In the recovery room after egg retrieval

Posted on by
Reply

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.

When someone appears when you need him the most

Posted on by
Reply

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.

Oocyte retrieval day

Posted on by
Reply

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.

Preparing the house before the procedure

Posted on by
Reply

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.

Fertility evaluations

Posted on by
Reply

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.

IV sedation or local anesthesia?

Posted on by
Reply

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.

“Barely speaks English”

Posted on by
Reply

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.

Fertility medication in the US

Posted on by
Reply

So as I’ve been reading about fertility treatments and medication and also undergoing some of these myself, I was curious to understand… what the heck are you supposed to do with your meds if you do not need all of them? Are you supposed to donate them, give them to your clinic for patients who cannot easily afford… sell them on a black market….?! For your FYI in case you have never learned anything about American healthcare or infertility…. but this is actually a BUSINESS. Insurance companies, hospitals, doctors are profiting off of your diseases, every 15-min appointment, your inability to conceive naturally. Once you’ve been trying to conceive for over a year and have failed, you’re basically deemed “infertile” regardless of your age, and the ‘ka-ching!’ goes off at every single nearby fertility clinic around you. Billions of dollars are spent on healthcare here in the US every single year with pretty terrible outcomes, and I’m sure millions and millions are spent on allowing families to expand. For a basic IVF medication package, assuming you have zero coverage through your health insurance, the approximate sticker price for one IVF stimulation cycle is $8,900 USD. This number is assuming you don’t require extra meds because your follicles take longer on average to mature. If that number is not terrifying and absolutely absurd to you, you need to leave right now and stop reading this post because frankly, you are out of your mind, and I want nothing to do with you.

So I did look up what you’re supposed to do if you have leftover meds (and, inevitably, you WILL have leftover medications). It is illegal (yes, illegal) to give your meds to someone whose name is NOT on the prescription. It is illegal to try to sell these drugs to a friend or via Craiglist or some black market. It is illegal for pretty much anyone else to use your drugs that is not you. When I think about that, I realize… wow, this system is so unbelievably fucked up. You spend tens of thousands of dollars on trying to conceive, and you cannot even legally give your drugs to someone else who may be in financial need (or need, because some of these drugs have actually had a shortage, or try to recoup some of the insane dollars that were spent on this entire effort? And when someone else may run out of their drugs, be given last minute notice by their doctor that they need to continue medication for a drug they no longer have enough of that has also run OUT at their local pharmacy, they’re technically breaking the LAW if they accept it from someone who wants to give it to them nearby?????

The only people winning in these situations… are the doctors, the clinics, and the health insurance providers. It’s such a sad and infuriating process.

Self administering injections

Posted on by
Reply

Before starting fertility treatment, the idea of injecting myself with a needle was completely horrifying. I can barely look at the nurse when I have to get blood drawn at annual physicals or during gynecologist appointments. I’ve always turned away when they insert the needle into my vein and only look down when the needle has been taken out. Once I realized I was actually going to go through this journey, I realized I had to suck it up and deal with it. You have it so good, I thought to myself. I am a relatively young, healthy woman with no known illnesses, diseases, or conditions that would make me a bad candidate for this. I have generous health insurance coverage that actually covers the vast majority of these costs (and sadly, am also painfully cognizant of how few people have this luxury. I’ve read in many fertility support groups that some women, even those in the medical professions, have such poor coverage that they have taken up a part-time job at Starbucks once or twice a week *just* to get fertility coverage). I have a good AMH level (that’s the test that determines whether you have diminished ovarian reserve or not. In plain speak, that means I have a good quantity of eggs remaining in my ovaries). I also have normal hormone levels across the board. I should feel lucky, I told myself. So if the worst thing I have to do is self-administer injections, I got this! So many other women do this with zero medical background, so if they can do it, so can I, right?

I watched the videos for each medication at least 5 times. I read through the illustrated instructions a few times, also going through all the potential side effects I could experience so that I was well aware of what I could feel or experience. I mentally prepared myself for this. And oddly enough, it really wasn’t so bad. The first time, the second time, the 10th time… it all became relatively normal after the first prick. Occasionally I’d bruise a little. But this was all nowhere as awful as I imagined in my head. And lucky for me (again, I am counting my blessings here), the worst side effect I’ve felt was a little bruising as well as some tiny bloating post injection.

