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.

Selfie!
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.

 

A slightly pessimistic, albeit honest, update.

I’ve been getting lots of questions about an update. I can’t believe so many people in our lives give that much of a shit. Thank you, friends. Your support has been invaluable.

As many of you know, we bought a house last year. It wasn’t necessarily planned, until our landlord jacked our rent up a LOT. And while we’re so grateful we were able to buy, we wiped out every bit of savings we had. So baby stuff got bumped back a bit.

So here’s the current standing: the plan is to get started in April. Let’s get SXSW out of the way, get our loan finalized, deal with whatever medical stuff I need to deal with dealt with.

Part of the reason I started this blog was to show the actual reality of what infertility looks like. And I’ve always promised to be honest with this blog. So let’s be honest.

I’m fucking exhausted.

The end of 2015 marked 3 years of pre-baby brain. Everyone who has started “trying” knows that your world is immediately shaken. I went from a 3 cups of coffee a day habit to caffeine free life. I have taken some really bizarre herbs and supplements. I’ve eaten pineapple core, stopped eating deli turkey for half the month, made maca and flax seed smoothies, tracked every. single. thing. my body does. I’ve fallen off piles of pillows, peed on ovulation sticks 3 times a day for months on end AND taped the sticks into a notebook with the day/time taken (eew, I know), and taken my temperature upon exact moment of waking up (but you know, don’t move before because it could spike your temp). I’ve been vaccinated, changed every one of my facial/soap products to pregnancy safe, and researched every Advil/Zyrtec/etc to see what pregnancy category it falls under. I’ve been poked, prodded, injected, cut open, asked super personal questions, and had more people than I’d like in places I’d prefer them not to be. I’ve dealt with headaches, anxiety, and other various medical issues because the remedy isn’t safe for pregnancy. I have listened to every old wives tale, rumor, and/or tip on how to get pregnant, and explained countless times that no, I cannot “just relax”. I have truly believed I’ve seen pregnancy symptoms, completely discounting the 30 previous years of bouts of nausea for every single reason other than pregnancy, only to be let down at the end of the month. I’ve put my baking business on hold. I’ve smiled, made jokes, laughed, and acted hopeful for the sake of others when I just wanted to scream.

I’m. Exhausted. And the funny thing about all of this, is that the hard work hasn’t even started. It’s hard to be excited about the possibility of a baby when you’ve moved into the it’s not happening mindset (thank you, but no pep talks needed). Because it’s hard to see a baby in your future when you have injections, pills, blood, doctors, waiting, restrictions, and procedures, or home visits, birth parents, and approvals between you and that baby. And the giant pink elephant that no one wants to talk about: there’s a pretty significant chance that it just won’t work. So at that point, does it all become worthless? What happens when you’re paying back a $20,000 loan every month for nothing? When trying again becomes a whole new set of loan documents, injections, and broken hope.

I’m not all pessimism. Most of the time I know it’ll happen somehow. Mike and I have committed to finding a way to parenthood, whatever it takes. Whether that be IVF or adoption, we know we’ll love that baby the same and all of this will be worth it. And that’s a great feeling to have, at least most of the time. But there are just times it’s not enough, and I get all emo and shit. Calling a spade a spade.

So there it is, the update. I’m sure you can understand why I’ve been hesitant to put this out there. But we committed to honesty and that’s what I’m going to do. With any luck, this time next year, we’ll be able to look back at this and be glad we’ll never have to feel this way again.

See? Optimism.

 

Side note: I just want to thank all the friends and family who have privately spoken with us about your personal journeys. The good, the bad, and the ugly have all helped us navigate our own path. To you, we are grateful.

 

The Story of Two Tubes and Far Too Many Feels

I’ve been trying to write this blog for 2 weeks, and for some reason the words just entirely evaded me. I’ve started it a few times, would get halfway done, realize I was writing nonsense, and then delete it. I kept writing about the surgery I had a couple of weeks ago. The experience, the recovery. The stupid details that no one wants to hear about anyway.

But let’s start there – I had surgery on June 3 at 7:30a. Everything went as planned. Scar tissue, endometriosis, encapsulated fallopian tubes removed on both sides. Recovery went well.

But here’s what didn’t go as planned: how I was going to end up feeling about this whole thing. To be clear, I went in with 100% knowledge about what we were doing, and what the results would be. My doctor is amazing, and we talked in depth about what my options were, and the possible outcomes.

I knew that after surgery, I’d be clinically sterile. But what I didn’t know was the impact that term would have. The one thing we want more than anything is a baby, and now, here I am clinically sterile. Clinically. Sterile.

