After estrogen pills, patches, trental, vitamin E and baby aspirin failed to increase my lining enough and I never got a trilaminar line in my uterus, my doctor switched me to Gonal-F injections. It’s typically used in egg retrieval cycles (and I was on it when we did my egg retrieval a few years ago) and we were hoping that it would stimulate my uterine lining more than estrogen did.

Gonal F Protocol

I had bloodwork and an ultrasound on April 3 and then started Gonal-F injections that night, 75 mL once a day. After a few days, I went in for bloodwork on April 6. And there was basically no change, so we bumped up to 112.5 mL. Same thing after a few days – more bloodwork and more measurements and no change. My estrogen had gone up a little but not enough (from 18 to 32) and my lining was still only measuring at 3.7mm. At this appointment, I asked the nurse what we’d do if Gonal didn’t work. She said that PRP injections can increase lining thickness, but to not get too far ahead of myself. Then I left that appointment with instructions to bump up my Gonal dose to 150 mL nightly.

I also shared at that appointment that I was having mood problems since I had started Gonal.

I struggled with postpartum anxiety and depression with suicidal thoughts after I had Thomas. But I hadn’t had issues with that since I got on medication. However, the same dark thoughts came back within a week of being on Gonal-F. I was also crying a lot, which is not my normal. The nurse said that Gonal can cause these problems for those who already have a history with PPDA and that we’d monitor things closely.

On April 10, my lining had gone up to 4.8mm and my estrogen levels had increased (as well as the size of the one follicle I had) but when the doctor was reviewing the results, he instructed the nurse to have me stop Gonal and that we’d do PRP injections next. He said we simply weren’t getting the response we needed (we need to get to at LEAST 8mm), given the high dose I was on. Unless we did something else for my mood (like adjusting my anxiety meds or something), I was nervous to stay on it for much longer. Additionally, the medication is significantly more expensive than estrogen. A 450 mL vial of Gonal-F was around $500. And I was going through a vial every 3 days vs. the $75 monthly cost of estrogen.

So on April 11, I stopped gonal injections and went back to estradiol to prepare for a PRP procedure.

What I found frustrating at this point was that the nurse coordinator called me to schedule PRP but no one had explained anything about it to me other than the brief mention by the nurse. The only way I knew what PRP even stood for was because I’d considered it for a torn ankle tendon a few years ago, when I was struggling with a running injury that wouldn’t heal.

They didn’t explain the procedure, the goal, the recovery, anything. They simply tried to schedule it.

When I asked questions, the coordinator couldn’t answer my questions because “we don’t do it that often, so I’m not sure” and had to go ask the doctor. I asked if I could just schedule an appointment with my doctor to discuss the plan for my care and was told no. They won’t let me schedule an appointment with him. She said I can call his cell phone after hours or do a telehealth visit if I insisted on seeing him.

I’m honestly so baffled by this. I met with the doctor multiple times when we did the egg retrieval a few years ago (which was only a two month process) and now I can’t see him, even after being in their care — without the results we need — for four months. The only thing I can figure out is that the practice size has grown so much between now and then. And he prioritizes time on procedures. I don’t know if I should be understanding or if I am right to be frustrated. I suppose I’ll call his cell phone. But I’d much rather be able to sit down with the doctor and my husband and talk through all my questions and concerns.

It’s enough to make me want to switch practices. But they have one of the highest success rates in the country. And I had a horrible experience with the other fertility clinic in town (Baptist/Atrium) when we were learned about my ovarian failure four years ago.

Endometrial PRP

However, I do have PRP scheduled for next week. PRP stands for platelet-rich plasma and in short, they’ll draw my blood, spin it to separate the plasma out and inject it into my uterine lining. Plasma is high in growth factors, so that’s why it is used to help with lining thickness. Then, we’d hopefully get the thickness we need and a frozen embryo transfer would happen 6-8 weeks later. However, it’s a relatively new procedure for fertility treatment. And I’m curious why we haven’t first tried other protocols that I’ve read about. Perhaps I’m not a candidate for them. But I want to understand why PRP is what my doctor chose as the next step.

