I have a story to tell. It does not have a happy ending. But, perhaps, it has no ending at all. Perhaps we are still in the middle of the story, and this is just the hard part. This is the story of the past seven years, which I will share in segments over a series of posts.  This is the second post in the series, which I wrote a few weeks after we had completed the IVF procedures. Click here to read part one of our story.




What is In-Vitro Fertilization?
In-vitro fertilization. Or, IVF for short. This is most definitely not the route I wanted to take, and I'll explain why. But first, a little primer on the process. I've found that most parents have very little understanding of how their children actually came to be. If you're one of those who just did the deed and magically produced a child, consider yourself very blessed. It's an involved process, and for many people, any one little factor that is off can make it difficult or even impossible to conceive. In our case, we never did have a definitive answer on what the problem was -- likely a myriad of factors all working together against me. So, IVF became our only hope. In many ways IVF is very similar to what happens during a natural cycle, but the first two weeks are full of lots of extras. It is a somewhat complicated process of trying to balance the body's hormones in just the right way so that it produces multiple high-quality and mature eggs (typically a woman has only one mature egg per month). The eggs grow inside follicles on the ovaries, which during IVF are closely monitored and measured every couple days so that doctors know when they will be mature -- but you also have to keep the body from ovulating and releasing the eggs too soon, or you won't be able to retrieve them. The woman's hormones are balanced by hormonal injections, typically a couple different self-injections done daily in the stomach. Hormone levels are also tested through blood tests regularly -- looking particularly at estrogen levels, which should be rising, and progesterone, which can't get too high. Once the follicles are large enough and eggs presumed to be mature enough, another special "trigger" shot or two are administered to tell the body it's time to ovulate. This is very precisely timed so that the doctor can "catch" the egg before it is released, but after it is fully matured. The eggs are extracted with a long needle (you don't want to know the details, but thankfully the woman is under sedation or anesthesia), and the couple determines how many eggs they want to attempt to fertilize. The eggs and sperm are either put together in a petri dish or, as in our case, one healthy looking sperm is selected to be directly injected into each egg. A day later, you will know which ones successfully fertilized into little embryos. Then, depending on your clinic, either the next day after that or a few days later, the subsequent embryo(s) are transferred back to the woman's uterus (typically one or two are transferred, and the rest can be frozen for future cycles). With IVF, you have visibility into what's going on in your body during the first half of your cycle, which you could never know otherwise -- so, that's kind of cool. Once the embryo is transferred, it works like any other pregnancy, except the woman is often supported by additional hormones and more closely monitored. It's a two week wait from fertilization until a pregnancy test, the same as you would normally have, to find out if the embryo has implanted and started to produce the "pregnancy hormone," HCG. With IVF, doctors will perform a blood test, which is more precise and gives a quantitative value, rather than the qualitative "pregnant/not pregnant" from a home pregnancy (pee on a stick) test.

The Decision to Proceed
There were three main reasons I did not want to do IVF. First, it just felt very unnatural -- all these injections and doctors appointments and ultrasounds and blood tests, and doing it all in a lab... just, not really the way I wanted to build my family. I had seen friends go through the process, and I knew it wasn't a simple one. Secondly, I had a few ethical concerns that I wanted to make sure could be properly addressed. How do you decide how many eggs to fertilize? What happens if you end up with more embryos than you can use or more embryos than you want kids? They can be frozen for future use, but what if something happens and you can't use them? Or you end up with 10? I wanted to make sure that we used all of our embryos, as each one was our potential child, so we'd have to be careful about how many eggs we fertilized. Lastly, one of the main reasons I was scared to do IVF was because of the progressive chronic pelvic pain that developed last fall. I believe the pain is from endometriosis growing into a nerve in my pelvis, and it is directly correlated to my hormone levels. Injecting myself with extra hormones seemed like it was inviting trouble. And, with limited options for pain medication (Tylenol) while trying to conceive, there wasn't much I'd be able to do to stop the pain. That thought was terrifying, because I knew how bad this pain could get.

