When things happen in the infertility world, they tend to happen all at once or very slowly, with almost no in-between at all. Right now, we’re in the “happen all at once” area, after a whole lot of “nothing going on.” All the way back in November 2019, we stopped treatments due to other health issues deciding they needed priority. We never did figure out what those other health issues were caused by, but they resolved themselves enough that I could live life again. In July 2020, we decided we were ready to move forward with fertility treatments, and had decided to pursue InvoCell. Unfortunately, InvoCell required us to leave the clinic we absolutely love for a different clinic in Colorado.
We had our initial consult with the new clinic on August 5th. Initial impressions weren’t fantastic, but I understand the doctor’s personality better now and while she’s not warm and fuzzy, she’s nice and understanding and knowledgeable. They’re our only option for InvoCell in the state of Colorado, and I trust them to do it!
My last post about InvoCell, turned out to be old information. InvoCell is a fairly new (medically) procedure, so the process is still evolving. Some of the things I saw on their website and had read online are not accurate anymore.
Original reasons we chose InvoCell:
- Less medications than traditional IVF
- Significantly lower price tag than traditional IVF
- Shorter timeline from start to finish
As it turns out, the “less medications” is no longer accurate. This is a bit of a bummer, as we are worried about how my body will handle the heavy duty ovarian stimulation. However, the lower price tag and shorter timeline are definitely accurate.
At the InvoCell clinic (“the clinic” going forward), they require an ERA, SIS, and TET before new IVF cycles. InvoCell is technically a type of IVF, though the ERA is optional for InvoCell patients at the clinic. The doctor wanted me to do an ERA, so we could see how my body responded to the meds with all of my sensitivities and oddities. This made total sense, so I started the meds on August 16th and had the ERA biopsy on September 9th. (More about the process below.)
We did a lot more testing, which confirmed that the decisions we were making were right for our situation (again, more details below). And, now we’re moving ahead with InvoCell! I’ve spent all day on the phone organizing various things, and still have even more phone calls to make. It’s amazing how involved this process is. Make sure you’re following me on Instagram to get the most up-to-date information (send me a DM if you want to see the full details of infertility treatment and I’ll see if I can add you to my “close friends” list).
Endometrial Receptivity Assay, or ERA, is a controversial test in the infertility world. Not all doctors agree with the validity of the test, but to me it seemed like a “no harm done” test to have performed. It is definitely uncomfortable, but the information can be useful.
For the test, they take a biopsy of your endometrial lining (the lining of your uterus) and evaluate it to see if it’s receptive to implantation. To prepare for the test, you do all of the medications you would do for a frozen transfer, but on “transfer day” they take the biopsy and mail it to the lab performing the test.
I really thought it was going to be a two second pinch or slice of the lining, but that was most definitely not what happened. Turns out, an endometrial biopsy is more like a thin little suction tube that goes through the opening in your cervix and fishes around inside until they get enough tissue for analysis. It’s extremely uncomfortable, but only lasts for about 5 or 6 deep breaths, so it’s doable.
After 25 days of estrogen patches, and six days of progesterone in oil injections (days 19-25 of the patches), they performed the biopsy and mailed the sample off for analysis. Ideally, the test would have said “receptive.” However, I’m very grateful we performed the test because it turns out I was “pre-receptive.” Being pre-receptive means that my uterus needed an extra day before it was ready for implantation, which is called a “displaced window of implantation.” From a handout given to me by the clinic, a displaced window of implantation occurs in 3 out of 10 patients, and can be a cause for infertility.
Because InvoCell does a fresh transfer, I cannot be on medications for “extra days.” Usually, for a fresh transfer, you start medications the day after your egg retrieval. Since my body needs an extra day to be receptive, I need to start the transfer medications the same day as my egg retrieval.
And, yes, I’ve probably had a displaced window of implantation this entire time, which could be a reason we have not conceived.
SIS & TET
After the ERA, I needed to do a saline infusion sonogram (SIS) and a trial embryo transfer (TET). In a TET, they use the same style of catheter they use when transferring an embryo, and an ultrasound, to measure the size of your uterus for optimal embryo transfer. The TET only takes a couple minutes, and doesn’t hurt at all. The most uncomfortable part of the TET is the fact that you have to have a full bladder! (The full bladder helps the exterior ultrasound picture, and it straightens out your uterus so the catheter has a straight shot.)
The SIS is an ultrasound that looks at your uterus, after they’ve filled it with saline. When your uterus is not full of fluid, the inner walls are camouflaged because they are smooshed together. An SIS looks for polyps, fibroids, unusual shapes, or any other abnormalities inside your uterus. It takes longer than a standard uterine ultrasound, and is not comfortable. The saline causes some cramping, and if the tech isn’t extremely skilled the catheter that fills the uterus can poke you periodically which causes a pinching-like pain for a second. It’s definitely more comfortable than the ERA, however.
