The embryology lab let me know on the phone on Monday that we’d wait until six days of culture rather than 5 to give me the final blastocyst update because I had so many immature eggs.
Well. That is not promising. That just makes me feel even worse.
This week is truly one of the worst weeks I’ve experienced.
While I was in college, I can assure you that I never, ever thought about the concept of infertility. I naively thought that one day, I’d just get pregnant naturally, and poof! I’d have a baby!! Well, fast forward 16 years later, and here we are, trying to conceive with nothing to show for, not to mention annoying relatives and family friends who keep asking when they can expect us to have a baby. My mom actually said to me that if I “waited too long, your baby will have ‘problems.'” Thanks, Mom.
Unfortunately, you can’t just say something like, “We’ve been having tons of sex every day! You’ll know eventually!” because that would be rude… but hey, isn’t it rude for them to constantly ask and plant hints every chance they get?
So when I got addicted to watching Sex and the City, Charlotte York (eventually Goldenblatt’s) fertility journey was completely new territory to me. She struggled to conceive with two different partners, and after many tests, they discovered that she had some condition where her cervical fluid attacks sperm instead of fostering it along to merge with her eggs, and that she had less than a 10% chance of ever conceiving.
While it was heart wrenching to watch this and see her mental health go through a complete downward spiral, and while many of her moments have been relatable as I go through my own road of reproductive challenges, I will say that at times, she probably was a little too extreme in the way she was with her loved ones. To tell Miranda “How could you do this to me?” seemed pretty extreme, when Miranda accidentally got pregnant after having sex just once with Steve. One person’s pregnancy or success (and it definitely was NOT perceived as happy news to Miranda at that time) is not at the expense of another person’s; all our journeys are completely unrelated to each other. There’s also just the fact that we need to better compartmentalize our feelings and struggles from that of others.
Also, I will say that given the few times when she was with Trey and they showed the injections that were done during their IVF cycle, it was completely inaccurate to show butt shots. Butt shots are progesterone in oil injections that are done to prepare the lining of your uterus to receive and fingers crossed, successfully implant an embryo. That is WAY after stimulation cycle and egg retrieval. If they were at the beginning of their IVF stimulation cycle, the only injections needed (haha, “the only”) would be subcutaneously in the stomach region.
Because if they really had gone through egg retrieval and fertilization and were preparing for an embryo transfer… my next question, given that they eventually separated and divorced, would be… what happened to those potentially surviving embryos….?!
After your egg retrieval, depending on the clinic you are working with, you will receive updates the day after egg retrieval. The day after egg retrieval is considered Day 1, about 24 hours after the eggs and sperm have been examined, and after they have, fingers crossed, done their dance with each other and fertilized. So, Day 1 update is also called “Day 1: Fertilization Update.” Some labs will call you. Others will email. Some may do some combination of both of the above. My lab sends a secure email message, likely because they probably cannot deal with an emotional, hysterical post-oocyte retrieval woman hearing what could potentially be bad news and then balling her eyes out.
Day 3 Update is next: that is considered “Day 3: Embryo Update.” Three days later, these fertilized… things will become actual embryos. The development here matters because if they are not multiplying into at least 6+ cells by day 3, they are very unlikely to survive to become blastocysts, which is the stage they need to reach by day 5 or 6 in order to be potentially successful candidates for implantation.
It’s Day 3, and I already feel like it will be a miracle if we even have one single embryo that reaches blastocyst. On Day 1, we were told that of the 12 eggs retrieved, three were far too infant (read: JUST DEVELOPING!) to be fertilized; these were discarded immediately. Of the remaining nine, only 5 were mature oocytes that fertilized normally. Four were one level below mature (so …. immature), but they fertilized anyway. Two of these fertilized normally, while two fertilized abnormally. They warned us that immature oocytes were highly unlikely to progress through the stages, but they would still keep them in culture to see how they’d progress.
My takeaway from the above Day 1 update: I took nearly three weeks of daily injections and that only yielded FIVE MATURE EGGS???????
Why didn’t my RE just have me continue with the daily injections and push the retrieval out by a few more days to allow those immature oocytes to… MATURE MORE?
