This is my FET cycle

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Everybody who goes through IVF, IUI or an embryo transfer cycle will have a protocol designed specifically for them. While there are a lot of similarities with these well-established medical interventions to create the miracle we dream of, there are a lot of differences too. This is what my frozen embryo transfer cycle looks like for me…

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For most of my cycles we have done a “controlled” cycle. This means that my cycle leading up to the embryo transfer is controlled by hormone injections (estrogen and progesterone). In the past I was able to try a natural cycle, which relied on my body’s own ability to manage my menstrual cycle and thickening of the uterine lining where there was minimal medication use. That worked one time, then the next try, my ovaries weren’t cooperating and we had to start over. In my controlled cycle, I start with a baseline ultrasound on day 2 or 3 of menstruation to check that the uterine lining is thinning and that there are no cysts developing on my ovaries. From there I start on Delestrogen intramuscular injections twice a week for a little less than two weeks. This also involves blood draws to check my estrogen levels and any necessary dosage adjustments.   Another ultrasound is performed to check that the lining is thickening appropriately and to check that my ovaries are “quiet” and no cysts are developing. Then the progesterone injections start.   My husband has become a pro at giving me injections. We went through IVF twice and have now made it through eight embryo transfers, plus a couple cancelled cycles. So, he’s really got this down.

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Here’s the cool thing about the controlled cycle. The progesterone injections (which are daily) are required for 5 days and on the 6th day, the embryo transfer occurs. This gives me and the doctor flexibility in scheduling the transfer because we can start the progesterone on the right day based on our schedules (well, mostly his schedule). Since we want to make sure we get to have “our” doctor for the transfer, we can make sure to set up the injection schedule accordingly as well as avoid weekends or holidays.

Here’s the tough part about the controlled cycle. Once the progesterone injections start, there are daily intramuscular injections into my hip/glute area. After doing SO MANY of these cycles, it’s getting pretty painful and there’s a build up of scar tissue and/or “oil” (ethyl oleate) from the medication settling into my muscles. Delestrogen and progesterone are oil based medications. After two very painful injections leading up to our transfer on Friday, we did learn some new tips from the nurse for intramuscular injections:

  1. Use a cold pack on the area of injection for 10 minutes prior to injection
  2. Immediately following injection, massage the injection site
  3. Use warm compress on area of injection for 10 minutes after injection
  4. Do glute and hamstring stretches to help the ethyl oleate part of the medication move through the muscles. This is what tends to build up. Even though the progesterone will get absorbed, the oil base of the medication can build up (yuck).
  5. Make sure you understand the full surface area available for the injections. My husband had been using a smaller surface area which left us little real estate for repeated injections. After another session with a nurse, we discovered there was a bigger area we could use that was still safe.

The embryo transfer occurs on Day 6 after starting progesterone injections. The procedure itself is a simple one and just a bit uncomfortable. This has to be done on a full bladder to help visually guide the small catheter on the ultrasound through the cervix and into the uterus.   The ultrasound wand is pressed on the lower abdomen…yep, right over bladder territory so that’s the biggest challenge. After a couple of rounds of verifying our information and number of embryos to be transferred, we are then ready to go. It’s very exciting to watch the catheter on the ultrasound make it’s way into the uterus where you can see it as a very faint white line with slight movement. Then the embryo is released and it is slightly visibly as a white flash or very small blob on the ultrasound screen. After the embryologist checks the catheter to confirm it’s empty, we are then free from medical intervention and now it’s up to luck, a healthy embryo and lots of baby dust and embryo sticky vibes to implant and make this miracle happen.

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The embryologist brings us a photo of our little embryo and we get to feel hopeful and terrified for 10 days.

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We get some time alone with our little embaby photo and think positive thoughts. Since my husband is a huge Star Wars fan, there were a lot of good vibes with references to Jedi’s and the force awakening in my uterus. Maybe it will work.

Our HCG blood test will be on November 15. We’ve been let down so many times. Please, please, please, let this be the one.

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Cervix Denies Entry But Plan Continues

IMG_5254My July cycle to do the endometrial biopsy and ERA (Endometrial Receptivity Array) did not go as planned. My doctor had me go through the same controlled cycle that we would do for an embryo transfer but instead of transfer day, we would do this procedure. The hope was that 1) the endometrial biopsy would make the uterine lining “sticky” for the following cycle’s embryo transfer and 2) the ERA would let us know if we were transferring the embryo on the right day of the cycle for optimal endometrial receptivity. Sounded like a fabulous plan to me. There is no solid evidence that the endometrial biopsy directly increases chance of pregnancy, but I was willing to do it in hopes that it could make a difference for me.

The endometrial biopsy is not a fun procedure and I had done it once before and it did lead to my second pregnancy. The first time doing this procedure was without any pain medication and wow, that was a mistake. I remember getting ready for the procedure and the doctor asking me so calmly if anyone had warned me ahead of time of the pain level. Um, no, I was expecting it to be something like a pap smear. He proceeded to tell me it’s about a 7 out of 10 on the pain scale. Holy crap. Yep, he was right. Luckily it’s not a long procedure but I did not want to go through that again. For this second time around I was very apprehensive about the pain, so my doctor was able to do a paracervical block (lidocaine injection) and I could tell it was helping a lot. However, after what seemed like forever, staring at the ceiling, scared to move, and at least 4 tries by the doctor, he could not get through my cervix. It was such an unnerving experience and very frustrating for both of us. It turned out that my cervix had developed nabothian cysts. Luckily they are benign and not harmful, but due to the cysts, it was not possible to pass the instrument through the cervix. As I was lying there in tears, clutching the hand of the nurse and quickly becoming her new best friend, I could tell it was not easy on my doctor either. So we called it a day and decided to think things through for a few days. That procedure was now out the window and I’d have to consider starting over again.

In the follow up conversation with my doctor barely a week later, I was in the precise condition to start another controlled cycle. After a thoughtful discussion, we all decided to move forward with the embryo transfer cycle and skip the other procedure all together. We are now two weeks into this process and the frozen embryo transfer will happen in one more week on August 21. Due to the cervix denying entry just a couple of weeks ago, we decided to do a mock embryo transfer and this happened yesterday. He was able to see that some of the cysts had gotten smaller, but also mapped out the path through my cervix on the ultrasound. It’s like a labyrinth in there! It is not a direct shot. There is a hard sharp turn on the way in. Luckily, the mock transfer went without a hitch and was very quick, so that boosted all of our confidence for next week. We are quickly approaching attempt number 8 and I’m trying my best to be healthy, stay rested, get in plenty of acupuncture and ready to accept positive energy, prayers, and happy thoughts from anyone who will give them.

Photo by – CJE, Catalina Island