Fertility Part 21

Yesterday we had our 6 week ultrasound. Everything is wonderful. We got to hear the fetal heartbeat together with our doctor (116 bpm). We got these printouts of the yolk sac. The placenta is visible. The baby is measuring 6 weeks 3 days. The due date is March 9, 2020.

July 3rd - 11dp5dt - hCG: 260 IU/L - E2: 1,014 pg/mL - P4: 31.4 ng/mL
July 5th - 13dp5dt - hCG: 664 IU/L - E2: 912 pg/mL - P4: 28.6 ng/mL
July 12th - 20dp5dt - hCG: 7,986 IU/L - E2: 1,110 pg/mL - P4: 29.4 ng/mL
July 19th - 34dp5dt - hCG: 32,585 IU/L - E2: 1,364 pg/mL - P4: 35.85 ng/mL

The coordinator had a sit-down with us to let us know that it is time to seek out a "regular" obstetrician, or OB for short. So after seeing our reproductive endocrinologist we went home to do our shots. Thank goodness dear husband is my co-conspirator, who has been absolutely great at administering ALL shots throughout this entire process. Here is a list of the medications that I am currently taking and the dose schedule.

• 1 mL injections of 50 mg/mL progesterone in sesame oil DAILY.
• 0.2 mL injections of delestrogen (estradiol valerate) 20mg/mL every third day.
• suppository endometrin 100 mg vaginal capsule three times daily.
• oral estrace (estradiol) 2mg tablets twice per day. 
• oral "One A Day" prenatal vitamins.
• oral omega 3 fatty acids: DHA and EPA.
• oral vitamin D 2000 IU twice per day.
• oral vitamin B6, or pyridoxine, 100 mg once per day.

I am listing all of the above medications because my mom revealed a misconception, she said, "Oh great, you're pregnant. So that means no more shots." Yes mom I wish that were true, but also I am happy to keep doing what we have been doing in order to hang on to the success we have had. We are in week 6 now, and the medications will continue into week 8 or 10 depending on what they see on the next couple of ultrasounds. 

In addition to the medications, I have been having morning sickness (hence the Vitamin B6). One day I vomited up right after taking all my pills and I panicked and emailed my coordinator. She said don't worry about it, just take the next day's dose tomorrow. Also try spreading out the pills. She suggested eating crackers and soup. So now every morning when I wake up, I eat 150 calories of multigrain crackers (packed with folic acid) before doing anything else. Also, I wait until 10am and my second breakfast to take the "One A Day" prenatal vitamin pill. The iron in that one has always made me a bit queasy and I find it easier to keep down if I am more awake and have had two servings of our breakfast smoothie.

After the meds, I went to my office at school. It felt good to sit at my desk and turn on my computer, have a to-do list and knock it out. My school computer is the fast one and the least cluttered with files. Although my office is messy and cluttered, it looks exactly like it did on the last day of the spring semester, it is a place that I have spent lots of time so it kind of feels like home. I got my schedule for the fall semester, it will be very busy. Not more than usual, but not less either. I picked up a required reading for my freshman seminar and then left campus for another doctor's appointment.

My "regular doctor" feels pretty disappointing compared to my "reproductive endocrinologist, or RE for short." In fact, I have never seen the doctor at my regular doctor's office. I have only seen the physician assistant, or PA for short. The waiting room at my regular doctor's office had the morning news blasting, with stories about shootings and high speed chases ending in death. The exam room was dirty and had chipped paint on the walls, it was grosser than the bathrooms in public transit (subway) stations. They don't explain anything thoroughly, the call me "babe" "sweetie" and "honey," which I find insulting.

The reason I had to go there is because of my insurance, it's a gateway to a referral. They had me pee in a cup for a pregnancy test and then ordered a quantitative hCG at a lab down the street. They asked me what I wanted in an OB and I said, "I don't really know how all this works, but I want to deliver at Northridge hospital so I want someone with privileges there. Someone nearby." I have no idea who I will be referred to, the referral will arrive in the mail in about a week.

