today, I am pregnant ...

What a long, complicated day it has been. I went for my blood draw this morning at 8:15. I have been told several times over the past few months that I would receive a phone call with my results by 3:00 this afternoon. It was a looooong day. As the clock approached 3:00, I kept waiting for my phone to ring. It didn't. I called the office at 3:00 to find out what was going on. I was told that the results arrive at the office between 2-3, and someone would be calling me shortly. Soon, it was 3:30, and there was still no phone call. I called the office again, expressing my concerns that the office was going to close for the day and I wasn't going to know my results. That time, I was told that my results hadn't arrived (implying that other people's results had), and someone would call LabCorp to find out what was going on. As the clock approached 4:00, I was on the phone with Heather. She decided to call the Akron office to put some pressure on. She spoke with Michelle (the nurse we have been working with the whole time), who told her that the results for everyone had been delayed today, and it could be 4:30 before the results came in. Finally, around 4:30, the phone rang ...

It was Michelle. She told me that I am pregnant, but my beta hCG (pregnancy hormone) level was lower than it is supposed to be. According to Michelle, 50 is the number they look for on this blood draw. My hCG was only 19. She said not to worry, because it's possible that the embryo(s) just implanted late and that's why the number is low. There are also a few other possibilities (ectopic pregnancy or chemical pregnancy/early miscarriage). I am choosing to focus my energy on the first option ... late implantation. The fact that my hCG is 19 means that the embryo(s) DID implant, and I am technically pregnant. I have to continue taking all of my medications, and I have to go back for another blood draw on Wednesday morning at 8:00. Then, I will meet with Dr. Nash on Wednesday afternoon at 3:00, to discuss everything. Wednesday is the big day. If my hCG blood level doesn't at least double by Wednesday, then the pregnancy is most likely not viable. So, for now, I am cautiously pregnant. Here is some good info on beta hCG, for anyone who is interested.

I somehow managed to keep myself from buying a home pregnancy test, until today. For those of you who have been following this blog since the beginning, you know that this is a very big feat for me. In the past, I always tested early. This time, I think I was just too scared to test early. After my blood draw this morning, I finally bought a home test. I stared at it in its package all day. After Michelle called to tell me that I am cautiously pregnant, I decided to have my POAS (pee on a stick) moment. Sure enough, the test was positive. The line is faint, but it is definitely there. The paperwork that comes in the box clearly states that any line, no matter how faint, means pregnant. So, I finally got my BFP (big fat positive)!!

I have been experiencing waves of nausea, cramping, and headaches the last few days. These are all signs of pregnancy. I am going to focus on the fact that I am pregnant today, and I will worry about the next step on Wednesday. So for now, I am jumping for joy inside, and daydreaming about the *now more real than ever* possibility that I am going to be a Mama.

... and now, we wait ...

The transfer went well yesterday. I took a valium pill at 10AM, and we arrived at the office around 10:30. At 11:00, Alex, the embryologist came and got us. He took us to a preop/recovery room, and we talked about the embryos. He said that one of the 5 eggs that they took from Heather did something very rare ... it began dividing on its own, as if there was a sperm in it, but without a sperm! He said this is called a parthenogenic egg, and it is obviously not compatible with life. Pretty wild! That is the one egg that they did not fertilize. They fertilized the other 4 eggs. By day 1 (Tuesday), one of the eggs did not divide any further, so there were 3 eggs left. I called on day 2 (Wednesday) to check on the embryos, and Alex said that one of the embryos had stopped dividing, meaning that we had most likely lost it. :( So, we went into Thursday knowing that there would be only 2 embryos.

Alex showed us pictures of the embryos. See below for the pictures. They are graded on a scale of 1-4, and 1 is the best. Ours are both grade 2. Here's a chart that describes the grading:

Grade 1	Cells are of equal size; no fragmentation seen
Grade 2	Cells are of equal size; minor fragmentation only
Grade 2.5	Cells are mostly of equal size; moderate fragmentation
Grade 3	Cells are of unequal size; no fragmentation to moderate fragmentation
Grade 4	Cells are of equal or unequal size; fragmentation is moderate to heavy

Alex told us that grade 2 is very good, and about 80-85% of the embryos they see are grade 2. In order for the embryos to be viable for transfer on day 3, they need to have 4-8 cells. One of ours had 6, and the other had 8. The cells are the large, circular shaped objects. The cytoplasmic fragments (bits of cytoplasm that break off during cell division) are the smaller, bubbly-looking objects. See below for the embryo pictures:

This embryo has 8 cells and 20% cytoplasmic fragmentation

This embryo has 6 cells and 25% cytoplasmic fragmentation

Alex told us that because we only had 2 embryos, they wanted to give us the very best chances for success. So, they did something called assisted hatching. The embryos are enclosed in a shell called the zona pellucida. The embryos have to break out of this shell before they can implant. In assisted hatching, the embryologist makes several nicks in the zona pellucida, which gives the embryos a jump start at breaking out of their shells. We will take all the help we can get!! After we talked about the embryos, he told me to change into a hospital gown and put on a cap. He told Brian to put on a one-piece white spacesuit-looking getup, along with a mask and a cap. Here we are in costume:

They took us across the hall to the procedure room. I sat in a chair with the traditional stirrups at the end. Brian sat to my left. Alex came into the room and said that the doctor (not Dr. Nash, unfortunately ... Thursday is his day in the Columbus office) would be in shortly. He would be inserting a speculum and then cleaning off and drying my cervix. Then, he would insert a catheter through my cervix to make sure there were no issues getting through. A few minutes later, Dr. Moretuzzo (the medical director of the practice) came in and introduced himself. He had Alex use an abdominal ultrasound wand to press against my abdomen, and they were able to see the catheter in my uterus on the screen. He had no trouble getting the catheter through my cervix, so he gave Alex the go-ahead to get the embryos. Alex went through a door to the lab, and soon, the flat-screen TV on the wall came on. A petri dish with my last name and date of birth appeared on the screen, and Alex came into the room to get a verbal confirmation that this was the right container. Then, he focused the camera on the embryos, and we watched on the screen as he sucked the embryos up into a small, flexible tube. Then, he brought them in and gave them to Dr. Moretuzzo. Alex used the ultrasound on me again while Dr. Moretuzzo threaded the tube with the embryos up into my uterus. When he could see that the tube was in the right place, he released the embryos into my uterus. Then, it was all over. They had me lay there for about 10 minutes, and then Alex brought a gurney in and had me scoot over to it and stay laying down. He wheeled me back into the preop/recovery room, and told me to lay there for about a half hour. After a half hour, a nurse came and told me I could get dressed. Once I was dressed, she wheeled me down to the parking lot in a wheelchair, and Brian picked me up.

It feels very surreal that it's all over. Dr. Moretuzzo told me that the embryos will continue growing and dividing rapidly, and on day 5 (tomorrow), they will be blastocysts. At that point, they will begin breaking out of their shells, and by day 6-7, the embryo(s) will hopefully start to implant into the lining of my uterus. My pregnancy test will be Monday, March 26, 10 days from today. I will have the blood draw that morning between 8-8:30, and I will receive the phone call by 3:00 that afternoon. Oh, how those hours will drag ...

So, now we just wait. I am on 3 days of modified bed rest now. I am supposed to take it easy, not exert myself or do anything strenuous, and lay down as much as possible for the next few days. I am supposed to continue to take it easy and not do anything strenuous until after the pregnancy test.

Thank you to each and every one of you reading this, for all of the love and support you have given me. It has carried me through the last couple years of this roller coaster journey, and I am hoping more than anything (I have never wanted anything so much in my whole life) to give you the most amazing blog post of my life on Monday, March 26th. Until then, please keep sending positive thoughts and sticky baby vibes. :) xoxo

Optimistic and excited!!

Heather's egg retrieval was yesterday, and they took 5 eggs!! We were so excited!! Heather doesn't remember anything about the procedure, and is doing really well. Brian also dropped off his piece of the puzzle :) yesterday morning. The embryologist worked his magic yesterday afternoon, and fertilized the eggs. Typically, one egg and one sperm are put in a petri dish, and they are left to do their thing. Since we didn't have a lot of eggs to start with, the embryologist did an extra step called ICSI (intracytoplasmic sperm injection). Each egg was injected with a single super sperm, which cuts out the process of the sperm making its way into the egg. This adds an increased chance for fertilization. I was happy to hear this, as we will take all the help we can get to make this a success!