Is my case so unusually difficult that he wants to do PRP? Why is it uncommon at their practice, so much that the IVF coordinator didn’t know much about it? I have more questions than answers. And not understanding the recommendations makes it hard for me to trust the plan. And trusting my doctor and the plan is crucially important.

The Personal Stuff

An additional layer that I was trying to figure out was when to go home to see my family in Utah. I had postponed the trip for months because of fertility treatments. I was planning to take the month of May off to visit. But then the PRP threw a new kink into things since the timing is different from what we’d been doing before. So, where I’ve landed is that I’ll do PRP and then go to Utah in the next 4 weeks afterwards. Once the PRP is done, we just let things “brew” as the IVF coordinator relayed to me. And I don’t have to go in for bloodwork and ultrasounds in those 4 weeks. Then, once I get back from Utah, I’ll resume my twice-weekly appointments at the clinic.

The upside of all this is since I went back on estradiol only, my mood has stabilized.

I feel good, although tired like I was in month 1. I’m also having problems sleeping again, but both of those things are manageable. And yes, I did get to go to the Masters so at least fertility stuff didn’t prevent that.

—

Note: Like I’ve shared in my previous posts on the topic, I’m not a doctor and I’m not in the medical field so I may get little details wrong and everyone’s experience will be different since the treatment and protocols are unique to each situation. There is no one size fits all. So don’t take any of this as medical advice or as an indication that your process will be exactly the same.

Also, if you decide to leave a comment, please be kind. This is a hard, sensitive time for Tommy and me but I truly do hope that sharing our experience can help others. I’ve received a number of messages on Instagram telling me that it has helped others feel less alone. And hearing from YOU has also made me feel less alone. So thank you for sharing your struggles with me as well.

The post Month 3 of Fertility Treatments: Gonal F Protocol appeared first on TeriLyn Adams.

Yesterday was a tough day. We were hoping this was our final week before we did an embryo transfer next week and when we went in for our final appointment before the BIG appointment, my uterine lining had lost all the thickness we were working to build. I was stunned and devastated. Our mock cycle had gone well (which I blogged about here) and everything in this “real” cycle was going well… until it wasn’t. My body just stopped responding to the medication.

I had shared an update on our Frozen Embryo Transfer process in this blog post and I was thinking that I would just update it along the way. But, the post was already getting too long and too hard to follow with “Updates” added, so I decided that writing a monthly update would be easier.

And the fact that I thought I could just update one post is indicative of something I underestimated… how hard the FET process would be. I thought the hard part — the egg retrieval — was done and I had no idea that I’d feel so awful on the FET medications and that it’d be just as hard and heartbreaking in the process leading up to even using the embryo. I know a miscarriage would be devastating (thankfully, I’ve never experienced that) and I know the risks of miscarriage are higher with an FET. But I didn’t realize that it’d be so hard before we even get to transfer day.

Again, my goal with sharing all this is to help others going through it not feel so alone.

It can feel so isolating (especially because so many women don’t talk about it) and I want others to know that they aren’t alone. The emotions are hard to explain until you’ve been through them and the highs and lows are so real.

I’ve said it before, and I’ll share it again, I am not a doctor and I’m not in the medical field so I might get little details wrong and everyone’s experience will be a little different since the treatment and protocols are personalized based on each situation. Plus, I’m going off memory of what the doctors tell me, so don’t take any of this as medical advice or as an indication that your process will be exactly the same. I go to a clinic in Winston-Salem, Carolinas Fertility Institute (CFI) and I’ve been extremely happy with them, both this go-around and during my egg retrieval cycle a few years ago.

Also, if you decide to leave a comment, please be kind. This is a hard, sensitive time for Tommy and me but I truly do hope that sharing our experience can help others.

Frozen Embryo Transfer, Month 2

So, where I left off last month was that we were in the middle of progesterone in oil (PIO) shots. The shots were uncomfortable and a little painful as the medication being pushed in. I don’t know exactly how to describe it except a lot of pressure and a dull ache. Then as the day went on, my butt was so incredibly tender. Some evenings I could barely sit on the couch. It was no picnic for Tommy either. I know he hates giving me shots and seeing that it’s uncomfortable for me and that I’m nauseous, dizzy and tired from all the estrogen.

