IVF Update: Next steps?

My last IVF update was in early December when I let you all know that we got two genetically normal embryos from our second round of IVF! A lot has happened since then, including an endoscopy (for my acid reflux), a hysterosalpingogram (HSG), a Trial Embryo Transfer (TET), a doppler ultrasound, an office hysteroscopy, and a follow-up meeting with Dr. Bush to determine next steps! Read below for all the updates!

I was propped on my left side in the frigid procedure room. Ariana Grande played on the speakers overhead (why?!). I looked around the room. Shiny silver sterile instruments on the nearby table. The scope that would soon be entering my mouth and descending through my esophagus, down to my stomach, and then on to my small intestine. A nurse busily filling out paperwork.

My doctor entered the room.

“We are going to take really good care of you, Kristen.”

I nodded.

And then came the bite block. The nurse inserted it into my mouth. The bite block helped keep my mouth open during the Esophagogastroduodenoscopy (EGD), allowing the tube to be inserted with ease. She strapped it behind the back of my head. Like the over-the-shoulder restraints on a roller coaster. Secured. Trapped. Nervous energy coursed through my veins right alongside the Propofol, a powerful anesthetic. The very anesthetic that may have led to Michael Jackson’s death.

“This is when is starts to sting a little,” my Tom’s-wearing, nose-ring-rocking, 30-something anesthesiologist warned me.

An endoscopic bite block. Photo credit:  here

An endoscopic bite block. Photo credit: here

This was the third time I had Propofol in three months. Don’t be concerned. I’m not (moon)walking down the same road as the King of Pop. While I would love a small dose of this potent "milk of amnesia" (the cool kids call it this, for real) every night before bed, I surely can’t afford it and I’d prefer to not engage in illegal activities at this point in my life.

As my new favorite anesthesiologist inserted the medication into my body, I felt the sting of the fluid quickly travel from my hand to my forearm. It would be only seconds before the medication reached my brain and I would be a sleepy lump of flesh on the procedure table. Since medical procedures have become my new hobby this year, I decided to have a little fun with it. Right before I lost consciousness, I shouted (with the bite block in my mouth, mind you), “I’m gonna fight it! I’m gonna fight it! I’m gonna stay awa...” And awake I was not, and away I went.

I woke up 30 minutes later, still propped on my left side. My eyes slowly opened. My groggy brain tried to make sense of the images I saw. A white wall directly in front of me. Soft lighting. The endoscopy is over, I thought. I must be back in the pre-operative room.

And then I noticed the drool. A line of saliva had leaked out of the left corner of my mouth onto the pillow. I wiped it away. No big deal.

And then I noticed the flatulence.

Vibrating, booming, semi-silent farts flowing from my rear. (Sorry, mom. I know you hate the word “fart.” I know you prefer “toot,” but toot really doesn’t capture these mighty, fierce winds.) I was farting. Uncontrollably. It was like my mind had woken up and regained control but my lower half had not. The farts kept coming, and I didn’t fight it. What the hell, I thought in my half-lucid state. The inner tubes of my body had just been explored by a camera. I deserve to expel this air in peace. Without shame.

Just after that liberating thought, I heard a nurse right at the entrance of my room say to another nurse, “Hey, I think she just pooped her pants.”

Was she talking about me? No way. Nurses wouldn’t say “poop her pants.” Nurses say “bowel movement” or “incontinence of bowel.” She surely wasn’t talking about me. I lifted up the covers and gave it a whiff, Dutch oven style. No smell. Clean, like laundry. Definitely no poop.

My mom walked into the room minutes later.

“Does it smell like poop in here?” I asked hurriedly.

My mom paused. Sniffed. Thought. “No, it smells like…like…mouthwash!”

I explained to her what had just happened, half-ashamed, half-entertained. “A nurse wouldn’t say ‘poop her pants,’ would she?”

“Yes, she probably would. Especially if she thought you were asleep still. Don’t worry, monkey. It’s fine. Now let’s go get some lunch. How about Sushi Den?”

Any past worries of bite blocks or Ariana Grande or audible anal exhales left my mind. The promise of sushi healed all. Who needs chicken noodle soup when you have the option of the house roll from Sushi Den? My mom always knows how to make me feel better!

(PS: Check out Huffington Post’s 150 Different Words for ‘Fart’ …because we’re all 13-year-olds at heart, aren’t we? Don’t fight it.).

Now that I’ve broken the ice with that story, it’s time for some fertility updates!

On Monday, December 17, I had a Hysterosalpingogram (HSG). This is a diagnostic procedure where dye is inserted through a catheter that goes through my vagina, through my cervix, and into my uterus. Learn more about HGSs at FertilitySmarts.com.