THOSE FIVE MATURE EGGS NEED TO HOLD DOWN THE FORT FOR US ALL!
Day 3 update: only three have progressed well with 6-7+ cells. That is three out of a total of nine embryos. And I believe I read that only about 20-30% of all embryos make it to Day 5/6, or blastocyst.
I feel defeated and like my body has completely failed me. And maybe, I have committed great sins at some point in this life to deserve this type of mental and emotional torture.
In full honesty, the stimulation period of daily injections, of nearly every other day doctor’s visits, was the calm of this whole period in my mind. I managed it well, and so did my body given my lack of side effects. It was the easiest part to endure because all I had to do was do exactly what I was told at the times I had to do it. I was completely focused during my daily meditations. I was focused at work. I was able to compartmentalize everything. I was so full of hope every single day during that period that this would work out for us.
But this period of receiving the updates of what seems like my dwindling chances of becoming a mother every other day — this is the most brutal and excruciating. In some ways, I wished they just would forgo the day 1 and 3 updates and just provide a final update on day 5/6 of how many made it to the blastocyst stage, just to spare me of the anguish of this every-other-day waiting game.
Two days ago, I had my egg retrieval.
Well, that’s not really a sentence I ever thought I’d ever write.
After the nurses walked me out of the operating room, I was led into a recovery room where, unlike the operating room, it is a shared space. There are about four beds for patients who will eventually be recovering from their own procedures, and you are separated from the rest of them by a curtain. After the procedure, I was predictably groggy and sleepy from the IV sedation. I could feel mild cramping and bloating from the procedure (as is considered normal), and the nurse immediately gave me two Tylenol and water before allowing me to sleep and gain back energy to go back home. Chris would be in the waiting room downstairs, waiting for me to wake up and be discharged.
The RE came over and tapped on my foot to get my attention. He provided the update that they retrieved 12 eggs, but we wouldn’t know until the following day how many of them would be mature (immature eggs are highly unlikely to fertilize and reach blastocyst stage, meaning they have extremely low chances of “sticking” after an embryo transfer). That number sounded higher than what the sonographer had estimated with me a few days ago during my last ultrasound, so I felt pretty decent about it and thanked him as he left.
What was the most disturbing thing that happened was what I overheard next to me about ten minutes later. A woman whose procedure had also completed was distraught. A nurse came over to say to her in a lowered voice that she was so sorry about what happened, but the doctor and embryologist would examine the results in more detail to better understand. From what I could hear through the curtain, her egg retrieval… resulted in zero eggs retrieved. While the aspirating needles were able to remove liquid from her follicles, there hadn’t been adequate “cellular development” resulting in eggs.
I was only half conscious listening to this, but I could already feel myself getting choked up. Why and how could this have happened to her, this poor woman? Like me, she had to go through countless injections, endless ultrasounds and bloodwork, too many doctor’s appointments nearly 3-4 times every week for 2-3 weeks…. all to retrieve zero eggs? I felt so horrible for her, and I don’t even know who this person was, nor was I able to see her face.
A woman’s fertility journey can be an extreme life struggle. And when defeats like this happen, it really does feel like your body has failed you… and that part of you is just broken.
In the couple of nights leading up to the egg retrieval day, I kept waking up multiple times in the middle of the night. It was likely my subconscious expressing anxiety over the big event that it knew would eventually happen. The last time I had this happen to me, when I would wake up without much explanation or needing to pee, was nearly eight years ago now, when Ed passed away unexpectedly. That continued for about a week or two after I knew he was gone.
The night before our wedding in March 2016, I dreamt of him. Today, I cannot remember what I dreamt, but I do remember seeing him in my dreams. It was as though he wanted to be there with me in my most significant life moments. I woke up feeling miserable that morning and was crying.
This past Friday night, the night before egg retrieval, I saw Ed again. He hasn’t appeared in my dreams in quite a while. He came to my apartment, ready to take me to my egg retrieval. We walked east towards the clinic early Saturday morning, and he dropped me off in front of the office building where the clinic is. I don’t remember any real conversation or words exchanged. All I remember is that he looked at me, smiled, and gave me a big hug before I walked in.