ERA Biopsy in Month 1

After 5 days (I think), I stopped the PIO shots and went in for the ERA biopsy (explained here). Aside from the procedure itself, it was a weird experience… I checked in for my appointment and paid my balance (we don’t have insurance coverage for fertility treatments so everything is out of pocket). Then, I had my blood drawn and was moved to an exam room.

Before they did the biopsy, they brought me more paperwork and asked for my credit card while I was in the exam room after I’d already stripped down and was under the sheet. It was just super odd. The billing goes out to a third-party lab who analyzes the biopsy but I’m not really sure why they had me give my credit card at that particular point vs. taking my credit card information at the front desk like they’ve always done. I’m also not sure why it felt so weird but it did…like it took a medical procedure and made it feel like an odd hidden transaction.

Anyway, weird billing experience aside, I’d read and heard horror stories about how painful the ERA biopsy is but I honestly barely felt it. I had taken 800 mg of ibuprofen before my appointment, so I’m sure that helped. But I’d done that for my initial biopsy which was still excruciating so who knows. Bodies are weird. But, if you have an ERA biopsy on your horizon, I hope it’s as painless as mine was.

Frozen Embryo Transfer, Month 2… we didn’t get to transfer day

After the ERA biopsy in the first month’s cycle, I started an antibiotic and stopped all the other medications. I waited for my period to start and then, once it did, I called CFI and restarted the same medications on Day 2 of my cycle. I was on estradiol pills, estrogen patches, Trental for blood flow, Vitamin E and baby aspirin which both help with uterine thickness. Then I went in about a week later to get more bloodwork and have my uterine lining measured and everything was on track. The lining was almost at 7mm and blood flow was looking great.

However, while I was at that appointment they told me that they didn’t have my ERA biopsy results (which should have been back days before) and asked if I had paid for the test. Um, yes, I did. In front of you. I confirmed my credit card had been charged and they called the lab back and the lab apparently couldn’t find my biopsy, which was super frustrating since we’d have to start all over if we didn’t have those results. Thankfully, a few days later, CFI called and said the lab had my results and that everything with my ERA biopsy was perfect. The good bacteria we needed was there. I had no bad bacteria. And my uterine lining was “receptive” so the timing was good for implantation.

Given the ERA results and the previous uretine lining measurement, we tentatively scheduled my frozen embryo transfer for March 13.

I went back in for one final check yesterday, March 8, to ensure my bloodwork looked okay and that my lining had increased to at least 8mm. (Research shows that optimal thickness is between 8.7 – 14.5 from everything I’ve read so that’s why my doctor wanted to get me to at least 8.) However, as the nurse was measuring, I could see on the screen that while she was measuring, it was showing around 4.5. She asked me the highest number we’d gotten to and I told her 7mm the previous week. I asked her if I was really seeing 4.5mm as the lining thickness and she said yes. My heart sank.

I asked her if I had done something wrong with the medications or if there was something I shouldn’t be doing (running? coffee?) and she assured me it was nothing I did. She didn’t know why it didn’t work, but it didn’t. She said she wanted to talk to Dr. Yalcinkaya before we decided next steps so I got dressed and went into the “round table room.” If you’ve been a patient at CFI, you know this room well. I was still a little stunned as I sat there and when she came in and told me that we needed to try again and couldn’t transfer on Monday (which I’d already surmised), I started to cry. I was so excited going into the appointment since it was the last check-in before transfer and everything had been looking so good. So I was stunned that it all turned so quickly.

Thankfully, Dr. Yalcinkaya was able to come in and explain what he wanted to do next.

(He’s so often in procedures that it’s rare to meet with him and instead he communicates through nurses.) He suggested that rather than trying the same thing again — since I never got past 7mm in month 1 or month 2 — that we try a new medication and a different approach. My uterine lining obviously wasn’t responding enough to the medication, even with extra time, and instead started doing the opposite of what we needed – losing thickness.

Our new plan – Month 3

So, I left the office with a new plan. I’m stopping all medications — no more estrogen pills, estrogen patches, trental, Vitamin E or aspirin. I started a new medication, Provera, that will help bring my lining back to baseline and start a “withdrawal bleed.” It’s not a true period since my cycle is all off at this point given all the medication. So, by stopping the other medications, my body will think it’s having a period and my lining will shed. At that point, I’ll go back in for another round of bloodwork and we’ll measure to see where my lining is at.

