Round 2. Fight!

It’s been a bit too long since we posted here. In the meantime an awful lot has happened, and most of it we’ve been sharing via cryptic posts on Facebook.

And over the last several weeks, we’ve been sharing our story in person with a great many people, but now it’s time to catch everyone up. So here we go.

Part 1: In which we decide to do IVF again

This happened a while back. We’re still fighting the good fight, but with some key differences as you’ll see below.

We started round 2 in February, and we’re well into it now. It’s been a roller coaster, as you’ll see, and for the sake of clarity I’m going to try to explain each step.

And Doris gets her oats.

Part 2: In which we retrieve 13 eggs

Holy shit! 13 eggs! That’s waaaayyy more than we were expecting. Last time around we only retrieved 6 eggs. Of course we pretty much maxed out Courtney on medication, stimulating her ovaries as much as possible. Much crying was had that day in the fertility clinic, and it was the good kind.

Part 3: In which 4 eggs are fertilized

And this is where the roller coaster begins. Is mild devastation a thing? Because that’s how I felt when I heard this news. I mean, it’s still 4 fertilized eggs, but that number is not what we expected.

For comparison: in our last round, all 6 eggs fertilized. One fertilized abnormally (i.e. more than one sperm got in), leaving 5 fertilized eggs to work with. To have only 4 fertilized in this round seems like a big step backwards.

But then we remembered: the first go-round was not normal. This round was normal. It’s not unusual to have fertilization rates like this, and the past was an anomaly.

Here’s where things got a little different from the last time too. This round, we’re doing genetic testing (more on that in a second), and when you do genetic testing, it’s required to do a procedure called intracytoplasmic sperm injection, or ICSI. This is just a fancy way of saying that they pull out one teensy weensy sperm and use a very fine needle to inject it directly into the egg.

The last time around, we didn’t do ICSI, as it’s quite expensive, and not really necessary for a typical IVF cycle. ICSI is required for genetic analysis, as it helps prevent contamination of the genetic material by extra sperm in and around the egg. In a normal fertilization procedure, they pretty much just drop a blob of semen on the egg and see what happens.

Strangely, ICSI tends to have higher fertilization rates than non-ICSI procedures, but again… we were not the norm the first time around.

Part 4: In which we biopsy 2 blastocysts for genetic analysis

Two of our embryos grew for 5 days. This is the cutoff at which it’s clear these are growing well, and stand a good chance of implantation on transfer back to the uterus. At this point, they biopsy a small number of cells from each embryo, and send them off for analysis. Both embryos are frozen until we know whether they are viable.

Again, a sort of mild devastation. We started with 13. Now we’re down to 2.

So why do all this genetic testing? Well, the last round of IVF, we really didn’t have any clear understanding of why it didn’t work. Often the answer is that the embryos are simply not genetically compatible with life. In natural conception, these embryos simply don’t implant. This happens in an IVF scenario too, but when you’re spending thousands of dollars per transfer, the last thing you want to do is use embryos that never stood a chance to begin with.

Going into the next step, we know it’s typical for half of the embryos sent for genetic testing are found to be viable. That would put us with exactly one shot at success.


Part 5: In which both embryos are genetically viable

And there’s one boy and one girl 🙂

To say this is a relief is a bit of an understatement. Right now we’re at the top of the roller coaster’s final hill, waiting to see what happens around the last turn.

We’re going to transfer one embryo at a time, and we’re not going to ask them which one (gotta have some good surprises, right?).

I’ll let you guess what my next Facebook post is gonna be.

If at first you don’t succeed

It’s been a long two weeks, which makes the bad news even more hurtful. Yesterday our test came back negative. Cycle one has failed.

A bit of backstory, as I haven’t updated here in a minute:

  • 6 eggs retreived
  • 5 eggs fertilized
  • 2 embryos made it to 5-day transfer
  • 1 embryo transfered, and 1 embryo went to cryo-storage

In other words, we’ve got one more shot at this.

Describing a failed IVF cycle escapes words. Because it feels like a loss, even if it isn’t the same as, say, a miscarriage. Just a couple of cells, not even implanted, so pregnancy hasn’t even happened yet. And yet, I feel as though…. well, it hurts.

We had some great news this week too: I haven’t yet updated over at my other blog, but Mom’s PET scans show no signs of cancer! The bone marrow biopsies are showing some atypical cells, so we can’t say the words “cancer free” just yet, but all signs are pointing toward an excellent recovery.

