Sunday, October 3, 2010

What does progesterone do to the birds anyway?

This post isn't really about birds.  But just for interest sake, birds who are given more progesterone hatch more females.  I would have thought it to be the other way around being that progesterone is more of a male hormone.  But that really is beside the point.  This post is really about IVF cycle #1....better known as my costly failure.
Back when I knew that getting pregnant wasn't going to be easy, but before I really knew how difficult it was actually going to be, I used to say that I wasn't interested in trying in vitro fertilization.  To me it was like putting a $10000 deposit down on a car with only a 50% chance of actually getting the car.  As time past and I became more desperate to become a mother, my thoughts on IVF changed completely.  I now suggest that anyone who is struggling at all to get pregnant should get a referral to a fertility clinic early in the ball game.  It often takes a long time to get in and once you realize you need it, that wait is painfully long. So what if they call you and you are already pregnant?  What harm is there in that?

Even though I was pretty sure early on that we were going to have issues, my family doctor made me wait eight months before referring me to the gynecologist.  Gynecologists are female experts, but they are not fertility experts.  They are a good start to help you track your cycle to see where things are at.  I did 13 cycles of Clomid (a drug which causes and improves ovulation.  This is often how high number multiples are created.)  The recommended number of Clomid cycles is never to be more than 12 cycles in your lifetime.  My last two cycles of Clomid were IUI cycles (where they monitor your cycle and then introduce your partner's sperm into the uterus via a catheter at just the right time. Very romantic.)  Usually people do three cycles of IUI but after the two failures, I was starting to literally fall apart and decided to take a break until we could get into the fertility clinic.
We met with the fertility specialist and she recommended that we try IVF.  At this point we had tried everything else and so my opinion on this costly venture had changed.  We first needed genetic testing, which was the first thing we passed in a long time, but it added more time to our wait.  Our first appointment at the clinic was in November and by April things were finally a go.
This is the story of my first IVF cycle.  Everyone is different and every cycle is different, so don't think they all go exactly like this. The ironic thing about starting an IVF cycle is that you are put on birth control.  This is to make sure you are in the right part of your cycle when they want to begin.  It felt really weird after all that time to actually need birth control again.  And then start the vaginal ultrasounds....large object in large condom placed in the vagina to get a good look at the uterine lining and ovaries.  The first time this happened, the room had two doctors and three residents.  My husband, always the joker (but sometimes inappropriately so), made a joke that this reminded him of that time in Mexico.  No one laughed and he became even more quiet and uncomfortable.  Oops.  You are then started on a medication that suppresses the body's ability to make its own hormones.  It is like going rapidly into menopause.  And then start the stimulation hormones which produce a high number of eggs in each ovary.  Every few days you return for blood work and another ultrasound to make sure everything is going well and to adjust your dose.  Unfortunately, the drug that I was injecting wasn't working for me and by the tenth day of injecting and testing, I was switched to another.  This drug worked better but the first drug caused me to produce very few eggs and the ones that we had were of poorer quality.  It was too late in the cycle to do anything about it and so we pushed on.  When the follicles containing the eggs are large enough and your estrogen level is at an appropriate level, you inject another drug which ripens the eggs.  Exactly 36 hours later, those eggs are retrieved.  You start inserting progesterone capsules vaginally three times a day to get the lining ready for implantation.  This continues until a negative pregnancy test or 12 weeks pregnancy.  It is not fun, but you get used to it after a while.  The day of retrieval you are given Ativan to relax you and narcotics by IV.  I'm not going to lie.  Having a needle stuck through your vaginal wall and into your ovaries over and over is extremely painful even on those drugs.  We retrieved six eggs.  I was really disappointed.  We rested for a bit and then headed for home.  I passed out in the elevator and my dear husband had to carry me to a bench and get me a wheelchair.  I can't remember any of it.  And then we went out for lunch.  It had become a routine for us to go for lunch following any procedures and so we went again.  I can't remember that either.  The next day they called to tell us that four eggs were immature and could not be fertilized but the other two had fertilized.  This caused panic because we were putting two embryos back in and what if they didn't make it to transfer?  Not all fertilized eggs become embryos and if they do, not all embryos are good quality.  But we weren't going to have a selection.  I prayed for the next three days.  I don't often pray.  I think that if there is a God that is actually listening, there are so many other things that he or she should be looking after.  But this time I decided I wanted it to be me.  The day of transfer we had two beautiful embryos.  We were hopeful and happy.  They were transferred back into me the day before Mother's Day and so I spent that Mother's Day on bed rest but knowing that I had babies swimming in my belly.  The vaginal progesterone is supposed to keep you from getting your period but exactly one week after transfer, I got my period anyway.  No one knows why, but these things happen.  Unfortunately I was at work and I was devastated.  I called the office and they said that sometimes people have bleeding and still end up pregnant.  I wanted to believe them but I didn't.  Because there was a chance I continued my progesterone up until my pregnancy test a week later.  Because we knew things did not look good, we planned a trip to Edmonton for that weekend.  We needed some time away together to mourn the loss of those babies.  We had seen pictures of those embryos and had become attached to the idea of the family we were to become.  I went to get my blood taken and then we jumped in the car and drove to Edmonton.  I brought the progesterone just in case we had a miracle and I still needed it.  Halfway there, the nurse called my cell phone.  The result was negative.  We were not going to be that family that we had dreamed of.  Without thinking, I opened the car window and let my progesterone fly through the air.  They are perfectly round little balls and they looked really neat bouncing on the highway behind us.  I don't know why, but something about that made me feel a bit better.  In hindsight, there were probably a lot of female birds hatched in that area from my progesterone.

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