This morning, I received a phone call from the embryologist. He said that we have 3 embryos!!! He said that one of the eggs wasn't mature, and one didn't fertilize. We are SO THRILLED to have 3 embryos!! He also told me that we will do the transfer on day 3 (also very exciting news!). The transfer will be Thursday morning at 11AM. Dr. Nash's office has a protocol that they use to determine how many embryos will be transferred. They go by the age of the eggs (so in this case, they use Heather's age, which is 31, not my age, which is 36). For age 30-35, they transfer 2 embryos. If they were going by my age, they would transfer 3 embryos. I asked the embryologist if we could transfer 3 embryos, and he said they are reluctant to do so because the chance of triplets is so high. So, I'm not sure what we will do. In any event, we are so happy to have embryos!! Now, we just have to hope that the embryo(s) (yes, I would be overjoyed to have twins!) implant in my uterus.

I had my first intramuscular progesterone-in-oil injection last night. Brian has to give me the shots because they go in my backside, and it's hard to twist around and give myself the shot. We were both very nervous about the shot (there is a picture below to show you how big the needle is!). Brian did a great job, and surprisingly, it didn't hurt very much (thank goodness!). :)

So, I will update again after my transfer on Thursday. Lots of positive thinking going on here!! :)

Heather getting ready to give herself the HCG trigger shot 35.5 hours before the retrieval

Heather "pulling the trigger", aka giving herself the HCG trigger shot 35.5 hours before the retrieval

Heather in the recovery room after the retrieval

Beautiful card from my parents that arrived in the mail yesterday ... inside, it says "It's that beautiful place between the way things were and the way things are yet to be."

Brian holding the progesterone-in-oil injection ... look at that 1.5-inch needle!!

hope is a beautiful thing :)

Well, the roller coaster has continued for the past week, but I am thrilled to say that things are very much looking up right now!!

Heather had an ultrasound last Sunday, and the doctor (not Dr. Nash) told her that she didn't see a whole lot. This was discouraging, because Heather had been on her meds for almost a week, and we thought for sure there would be a bunch of growing follicles in there. She went back on Tuesday for another ultrasound, and Dr. Nash saw 4-5 follicles, with one being bigger than the others. He told her that she wasn't responding to the meds as well or as quickly as they had hoped she would. We felt pretty discouraged at that point. Michelle (Dr. Nash's nurse) told me on the phone that day that it was possible that the bigger follicle would continue to grow while the others stopped growing, and only one follicle would really not be enough to continue this cycle. Heather was pretty upset, feeling like she was failing and disappointing Brian and me. If only she could know how wrong she was. Yes, we were discouraged about the follicles (which, of course, Heather had absolutely no control over), but we couldn't be more thrilled that she agreed to give us this amazing gift, and we would NEVER be disappointed in her or feel like she failed us.

I had an ultrasound with Dr. Nash on Thursday. He said that the lining of my uterus was looking great, and my ovaries looked nice and quiet (meaning that the Lupron injections are doing their job). I expressed some concern about the follicle situation, and he quickly reassured me. He said that in the past, there was a lot of focus on a magic number of 10 follicles or more when doing an IVF cycle. In more recent years, there has been a lot of research that shows that quantity is not nearly as important as they once thought it was, and quality is really what matters. He said that maybe she was focusing her energy on a smaller number of follicles, and they are going to be really high quality. I like that! He assured me that he believes that the follicles will all still continue to grow, and that this will be a successful cycle. I left his office that day feeling much more encouraged and optimistic.

Heather had another ultrasound yesterday (Friday), and we got great news! Two of the follicles are ready, and three more will most likely be ready by the retrieval date. Yay!! :) Her estrogen blood level is also increasing nicely and appropriately, meaning that the eggs are good. She had another ultrasound this morning, and we got the best news yet ... 4 follicles are ready, and there may be 3 more ready by the retrieval date!! Yay!!! :)

Heather has one more ultrasound tomorrow (Sunday) morning, and the retrieval will be bright and early on Monday (3/12) morning. Brian has to be at Dr. Nash's Akron office (where the retrieval will take place) on Monday between 7-10 AM, to drop off his piece of the puzzle. :)

The eggs will be fertilized by an embryologist on Monday afternoon, and on Tuesday, I should get a phone call letting me know the transfer date. It will either be Thursday (3/15) or Saturday (3/17), at the Akron office. Brian and I will be heading up to my parents' house the night before the transfer. I have to be on 3 days of strict bedrest after the transfer, so my parents, Brian, and I are going to head to the lake for a few days of relaxation.