My reproductive endocrinologist will be putting together a packet of my medical information and releasing it to us at our week 8 ultrasound, so hopefully the timing will work out where we can get an appointment with the new. I wish the PA would have given me a bit more information about the process that will happen over the next 8 months, but she just smiled and said that there will not be many doctor visits.

I had a second vial of blood drawn for the quantHCG test at LabCorp and I keep checking my patient portal but the results are not posted yet. I am not worried but neither my RE nor my regular doctor have released the numbers on yesterday's hCG levels. I was concerned that taking too much blood was a bad thing. My heart rate was going up and up from the day of my transfer (June 22) until July 8th. It was kind of scary to see that on my fitbit, but I guess it was also kind of comforting because I felt like my heart was pounding with even the slightest exertion. I guess it is something to do with increased blood volume and then at some point the body gets used to it.

I am super grateful that everything is working out. I have heard that unicorns fart rainbows, and I am definitely no unicorn. I have had pretty regular diarrhea, and lots of stinky farts. But I also heard that during pregnancy many women experience constipation, which is the body's way of extracting more nutrients out of the food that is digesting. So maybe this means baby AA has enough nutrients and is happy to excrete what is not needed. Or maybe since I'm generally constipated when I am not pregnant, then when I am pregnant I get to be the opposite. Who knows? Biology is complicated.

via GIPHY

We are discussing a possible "babymoon" which is a vacation that a pregnant couple takes during the second trimester. Like a last hurrah before you have another human in the family. Maybe we will go to Cayucos and Morro Bay. The babymoon would have to be scheduled between Friday, September 6th (start of week 13) and Thursday, December 12th (end of week 26). Unfortunately, according to our academic calendar that is the entire semester. Classes begin on Monday, August 26th. We have a break for Labor Day on Monday, September 2nd. We have a break for Veteran's Day on Monday, November 11th. We have Thanksgiving holidays on Thursday and Friday, November 28-29th. And finals week starts on Wednesday, December 11th. So we would have to do it over T'givs.

Finally, I want to document a feeling I had. It started two weeks ago when we got the positive pregnancy result. I feel like we are a family now. I don't know if it is the stress of going through IVF that has made our marriage stronger, or the fact that we are preparing to welcome our offspring into the world, but when I wake up on a Saturday morning, I feel like we are a "real" family now. We have taken what at first seemed like an impossibly large leap of faith and it seems to have been worth it for us. When you think about it, spending $22,000 wouldn't even buy you that nice of a car. It wouldn't even pay for 1 semester of college at a private school. Looking back, it is easier to justify.

I am so excited. Today, we are going to a birthday party for a 1-year old that was created through IVF at the same clinic where we went. It is my best friend from grad school's baby girl. We got some cute little things for the baby, but more than that I just want to catch up with them and see how they are feeling 1-year post birth. I feel like I can really celebrate and participate in baby-centric rituals now, without feelings of jealousy and self-hatred. There's a really great piece of writing here about being in the stage of life where you are risking what seems like everything to create a baby. And now it's time to go and do SHOTS!

Fertility Part 20

A few significant things happened this week. First, my acupuncturist will no longer see me because I am pregnant. Second, I got the results of my blood-work back and I am still pregnant.

July 3rd - 11dp5dt - hCG: 260 IU/L - E2: 1,014 pg/mL - P4: 31.4 ng/mL
July 5th - 13dp5dt - hCG: 664 IU/L - E2: 912 pg/mL - P4: 28.6 ng/mL
July 12th - 20dp5dt - hCG: 7,986 IU/L - E2: 1,110 pg/mL - P4: 29.4 ng/mL

What is considered normal E2 levels? 188 - 2497 pg/mL in the first trimester. What is considered normal P4 levels? 100-200 ng/ml by the end of pregnancy. There are also some values presented in this paper. hCG: 4620 IU/L - E2: 1,627 pg/mL - P4: 24.8 ng/mL in 42 women, average age 29, at 8 weeks pregnant.

There are so many acronyms in the fertility community. Human chorionic gonadotropin (hCG) is a hormone produced by the placenta after implantation. This is the substance that is detected in home pregnancy tests, such as First Response Early Response (FRER). E2 is estradiol and P4 is progesterone, these are the hormones that I am taking every day.