Despite my fears, we decided to proceed, as it was our last chance at having biological children. Problem one was addressed -- my work was super accommodating, and I got used to going in for appointments every couple days, it was what it was. As for two and three...well, here's my IVF story.


IVF Step 1: Stimulation

I counted 78 syringes that I used in the pre and post IVF process. Believe it or not, this was NOT the painful part!

My IVF cycle began on May 31, 2019. June 2nd is when I began my first injections -- two shots in the stomach every morning. I had a little trouble learning how to mix up the drugs myself, prepare the syringes and inject with actual needles for the first time (I do weekly injections for RA, but it's an auto-injector pen). Once I figured it out, it was no big deal, My stomach just quickly filled with pin prick bruises. I was in the Fertility Center regularly for ultrasounds, and they saw five follicles growing. That's not a lot, but I only have one ovary and I knew my egg quality and quantity were likely to be low, so it was expected. I also had five in mind as the "magic number" of eggs I wanted to fertilize, taking into account an 80% fertilization rate -- and there's also a high chance that not all of the embryos will survive. During this time, my estrogen and progesterone levels were being monitored through blood tests. I thought my first estrogen level was kind of low, but it was rising and the nurses said it looked good. I felt fine for the first several days, but on June 8th, my pelvic pain started to flare. I had bad pain the previous month, with no extra hormones, so I was not really surprised. The Fertility Center staff told me that most women do fine on the IVF injections because they are very targeted and precise. Well, if you haven't figured it out by now, I am not most women.

They had given me a prescription for Tylenol 3 the prior month, and since I couldn't take NSAIDs for pain, that was my only option other than regular Tylenol. But, it didn't work. The pain was still not controlled. It. was. terrible. By June 10th, it was so bad that I had to leave work and could do nothing all day but just try to breathe. It was like a constant knife stab in my lower right front and back, sometimes twisting and just taking my breath away. All of the injections I'd been doing were nothing compared to this pain. I'd inject myself all day long, no big deal. But this...this, I did not know how I was going to survive. Meanwhile, my follicles were growing really slowly. Only four were measurable, and the potential retrieval date kept getting pushed back. I knew there was a chance I could feel better after the retrieval, as the hormones would be stopped. But the longer that got delayed, the more despair I felt. Thankfully, my boss let me work from home (read: bed) that week, but by June 12th, the pain was more than I could bear. It was one of the worst weeks of my life. I had called the IVF nurses crying a couple times, and they felt bad because there wasn't much they could do. Eventually, the doctor agreed to prescribe Norco for me, in hopes that that would control the pain better than Tylenol 3. After three doses of Norco, I finally started feeling some level of relief, though the pain was still often pretty bad. Being on Norco also meant that I couldn't drive. Tom was so wonderful and supportive and found a way to drive me around to all of my appointments.

On June 14th, it was already past when I thought the IVF procedures would be complete, but my follicle growth was still lagging behind. I had my blood drawn that day, as well, and my progesterone levels came back as kind of high. I was informed that if that got too high, we would have to freeze any embryos and wait to do the transfer until the following month. Not what I wanted, but okay. I had my hormone levels checked again the next day, and the progesterone was fine, but my estrogen had dropped! That's supposed to keep going up until they retrieve the eggs. My doctor informed me that my body may be preparing to ovulate on its own -- we had been artificially keeping it from ovulating (with yet another daily stomach injection), but perhaps we had pushed it too long. If my body ovulated on its own, IVF would be canceled and we'd have to start all over again. After that pain, I told my doctor, "I am NOT doing this again." She agreed to have me keep on my injections through the rest of the weekend and we'd check my follicles and hormone levels again on Monday.

June 16th was our 12th wedding anniversary. I realized then that we had been trying to grow our family for half our marriage. I wasn't feeling great, but we went out to dinner anyways. At that point, I felt like I had come to the end of myself. I was on edge, wondering if we'd have to cancel IVF and give up. I felt like all I had left was God and the strength that he gives me. I kept thinking of the verse that says "when I am weak, He is strong." Then, I got a text from a friend of mine who told me that she was praying for me with her four year old and after she was done praying, he looked at her and said, "God is strong for Dana," then left the room. Wow! What truth from such a young child. And what encouragement!