My managers at work have been incredibly supportive and flexible with me, and I am so grateful. They have allowed me to switch my schedule around at the last minute for the next two weeks, and it has taken such a weight off my shoulders. Brian and Heather's managers have been equally supportive and flexible, and we are all very lucky to work for such great employers. :)

As far as the meds go, Heather will take her last injections of Follistim, Menopur, and Ganirelix tonight, and she will take her HCG trigger shot (which will trigger the follicles to "finish" and be ready for retrieval on Monday morning) tonight. I will take my last Lupron injection tomorrow. I have to continue the estrogen patches through the end of the first trimester (assuming I get pregnant!!), and I will start the intramuscular progesterone-in-oil injections on Monday (eeek!). Those would also continue through the first trimester, and possibly the entire pregnancy.

We are feeling very optimistic, and are hoping for the best over the next couple weeks. The official pregnancy test (a blood draw) will be on Monday, 3/26 in the morning. I will know by that afternoon if I am pregnant. I can't believe I am 2 weeks from hopefully being pregnant!!! It's so hard to believe that we are finally at this point in our long journey. I am trying to stay composed on the outside, while jumping up and down and squealing with excitement on the inside. :)

Se, we are accepting all positive thoughts and good energy sent our way over the next couple weeks ... I will update soon!! :)

Moving right along ...

I have been taking daily Lupron injections for 2 weeks and 3 days. The hot flashes, bone and joint pain, and mood swings have been interesting, but I dare say they haven't been as bad as I thought they would be ... maybe because my reproductive hormones were already diminished? The worst side effect has been terrible headaches. :( I had a baseline ultrasound and blood work last Thursday, and Dr. Nash said that everything looked great. On Friday, I added several more medications to my daily regimen ... transdermal estrogen patches, estrogen tablets that are taken vaginally, aspirin (to prevent blood clots from all of the estrogen that I'm taking), folic acid and vitamin B12, and a prenatal vitamin (I have already been taking those daily for the last 2 years). My Lupron dose decreased by half on Friday, when I added all of the other meds. I will continue these meds until March 8, when I will go for another ultrasound and blood work. My daily progesterone-in-oil intramuscular injections (ouch!) will begin on the day of Heather's retrieval.

Speaking of Heather, she had a prolactin blood draw on Thursday. She had a baseline ultrasound and blood work today. She found out today that her prolactin level is NORMAL (yay!!), and everything with the ultrasound and blood work looked great. She will begin her daily injections of Follistim and Menopur tomorrow, and she will go back for another ultrasound on Sunday. Then, she will have daily ultrasounds until her follicles are ready to go. At some point (I'm guessing maybe Sunday?), she will add a daily Ganirelix (a drug that is similar in function to Lupron) injection to her regimen. This drug will keep her from ovulating prematurely. I taught her how to give herself the injections this weekend ... she will do great!! :)

The tenative egg retrieval date range for Heather is March 8-10. Brian will also have to go to the Akron office the same day as the retrieval, to drop off his excellent and high quality swimmers. :) haha! Then, the embryologist at the office will work his magic and hopefully create some beautiful embryos. :) The embryo transfer into me will be 3-5 days after the retrieval. If the embryos are high quality and divide the way they should, the transfer will be 3 days after the retrieval. If the embryos are good quality, but don't divide as quickly as they should, the transfer will be 5 days after the retrieval. Apparently, day 3 embryos tend to have a higher pregnancy rate, but Dr. Nash said that plenty of women still get pregnant with day 5 embryos.

So, that's about it for now. I have been trying not to let myself get too excited, while still trying to stay optimistic. Brian and I talked about baby names the other day, which of course got me excited. But, I'm also very nervous and trying not to get my hopes up too high. It's a balancing act, for sure. I will update again soon!

Here we go ...

Heather had her prolactin rechecked last Friday. Her prolactin is actually too low now (go figure!!), so Dr. Nash is decreasing her daily bromocriptine dose. By the time she starts her injectible meds, her prolactin level should be normal. So, Dr. Nash said that we can move forward with everything!

I have to say that I thought I would be incredibly excited upon hearing these words from Dr. Nash. I suppose that I am excited somewhere deep inside, but more than anything, I am scared and nervous. I know that this is our last ditch effort ... our last chance for me to experience pregnancy and to have Brian's baby. This is a scary reality for me. We have so much vested in this (emotionally, physically, and financially), and I just can't stop thinking about everything that could still go wrong. I'm normally an optimistic person, but I feel like this infertility journey has changed that. That makes me sad. I am trying to work on it, but one disappointment after another can really damage one's "glass half full" perspective on life.