Then, I’ll start Trental, Vitamin E and baby aspirin again and I’ll also start a low dose of Gonal-F injections. Gonal-F is one of the medications we used when we did my egg retrieval cycle and it helps mimic a cycle to help thicken my lining in a different way. I viewed it kind of as a round-about way to get the results we want. Estrogen medication should have helped thicken, but it didn’t do enough. So instead, Gonal-F will stimulate my ovaries which in turn will (hopefully) thicken my lining and hopefully my body responds to that more positively.

I’m trying to stay hopeful about that route even though my body didn’t respond to the egg retrieval medications.

I was on the highest dose possible and we still only got three out (most people get 10+) and not all made it past the day 5 blastocyst mark. But, given that we don’t have wiggle room for failed transfers, I appreciate that Dr. Y is being very cautious to make sure the conditions are as perfect as possible. I guess just because my ovaries didn’t dump more eggs out (I have premature ovarian failure and simply don’t have more eggs) doesn’t mean that my uterine lining can’t get thicker. I honestly don’t know if those two are related, but I trust Dr. Y’s decision.

How I’m doing

I cried for a few minutes at the appointment and then pulled myself together to get my instructions and left. Once I was in the car, I lost it. I was sobbing. I drove home, stopping for a few errands while I was in the area (the car wash… a great place to cry, BTW) and cardboard box drop-off (like, why did I think that needed to happen right then?) and called Tommy while I was driving. In fact, I was crying so hard I couldn’t talk and knew I shouldn’t be driving in that state. So we hung up until I could get home.

My husband, Tommy, didn’t go with me to the appointment since it was early and we didn’t arrange to have our nanny come early because I thought it would just be a simple, straight forward appointment. That’s one lesson I still haven’t learned with all this…

the appointments are rarely simple and straight-forward.

But, thankfully, he was still home by the time I got there, and I was sobbing in the front seat of the car. I couldn’t even get out, so he held me while I cried. I eventually got out of the car when he suggested we walk and talk (he knows me well and knows that movement helps me process emotions… it’s a major reason why I run) and as I got out of the car, I went to shut the door and slammed it on my head. We both burst out laughing at the absurdity of the timing, so that was a much-needed comic relief to kind of reset the situation. (It still hurts a day later, ha!)

We walked and I explained to him what they told me and then went inside to give Thomas a hug and a kiss, and in his 2.5 year old way, he told me “no way” and pushed my face away. Thanks Thomas. lol. Kids, I tell ya. I texted my mom and a couple close friends to give an update and then I honestly don’t remember what I did for the next hour until I had to leave for an appointment. I have no clue.

Yesterday was, unfortunately and perhaps fortunately, a very busy day.

I had an appt at The Parlour, then pilates, then I met a friend for a super quick lunch and then I worked for a bit before I had pelvic floor PT at 4. I cried at every single place. But I’m so lucky that everyone was so understanding and loving. I also had an outpouring of love from family and friends almost immediately when they saw on Instagram that the appointment hadn’t gone well. Texts, emails, phone calls, cards, flowers, chocolate, eclairs, DMs. Thank you… truly.

It means so much that so many of you care so much to follow along. I’m so grateful for those who have said they’ve been there, others who have said they’re praying for me and others telling me they’re so sorry I’m going through it. I’ve felt so loved and supported by so many people I don’t even know in “real life” and it’s such a blessing to have this community.

I cried all day yesterday (and I’m a person who almost never cries) so I suppose I needed a day to process it before accepting and moving on and moving forward. And around 5pm, I put on makeup since it always makes me feel better and I’d cried it all off when I’d left the doctor’s office. (But hey, at least tubing mascara is easy to wipe away.) It helped.

And today, I woke up today feeling happy and hopeful.

I did my daily Bible Recap reading and this section in Deuteronomy particularly stood out to me. It reminded me that the Lord has provided throughout this entire fertility journey. The fact that I even discovered I have premature ovarian failure before we’d even tried to get pregnant was a miracle. Getting into CFI when they had a waitlist was a miracle. Getting even a couple eggs out was a miracle. So why am I doubting that he can continue to work miracles now? Maybe it won’t turn out how I envision, but he always has a greater plan, even if I can’t see it now.