Still, negativity bias. Whomp, whomp.

That’s not really how I am, or at least not how I try to be. I try to stay positive, I try to be chipper. I try not to bury myself in work, or distract myself. I try to process real emotions, but remain optimistic.

Yet, when push comes to shove, I retreat to these old ways. I work longer hours. I watch too many movies, or listen to music too loudly. I read books. I futz with my phone at dinner. Call these coping mechanisms, I guess, but today they just feel like the only option.

When your first round of IVF fails. I asked for extra listeria. Too soon?

A post shared by Courtney Grinfeld Fabio (@ringleaderc) on

I can only keep reminding myself that the goal is not to be pregnant, the goal is to have children. And we’re a long way from reaching that. We’re getting one step closer to that goal, even with each failure.

Now excuse me while I escape to Westeros for a while.

2016-08-27 11.12.57

Quick update for some good news

Thursday: 6 eggs retrieved.

Friday: 5 eggs fertilized.

Saturday: “Several of your embryos look good today so we will go on to a day 5 transfer.”

This is spectacular news. The 6 eggs we had on Thursday got us pretty worried. That’s a bit of a low number. But to have 5 eggs fertilize is huge. Typical fertilization rates are usually around 50% with standard fertilization (i.e. put the egg and sperm together and see what happens) versus 50-80% for intracytoplasmic sperm injection (ICSI) (i.e. injecting the sperm into the egg). We opted for conventional, so to get 83% fertilization is a real boon.

Moreover, day 5 transfer means that the embryos are growing well. Day 5 is preferable to a day 3 transfer. Some clinics see as much as 30% higher live birth rates with day 5 transfers.

Now the long wait begins.

Paying the toll

Today was our egg retrieval day. That’s one of the two big days in the IVF process. I could write all about the process, but you could simply Google IVF and find a zillion explanations of what this entails (two months of meds leading into two big days at the clinic). We’ve been a little quiet lately, primarily because we’re just heads down focused on making this happen, balancing work and life and endless doctors visits and injections.

This is what I look like after waking up at 5am for egg retrieval
Here’s the quick update: we’ve got 6 eggs. At this point that’s all we know. We can’t tell how many are viable, and we won’t know until tomorrow just how many are fertilized. And we won’t know whether it’s going to be a day 3 or day 5 transfer until Saturday.

6 eggs isn’t what anyone really hopes for. Mathematically, that number doesn’t work in our favor. According to some research, that puts our success rate at 38%.

IVF success rates by number of eggs and age

Still I’m hopeful. Optimism has gotten me through so many things in life. I’m not even an optimist by nature, I’ve just trained myself to think positively (most of the time). The pessimist would say we have a 62% chance it won’t work. But I’m gonna say this glass is half full.

Courtney wore appropriate socks today
Courtney wore appropriate socks today
But the hard truth of it is that the dice are just gonna fall where they fall. It’s all a crapshoot. I’m not gonna lie, this shit takes a toll.

The physical toll: As with most things in life, men have it easy when it comes to IVF. Seriously, I mean how could you not get turned on by this sexy room? I forgot my Marvin Gaye cassette tapes, though.

If you're wondering, yes there's porn in the room. I opted not to touch it.
If you’re wondering, yes there’s porn in the room. I opted not to touch it.
Courtney hasn’t had it quite so easy. The physical toll for her is incontrovertible. For the last two months she’s taken needles like a champ, downed more pills than I can count, drawn blood, been prodded with an ultrasound wand numerous times. Today she went in for egg retrieval, a short procedure, but invasive, painful, and uncomfortable. Her resilience and resolve is astounding, and I am so proud of her. She’s one tough cookie, and I am so fortunate to have her as my wife.

One of many, this is the ganirelix shot.
One of many, this is the ganirelix shot.

Here are all the meds needed for one cycle of egg retrieval and transfer.
Here are all the meds needed for one cycle of egg retrieval and transfer.
The emotional toll: we’ve been trying to have children for going on three years now. The first year was full of hope, followed by a slow decline into despair. The gradual realization that this might not be working is so difficult to explain, and so devastatingly debilitating. Hope dies an agonizing death at the hands of ignorance – unsure of what the cause is, unsure of what can be done, unsure of the path forward, or if there even is a path forward.