When I woke up yesterday morning from this dream, I thought of this as a sign. Maybe this dream is a sign that he knows this is happening, and he’s been looking down at me this whole time, sending his hopes and prayers that this all works out for us. Maybe his appearance is a sign that all of this anxiety and frustration and anger and sadness and turmoil will actually have a happy ending. Maybe he’s trying to give me the head’s up that we will finally experience some success.
I can only hope that will be the case.
Today was the day when I got sedated, had eggs sucked out of my developing follicles, and got told how many eggs my body had produced during the stimulation period. It was kind of a weird day in that all these experiences were new, and it was on the one hand a little exciting, and on the other hand, completely and utterly terrifying.
After signing some forms and undressing, I was given a pink gown to wear. I had to confirm my identity a few times, was given a bracelet with ID/procedure name, and led into a waiting room to wait for the doctor to greet me briefly before the procedure. The doctor, whose official title is reproductive endocrinologist (RE) and who would perform the procedure, came out. He’s actually new to this practice as the third RE onsite. Meeting him was pretty boring and useless. He cited a few stats that did not help me or make me feel better (it’s not really the doctor’s job to make you feel better, but it IS the doctor’s job to have some damn empathy), gave me some generic pieces of advice that I could have Googled (and DID Google prior to the day). My own RE, who I have met fewer times than I can count on one hand despite coming to this clinic dozens and dozens of times, “does not work on the weekends,” the nurse let me know a few days before. Well, how glorious for him. Gotta love the empathy here. As you can tell, we have a tight connection.
Then, I got led by a nurse into the operating room, which has one tiny window that appeared to look into a laboratory. I was set up on a chair to lie down, and the nurse strapped my legs and feet on. Everyone was masked (duh), and through the tiny window peering into the lab, I could see multiple people in lab coats, one of whom was looking right at me. The man introduced himself to me as my embryologist, who would be working with me. He asked me to confirm my name, date of birth, my partner’s name and date of birth, and to confirm verbally what procedure I was there for today. Then, the anesthesiologist stuck an IV into a vein in my arm, and when the RE came in, closed the door, and confirmed that we were ready to begin, the anesthesiologist let me know he would activate the IV, and I’d immediately feel a metallic taste in my mouth and within 10 seconds, fall asleep.
“You should taste it now,” the anesthesiologist said.
Yep, I did. “Whoa, I can definitely taste it,” were the last words out of my mouth before I passed out. They worked on me for about 30 minutes. During the time when I was asleep, this is basically what happened:
The RE, guided by an ultrasound, sticks a long needle through my vaginal wall into one ovary and then the other. As he views each follicle on the ultrasound screen (from what I could see before I passed out, there were three large screens they were all viewing), he sticks the needle, which has an aspirator at its tip, into each follicle, sucking out the liquid inside, which hopefully will have an egg in it. He removes the needle after sucking out liquid for each follicle, and then each follicle gets one tiny vial. The RE hands this over to the nurse, who then walks the vial over to that tiny window where the embryologist is sitting and waiting. The embryologist takes the test tube, and using a high powered microscope, examines the contents of the vial to confirm whether there’s an oocyte. He says “confirm” if there is an oocyte/egg. If nothing, he says “none,” or something similar, and they continue the process until the RE extracts liquid from every visible follicle. This is why and how, before you leave for the day, the RE will tell you how many eggs were retrieved. Whether they were mature or not will not be shared until the next day, when you get your fertilization update. As you can probably guess, the more follicles you have, the longer this procedure will take. Once this is done, the IV is removed, and within seconds, I regain consciousness, and two nurses tap me lightly to wake me up, unstrap me and help me out of the chair, and guide me into the recovery room, where I continue to sleep and rest until I’m deemed okay for going home. That takes anywhere from 30 minutes to over an hour.
And during this time, when I’m in my deep sleep, my partner is in a tiny, sterile room, masturbating to provide his “sample” into a small, sterile cup that we hope will then be used to fertilize my oocytes. What a truly memorable day it was.