Anyway, Brian and I have an appointment next Thursday (2/2) to sign the consent paperwork and pay a very large sum of money. We have to pay the entire balance on that day, which is a bit terrifying. Once the consent paperwork is signed, I will stop taking my birth control pills so I can have a period. Then, I will start taking my meds. I have to take daily subcutaneous Lupron injections, which will essentially shut down my body's production of estrogen and progesterone. I'm not sure how long I will take those ... I am guessing I will take them until right before the embryo transfer. At some point, I will start daily intramuscular (big, long needle = OUCH) injections of progesterone in oil, as well as estrogen transdermal patches. Because the Lupron will stop my body from making estrogen and progesterone, I will be giving myself very specific doses of these hormones to prepare my body for pregnancy.

In a couple weeks, Heather will stop taking her birth control pills so she can have a period. Then, she will begin her injectible meds. She will be taking daily subcutaneous injections of Follistim, Menopur, and Ganirelix. Those meds will all help Heather grow multiple follicles, which will then be retrieved once they are mature.

If everything goes according to plan, the egg retrieval will be sometime around the first weekend in March, and the embryo transfer into me will be within a week after that.

So, that's the plan. I will update periodically over the next month. I can't believe this will all be done in a little over a month. It seems like there is so much to do, but I guess it will start moving very quickly very soon.

If all goes according to plan, we may be looking at an late November/early December baby. Now THAT makes me excited ... :)

new year, renewed hope ...

Happy New Year! I am happy to put 2011 (and for that matter, the last 4 years) behind me and start fresh. I believe that 2012 will be a good year.

A lot has happened since my last post. Heather and I are both now on birth control pills, which means that our cycles can be manipulated as needed by Dr. Nash. I had my sonohysterogram a couple weeks ago, and Dr. Nash said that everything looked great.

Unfortunately, we recently encountered a big and unexpected hill on this infertility roller coaster. This time, it involved Heather. I seem to have spoken too soon in my last post regarding her lab work. As it turns out, her prolactin (a hormone produced by the pituitary gland - in the base of the brain - that stimulates breast development and milk production in women) level came back high when she had her initial blood work. This level should be low in a woman who is not pregnant or breastfeeding. Dr. Nash had her go for a redraw, just to rule out lab error. Unfortunately, the level doubled during the two weeks between blood draws. This can indicate a tumor on the pituitary gland that causes an overproduction of prolactin. Of course, we all went into high alert when we found out there was the possibility of a brain tumor. We all did way too much internet research, which more often than not results in some misinformation and worst case scenarios. I learned that these tumors (called prolactinomas) are almost always benign (not cancer), and can usually be treated with medication (more uncommonly, with surgery). I also read about some other, much more scary brain tumors and diseases that can cause elevated prolactin levels. Needless to say, we were all very worried.

Dr. Nash scheduled Heather to have an MRI of her brain, which would give us some answers. The 1.5-week span between the first elevated prolactin level and the MRI results seemed to drag on and on. Finally, on December 19th, Heather and Mom met with Dr. Nash to discuss the MRI results. NO TUMOR!!! Apparently, there are some cases in which the elevated prolactin level truly can't be explained (for my fellow medical nerds, this is called idiopathic hyperprolactinemia).

Words can't begin to describe the relief we all felt. Dr. Nash explained that he will be Heather's doctor for this issue going forward. He started her on a medication called bromocriptine, which causes the pituitary gland to produce less prolactin, thus lowering the prolactin level in the blood.

Dr. Nash assured Heather that she can still be our egg donor, and that moving forward with this process will not cause any additional issues for her. High prolactin can cause issues with infertility, so we can't move forward with this journey until Heather's prolactin level is normal. Because of potential negative side effects of the medication, Heather has been gradually increasing her bromocriptine dose. She will be at her full dose in about a week, and after she has been on the full dose for a full week, she will have her prolactin level checked. If it is normal, we can move forward. If it is still elevated, I'm guessing Dr. Nash will adjust the dose accordingly until the level is normal. Heather will have to take this medication until we are done with the egg donor process, and then she can stop taking it until/unless she starts having symptoms of high prolactin (menstrual irregularities and/or milk production when not pregnant or breastfeeding) or wants to have a baby.

I never would have imagined that a hormone called prolactin would turn our lives upside down for a few weeks! I guess the upside is that this prolactin issue was only discovered (and subsequently treated) because of Heather's generous decision to be our egg donor. :) For now, we are waiting for her prolactin get back to normal, and then we'll be full speed ahead (albeit cautiously, since we seem to have a tendency for bumps in the road) with the next step in our journey ...