Courtney peed on a lot of sticks. All of them said no.

Year two was filled with picking up the pieces, making sure we had the information. We diagnosed the primary cause of our infertility (we hope), and fixed it through a bilateral salpingectomy (not pleasant, irreversible). We visited adoption centers, fertility clinics, and made sure that we had all our ducks in a row, that we understood all our options.

Somewhere around June of 2015, just after Courtney’s surger and before we were about to begin IVF for the first time, we were hit with a particularly difficult blow, when our landlord at the time decided to hike our rent by more than 30%. Forced to move, we had to put our plans on hold while we sorted out our living situation, our financial situation, and get back on our feet. Now this wasn’t all bad – we bought a beautiful house, consolidated our debts, and I got a new job – but it wasn’t an easy year, and given our age the clock is definitely ticking (fertility falls off sharply starting at age 35).

Which leads me to the financial toll: I’ll just be blunt about it, and tell you that this month we’ve spent $13,526.90 on our fertility treatment. $4,476.90 of this was for drugs, the rest covers the clinic fee which is mercifully set at a flat rate of $9,050.

In the United States (‘Merica!) fertility treatments are not mandated to be covered by insurance (ugh). Some states include it, but not Tennessee. Our insurance doesn’t include any fertility coverage. So we’re paying out of pocket. And I didn’t even mention the lab testing, doctors visits, and all kinds of other shit we’ve paid for that I currently don’t have the brainpower to tally up.

Needless to say, we didn’t have a spare $13,526.90 laying around. So we’ve called upon the slavedriver known as debt once more. We got turned down by one company, another offered us less than what we needed, but the amazing folks at SoFi have given us all we need and more at an extraordinarily reasonable rate. I can’t highly recommend them enough. If you need a personal loan or a student loan refinance, please give them a try (those affiliate links will help us pay off our loan too!).

All this to say that I’m exhausted. We’re exhausted. Midway through writing this post, I took a break to drive a 2 inch needle into Courtney’s left hip, full of progesterone and sesame oil. As Courtney is very fond of saying, “Why can’t I just make a stir fry?!”

And yet, think about it: our child may have been conceived today. That’s a crazy thought. And while 6 eggs retrieved may yield anywhere from 0-6 viable embryos, the thing that keeps me going is the knowledge that it only takes one.


It’s official: I’m a (hamster) daddy

doc03519420150526155133.pdf (1 page)

As I mentioned before, I recently completed a sperm penetration assay. And wouldn’t you know it, I managed to impregnate a bunch of hamster eggs. OK, not really, but the results look good, and my sperm did indeed penetrate the eggs.

I’m not sure how to read this: did 309 sperm penetrate 20 eggs? or did 309 sperm go into the test, and 20 eggs were penetrated? (If you know, leave a comment)

The results are good, and I’m happy with that.

Oh, also my sperm concentration is 172 million/mL. I don’t mean to brag, but well, normal is somewhere around 20. So yeah, I’m bragging. Afford me these little wins, please.

The Weirdest Thing I Will Ever Do


On Wednesday this week, my sperm will be combined with hamster eggs in a laboratory.

No, I’m not making this up.

As if the barrage of tests weren’t bad enough; as if the awkwardness of telling your friends and family that you’re having fertility issues isn’t weird enough; I have to go and become a hamster daddy.

Well, not really. Technically the sperm don’t fertilize the eggs. But they do penetrate the eggs (hopefully).

All of this is part of a sperm penetration assay, otherwise known as Hamster zona-free ovum test. And it’s easily the weirdest thing I will do as part of this process. Maybe the weirdest thing I’ll ever do.

Did you know you can procure fresh hamster eggs in just 2 weeks?

And to top it all off, a successful test doesn’t guarantee anything!

The things we go through to have a kid.

Another day, another test

Today: getting blood drawn for the anti-sperm antibody test. Yes, you read that right.

Yesterday I had blood drawn for a whole array of STD tests (which I’m near certain I don’t have to to worry about) along with blood typing.

And while the number of tests I have to undertake pales in comparison to those of Courtney, I can’t help but laugh at the ridiculousness of it all.

Still: worth it.

Oh I’m not done with testing, of course. I still have to have a variety of sperm tests (some of which are repeats of tests I did a year ago). More on that later.

Having a baby, one test at a time.