Today, I had the day off because my company gave us a Wellness Day today. And even better news is that I have the day off on Monday, as well, for Martin Luther King, Jr., Day, so all in all, this weekend will be a four-day weekend, with tomorrow’s procedure and my birthday on Sunday. And on my day off, what did I do? I went down to Chinatown to stock up on ingredients, produce, and baked goods, and also get the apartment ready for my bedrest day tomorrow post procedure. I cleaned the bathroom (because honestly, Chris’s bathroom cleaning methods are just never up to par) even though I’ve read that most women don’t do any housework before the procedure and instead rest until the day of for their entire period of stimulations. I even made Instant Pot chicken pho because I read that some women cannot eat solids after the procedure, so they subsist on soup and light foods for up to a week after the procedure. I even prepped a bunch of vegetables to make sure we had greens to eat for at least 4-5 days after. I think we’re all ready.
I’ve been relatively calm during this period of “stims” as they call it. I’ve been fairly positive and optimistic. All my appointments seemed to go well. I’ve been consistent with my daily meditations and exercise, although the exercise, as advised, as gotten lighter as we’ve gotten closer to retrieval day. I’m lucky in that I have not had any bad side effects from the medications. Common side effects include nausea, vomiting, headaches, migraines, stomach protrusion/swelling, and especially mood swings. Many women have reported crying frequently or having excessive arguments or tantrums with family/friends/their partners, including friends who have gone through this. I’ve encountered none of these symptoms. The worst symptoms I’ve had, which I cannot complain about at all, are slight soreness at the site of injection immediately afterwards, plus some slight bruising. I feel decent. I think I will be okay. I can do this. I’m going to do this.
I’m ready for tomorrow morning.
I don’t really know why, but despite the thousands of years that human beings have been in existence, there seems to have been so little progress made specifically in understanding fertility from both the man’s side and the woman’s. For a long time in society, people only expected to live until their thirties, and then, well, they’d die. Therefore, their prime time to have a child was in their teens. In modern day society, even in more conservative societies, teens giving birth is… no longer really a thing. The earliest you tend to hear of people giving birth is in their early 20s. But when you live in western society where the goal is for men and women to at minimum finish high school, perhaps college or even graduate school, the age to have a first child gets pushed off further and further. I think a few years ago, I read a stat that said that in Silicon Valley, the average woman has her first child at age 37. Wow.
I guess what I am struggling the most with is… why would a process like IVF pretty much be exactly the same today as it was in the 90s and early 2000s, when Michelle Obama conceived both her daughters via this process? That means 20-30 years have passed, and the process is exactly the same. Why is it like this? Have people just stopped prioritizing research on infertility/subfertility… because of the fact that the main onus is on the woman, with endless hormonal injections, transvaginal ultrasounds, and bloodwork, not to mention surgery at the end, plus progesterone supplementation via butt shots, vaginal suppositories, and oral pills? Men don’t have to be inconvenienced (well, financially, but not physically or emotionally) as much as woman do, so let’s just stop research on this…?
The scariest thing to me about all of the lack of progress in this area is not even the above, but rather the complete inability to evaluate oocyte (egg) quality until after an egg retrieval. Science has long made it possible to evaluate sperm count, motility, and morphology (and thus overall sperm quality), a woman’s estrogen, luteinizing hormone, AMH (ovarian reserve) level… but NOT the actual quality of the eggs. Why is this? …You just have to go through a $15-20K IVF procedure to then find out that your egg quality just sucks? Then, what are you supposed to do with this information — Go home and cry your eyes out?
I was researching the interactions of eggs and sperm earlier today, and read a likely bullshit but nevertheless devastating article that puts even more pressure on women (because, as you can tell, ALL the pressure is on women when there are fertility problems, and even without fertility problems, women have the sole responsibility of carrying a baby to full term!): some random study was done that was trying to evaluate how male factor infertility can be solved for during IVF via “healthy eggs.” The study somehow came to the conclusion that if you have a very healthy, high quality egg, and you inject it with a single sub-par sperm (that’s the ICSI process, minus the sub par status), the healthy egg will be able to “heal” the subpar sperm and develop into a healthy embryo that would be ripe for future implantation.
I read this and immediately closed out the tab. You’ve got to be ****ing kidding me, I thought. The woman even has the responsibility of having healthier eggs than her partner’s sperm and has to HEAL ITS DEFICIENCIES….??!!
