Month 2 with the Frozen Embryo Transfer Process

Hi friends,

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.