Infertility in 2020 and Next Steps

I haven’t written about infertility, in detail, on my blog since I did my “catch up” posts in February 2019 (one, two, three). I did do a quick summary of 2019 in these two posts (one, two), which includes a quick rundown of when we did what in regards to infertility, as well as what else happened in our life that year.

In 2019, we started fertility treatments with a clinic we really love. It’s a small, two doctor clinic, and it feels very welcoming and loving. Based on all of the tests, I should have conceived with the IUIs (intrauterine insemination, or artificial insemination), so we’re not sure why I have been unable to get pregnant. In 2019, we tried for 9 cycles. Those nine cycles included: three rounds of Clomid with two IUIs, three rounds of letrozole with three IUIs, two cycles cancelled before medication due to “functional cysts,” and one non-medicated cycle trying. Before 2019, we had done two unmonitored cycles with Clomid, an unmedicated IUI, and a cycle with progesterone after ovulation only. We started trying to conceive in July 2017, and I started preparing my body in 2016. It’s been a long road, and it’s not over yet.

When my gut went completely haywire in November 2019, days after the clinic cancelled our next cycle, we had to take a break. We spent months trying to figure out what was going on with my body, and we still have no idea what happened. We suspect it might be endometriosis. When we made that realization, we spent a lot of time juggling “what ifs” and trying to figure out what to do next. (Instagram posts about my gut issues: one, two, three, four, five, six, and seven.)

We figured out that for my body, and my potential endometriosis, I need the best team available. From my research, that team is at the Center for Endometriosis Care in Atlanta, GA. I live near Denver, CO. CEC isn’t in-network for any insurance carriers, so it’s a matter of what the out-of-network out-of-pocket maximum for you plan is. It’s expensive, especially when you factor in travel costs.

The thought of traveling to the other side of the country, living there for a week or more, having my sixth surgery, and then having to recover from an abdominal surgery was daunting. I’ve had one abdominal surgery, a “simple” ovarian cyst removal in 2009, and it took me about 2-3 times as long to recover as it was supposed to take. Eleven years later, and my health is not as good as it was. Even though I was intimidated by the process, I started trying to compile my records to send to them for their free out-of-state/country records review process.

Then, coronavirus hit.

White woman with purple and blue hair, wearing blue glasses, a purple face mask, blue shirt, and purple jacket, sitting in a car with black seats.

It became harder to get in contact with my doctors and medical offices to get the records I needed. Travel shut down (especially in and out of both Denver and Atlanta). People that are “high risk,” people like me, started to fear for our lives even walking out our front door. The thought of trying to pursue an out of state, extensive surgery was paralyzing. Especially since I was technically still recovering from my hip surgery. (Instagram posts about my hip surgery: one, two, three, four, five, six, seven, eight, and nine.)

As restrictions started lifting, I had to start considering it again. Suddenly, none of the reasons felt good enough. The amount of work I needed to do felt horribly overwhelming. A sixth surgery? Did I really need it? A good friend of mine had a diagnostic laparoscopy and was told she only had adenomyosis, but then she had a hysterectomy and that surgeon found endometriosis. Do I have the emotional capacity for a similar situation? It’s a very real risk, going into the surgery blind (it has to be for this one) and not knowing if or where endo may be, they may not find any at all and then I have to recover from a pointless abdominal surgery.

I talked about it in length with my therapist (who is absolutely amazing) and she kindly pointed out my age. I’m 30 now. That’s not “too old” for female fertility, but it means I don’t have tons of time left until my fertility significantly drops off. Female fertility takes a sharp downwards dive starting at age 35 until you hit “zero fertility” at menopause (average age of onset is about 55). However, I’ve also been diagnosed with diminished ovarian reserve due to my AMH being closer to the level one would expect of a woman ten years older than me. My ovaries are probably closer to 40 years old than they are to 30 years old. DOR can be genetic, and I believe mine may be, because my mom (if I remember correctly) started menopause earlier than average.

After talking with my therapist about everything regarding potential surgery versus fertility treatments, we came to the conclusion that pursuing fertility treatments is probably a better option. I discussed it with Dan and my OB/GYN and we all agreed that the endometriosis can probably wait.

In the eight month treatment break, I had time to research treatment options. There’s one called InvoCell, which is kind of between IUI and IVF. It’s newer than IUI and IVF, and the company website (not sponsored) talks about it having slightly higher success rates than IUI and slightly lower than IVF, with roughly a 25% live birth rate. My main attraction is less medicine, and a lower price tag.

With IVF, the person with the ovaries and uterus does “stims,” an egg retrieval, the eggs and sperm are combined, scientists watch them for fertilization and development, then you either freeze them to transfer later or you can do a fresh transfer about a week after retrieval. Stims are a series of injectable medications designed to stimulate your ovaries into producing a humongous amount of eggs. (In an average unmedicated cycle, a woman’s ovaries mature a single egg every month.) For perfectly healthy individuals, stims are physically stressful and emotionally taxing. Unmedicated, your ovaries are the size of your thumb, but right before an IVF retrieval they can be the size of baseballs. This extreme medicating comes with a potential and very serious risk called Ovarian HyperStimulation Syndrome. In OHSS, after retrieval, fluid fills your ovaries and spills into your abdomen. Severe OHSS can be fatal, and anything over “extremely mild” usually requires a lengthy hospital stay. During retrieval, they use a needle and syringe to suck out the contents of every follicle that developed during stims (thankfully, while you’re unconscious), then put each egg in it’s own petri dish. Fertilization can be done artificially in a process called ICSI or “naturally” by putting several sperm into the same petri dish and letting them attempt fertilization on their own. If the person with the uterus overstimulated, any blastocysts have to be frozen so their hormones have a chance to calm down. If they didn’t overstimulate, they have the option to do a fresh transfer (the blastocyst is never frozen) about a week after retrieval. Some clinics do not allow fresh transfers, as they have a lower success rate than frozen transfers, probably due to hormonal instability. If you do a frozen transfer, you have to take medications to help prepare the uterus and create the best environment possible for implantation. During transfer, a syringe deposits the blastocyst into your uterine cavity. The doctor does not implant the blastocyst into your lining, but tries to place it close so it has an easier time implanting on its own. The person with the new blastocyst stays on medication until a negative pregnancy test or until they are twelve weeks pregnant (when the placenta is fully formed and takes over hormone production). Some pregnant people require more than twelve weeks of hormones, some do very lightly medicated transfers and can come off medications before they hit twelve weeks.

