A Note to my Readers

Dear readers,

I'm taking a short break from posting on the blog. I decided that I need some time to just spend with hubby. I promise I'll be back with updates when I'm good n ready! 

Write soon,

A Tough Cupcake <3

PUPO!

Lucky Tinkerbell Socks!

 On Tuesday we went to the clinic for our second IVF embryo transfer. Our previous IVF was a fresh transfer, and this one was our first time using a frozen embryo. I wore lucky Tinkerbell socks this time! Excited, hopeful, and with way too much water in my bladder, we changed and met with the embryologist. She gave us the good news that our first embryo thawed perfectly, so they didn't need to use any of the others. We still have 7 frozen ones left.

Placement in my Uterus

The embryo they were putting back inside me was graded 4AA, the highest grade. It was frozen when it was 5 days old, so its age continued at day 5 when it was thawed (even though it's been sleeping in the freezer for a few months). During the transfer, my main focus was not peeing on the doctor. Same as last time! It doesn't help when the nurse pushes down on your bladder with the ultrasound probe during the entire procedure. The doctor showed us where in my uterus the embryo was placed and printed out a picture for us. Then we were good to go!

Normally, a woman is assumed to not be pregnant until, of course, she finds out she is pregnant. When you go through IVF, it's the opposite. After your transfer, you are said to be PUPO - pregnant until proven otherwise. Being PUPO is an exciting time because "until proven otherwise", you can live in the world of being "maybe pregnant"... which is a whole lot more hopeful than not being pregnant. 

Completing embryo transfer also means you're in the two week wait, often abbreviated tww or 2ww. The two weeks is the time between transfer and the beta-HcG blood test that tells you whether the treatment was successful or not. During that time, you hope that you are pregnant. You get scared that you're not pregnant. Time goes by slowly. You feel something and wonder, is that a sign of pregnancy? And you feel something else and wonder, is that a PMS symptom? You act like you're pregnant. You watch what you eat, get lots of rest, walk to keep good circulation, avoid pushing or pulling or lifting anything heavy. You do anything and everything you can to make yourself feel like you've done your best to make that embryo stick!

Ready for Transfer #2

I've been mostly happy and hopeful during this two week wait. I'm lucky that I was able to take time off to take it easy as the doctor recommended. I'll be heading back to work tomorrow - the first day of classes - so that will help the 2ww go by much faster. I'm finished with antibiotics, so that has helped my digestive system. It's still moving in slow motion because the progesterone makes everything sluggish. I'm not as terrified about heartburn either. Last week I was napping almost daily, exhausted from the hypothyroidism and also the progesterone. I'm trying to wean myself off of naps for the last couple of days just to get ready for work. 

I'm currently 5dp5dfet, five days past a five-day frozen embryo transfer. Today, implantation should be complete, and the cells that will eventually become the placenta and fetus have begun to develop. 

The Schedule

As of a few days ago, my medications/vitamins routine has become more complicated. I had to make a schedule to keep track of what to take, when to take it, and under what conditions. I spaced out the ones that will interact with or affect the absorption of others. And I tried to time them so that I could take the majority of them at home instead of at work. It doesn't help that in my work week, I have three different sets of start/end times. This is what I came up with.


7:00 am - Synthroid (thyroid medication):  need to take it on an empty stomach. No antacids or dairy or iron or multivitamins for 4 hours before or after (3:00 am - 11:00 am). No food for one hour after. I miss eating cereal for breakfast!

Get it? hehe

8:00 am - Doxycycline #1 (antibiotics): need to take on a full stomach which is hard to do since I can't eat the hour before because of the Synthroid. This leads to a big rush to eat something filling within a few minutes. Having toast with peanut butter n a glass of juice most mornings. These pills make my liver unhappy (and last time around helped to land me in the ER with severe heartburn). As of today, these make me nauseated if my stomach doesn't stay full.

8:00 am - Estrace #1 (estradiol). Same as I've been taking the past several weeks. Better on a full stomach.

8:00 am - Crinone #1 (progesterone gel suppository) - this one always ends up being late because of needing to fill my stomach to take the previous meds. It also requires me to lie flat on my back for several minutes after using it to prevent it from coming back out.

11:00 am - Pre-natal multivitamin #1: Yay for gummies!

11:00 am - Folic acid. Nothing much to say here.

8:00 pm - Doxycycline #2

8:00 pm - Estrace #2

8:00 pm - Pre-natal multivitamin #2

8:00 pm - Crinone suppository #2. I haven't figured out yet how I'm going to manage this one when I'm back at work as it conflicts with my Thursday shifts. I'm picturing myself lying on the floor in the staff bathroom at work.

My Daily Cocktail

So that makes 10 items on my daily "to take" list. I've been staying home a lot because it's just easier to deal with the meds and the timings and the side effects. But I did have a few girls over last night and had a fantastic time chatting and eating and watching Frozen together!

The hypothyroidism is still keeping me pretty tired. But I'm keeping my eye on the prize. And tomorrow is the BIG DAY! Our sweet little embryo will be back in my uterus where he or she belongs.. and will hopefully stay and grow there for nine months!

Blood!

Yesterday morning I headed to the lab with my two requisitions - one for LH and progesterone as part of my FET protocol, and one for TSH and CBC as part of the routine updating of my bloodwork for my fertility clinic's records. A 40-minute wait and three vials of blood later, I was good to go.