But even when I remind myself that God is ultimately in control and I know things happen for a reason, it still just HURTS and it’s HARD and I’m sad and I’m frustrated. And it’s only been a couple months. I told Tommy last night that it’s only been two months and I can’t fathom doing this for years, which I know so many women do. Many women never get even one child and I’m so thankful for Thomas. I held him and enjoyed extra snuggles when I put him down for his nap just now.

We’ll try again next month, with a different medication. And in the meantime, I’m focusing on all the perks of not being pregnant right now — really enjoying my running (which has been SO good this week), using retinol, getting dry needling and buying new jeans. And so help me, if I can’t go to the Master’s next month, I’m going to lose it.

The post Month 2 with the Frozen Embryo Transfer Process appeared first on TeriLyn Adams.

I wanted to share a bit about the process for a frozen embryo transfer (FET) with hopes that it helps if you find yourself in a similar spot or if you have friends/family going through it. Keep in mind, I am not a doctor and I’m not in the medical field so I might get little details wrong and everyone’s experience will be a little different since the treatment and protocols are personalized based on each situation. Plus, I’m going off memory of what the doctors tell me, so don’t take any of this as medical advice or as an indication that your process will be exactly the same.

What I am hoping to share is what I’ve experienced mentally, physically and emotionally since fertility treatments involves so much more than doctor appointments. Also, if you decide to leave a comment, please be kind. This is a hard, sensitive time for Tommy and me but I truly do hope that sharing my experience can help others.

Frozen Embryo Transfer Process

We did an egg retrieval cycle at the end of 2019 (which I can write about if y’all are interested) so we’re now starting the process of using a frozen embryo. Most people get a lot of eggs out during the retrieval but because I have premature ovarian failure, that’s not what we’re working with. Given that, our doctor wants to be as precise as possible when we do transfer our embryo so we are doing an ERA cycle.

ERA stands for Endometrial Receptivity Array (ERA) and it’s a diagnostic procedure to help determine whether the endometrial cavity is ready for embryo implantation. It’s a type of mock cycle where we’re doing everything that they would do leading up to a frozen embryo transfer, but they won’t actually transfer this month. Instead, they’re checking things along the way and adjusting medications and timing and doing a couple biopsies and tests (including the ERA) so we have a higher likelihood of success when we do transfer.

My experience with the Frozen Embryo Transfer Process

Month 1

Once we decided we were ready to start the process, all I had to do the first month was notify the fertility clinic when I started my period. Then, I went in about a week later.

The first step was an appointment to measure my uterine lining, have a uterine lining biopsy and then to start taking estrogen pills 2x a day, baby aspirin once a day and applying an estrogen patch every 3 days. The biopsy was painful for a few seconds but the measurements were significantly more painful and that lasted about 5 minutes. That part should NOT be painful but moving the device around internally was causing extreme pain, bringing me to tears, and they’re not sure why. Thankfully, that hasn’t happened since.

After a few days of estrogen pill and patch fun, I went back in to have my lining measured again and to get bloodwork. The thickness hadn’t gotten to a point where they were happy moving forward with the next step in medication, (they were looking for 7-8mm and I was only at 4mm) so I continued the estrogen protocol. They also also added in another medication, Trental, (a tablet that I take 3x a day) to help with blood flow to my uterus. That caused even more dizziness and weird headaches that seemed to circle throughout my neck and forehead. It was a super odd sensation.

Progesterone in Oil injections

Last Friday, I went back in for another lining check and more bloodwork. My uterine lining was almost where they want it and my blood flow has improved so we’re moving onto the next step – daily progesterone in oil (PIO) shots in the booty. They drew some squares on my butt with a permanent marker (it’s a suuuuper cute look, ha) to make sure we inject in the right spot and told me to massage the heck out of it after the injection since it can cause a lot of pain if I don’t.

Apparently the progesterone can cause constipation, which has already been a struggle since I started estrogen (GREAT) so I’m going to be even more conscious about my diet and take my fiber supplement more regularly. I’ll also add in a stool softener if need be.

