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):

• Our first miscarriage announcement on social media
• Our 1 in 6 story with Fertility Matters Canada
• This personal blog journaling our experience with IVF

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.

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!

Injections!

Tonight is my last night for injections! YAY!

I've pricked myself, typically with 3 needles a day, for 8 days now. So I am happy to say that the "stimming" stage of IVF is over!

This is what happens when you are rushing to give yourself an injection in the morning... you end up pricking yourself in the wrong place! That might look like a small drop of blood... but when you aren't expecting it and inject that needle deep into your finger, yowzers!

Also, this is what it looks like when you're trying to maintain a social life, but you have to keep up with your injections at the same time! Injections in a parking lot... not sketchy at all... ;-)

Yesterday we went into OFC for our first ultrasound to check-in and see how I was responding to the injections. It turned out that I was responding quicker than average - most people need around 10 days of stimming, whereas I was only at 7 days at that time. I figured I was responding to the meds because I have been feeling very tired and my ovaries feel like a million pounds! They found 2 follicles that were over 17 mm, 3 that were between 15-17 mm, and another 3 that were between 10-15 mm = 8 potential follicles total. Some people on the high end of the spectrum of IVF will have 15-20 follicles, and some on the low end will have around 1-2... so they said I was somewhere in the average in terms of our response quantity. They scheduled our egg retrieval for Saturday (EEK), expecting that the follicles will continue to grow until then.

Of course, as life would have it, our egg retrieval is scheduled at the exact same time as Jake's final customs exam for work. He can't reschedule his exam, and we can't reschedule the egg retrieval. So I've asked my mom to take me and come with me to the egg retrieval while Jake does his exam.

Soon after the egg retrieval we will know how many eggs they were able to retrieve (if any - there are no guarantees). If we have eggs, they will do ICSI and inject 1 sperm into each egg. We will get a call about 24 hours later (on Sunday I hope) to tell us how many eggs were fertilized. And from there, we monitor them.

Here's hoping that Saturday goes well - Im hoping for a few good eggs that can get fertilized by Sunday!!! If that all works out, hopefully we will transfer a healthy embryo next week!

It's a go!

Yesterday I went back into OFC for another ultrasound and blood work. At the ultrasound, they checked and measured the cyst on my right ovary. It had shrunk from about 4 cm to 2 cm. It was still big enough that they were considering it a cyst, but not big enough that they were too worried. They said that they would continue monitoring it throughout IVF... but... we still had to wait for the results from the blood work to confirm that we were officially a GO! It turned out that they had a problem with their blood lab that day, so they needed to send the blood out to another clinic. They promised to call me the next day to confirm if we were to go ahead with IVF or not.

Today they called and confirmed that we can officially start IVF! My progesterone and estrogen levels were normal, which confirmed that the cyst shouldn't interact with the IVF protocol.

So I went to OFC to pick up the injectable medications.

This is what 10 days of injectable meds looks like (ignore our dusty kitchen table):

Looks like we will be clearing out a shelf in the fridge for these bad boys. I start taking Gonal-F (275) and Luveris (250) tomorrow (Thursday September 14th 2017) between 4-7 PM at the same time each day. I will take these for +/- 10 days. On September 18th, I will also start taking Cetrotide (250) every morning at the same time, before 11 AM, to prevent ovulation from occurring before the egg retrieval. They want to ensure that the follicles do not release any eggs before the planned egg retrieval.

Now we just wait until tomorrow to start poking myself!

Things are back up in the air!

Well in the last 24 hours, I've been to OFC 3 times! Ugh!

Yesterday (Tuesday September 5th, 2017), I went to OFC to have my blood work drawn and an ultrasound. Unfortunately, it turns out that I currently have a cyst on my right ovary...

Today (Wednesday September 6th, 2017) I went back into OFC to meet with our fertility doctor, Dr. Vause. She told us that if the cyst doesn't go away on its own within the next week, our IVF cycle will have to be delayed. They do not want to proceed with IVF until my ovaries are clear of cysts because cysts can mess with my body's hormones and interact with the hormones that I would inject myself with.

I also had to go back into OFC for the 3rd time in 24 hours for our IVF "scheduling appointment." For this appointment, I met with a nurse who walked me through what would happen on each day of our IVF schedule; however, because of the cyst, the schedule is still up in the air.

So this means that I am still waiting for my next period to show up (+/- the next 7-10 days). Once I have my period, I will go back into OFC on day 2 of that cycle to have my blood work checked again and also have a repeat ultrasound. IF my progesterone is too high, and/or IF the cyst still exists, our IVF cycle will be delayed.

So now we wait, for results from the day 2 tests... Stay tuned!