The way women tell other women online how far along they are is in weeks+days. For example today I am 5+1. For IVF cycles with a frozen embryo transfer (IVF), the abbreviation is days past (dp) and age of the embryo transferred (dt). So for me, I did a 5dt because the embryo we transferred was a 5 day blastocyst when it was frozen and thawed.

Today I am attending my first RESOLVE meeting. It is a support group for infertility. I do not know how the group will respond to a newcomer that is actually already pregnant, but I know that I do need support and connections in case I do end up with a miscarriage. I am not expecting that outcome, but until 8-10 weeks, there is still a chance.

My symptoms include feeling hot, very tender breasts, sore backside (where I take the shots), alternating between hungry/full/nauseous. I felt a little emotional the past few days, crying easily. I am not in the phase yet of taking pictures of my invisible baby bump. We got our first gift from a friend last weekend in Riverside. So cute booties, hats and onesies. I am starting to create space in our 2nd bedroom to accumulate "baby stuff."

Fertility Part 19

I am writing my first post about pregnancy. We are currently pregnant. It is a scary feeling because I know there are still many things that could derail our train, but at least our locomotive has left the station.

July 3rd - 11dp5dt - hCG: 260 IU/L - E2: 1,014 pg/mL - P4: 31.4 ng/mL
July 5th - 13dp5dt - hCG: 664 IU/L - E2: 912 pg/mL - P4: 28.6 ng/mL

Here is our schedule going forward:
July 12th - week 5 - Labs only
July 19th - week 6 - Labs + ultrasound
Aug 2nd - week 8 - Labs + ultrasound (might be able to lower medications)
Aug 16 - week 10 - Labs + ultrasound (might graduate to regular Ob-Gyn)

I am heading out in a minute to get acupuncture. I skipped restorative yoga on Friday, instead I found a gorgeous shaded walking trail. I feel a bit uncomfortable since I have a lot of tightness in my lower abdomen. I am afraid to overdo other stretching or exercise. I am weighing 192 pounds as of today. I have a fear of gaining too much weight too fast. I had a good birthday weekend.

Fertility Part 18

This is the last post before our beta hCG test (quantitative). Whatever happens, we will know that we gave it a good effort. We did the 2-week cleanse from the IVF diet 6 times (for 12 weeks). Since the frozen embryo transfer (FET) I have been wearing warm fuzzy socks to keep my feet warm. I have been taking it easy and staying out of the heat. I have taken sub-2 minute showers. I have relaxed as much as possible, under the circumstances.

I am feeling nervous, but for all the above reasons, I know that there is nothing left to do but get an answer. If our blood is drawn at 7am, we should have the result in two hours from that time. For the past two days, I have had an extreme aversion to smells (bad ones). I have had a bit of nausea in the morning and evening. I looked at my breasts yesterday in the mirror and they are the biggest ever (and sore) and my nipples have turned an interesting shade of purple. Kind of like red with blue polka dots. Usually they are a creamy-pale pink.



I hope these are signs that the embryo is implanted and growing stronger. I have resisted the urge to document every symptom with a new blog post, partly because I did not want to seem like a crazy person in case today's test results are negative. I have also (miraculously) resisted the urge to take home-pregnancy tests every day. It is an exercise in delayed gratification.

One bit of advice I could offer about PIO shots... prior to my embryo transfer I was doing lots of walking. My good old fitbit helped me track 10,000 steps per day. After embryo transfer, I got 2,000 or less because dear husband was watching me like a hawk to make sure I rested. But my injection sites started building up bruising and the shots were getting more and more painful, as I alluded to in a previous post.

On Monday, I went for a long walk and then Tuesday morning dear husband noticed that my bruising was much less and I noticed the injections hurt less. No tears, less pain. So yesterday I made sure to get my 10,000 steps. I tried Kundalini Yoga but I am not sure that was the best. It was not very relaxing and the breath of fire was something I could not (would not) do.

I have found the meditations on the FertiCalm app really helpful. When the injections were getting more painful, I would do a mini meditation before going downstairs to get all the syringes ready. And now dear husband is awake and we are going to jump in the shower (for 2 minutes) and then head out to the doctor's office.