I’d read of some pretty awful side effects, from intense nausea, massive bloating, constant headaches, vomiting, and noticeable mood swings. I was really preparing myself for the worst. A few people who posted in groups I am in said they were crying nearly every single day during their shots. Some people truly had the worst experiences of their life using these medications. I was also concerned about medication mixing, but these pharmaceutical companies have dummy proofed these pretty well to the point that pretty much anyone could self-administer these shots after reading through the instructions. They have so many checks in place to make sure you DO NOT overdose and that you do NOT mess up.

When I called with a question for a nurse on one of the injection pens and she gave me the answer, I exclaimed immediately, “Wow! These things are incredible! They really are mistake-proofed, aren’t they?!” She laughed in response. “Well, that’s the first time I’ve ever heard anyone say that about these meds, but I’m happy you feel that way!”

This isn’t so awful, I kept telling myself. This isn’t so awful. I can do this. I’m getting through this, and I’m nearly done. And this will all be worth it in the end. I just need to keep meditating, keep calm, and keep positive thoughts. I’m going to get through this, and I’m going to have the successful outcome I want. I have the grit to get through this. I am mentally and physically tough enough for this.

Pleaaaaase. Please, be true.

When things do not work out the way you hope they will

Posted on by
Reply

I really do not think any woman ever looks at their life path, at any point of their life, and thinks, “Yay! One day, I’m gonna do fertility treatments/IUI/IVF! I CAN’T WAIT!” It’s not a decision that any woman would make with a light heart, and it’s one that requires a massive emotional, mental, and in almost all cases, some financial burden and stress. Unfortunately, I’m currently in that boat right now, and it… is disheartening, to say the very least.

Over the years, I’ve met and am friends with many women who have had many types of fertility treatments, whether it was surgeries with their Fallopian tubes or uterus, IUI, IVF, and everything in between. I follow bloggers who openly talk about their fertility struggles and journeys. I also have a good friend who recently went through IVF and gave birth via the IVF process. But I guess what I never really thought much about before I was actually in this situation was how lonely it can feel. You have to go to all these appointments on your own. You have to keep track of schedules and medications and insurance and pharmacies. You have to do all these things all by yourself even when multiple doctors have told you after many (costly) tests that nothing is “wrong” with you, and that you’re in “optimal health.” In their eyes, I am “young and healthy.” It is infuriating, lonely, terrifying, and deeply unnerving.

I’m not really the kind of person who gets jealous easily. When I see other women with babies or hear of other people getting pregnant, I don’t really feel anything. For my own friends and colleagues, I am genuinely happy for them because I logically know that their situation has zero to do with mine. Everyone should have all the happiness in their life that they deserve. But what bothers me is when I try to share my own experiences with some close friends, particularly ones who have gone through their own fertility struggles, with the hope of seeking empathy and support, and instead, I am turned away, reminded of my privileges from a health insurance standpoint or that I “am so lucky” to be in the situation that I am in now.

I told this to one of my friends recently who gave birth last year to her first and only child, and she said to me, “Geez, Yvonne, this isn’t the privilege Olympics. You’re allowed to be scared and confused and upset and stressed.” For some people, she said, it doesn’t matter how much hardship they go through, even if it’s the same kind of hardship you are currently going through, but they just “lack an empathy chip.”

Joining infertility support groups was supposed to help, but that, while it has given me some more insight into issues like side effects and emotions, has also possibly increased the level of worry because a lot of the people posting have “worst case scenarios” that I do not necessarily want to be bombarded by. I am aware of all these worst case scenarios, as nothing in life is guaranteed, but I do not want to read these stories over and over in my feed because then, on some subconscious level, I may think that may end up happening to ME.

It’s unfair and infuriating to me that women and women alone have to go through this burden, that the most men will never have to do in this journey, even when male factor fertility is the supposed cause, is masturbate into a cup and make sure their semen sample doesn’t miss the cup. The world of infertility is only a further reminder to me how much more women have to bear the brunt of in this sexist world, and how we will continue to do so until there actually is some real, tangible change in society… and SCIENCE.