I’m on day 3 of the PIO shots and the shots themselves don’t really hurt, but the medication is very viscous (since it’s in an oil) so it’s incredibly uncomfortable going in. The pain lingers for days, but I’ve found that warming the vial before injecting helps and afterwards, a hot shower, running and a heating pad all all help. The lingering pain feels a bit like dry needling pain… just a dull ache.

He practices on an orange before each shot, ha.

So what happens next is I continue the estrogen pills and patch, aspirin and blood flow medication and keep doing the daily progesterone shots. I start taking yet another pill tomorrow (Medrol). I’m not entirely clear what it does, however. Then, I go back later this week for the ERA biopsy and more bloodwork.

If all looks good there, we’ll stop medication and let my period start. Once that happens, I call them back and we start the whole process over — medications and appointments and all — with the hopes that we can transfer an embryo the next month. However, I know multiple women who have gotten to the transfer week and things weren’t ideal for a transfer so it didn’t happen, so I’m trying not to get too far ahead of myself and just taking it one appointment at a time.

How I’m feeling

The medication side effects are rough, for sure, but the waiting  and the unknown and the unpredictability are the hardest part (The accompanying emotions aren’t fun either.) Thankfully, I’m in good hands. Everything that I’ve read online says the success rate for an FET for someone my age (38) is around 25-35% but my fertility clinic – Carolinas Fertility Clinic – has one of the highest success rates in the country, at 80%.

Physically, I noticed dramatic fatigue, dizziness and nausea after starting estrogen. I’ve also had problems falling asleep and have been awake until 2 am multiple nights. The fatigue and dizziness are oftentimes so bad that I can barely get out of bed and have had multiple days where I worked from my bed or worked from the couch. But other days I feel totally fine throughout most of the day, But without fail, by the end of the night, I almost always have nausea.

I also get really lightheaded with the PIO shots.

The needle doesn’t hurt (and needles don’t bother me) but the first time we did the shot, I almost passed out and had to lay on the sofa for 15 minutes. The second time I was fine and today, I just got a little dizzy but was fine a few minutes later. I’m thinking it’s just nerves and a rush of adrenaline.

Mentally, all of the nausea, dizziness and fatigue has been frustrating since I’ve felt pretty darn bad on some days and I’m not even pregnant. So thinking about being sick for two months before I’m even pregnant is mentally hard. But I try to just take it day by day and I’m also tremendously grateful that I now work for myself so I do have the flexibility to work less and work in bed.

2/19 Update: The ERA Biopsy

I had the ERA biopsy last Thursday. Honestly, I barely knew it was happening. I didn’t find it painful at all, but I had taken 800 mg of ibuprofen before had. After the biopsy, I got a nice break from shots and all the pills. I’ll get my results back in a week or so, and the next step is to start the estrogen pills and patches again, once my period starts. Then, we repeat the whole process.

Emotionally, I’m doing okay most days.

I sobbed after the first appointment we went to when starting the process, but I’ve been okay since then.  The pain started the tears and then I just couldn’t stop crying since it was all so emotional, thinking about the whole process the last time we were at the clinic three years prior and what might happen this time around. Thankfully, Tommy was with me at that appointment and just held me while I cried.

Tommy is hugely supportive and thanks me every day, multiple times a day, for going through all the medications, appointments and side effects. After the first appointment, I told him he didn’t need to come because sometimes the wait time is extreme. (At my second appointment, I waited 90 minutes to even be called back. It was like this during our egg retrieval process too so I’ve learned to take my laptop and just work while I wait.)

It’s overwhelming to think that if this doesn’t all work, that we might not be able to grow our family.

I carry a lot of guilt and fear around that, even before we know the outcome. And yes, I know logically it’s not my fault, but we’re going through all of this because of my body, ya know? I would tell someone else in my same shoes that it wasn’t her fault, but I’d also understand the emotions completely.

When I start to feel overwhelmed by everything I need to remember (so many pills with various timings and changing schedules) or the potential FET transfer (what if it fails?!), I remind myself that ultimately, God is in control and he works all things for our good. I also LOVE this verse in the Bible:

he is before all things, and in him all things hold together.

(Colossians 1:17)

The post My experience with the Frozen Embryo Transfer Process – Month 1 appeared first on TeriLyn Adams.