My TET went very well. Unfortunately, during my SIS we found a sizeable polyp inside my uterus. Polyps, or other foreign bodies inside the uterus, block implantation (that’s how non-hormonal IUDs work), so before a transfer they have to be removed. On October 8th, I had a hysteroscopy surgery (they put a camera and tool through the openings that naturally exist) to remove the polyp. While we only saw one polyp on the SIS, they actually removed ten polyps during the surgery! Thankfully, the recovery was extremely quick. By the next day, I felt completely back to normal!
I’ve had one SIS before, back in April 2019, and I didn’t have a polyp then. We’re not sure when it developed, but it’s definitely there now. If it developed while I was doing treatments, it very likely could have prevented any of them from working. But, with everything else going on, it probably wasn’t the biggest problem.
Finally! Not a test done on me! Though, it really wasn’t difficult for Dan, at all. For all IVF cycles, you need to have completed a semen analysis (SA) within the last six months. Because we hadn’t done any treatments since October 2019, he needed to get a new SA. When he provided his sample at the clinic, they asked if he’d like to add on the CAP Test, which was not something we’d ever heard of before. He decided to go for it, as it didn’t cost extra and all information we can get is helpful!
As the sperm swim towards the egg, they are supposed to increase their speed. Sperm are also supposed to release an enzyme that makes it easier for them to penetrate the shell of the egg (when paired with the extra speed). Both the speed and enzyme activity need to be correct for proper fertilization, and neither are measured in traditional SAs. That’s where the CAP Test comes in. They look at the speed and enzyme activity, and give you a “percentage chance of generating a pregnancy within three IUIs” (with a perfectly fertile partner).
Dan’s score was 33%, and the lower cut-off for normal was 32%. While he’s technically still fertile, it’s just barely. His morphology is also on the lowest end of normal, which doesn’t always cause a problem. Since I’m not totally fertile, however, this is probably just one more reason things haven’t been working for us!
The scientific study validating the results of the CAP Test was only published in 2018, so it hasn’t been used much. Being brand new, many clinics likely don’t use it yet, which is probably why it was never mentioned to us before!
We did 6 IUIs, which means that if I was completely and totally fertile (had no fertility issues), we would have had about a 66% chance of conceiving. That isn’t quite high enough to say “yes, this should have worked!”
Prolactin & MRI
I also had my prolactin checked. The first time, it came back elevated, so I needed it rechecked while fasting. It was still slightly elevated when we got the results of the recheck back, so I was sent for an MRI. A common cause of elevated prolactin is a (usually benign) brain tumor called a prolactinoma. A prolactinoma is an itty bitty tumor that presses on the pituitary and produces excess prolactin, and can be treated with medication. My MRI came back normal, so we’re not sure why my prolactin is elevated. It’s been elevated before (see: this post), but it’s also been normal before, so it’s probably just “one of those things.”
Summary of Infertility Issues
With all of this testing, we now have a far more complete picture about why we have been struggling to conceive!
- Diminished Ovarian Reserve (low AMH)
- Displaced Window of Implantation
- Uterine Polyp
- Suspected Endometriosis/Adhesions – may make it difficult for eggs to get to my uterus to be fertilized
- Borderline Morphology
- Borderline CAP Score
Now, we’re moving on to InvoCell with ICSI! I will be doing my egg retrieval near the end of October, transfer near the beginning of November, and should be able to tell our families that I’m pregnant by Thanksgiving! (IVF procedures are not a guarantee, but I’m choosing to remain optimistic that it will take on the first try!) Everyone that follows me here and on social media will likely have to wait until December (at the earliest) to find out the results.
ICSI is a procedure where they take each mature egg and inject a single sperm into it. This increases the chances of fertilization, because the sperm do not have to try to penetrate the egg shell. However, it does not guarantee fertilization, as the cells still have to combine properly and start dividing!
We’ve received our medication calendar, the medications have been sent to the correct pharmacies, and delivery of the medications has been scheduled. I’ve had my surgery, insurance has covered the medications, and payments have been made. We have to receive and inventory the medications, and get started! It’s happening so fast!
As I’ve mentioned before, this process is not cheap. Even doing the “cheaper” option of InvoCell, it’s about $10,000 (USD). While insurance covers some of the medications and the InvoCell device, it doesn’t cover the process. Specifically, trying to figure out what it covers is almost impossible so paying the discounted self-pay package price is cheaper.
If you would like to help, as most people our age in 2020 don’t have $10k just lying around, there are several ways you can:
Free Ways to Help
- Share our story! Share my blog posts, Instagram posts, etc. One in eight people that want to conceive struggle with infertility, so even if you think “I don’t know anyone that can relate,” you likely know several people that are struggling in silence.
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- Read more of my blog posts! I make a very tiny amount of money for every ad that is viewed on my blog. By reading more of my posts, more ads appear on your screen, and the more pennies add up!
- Bonfire! Bonfire is a print on demand service for fundraising. When a design is sold, a campaign launches, and after two weeks all of the products sold with that design are printed and shipped to the purchaser, and we are given a “check!” Thank you so much to everyone that has already purchased!
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Thank you to everyone that has already shared our story, and to all of the fantastic people that have donated to help us bring home our little #BabyBee!