It's Official! IVF is our next step!

Well guys, it's official! We're preceding with In-Vitro Fertilization (IVF) as our next step for our infertility treatments!

Today we went into our local fertility clinic, the Ottawa Fertility Centre (OFC), to meet with one of the nurses for a "consent signing appointment". The purpose of this appointment was to find out what protocol (the process) we would be doing, what the success rates and risk factors are, and to basically sign our life away on a bajillion medical forms.

We found out that we would be doing an "Antagonist" protocol with intracytoplasmic sperm injection (ICSI). ICSI is the procedure where they inject 1 single sperm into an egg, rather than letting all the sperm swim around the egg and fertilize it themselves.

We're also lucky patients of the Ontario government funded IVF program, which means that much of the costs of IVF will be covered by our health care (hallelujah!). What's not covered is the cost of injectable medications (roughly $6,000) and cost for annual embryo freezing should we be lucky enough to have high-quality embryos to freeze for later ($500/year). I also have prescription drug coverage through my work so part of the medication will be covered, which will help us out a lot. We've been on a waiting list at OFC since November 30th of 2016, so we're very happy to be moving forward with the government funded program.

So what are some of the things we found out at our appointment today?

• We were told that the expected pregnancy success rate was 42% - this was a stat individualized based on us, our age, health, medical history, etc. However, we're staying realistic because that means there's also a 58% chance that it won't result in a pregnancy. This stat shouldn't be confused with a live birth rate, because just because there's a 42% chance we could get pregnant, that doesn't mean the pregnancy would be viable. 
• We also found out that there's about a 10% chance of our cycle being cancelled by the clinic... that could be for reasons such as poor stimulation or over stimulation to the meds, problems accessing my ovaries, no eggs being retrieved, zero eggs that were fertilized, or no surviving embryos... we really hope that we won't fall into that 10% and have our cycle cancelled. 
• Because I have PCOS, there's also a 20% chance I could get ovarian hyper stimulation syndrome (OHSS), which if you read about it, would really suck... so lets hope that also doesn't happen!
• Apparently there's also a 25% risk of multiple pregnancies, even if they only put back 1 embryo (yes, only ONE) on day 5 (day 5 after egg retrieval)... this rate is much higher than the general population who might have that occur naturally at a rate of 3% in Canada. 
• Rates of miscarriage are still the same - so even if this works and we get pregnant, we still have about a 15-20% chance of having another miscarriage...

Hope we didn't bore you too much with all of those stats... but we found them helpful to keep us realistic about the process. Many people believe IVF is a magical solution to infertility. And while it is an incredible advancement in the field of medicine, there are still many people who it doesn't work for. I might sound jaded, but I'm just being realistic.

Also at this appointment, we had to make a lot of decisions that weren't necessarily prepared for. It would have been great if we had a heads up from OFC about the types of decisions we should be prepared to make at this appointment. For example, if one of us were to die, would we allow the other living person to use the remaining embryos to have a child on their own (or via a surrogate in Jake's case). Would we donate our embryos to science if we didn't or weren't able to use them. Would we allow for the clinic to destroy our embryos once we were done with them... these seemed to be tough questions for us to answer, so we made quick judgement calls to the best of our ability today, but we may revisit and revise these decisions over the next little while if we change our mind.

I'm also happy to report that I met the weight limit for IVF (based on OFC's restrictions), after losing 30 lbs with Weight Watchers (WW) since April. Yeah!!! OFC said I can stick with WW as I go through IVF, until we know a result at the end of all this. I plan on continuing to do so, especially since I won't be able to work out, other than just walking, while going through IVF. This is because any fast movements/turns/jumps/crunches can highten the risk of an ovary twisting and having the blood supply cut off... so yeah, walking it will be!

Overall, we're excited to be moving on. The last 2.5 + years have seemed to drag on and have seemed to move very slowly to get to the next step. So here's hoping this one goes by fast, and even maybe better, works, and sticks for good!

What are the next steps?

• We have a "scheduling" appointment on September 6th where we will get all the details about the process, meds, restrictions, etc.
• Once I get my next period, I call OFC to report my "day 1" 
• I'll be scheduled to have blood work drawn on day 2. The purpose of this will be to check my progesterone levels. If they are too high, our IVF cycle could be delayed by a month. They don't think that mine will be, and this is a standard test, but they are checking it nonetheless. 
• I'll start injectable medications between days 2 and 4 (depends on if my day 1 falls on a weekend, OFC's schedule, etc.). I'll probably be on medications for around +/- 10 days.
• And of course... more to come... but it gets fuzzy/complicated/up-in-the-air from here. 

Anyway, until next time!