You’re Diagnosed with What? Starting the IVF Process

The morning of February 11, 2019, started off as any morning does in my house hold. Robbie had already woke up, snuck a kiss on my forehead and left for work. I slept in a bit, woke up, feed the children (aka the Buck, Hemingway, and our new little addition, Rocco), and made myself a cup of coffee. As usual, I consoled that cup of hot coffee like my life depended on it. I was flipping through the flyers (being an adult is such an exhilarating life) when my phone rang. Across the caller ID read Ottawa Fertility Clinic. I picked up the phone so quick, just knowing they had no reason to call unless… our spot just opened up on the funded in vitro fertilization (IVF) wait list.

My heart has racing out of my chest as I said hello into the phone. I had picked up the phone so dang fast that the nurse on the line was so confused as to if I was actually on the line or not. She laughed stating that she doesn’t think she has ever had anyone answer the phone so quickly. After exchanging the formal, how are you? conversation, she says “so I am just calling to let you know your name came up on the funded IVF list. Before we start, are you and Robert still interested in pursing this?” I’m not even lying when I say I must have shrieked yes about four times in a row and than, yes, absolutely yes!

I wrote down on the back of an envelope (a skill I have acquired from my own Mom) everything she was saying during that phone call. We would begin our IVF process sometime in the late spring/ summer (she gave us two months that it would occur in – I’m just being secretive to allow Robbie and I some flexibility while we go through IVF), that I would have to undergo all the baseline testings (bloodwork on day 3, and 21, AFC – follicle count, baseline ultrasound, and hysterosonogram) that I underwent to get diagnosed. I wont go into too much detail about this but you can refer to my blog “Let the Diagnosing Begin” if you want to refresh yourself on what those entail. This is just to be sure that everything is still good before we begin and don’t have to worry about encountering problems once we’ve already begun.

Once I received my next period, I would call for my day 1 so that I can start all the baseline testing. Robbie and I also had an appointment booked for March 12, to meet with Heather (one of our two wonderful assigned IVF team nurses) to go over all the paperwork, sign consent forms, and go over what the egg retrieval process involves.

The whole entire time I was writing this all down, I was in shock. My legs and hands were shaking excessively. I ended the call and immediately starting to cry out of happiness. I just couldn’t believe IVF was actually here.

At this point Robbie was at work and he doesn’t carry his phone on him so I had to anxiously wait ALL (capitalized because it felt like eternity) day for him to get off work. I was overwhelmed with excitement and wanted to share this amazing news with everyone so naturally I called my Mom first. We both just cried on the phone, so very excited and so grateful that I got the call. Ironically enough, my Mom was at the hospital that day and they were having a vaccination clinic for babies. She had messaged me earlier to say that she was thinking of me and couldn’t wait for the opportunity to come up that Robbie and I could have kids of our own one day. Call it Mother’s intuition, as if she almost knew this was going to happen.

Afterwards, I sent a message to my sister Jordanne saying “GUESS WHAT GUESS WHAT GUESS WHAT” and she actually responded back with “you got the call for IVF?” What psychic little family I have. I called Sarah, a bunch of friends, and sent out more texts in that one day than I probably ever have. My excitement continued all day. I must have had an hour dance party with the children (I prefer calling them children over pets, this will be confusing once we actually have human children) while I just picked them up (except for my 90 lb golden retriever) and danced around. I felt so alive, so happy, so full of energy.

I ran out to Dairy Queen, grabbed an ice cream cake and got the DQ employee to write “we got the call” on the cake. The girl at cashier said “that’s pretty vague, do you mind if I ask what that means?” so I excitedly told her the good news too. I left with the cake and many good luck wishes from a handful of DQ employees I didn’t even know.

Robbie always calls me on his way home from work and to anyone that knows me, knows I struggle with keeping secrets from Robbie. To this date, I have only ever kept ONE SINGULAR present a secret from him and it resulted in him finding it early and then me crying because I had this whole ruined anticipation of keeping it a secret. So Myself + Robbie + secrets = something that just doesn’t happen. So that five minute phone call of just pretending I had the most ordinary day ever was killing me.

