if we still had fluid in my uterus, we would transfer the 1 fair embryo. Embryos rated as "fair" can't be frozen, so rather than let it go to waste, we could try and transfer the fair embryo and see how we would do - but likely it wouldn't work due to the fluid.

On the other hand, if there was no fluid in my uterus, the doctor advised us that we should transfer our highest quality embryo!

Shortly after that discussion, we were pulled into the operating room where an ultrasound tech did an ultrasound to confirm if there was any fluid left in my uterus. Fortunately, there was none, which meant that we could transfer the highest quality embryo!

It was a very cool process! Before transferring the embryo, the embryologist showed us a picture of the embryo (now known as a "blastocyst"). We were able to watch it be transferred into my uterus via a catheter and thanks to ultrasound technology.

They pulled everything out of me and the embryologist confirmed that there was no embryo left in the catheter (meaning it was now in my uterus left to do its thing)!

So now we cross our fingers and toes, and wait and see what happens to our little em-baby!

We also decided to freeze the other remaining embryos that were of high-enough quality to freeze. The 1 remaining fair-rated embryo had to be destroyed since it would not survive the freezing and de-thawing process, but the 2 other embryos (1 excellent quality and 1 good quality) would be frozen. There were still no guarantees that they will be successfully frozen, but OFC will call us tomorrow (Friday) to let us know if the freezing process for those 2 remaining embryos was a success. We really hope that they can be successfully frozen, because those would be our future options for Frozen Embryo Transfers if this embryo transfer doesn't work, if we miscarry, or if we want to try for more kids in the future.

So wish us luck!

Regardless of the result, we most likely will not be posting any further updates or news on here, but hopefully these blog posts helped you understand the process and everything we were doing to try and have a baby. AND if we're ever lucky enough to have a child from this IVF cycle, we will likely use these records if they are ever being a little-shit-teenager to remind them how much they were wanted and why they should be good lol!

Thanks for your support everyone! Now we wait and let science and possibly a little bit of magic do their things!

Egg Retrieval

On Saturday September 23rd we had our scheduled Egg Retrieval (ER).

As luck and the wonderful timing of life would have it, Jake had his final customs exam for work scheduled at the same time, so unfortunately he wasn't able to come with me. He got up super early to do his thing at OFC, and then rushed off to his exam which started at 9 AM.

My mom and dad drove back from the cottage to take me to the ER. I was going to have conscious sedation so technically I would be legally impaired for 24 hours, which means I needed someone to drive me (thanks dad). I also wanted to have someone with me throughout the procedure and in the ER (thanks mom).

We showed up at OFC at 8:15 AM and my mom and I were brought into a separate area of the clinic that I had never seen before. My mom changed into scrubs and I changed into a lovely hospital gown. After that, we were given a locker where we could safely keep our things, and I was directed to a chair (a hospital-type Lazy-Boy chair). A nurse set me up with an IV in my hand and started giving me fluids and a medication that was supposed to help me relax and forget things (yeah... I don't think it worked...).

At exactly 9:15 AM, I had the ER. I walked into the ER with my IV cart in hand, and my mom not far behind. They gave me 3 doses of fentanyl through the IV to "help" with the pain (this was the conscious sedation)... but I really don't think the meds worked because it hurt like a F@#$ing B*&$%! My mom was able to sit beside me throughout the process.

Our results were much better than expected! Based on the last ultrasound we had, it looked like I would only have about 5-8 follicles (and not all of those would have eggs), but it turned out that those follicles grew like crazy in the last 3 days and I had around 15 follicles. They were able to retrieve 12 eggs. OUCH! But that was good news!

The whole procedure lasted about 15-20 minutes and definitely wasn't a walk in the part, but we were very happy with the result! Here we are showing how many eggs were retrieved = 12!

After the procedure, I had to rest at OFC for an hour. They gave me some more fluids and offered me some food. I had to make sure I could pee before I could leave lol. Finally that happened and we left that morning.

I felt decent when leaving OFC and for the majority of the afternoon after the ER; however, that evening was HELL ON EARTH! I have never experienced such awful pain. Jake ended up calling the doctor-on-call at OFC during the night to see what I could do to help the pain. Luckily, they allowed me to take a Percocet (which I had left over from our miscarriage) and that made me feel so much better and I was finally able to sleep!

The next 2 days after the ER were also very painful. I had to take Tylenol every 4-6 hours, but it didn't seem to do much for the pain. My stomach was very tender and swollen! It was difficult to walk around - even getting in and out of bed sucked.

Luckily, by Tuesday, I was feeling almost 100% and back to my normal self!

Hopefully I never have to have an ER again in my life, but if I do, I will be more mentally prepared for the awfulness of the procedure and recovery!

Now let me back up in time again. So the day after the ER (Sunday September 24th), we were called by OFC and told that of the 12 eggs we had, 7 were successfully fertilized using ICSI. That was good news for us as well! From there, we needed to wait until Wednesday September 27th which was day 3 following the ER. We would be told how many fertilized eggs survived and if they were going to do a day 3 or 5 transfer.

Also as life would have it (good ole' life), there was one other potential snag in the process. Due to all the hormones in my body from the injections, the doctor found fluid in my uterus during the ER. This was fine during the ER, but it could potentially impact the transfer if the fluid was still there. If the fluid was still there on the day of the transfer (day 3 or day 5), they most likely wouldn't proceed with a transfer because there would be no chance of the embryo implanting - it would just float around in there.

So that brings us to day 3 after the ER - and I'll do a separate post about all that jazz!

We're pregnant!

We're pregnant! (again) On Sunday April 29, 2018 we transferred our frozen embaby who survived the ice age! I began taking pregnancy t...