Well, if that’s the case, why don’t we all just kill ourselves now and be done with it because we, as women, will always have to do all the work in society, and then some, just to make up for men’s laziness, idiocies, and complete deficiencies. This is just a great analogy.
So after endless doctor visits for bloodwork and ultrasounds, and nearly three weeks of self-administered injections, I finally get told today that the doctor thinks I’m ready for the procedure to extract my eggs this Saturday. This is called, in doctor speak, oocyte retrieval, or in everyday speak, egg retrieval. The nurse calls me today to ask me if I’d just like local anesthesia or IV sedation. In my head, I’m thinking they serve pretty much the same purpose. Well, guess what? I’m wrong since I know very little about this stuff.
The nurse explains that the local anesthesia would be an injection in my vagina (!!!!!). This would numb the area, but because the procedure goes so quickly, the actual numbness would not go into effect until about 10-15 minutes in, and this procedure, depending on how many oocytes there are, is only between 20-30 minutes. So in other words, I’d actually feel the doctor sticking aspirating needles into EACH of my follicles. Ummmmmm, NO.
The second option is IV sedation. This is when an anesthesiologist would stick an IV into my arm, and when the doctor was ready to begin, he’d have the IV activated, I’d initially taste a bit of metallic in my mouth, and within ten seconds, I’d be sleeping. So I’d have no recollection or feeling of anything that happened during this procedure.
This is a very easy decision to make. I absolutely want IV sedation!
But get this: the nurse explains the reason they have to ask this is that because most women who go through this procedure have zero insurance coverage, so having IV sedation would be yet another line item on your bill. I confirmed with her that my insurance does cover these benefits, and when I gave her the name of the provider, she then said, “Oh, then they will definitely cover IV sedation then!” (And because I’m paranoid, I contacted the insurance provider to confirm in writing that they’d cover this).
This really doesn’t have to be this complicated. But because we’re in the U.S. navigating healthcare, it has to be this insane.
I always marvel at how and why Americans and Canadians seem to think they speak proper English, or “English without an accent.” First of all, in case anyone needs a history lesson…. English, surprise surprise, comes from… ENGLAND. And second of all, American accented English still has an accent, as does Canadian accented English (let’s stay away from the regional accents for this conversation). We ALL have accents. It’s just that some may be easier or harder for you to understand given your own accent.
I was sitting on a Zoom 1:1 call with one of my Canadian colleagues, who I’ve gotten along with quite well. He’s a White male and is stereotypically Canadian in his accents (his “abouts” sound just as you’d imagine) and his politeness/friendliness. And out of nowhere, he started venting to me about how a new colleague on my team started, and he cannot believe my boss made the decision to assign her to one of his large accounts. “I mean, she’s new and she barely speaks English!” he complained to me. “Her written English is fine, but it’s so, so difficult to understand what she is saying during calls. Customers barely understand her. You know I’m a nice guy, but this is just ridiculous. You and Sabrina have been great at your jobs; you are so eloquent, you present so well. I need someone like you on this account.”
What he really means when he says “someone like you” is someone who speaks English with a Canadian/British/American accent. What he really means to say is that he doesn’t like the new colleague on my team, who was born and raised in Mexico up until she was 13 and who speaks English with a Mexican accent. What he means is that unless you speak Canadian/British/American accented English, your English is unacceptable and you “barely” even speak the English language. What he means to say is that he’s unaccepting of people who come from non-Western cultures who learn to speak English as a second language with the accent of whatever their first learned language was, and that if you speak with said accent that you no longer sound professional in front of enterprise customers who are spending a large sum of money with our company.
What I would like to know is: if HE were to speak another language, what accent would HE have, and how accepted would HE be by said country’s people? The complete lack of empathy for those who learn English as a second language infuriates me all the time, especially when I know English is the only language I am fully literate and fluent in. I really feel for those who learn English as second language because there is really nothing consistent or constant about it (no four tones like in Mandarin Chinese; not everything rhymes with a/i/u/e/o/n like in Japanese), and there are so many slangs and colloquialisms that even if you have studied English for 20+ years, you still won’t know it all.