My doctor wanted me to do this procedure to figure out if my right unicornuate uterus is connected to my left rudimentary horn by a long connective tissue (see picture below). In other words, is my tiny right-sided uterus connected to the little left-sided nubbin? We were hoping that they were NOT connected. If they were connected, there would be the risk that an embryo may travel through the connecting tube and implant on the wrong side, in my rudimentary horn. This would have really dangerous implications, and I would have probably needed surgery to disconnect the two halves. So hallelujah! They are not connected!

Taken from my laparoscopic surgery in May 2018.

Taken from my laparoscopic surgery in May 2018.

Let me talk a little about the HSG. I was really, really nervous for this procedure. I had heard from many women that it is really painful – one of the worst procedures they had experienced. They said it was like deep, severe menstrual cramps…but worse. Thankfully, my amazing nurse, Erika, prescribed me Valium for the procedure. It made me feel semi-checked out and sleepy. I took 800 mg of Ibuprofen an hour before the procedure as well.

Normal HSG with a full uterus and two open fallopian tubes. Photo credit:  here

Normal HSG with a full uterus and two open fallopian tubes. Photo credit: here

My HSG!

My HSG!

Long story short, the procedure was not that bad.

Uncomfortable? Totally.

Painful? Hell yes. I had to deep breathe throughout the entire thing. I moaned and groaned at certain parts. The radiology tech let me squeeze her hand.

Survivable? Of course. Humans are resilient. Women are powerful beasts, especially when it comes to fertility. I’m confident any of you could get through an HSG too.

Then, on Thursday, December 20, I had three more procedures (and another Valium…yum). First, I had a Trial Embryo Transfer (TET). This procedure is normally done by a midlevel provider, like a nurse practitioner. But since I’m a special unicorn, my doctor completed mine. Think of the TET as a dress rehearsal for the actual embryo transfer. My doc tried out a couple catheters to see which would allow him to enter my uterus most effectively. He chose the best speculum for my shape and size. Everything went well with this!

Then I had a Doppler Ultrasound. This is just a standard vaginal ultrasound where the tech looks at the blood flow to my uterus. Everything looked good! My uterus is adequately perfused. Yippee for perfusion!

Finally, my doctor did an office hysteroscopy (HYST). Essentially, he inserted a camera into my uterus to check for polyps, fibroids, scar tissue, and anything else that would get in the way of an embryo successfully implanting. Everything looked good, he said! It was a little painful, but nothing compared to the HSG. I really liked seeing the inside of my uterus. Super cool! Learn more about a hysteroscopy here.

Picture from my hysteroscopy!

Picture from my hysteroscopy!

I passed my HSG, TET, Doppler ultrasound, and hysteroscopy! My half-sized uterus is actually not half bad!

After all three procedures, Cory, my mom, and I met with Dr. Bush in his fancy, oak- and leather-clad office. Our main questions for this follow-up meeting:

Should we do another egg retrieval to try to get a few more embryos? The reasons we would do another egg retrieval now:

  1. My egg quality is tanking by the second.

  2. IVF success rate is about 70% with each transfer (and this is the 7th best statistic in the nation).

  3. My unicornuate uterus has a high miscarriage rate (37%).

Or, should we move forward with a frozen embryo transfer (FET)? This is where they put an embryo back inside me! Knock me up!

After a 15-minute conversation about statistics and risk and options, we decided to move forward with a FET! Dr. Bush feels really confident that if our first FET fails and the baby doesn’t take, then we can do another egg retrieval after that to try to get a few more embryos. He also said that if this first FET fails, it will most likely be due to the quality of the embryo. Even though our embryos are “genetically normal,” their tests can’t assess the multiple layers of genetic code in an embryo that will be crucial in early stages of development. It’s possible that my embryos, even though they are “genetically normal,” may still be poor quality because of my severely low anti-mullarian hormone (AMH) level of 0.54. He even said that the University of Colorado reproductive endocrinology center wouldn’t have even let me use my own eggs with an AMH level that low. All of this is just to help set our expectations for what may happen and why.

Now for the fun stuff! Our FET will be in approximately six weeks. This means that right around my 33rd birthday, February 1, we will be gently plopping a little Cory-Kristen embryo into my small (but perfect) uterus. Keep us in your thoughts. Send us all the positivity. And if you have any recommendations for what I should be doing/not doing before my transfer, leave me a comment! I have already decided to significantly decrease my alcohol consumption and eliminate sugar until the transfer. I’ll also be resuming acupuncture too. Anything I can do to help!

Peace, love, and unicorn farts.

 
Our child is bound to have fabulous hair, let’s just be real. ;)

Our child is bound to have fabulous hair, let’s just be real. ;)

 

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