I was hoping my blood would show low numbers for LH and progesterone indicating that I hadn't ovulated and wasn't about to. Ovulation would mean that my estradiol pills haven't been doing their job and also that my body is prepping to shed the lining.. that would be bad because then there wouldn't be a nice cushion for my embryo to stick to. I wasn't particulary concerned about the routine TSH and CBC check.

I had a relaxing morning and then headed out to meet hubby for lunch. It's kinda nice to have a lunch date on a weekday because that's not something we can normally do. While we were eating, I checked my blood results online on My E-Health. First up was progesterone - 1.7 meaning there was no way I ovulated - YAY! Next was LH - 12.9 indicating that I'm not likely to be currently ovulating - another YAY!

The CBC was good too. It showed that my red and white blood cells were in the normal range. This was a bit of a relief because last time I had them checked, my white blood cells were out of range. This was due to the IVF meds, but it still scared me.

The results for TSH took a while longer. When they showed up, I saw a level of 3.88 which is well within the normal range, but not within the desired range to do fertility treatments. Most clinics want your TSH to be under 2.5. This also explains why I've wanted to sleep so much and take naps after a full night of sleep. I thought it was the estradiol pills, but now I realize the fatigue is from hypothyroidism. All the meds I've been taking increase TSH too, so when unmedicated, it's possible my natural TSH isn't as high.

When I went in for my initial consulation in the summer of 2014, my doctor said that my level was higher than he wanted to see, and he'd re-test me in a few months. By November 2014, my level was significantly lower, showing that it was moving in the right direction, so I was never sent to have it tested again... until now!

So if it's within the normal range, what's the big deal? Well, even though under 5.5 is considered normal according to the lab reference range (although recently, endocrinologists say under 3 is the "new" normal), levels over 2.5 in the first trimester are highly linked to miscarriages. So unless you're pregnant, 3.88 isn't a big deal. And since I'm intending to be pregnant in a week, I got pretty jumpy. 

After lunch I headed to my parents' place for a while. I was waiting for the clinic to call me even though I knew I might not get the call til the following day. I worried that they would cancel my FET and that I'd have to sit around and wait for months to try again. I felt sad and mad. I wish they had tested it routinely to make sure my TSH kept going down, so we could have prevented this. Then I realized that maybe I wanted them to cancel it, so that I wouldn't waste my embryo. I'd rather not get pregnant then get pregnant and miscarry. Dr. Google confirmed what I already knew: going ahead with this level of TSH was pretty much asking for a miscarriage.

Eventually, I thought I'd drive myself crazy, so I called the clinic myself to talk to a nurse even though I was supposed to wait for them to call me. As usual, I got the voicemail. I explained that I was concerned about my TSH level and that I wasn't sure if my cycle was cancelled and that even if it wasn't, I didn't want to go ahead with it unless they could treat my TSH simultaneously. And then I went back to waiting for a phone call. I thought about how I'd taken 60 of those little blue Estrace pills, how I'd paid a good chunk of money, and how I'd woken up in the wee hours to take trips to the clinic... and now it might all be for nothing.

I was relieved to get a quick response - the doctor reviewed my results and said I'd start Synthroid right away to deal with my hypothyroidism and get my TSH down and that we'd continue with the transfer as planned. If I get pregnant, they'll test the TSH again to make sure it's gone down. Umm.. well that was simple. And unexpected. And made me feel silly for letting my thoughts take over without even knowing what would happen.

Fertility treatments make your mind funny like that. You try to be positive, you try to be optimistic, you hang onto hope even when the odds are against you, but one tiny thing really can ruin everything. This time I was lucky, but I've already had two cancelled treatments, so I know it's a very real possibility. I'm glad it didn't happen for the third time, though. I feel relieved and happy and blessed and excited that things are moving forward.

Our transfer date is Tuesday, September 8th, the first day of the fall semester! With two days of bedrest following the transfer day, that means I'll need Wednesday and Thursday off of work too. And since I don't normally Fridays, that means I'm missing the entire first week. Not ideal, but I'm still lucky because:

A) it's registration week, not classes;

B) I have a colleague who can cover for me; and

C) I have another colleague who's helping me get set up for when I begin teaching the following week. 

So now there's five more days. FIVE. MORE. DAYS!!! My entire life might change in 5 days and that is just oh-so-exciting. Meanwhile, I'll be busy trying to keep track of all the stuff I need to pump into my body to get ready for our little snowflake to be thawed and brought home to my uterus. I'll save that for my next post though.

FET cycle update

Yesterday, I went back to PCRM after 16 days away from the clinic. They checked my endometrium to see if it's thick enough for transfer, and I was pleased to learn that it's good to go! 

The next step is to have my LH and Progesterone checked by blood tomorrow. They also want to update their records on my TSH (thyroid) and CBC (complete blood count). 

For now, I continue with my 3 Estrace pills a day. They're making me want to sleep. A lot. I feel like napping every day even after a full night's sleep, and I'm not normally a napper. Kinda nice that I'm off of work and can sleep as much as I want. That will all change next week though! 

After tomorrow's blood draws, I wait for a nurse to call me back with instructions on what's happening with our frozen embryo transfer. She will also let me know when to add in antibiotics and progesterone suppositories. I have no reason to think there will be anything wrong with my bloodwork, but I still feel a little nervous. There are just so many little steps along the way, and so many places where something small could cause a problem. So I've got my fingers crossed (and I hope you do, too!) that everything goes well tomorrow and I get a transfer date soon.