Last time I wrote, we were just about to start InvoCell. As is usual for life, especially mine, things didn’t go quite as we planned, so let’s get caught up.
In “InvoCell Full Steam Ahead,” I talk in more detail about the tests that were required before we moved on to the actual InvoCell process, and the results of those tests. I’ll do a brief overview again, as a refresher, but please read the previous post for the details! Since we were at a new clinic for InvoCell (only one clinic in Colorado does the procedure), and since it had been almost a year since we’d last done any treatments, we had to do a bunch of testing before starting the stimulation medications. It was a little frustrating, but after we got the results, I was very grateful to have done them!
First we did an ERA, which is a test where I take a full month of fertility medications as if we’re doing a frozen embryo transfer, and then they biopsy my uterine lining on the “transfer day” to see if it’s ready. My biopsy came back “pre-receptive” which means I needed extra progesterone prior to a medicated transfer! Then we did an SIS and a TET, where they measure my uterus using a catheter and ultrasound to make sure they’re placing the embryo in an ideal location and then they fill my uterine cavity with saline to see if there’s any anomalies in the lining. Unfortunately, we found a polyp when they did the saline, which has to be removed before pregnancy as they can function like an IUD and block implantation.
On October 8th, I had surgery to remove the polyp from my uterus. While they were in my uterus, they actually found and removed ten polyps! TEN! A uterus really isn’t that large, at roughly the size of your palm, so it is very likely that having ten polyps in there was totally preventing pregnancy. Thankfully, surgery recovery was incredibly easy! I was surprised, but about 4 hours after surgery I just felt slightly bloated, and the next day I needed to remind myself to rest because I felt back to normal.
I also had to have my pituitary gland imaged (MRI) to make sure there wasn’t a tumor causing my elevated prolactin, and was started on medication to lower my prolactin. I was also put on thyroid medication, to get my TSH to a more “ideal” range for fertility treatments, and we repeated Dan’s semen analysis with an extra test. We also redid most of my bloodwork, such as AMH, and my AMH was indeed decreasing but at the expected rate.
Summary of our fertility problems:
- Diminished Ovarian Reserve (low AMH)
- Displaced Window of Implantation
- Uterine Polyps
- Suspected Endometriosis/Adhesions – may make it difficult for eggs to get to my uterus to be fertilized
- Borderline Morphology
- Borderline CAP Score
My baseline for InvoCell was on October 12th. They do blood work and an ultrasound to make sure that your hormone levels are low and your ovaries are quiet. Everything looked great, so we were cleared to start injections on the 14th! My first injections were twice daily micro-dose Lupron. Because I have a low AMH, I was put on a “microflare protocol.” The microdose Lupron is supposed to help my ovaries produce more follicles (which hopefully equate to eggs) and mature them simultaneously. After a few days on just the Lupron, I started Gonal-F and Menopur every evening.
The first check was just blood work to check on my hormone levels. After a few days on injections, they like your estrogen to be close to 200. Unfortunately, mine was only at 75. We increased the Menopur dramatically, and hoped for the best. At my first ultrasound, we were shocked to see that I was growing 8 follicles, and my estrogen was 295! If you have read other IVF stories, you’re likely wondering why I’m excited about 8 follicles, as many women get significantly more. I have a low AMH, at only 1.27, which is closer to the AMH level of a 40 year old (I am only 30). While it’s not a terrible AMH, it means I will respond with a lot lower numbers than “average” for my age. Eight follicles isn’t actually tons lower than average, so we were thrilled! We continued on the medications.
Side effects were not fun. I knew this process would be rough on my body, and I was grateful that it was actually easier than I had been mentally preparing myself for. October in Colorado tends to be quite chilly, but the medications were causing me extreme hot flashes! I spent every day that I was at home in tank tops, and half of the days in shorts! I would go from “eh, I’m okay” to “it’s 110 outside” with minimal activity. That was the worst part. Near the end, I also got quite bloated, and my chronic fatigue syndrome flared up. The last few days of injections, I was completely useless. Some days, I couldn’t form full sentences and every day turned into a game of 20 questions for Dan as he tried to figure out what I needed with a series of “yes” or “no” questions. As expected, my IBS also flared up, and I spent most of injections with some level of gut pain. My IBS is extremely sensitive to medications and stress, so that was the only “side effect” that was completely expected.
Unfortunately, my last two scans showed that only 5 of the original 8 follicles had continued to grow and would reach maturity. We were devastated. About 70% of mature follicles contain mature eggs, in a woman with diminished ovarian reserve (my official diagnosis), and only about 50% of mature eggs make it to transferable blastocysts (usually, less than 50%). That meant that with 5 mature follicles, we maybe had 3 mature eggs, and would maybe get one blastocyst to transfer. Retrieval and transfer are the two most expensive parts of the IVF process, so we had to decide if it was worth putting my body through an expensive surgery with possibly nothing to show, or if we should convert to an IUI.