IVF is commonly used to bypass tube problems (either problems with the egg getting to the tube itself, or blocked or missing tubes), correct for absent or ineffective ovulation, endometriosis, bypass fibroid issues, correct hormone imbalances, and unexplained infertility. Sometimes, there is a fertilization problem and IVF with ICSI can help solve that problem as well.

InvoCell is very similar to IVF, but less strenuous. Each clinic will have slightly different protocols, but from what I have read on InvoCell’s website, it sounds kind of like “IVF light.” There’s a stimulation process, retrieval, incubation, and transfer. The stimulation process is lighter than IVF, and it sounds like many people with ovaries can take pills (like letrozole or Clomid) instead of having to do the injections required for IVF. In the InvoCell process, they don’t need or want as many eggs as humanely possible because the device is only sized to hold about seven fertilized eggs. After stimulation, the doctor does an egg retrieval (in the same way I described above). The eggs are then either fertilized with ICSI or the eggs and sperm are combined and allowed to fertilize naturally. Then, up to seven of the fertilized eggs are placed in a device, and the device is placed into the vagina of the person chosen to incubate the embryos (it does not have to be the person that wants to carry the pregnancy). The device incubates the eggs in the vagina for 72 hours. After 72 hours, the doctor examines the embryos, and selects the number that has been agreed upon to transfer (typically one or two) from the highest quality embryos. The embryo is transferred into the uterus in the same way I described above, and then the patient usually takes medications to encourage implantation and pregnancy.

InvoCell Device, from InvoCell’s Website

InvoCell bypasses many of the same problems IVF does. You can still correct for fertilization problems using ICSI, the tubes are still bypassed, and the stimulation and post-transfer meds can still correct for hormonal imbalances and anovulation. If you’re at high risk of genetic diseases or mutations that could be life threatening to the embryo, you cannot screen for them before the fresh transfer. However, I believe you could do the incubation process then request the embryos to be biopsied and frozen and perform a frozen transfer at a later date; that would need to be discussed with the specific doctor for your specific situation.

As you can see, the InvoCell process requires significantly less medication, which means less hormonal dysregulation, and still bypasses many of the same problems that IVF does.

Image of an embryo at about Day 2 or 3

Everything about our case says that I should have gotten pregnant in 2019. We corrected for my lack of ovulation, my body responded well to the medications, and all other tests were normal (for both of us). We think there is either a fertilization problem, or my tubes aren’t grabbing the eggs my ovaries are releasing. There could also be an implantation issue, but we won’t know until we bypass the other potential issues first.

I am, however, very sensitive to medications. Not just fertility medications; I’m sensitive to all medications. My body tends to either treat medication like water or dramatically overreact. We’re nervous that IVF stims would cause OHSS for me, no matter the dose, and leave me bedridden both before and after the retrieval. But taking a slightly higher dose of letrozole would be doable for my body. And while progesterone makes me nauseous, it’s not so rough that I’m against taking it.

The catch to InvoCell a couple months ago was that the nearest clinics were in Salt Lake City, Utah. Salt Lake City is roughly an eight hour drive from Denver, so we would have needed to figure out travel and a place to live. After we decided to skip surgery and restart fertility treatments, I looked up clinics again and discovered that a clinic less than an hour away now offers InvoCell!

We’ve made the decision to schedule a consult with this new clinic, and hopefully move forward with InvoCell before the end of 2020! Our initial consultation is August 5, 2020. Because we will want family to be the first to find out if it’s successful, I won’t blog about it until after it’s been completed. I will probably post about it on my Instagram up to the transfer, but then nothing for a while. (I’m putting this warning out there so we aren’t bombarded by curious followers when I’m silent!)

While InvoCell is cheaper than IVF, it’s still not “super affordable.” Heck, nothing about infertility is affordable. IUIs are more expensive than you probably think they are. InvoCell is roughly $8000 at the clinic near us. The cost is estimated right now because medications are highly variable and dependent on individual protocols. Because we’re not independently wealthy, we made the decision to launch a fundraiser on Bonfire (you can get a shirt here or here). If you buy one of the shirts from our Bonfire fundraiser, you are helping us create our little Baby Bee and we are extremely grateful to you! If you’re not interested in a shirt, but still would like to help us, you can always donate via Ko-Fi or PayPal. Anything helps, even just spreading the word, and we are extremely grateful for every penny! If we raise more than a single InvoCell treatment, it will go towards infertility medical bills from 2019 (they added up quickly), and if we get more than that the rest will go into savings for a second Baby Bee in the future.

Thank you so much for all of your support on this unpleasant infertility ride! Remember to follow me on Instagram, as that is where I am most active and you will get the most up-to-date information about my life!

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