He said he wanted to go to the gym first so I had to tell him I got him a present to persuade him to come home. Robbie, don’t read this next part, but if you dangle the thought of a gift to my husband, he suddenly becomes this little impatient boy that needs it now. So luckily, that convinced him to come home.

I had set the ice cream cake on the counter, draped a towel over it and stood at the window waiting for his truck to pull into the driveway. I met him at the door and had to decline to play a game of 21 questions from Robbie. What did you get me? Where did you get it from? Is it food? Is it for you and me? Or just me? And so on. Like I said, impatient little boy.

He pulled back the towel and read we got the call. Instantly he looked at me and said “really?” At this moment I burst out crying again. We both cried and Robbie just engulfed me in this huge hug and we swayed in the kitchen. This moment felt like it must have been at least 10 minutes long. We were both just so happy and smitten that we got the call. Eventually we broke the hug to eat ice cream cake and for me to tell him of all the details the nurse had told me.

The whole next week, we would just stare at each other and say “we are doing IVF.” It was just so surreal. I couldn’t believe it, they told us the wait list was going to be about 12 months to 16 months. At this point we had been on since last April, so we were anticipating April as the earliest but holding out for the longest wait and preparing for late summer to get the call.

For people that might not know the difference between IUI and IVF here it is. IUI is when they attempt to get one follicle (egg) to be mature to ovulate, then when you ovulate, they place a catheter into your uterus to release sperm into the uterus and hope that egg and sperm meet and create a successful pregnancy.

For IVF, they attempt to get as many follicles (eggs) as possible to be mature, then they retrieve the eggs. They take all the mature eggs, place them each in a perti dish and release a bunch of sperm to let one sperm fertilize the egg (we ended up doing ICSI so I explain that below), and they transfer the embryo back into your uterus at either day 3 or day 5 in the petri dish. The goal is to create as many embryos as possible so you can freeze them for down the line when you want to expand your family.

I luckily got my period shortly after and was able to do my blood work by the end of the week. The following week, the clinic called and said that I had hypothyroidism and that I would have to start taking a medication (synthroid) to bring my thyroid levels to below 2.5 mU/L. Although the “normal” range for TSH levels are intended to be from 0.4 – 4.0 mU/L, but anything higher than 2.5 can impact infertility! I really didn’t have any symptoms of an under active thyroid other than a cold intolerance/ cold extremities and fatigue, but who isn’t tired these days? I took my synthroid although I wasn’t happy about taking medication and spent a lot of time trying to find ways to naturally correct my under active thyroid (including treatments and dietary suggestions for it by my acupuncturist). I ended up going back in 6 weeks to get my levels retested and it came back at 1.06 mU/L which they said was perfect so I continued on the same dose.

Since I wasn’t getting diagnosed with anything, they scheduled my AFC ultrasound and hysterosongram for the same day to save me the extra drive to Ottawa. All looked good, even my follicle count on a natural cycle looked better and to much surprise, my body had created a mature follicle! In the ultrasound room, I said to Robbie “see all my dietary changes and acupuncture is paying off!” In a really uncomfortable voice she said “um you know that’s a hoax, right? Acupuncture doesn’t do anything.” Well explain the better follicle count then because those are the two major life changes I’ve committed too. But all looked well from here so we got the all clear to start with IVF on the physical spectrum.

March 12, Robbie and I drove to Ottawa to sign our IVF consent forms and get the basic run down on the egg retrieval process. We met with our IVF team nurse Heather. She had our binder out in front of her with all our information, diagnosis, and past IUI’s history. In true clinic fashion, we had to confirm our names, birth dates, address etc. On the front page under diagnosis I saw something I didn’t recognize beside Low Ovarian Reserve. Asthenospermia. I asked “whats that written under diagnosis?” Apparently some where along the way, they officially diagnosed Robbie with low motility count and no one communicated this with us. Add this to the never ending list of things the clinic never communicates with us. It makes sense since our last two IUI’s both represented very poor motility numbers. We have no idea why Robbie had one really good sample and the others, not so much.

You know that song “so happy together,” I sang that in my head but instead “so infertile together.” I know, weird sense of humour.