We decided that it made more sense to convert to an IUI than to continue with InvoCell. I was devastated, because I had really hoped that an IVF process would be our answer, and here we were with my body deciding not to produce enough eggs to even be worth attempting. So, with five mature follicles, we injected the trigger shot. The trigger shot is an injection of synthetic hcg (pregnancy hormone) which mimics LH in the body. LH is the hormone that tells your body to release the eggs. Five follicles is a lot of follicles to perform an IUI with, and is usually only allowed when converting from an IVF cycle. The risk of multiples is quite high. Theoretically, every single mature follicle could have an egg that fertilizes, and every fertilized egg has the ability to split into identical twins. The odds of five follicles turning into ten embryos is extremely low, but the odds of five follicles turning into twins or triplets is relatively high.
IUI & Results
On October 29th, we completed our seventh IUI (intrauterine insemination). In an IUI, the person providing the semen goes in and leaves their sample. The lab then processes the sample by analyzing it and washing it (removing seminal fluid and “bad sperm,” then suspending the “good sperm” in a neutral fluid), which takes about an hour. After the semen has been processed, the person being inseminated goes in, has a catheter inserted into their uterus and the sperm injected up near the Fallopian tubes. Then, they lay on their back for 10-20 minutes (depends on the clinic) to hopefully prevent any sperm from being negatively affected by gravity, and continue on with their day. Thankfully, Dan was able to be with me during this insemination. I had always felt like extra fluid leaked out of me after an IUI, even with laying down for a long while, so I decided to put in a disposable Soft Cup for a little extra piece of mind this time. It wasn’t going to hurt anything (as they’re sterile until you open them), but I’m not sure it would help anything either.
We were told to have timed intercourse later that night (with a very specific time window provided), as there are some studies that show IUIs are more effective if the cervix ends up in contact with seminal fluid within a certain amount of time after an IUI. I took it easy the entire afternoon, just to give everything the best chance of getting to the right place, and we followed the doctor’s directions. Then, it was time to wait.
There are two weeks between ovulation and the time your next menstrual cycle is due to begin. Those are the slowest two weeks of your life, and they never get easier. A trigger shot can take up to 14 days to leave your system (which is about 10 days after the insemination), and the fertilized egg can take over a week before it implants. Your body will not produce any hcg until the blastocyst has implanted into your uterus, and it takes quite a while for the amount of hcg to be detectable on a home pregnancy test. Even if patience isn’t something you have in spades (and very few people do), you have no choice but to wait!
I was surprised I wasn’t put on progesterone after the IUI, so I pushed to have my progesterone levels tested as early as possible. I have required progesterone for every medicated cycle, so I knew I tended to run low (even though I ovulate on my own just fine). My progesterone was tested on November 2nd, six days after the IUI, and was lower than it should have been. We started progesterone in oil shots the next day. I am not a morning person, and being told we had to do them at 6am was awful! They’re also not fun injections, and they make your glutes extremely sore after a while, as the oil is really thick. I just kept telling myself that these injections were for our baby, and that they were making it a nice cozy bed to get snuggled into for the next several months!
Being on artificial progesterone is such a mind game. Most early pregnancy symptoms come from the extra progesterone your body produces, which means that you get them even if you aren’t pregnant. After a couple days on the shots, I was not feeling well: my breasts were incredibly sensitive, I was getting frequent headaches, I was dizzy a lot, had tachycardia, extreme fatigue, and severe nausea. Most of those symptoms I had gotten with the ERA progesterone, so I didn’t think too much about them. They were, however, getting more intense as time progressed.
I decided to test pretty early, because I was wondering if the trigger shot was out of my system. I tested the first time late in the afternoon (ideally, it should be “first morning urine”) on November 6th, Friday, just ten days after the IUI. I got a very faint positive, and was annoyed that the trigger shot was still in my system. Curiosity got the best of me, and I tested again on Saturday afternoon, and the faint positive was still there. I decided to keep testing until the line faded, as that was what I had done with my previous trigger shot.
I woke up Sunday morning for my progesterone in oil shot, and tested using my first morning urine. And, then I froze. The line was extremely dark and showed up almost immediately. Wait a minute, is this real?! I had actually used two different brands of cheapo tests, to make sure that I wouldn’t get a false answer, and they both had done the same thing! I opened the door, looked at Dan, and said “I think this is actually happening” as I pointed at the tests. “It appears so.”
I WAS PREGNANT!
This was the first time I’d ever seen those two lines from an actual pregnancy! In the three years and three months we’d been trying, the only time I’d seen two lines on a test was due to the artificial hcg in a trigger shot. The lines on Monday morning were even darker, and I immediately called the clinic to ask for a blood test on Tuesday. My hcg levels were fantastic, and increasing appropriately. When my second blood test came back, I was officially four weeks pregnant, so we just had to wait for two weeks to see if the pregnancy was viable (in the uterus). Spoiler: it was!
I’ll update again with a first trimester update soon!