Monday came and we went to the ultrasound, not sure what to expect. Well, my follicles were still in tact, meaning I hadn't ovulated! Moreover, when I got my bloodwork back, my estrogen had miraculously gone back up! We were in business! That night was a huge turning point, when I finally got to take my trigger injections, and I knew that we'd at least get our shot at IVF. The trigger injections also meant the first of many injections in my butt muscle -- which Tom, who has a needle phobia, has to administer. One was in the stomach and the other in the butt. Tom did great! I also got to stop taking my other injections the next day and just had a blissful day of waiting and no meds...other than the Norco I was still on for pain.


IVF Step 2: Retrieval and Transfer
The Norco had to be stopped that night, as the next morning was egg retrieval where they would give me IV sedation drugs. On the way to the egg retrieval, I was thinking about this roller coaster we'd been on and how unlikely it was for us to have gotten that far, given all of the circumstances. It reminded me of Gideon's army and how God kept whittling away their numbers, down to just 300 men, so that everyone could see that victory came from the hand of the Lord. I wondered if God was doing something like that with me -- stripping everything away until there was such a small chance of success that all would know that his child was possible only by the grace and power of God. That feeling only strengthened after the egg retrieval.


Four mature follicles means four eggs, right? Nope. It should have. Usually it would. But I'm not normal, remember? Out of the four follicles, I only had ONE egg. One! There was no choosing how many eggs to fertilize. We had one shot at this. They would attempt to fertilize my one egg that day and call me in the morning with the results. Talk about nerve wracking! The next morning, I got the call: the egg had fertilized and we had an embryo! I cried of joy and hope and relief. I knew the odds were still against us, but we had SO many people praying for this little life, and I kept praying that when my faith failed, someone else's would stand in its place! The day of egg retrieval, I was SO tired. I just did IV sedation, no anesthesia, but I came home and slept in a coma-like state until Tom force fed me water and made me eat something. I was literally knocked out all day. Tom was just amazing through all of this. Never complaining and always supportive. The next day I woke up to another miracle: no more pain! After stopping the hormone injections and doing the egg retrieval, plus whatever IV cocktail they gave me, the pain was completely gone! After a week and half of pure agony, it felt amazing.





June 21st, on the summer solstice, we went in for the embryo transfer, where they take a small catheter, guided by ultrasound, and place the embryo in my uterus. It's a quick and mostly painless procedure. When we got into the room, the doctor handed us a photo of our little embryo -- just four cells! She informed us that it was a "C" grade embryo -- which isn't what they want to see (of course, because that's how this how thing is going) -- but she also assured us that these embryos turn into babies all the time. We got to watch on the ultrasound screen as the embryo was placed, and a little flash of white indicated that it had been transferred. This was the first time in my life that I knew I had a little life growing inside of me! In a natural cycle, you would never know if you had a fertilized egg that never attached. It's possible that we'd gotten to that stage before, but there's no way to tell. So, that's a cool thing about IVF -- you know exactly what is happening! From the transfer day, it was 10 more days of waiting before I could go in for a blood test to check my HCG levels and find out if it had attached, if I was actually pregnant!

Each time we hit a milestone in this process, I felt kind of like I was leveling up in a video game. The whole process felt like a video game you had played hundreds of times before, but could never make it past the first level. Then, one day, you do. And then you beat the second level, and then the third! You start thinking, "wow, maybe I could actually go all the way and beat this thing!" Now we waited to get the ultimate level up.

Those were 10 long days, but I was feeling better and able to get back to my office to work at my desk! Tom also had to begin giving me daily shots of progesterone in my butt each morning, and I was taking estrogen pills twice a day. I was told if the pregnancy is successful, I'd be getting those butt injections all the way until I was 11 weeks along! They wait until the placenta takes over hormone production, just to be safe. It was weird to be back to a normal life, but I tried to take advantage and get some things done and have some fun. For the time, I was just grateful that we didn't have to cancel IVF, that we had our little embryo, against all odds, and we could give this a real chance!

Click here to read part three of our story.