This is not how this is supposed to go.

I am no more or less sterile now than I was before the surgery, so how is this weighing on me so much? Maybe in my head, there was still this shred of hope. Like there was a 0.002% that a spontaneous pregnancy would occur. Who knows, maybe I’m more of an optimist than I thought?

It’s funny how some people respond when they find out you’re doing fertility treatments. So many people have been wonderful, with the most amazing and appreciated words of kindness. But there are always those people who say, “Watch, you’ll go to start the IVF and then you’ll get pregnant!” I used to have energy for a witty comeback, or at least “nope, but nice thought”. Now, it’s just a sad “there is literally zero chance of that happening”. It’s generally an awkward moment all around, but it’s the truth.

I’ve learned to deliver all kinds of bizarre information through this process, but having to repeat over and over how defective my body is gets exhausting.

Emotions aside, there was no getting rid of one fact: I didn’t have a choice. As a product of 5 previous surgeries, my fallopian tubes were completely encased in scar tissue. There was a 0% chance an egg could have gotten in, and suspending reality and pretending it did, there was a 0% chance of fertilization as it was full of toxic fluids. Going the try-to-fix-it route only left me susceptible for them to close right back up, and at risk for ectopic pregnancy (yes! It’s totally possible, even with IVF) where I’d lose my tubes, and the baby, anyway. More than 50% of ectopic pregnancies are a result of damaged tubes, with many miscarriages a result of the toxic fluid coming back into the uterus and damaging the embryo.

My intention with this post isn’t to be depressing, it’s to bring these kind of things into the light. Since we’ve decided to be open with this, I’ve had the joy of connecting with so many people going through this. Some with good outcomes, some not. Some open about this, some who have hidden it from everyone – close friends and family included. I couldn’t have known how this would feel. I didn’t know it was even an option. But I do know this: this fight is much easier when you’re not doing it alone.

I suppose this is all part of the process. And I mean, if we’re being real optimists here, fallopian tubes are just a formality, right? I like to consider my surgery an upgrade to my future child’s uterine home. It’s like getting bumped to a suite at a hotel. Without the free toiletries. Silver linings all around.

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

hamster-sex

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.

My name is Courtney, and I’m about to share way too much information.

1 in 8 couples have an issue getting, or staying, pregnant. And we’re one of them.

We’re not starting this blog to to gross anyone out. It’s not for sympathy, either. There are so many people going through this, and not nearly as many talking about it. I get it. It’s a private matter. Talking about getting pregnant usually mentions (gasp) sex. But infertility is anything but romantic.

I’m going to be frank here. This shit sucks. It just does. And I’m still not entirely sure there’s a light at the end of this tunnel.  But I know that hearing personal experience helps me more in this process than any medical website or doctor. So if I can help one friend who’s silently going through this, that’s what I’m going to do.

I’ll get to the brass tacks here. We have female factor infertility. I’ve had 5 surgeries, of which started when I was 16. I’m like a medical text book. Ovarian cysts? Two different varieties. Endometriosis? Yep. Crazy adhesions (scar tissue) that tie your inner organs together? It’s about as awesome as it sounds. Fibroids? Let’s throw those in too. Now, we’re heading into the grand finale where scar tissue has screwed things up so royally that I have to have my fallopian tubes removed. Surgery number six will be happening soon.

We’ve been attempting conception for over a year and a half now, and with IVF being our only option in conceiving, it’s now science to us (I’ll touch on adoption in an other post). Of course the love exists, but where there were once thoughts of romantic weekends and Pinterest-esq announcements, there are now schedules, injections, blood draws, and strangers in scrubs.

Emotionally, I think we’ve experienced it all. Excitement, disappointment, guilt, love, anger – the list goes on. Funny enough, the diagnosis of absolute infertility made things exponentially easier. There’s nothing worse than a year and a half of the unknown. So when we told the fertility specialist “we’ve been trying for a year and half”, to which she responded with a head shake and a succinct “no you haven’t”, things were finally clear. There’s no doubt that having to do IVF brings on a whole different kind of stress, but it was finally a problem with a solution.

So what now? Well, surgery comes first, and then we schedule the IVF cycle, which goes for about 8 weeks. We’ll be chronicling this process along the way because it has to be talked about. For the record, we’re not offended if this is more than you want to know and prefer not to read it. We get it. But for those also going through this, just know you’re not alone on this (extremely confusing, emotion invoking, yet awesomely scientific) ride.