We went over the basic IVF procedure, basically the point is to stimulate as many follicles as possible, trigger ovulation with two separate injections to release the egg from the follicle wall (a follicle is basically the case that covers the egg, a follicle is a home to the egg but sometimes you can have a follicle with no egg in it), then have the egg retrieval where they extract the eggs and the follicle fluid, and introduce egg and sperm in a petri dish, allow fertilization to occur, then transfer the embryo on day 3 or day 5 based on how the cells divide and how many embryos you are left with.

Your traditional IVF process (very similar to natural conception) requires one egg, a multitude of sperm swim towards the egg, with one of the sperm making its way inside the egg. Except with IVF, its all done in a petri dish inside a lab.

For us, with Robbie’s new diagnosis of low motility we have to do a type of IVF called intracytoplasmic sperm injection (ICSI). With ICSI (pronounced ICK-SEE if you want to pretend you are so wise in pronouncing fertility slang), a singular sperm is picked and injected via a needle directly into the egg to fertilize it.

Under the OHIP funded cycle, ICSI is covered but only if the person needing it is under OHIP. Robbie however is not covered until OHIP. Robbie has his own benefits and ICSI is covered… but only if the person needing ICSI is the only one with fertility problems. But since I am the original problem we had to pay $2000 out of pocket. They originally charged us $2300 but a few months later picked up on the mistake, so if anyone is thinking she said it cost more, that’s why.

The last part of our meeting with Heather, was about which medications we (I say we, but I’m the one taking them) would be on. I will address in more detail during our IVF process blog when the time comes. We also went over the success rate of IVF working, our odds of miscarriages, multiples etc.

Based on our personal diagnosis’ we were given a 40% chance of pregnancy (much higher than our IUI rates), miscarriage rate 15%, ectopic pregnancy 2-3%, 25% of twins if we transferred 2 embryos (with the funded, we can only transfer one at a time – so this would be significantly lower for us) and of course the unknown risks: increased chance of birth defects (2% higher than average), increased death rate, decreased birth weight, unknown impact on future generations (possibilities of our children having infertility problems), and potential cancer rates. Although those odds may be small, they are uncertain.

I joked to Robbie that now we have to start a college fund for our kids and also an infertility fund, just in case. I said it as a joke but part of me really thinks we should.

We weren’t quite fully prepared for some of the questions we were asked next and had to decide on. Naturally, we both had to consent to the use of our embryos being used for our reproductive use. Duh, that’s why we are here. We also consented, God forbid anything were to happen to one of us, we still gave the other consent to use our embryos, whether it be pregnancy for me or a surrogate for Robbie’s use. Consent also was given to use the follicle fluid and immature eggs (not required to make an embryo) and the left over sperm from the sample not used by ICSI for scientific research, as no life will be created by them. But some questions involved using immature eggs and leftover sperm to create an embryo that would be discarded for scientific use only. It makes sense that they would ask these questions but it really did throw us off.

The following month, I had another appointment with the lovely Heather to go over how to give my injections, as I now had a few new injections that I hadn’t done previously with my IUI’s. It was a quick 30 minute appointment to go over my medicine routine recap and a few short demonstrations on how to administer my injections. After my appointment, I went and picked up the first batch of my IVF meds (in infertility lingo we call these injections STIMS because they are your follicle stimulants) since I had no plan to drive back to Ottawa for the next couple of months.

I went home, loaded all my STIMS into my fridge. From there on out, every time I opened the fridge I would just stare at them in anticipation of the good things that would come later.

I never thought we would ever get to the point where we would need to rely on science to have a family. But here I am, hoping for our science miracle. You never really understand how exciting it is to have this opportunity to go forward with IVF until you are in a situation similar to ours.

After our third failed IUI cycle, Robbie and I said how nice a few months off from the infertility world would be. You get so caught up in the craziness of it and putting your own life on hold because you didn’t know when you were going to start or when you would need to drive to Ottawa for appointments. We were anticipating a few months of no fertility appointments but we were genuinely so excited to get the call so that we could start the process to be completely ready for IVF.

Although we only had that one month off from feeling like we were completely stuck in the realm of the infertility world, that month gave us enough time to recuperate.

In the middle of your craziness in life, try not to get too focused on one thing. I know its inevitable and hard but don’t forget to take a break. Disconnect so that what the time comes to reconnect with it, you can start with a clear mind.

Rebecca

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