IVF #3: Trigger & Retrieve

“I wish I hadn’t cried so much!” said Alice, as she swam about, trying to find her way out. “I shall be punished for it now, I suppose, by being drowned in my own tears!”

– Lewis Carroll, Alice’s Adventures in Wonderland

Treatment is strange in that it seems to flip life upside down for a while. Time starts to lose its relevance and routine is lost to frequent appointments, blood draws, ultrasounds, daily phone calls with new dosage instructions, and strict injection schedules. This time around has been no different, and now, at the end of these weeks, I am ready to go back to normal life.

For the first time ever, I’ve done this treatment cycle on my own. The general busyness of Kyle’s current schedule has meant sitting by myself in a waiting room, often surrounded by couples. At times it has been very lonely. Although there is never much for him to do at this point, it was always a comfort simply to have him there for these appointments in previous treatments. Instead my family has been here to help with Ross: two of my sisters and my mom have taken shifts to keep him busy for each doctor’s appointment and the time in between. Somehow we’ve cobbled together a way through.

Then, after regular appointments every day this week and every other day last week, by Wednesday it all started to feel like too much. The side effects, the hours spent driving to the clinic and back again, the upside-down life we’ve attempted to become accustomed to– I didn’t know how much longer we could keep pushing. I knew I was getting close to the end: for the last few days I had egg follicles already within the ideal 18-22mm range and my estrogen level was rapidly approaching 4,000, the point where things start to get dangerous. Still, there was a part of me that hoped I’d get to stim for one more day. It was difficult last time to lose a greater percentage of eggs to immaturity compared to the first time, and in my limited understanding, it seemed like waiting just a little longer could give me a better chance. But, once those first follicles are ready to go, we can start losing eggs the other way too, rendering them unusable. Everything is a delicate balance.

That afternoon I received the phone call with my trigger instructions: stop all other injections and do the final one into my backside at exactly 10:30pm. The trigger would tell my ovaries to finish preparing the eggs and 36 hours later I’d have my egg retrieval to collect them before they are all released into my body and lost.

Last one!
The dreaded “trigger shot”

Yesterday I had off from everything as I waited for the retrieval this morning. This, to me, is the hardest part now. I feel ill and uncomfortable and I’ve cried an ocean of tears from skyrocketing levels of manipulated hormones. My ovaries are so large I can feel them through my skin, and the left one is pressing or pulling on scar tissue and causing sharp pain, as if a fish hook is caught in there. I hate that I am not allowed to eat or drink past midnight prior to the surgery, and as a psychological response, I’ve been feeling both desperately thirsty and ravenous with hunger pretty much since the minute it was no longer allowed. The anticipation of the procedure and my results is getting to me now, and I am ready for it to be over.

Yesterday was also significant in that it was the day we celebrated Ross’ 3rd birthday. I often think of how he came to be, but it felt even more poignant as I remembered back to four years ago, when I was struggling through this very same process in order to have him, too. It’s never easy, but it was more than worth it, and I am so grateful to still have this physical role. There is so much that I do not have control over and so much that has been taken from me, but not this, not yet. The results may not always be what I am hoping for, but I can still ask my body to do this.

In less than three hours now, I’ll be in the room with the doctor, nurses, embryologist, and anesthesiologist. By early afternoon I hope to be in my own bed recovering with a number of eggs retrieved and the hope for more embryos.

Advertisements

IVF #3: Third Time’s the Charm?

‘Who are you?’ said the Caterpillar.

Alice replied, rather shyly, ‘I–I hardly know, sir, just at present– at least I know who I was when I got up this morning, but I think I must have been changed several times since then.’

‘What do you mean by that?’ said the Caterpillar sternly. ‘Explain yourself!’

‘I can’t explain myself, I’m afraid, sir’ said Alice, ‘because I’m not myself, you see.’

-Lewis Carroll, Alice’s Adventures in Wonderland

Last Saturday, after more than two weeks of daily lupron injections with seemingly no end in sight, my period finally came. At that point I was able to schedule a baseline appointment for Monday, the last hurdle before getting the green light to begin stims.

There are very few surprises left in this process, but when a nurse handed me a packet of papers and told me I’d be having my FDA donor testing that morning, I was a little caught off guard. This is something we go through for every IVF cycle specifically because of the surrogacy, and should we find ourselves needing further treatment, we’ll go through it again. Beyond being tested separately for any infectious disease, both of us are required to submit urine and blood samples, receive an exam, and answer several pages of questions regarding our lifestyles: Have we been in prison recently? Have we had sex with someone who was in prison recently? Have we used any non-sterile needles in the last several months? Have we engaged in homosexual intercourse? Have we traveled to certain countries? How many sexual partners have we had in the last 12 months? Since the Zika scare, we also have to list any and all time spent in Texas and Florida over the last year. Everything is overseen by the Food & Drug Administration, and the risk we pose to a gestational carrier (through our embryo) is determined by the results. With the government shutdown, I am now a little nervous as to how our review might be affected.

As a woman, I am assumed to carry less risk to an embyro (and therefore, a gestational carrier) based entirely on stereotypes of sexual behavior, so I’m able to complete this testing within 30 days of my egg retrieval. However, as a man, Kyle is only given a week of clearance. Several years ago, when we knew nothing about all the extra steps required for an embryo transfer via surrogacy, the testing felt excessive and humiliating. Now it feels excessive and annoying (and maybe just a tiny bit humiliating, too). But, it’s usually done during the end of my treatment cycle, so I hadn’t mentally prepared myself for it yet. Nevertheless, fifteen minutes later I watched as 10 vials of blood drained out of my good arm to be set aside for the FDA.

When it comes down to it, the questions and the tests don’t feel like much of a difficulty in the midst of the invasive procedures that come with fertility treatment. What bothers me is the name: donor exam. At its most basic use, I understand why this term was chosen, but it’s a painful label to carry in a process where I already feel so devalued. Although my body will not receive my embryo, this is not a donation. I am not a donor.

Fortunately, the rest of the appointment was uneventful. Dr. M remarked on the large number of follicles present, particularly on my right side (my better ovary), but I am lucky in that this has always been the case for me. Still, he seemed pleased by how many there were, which made me feel hopeful that somehow this cycle might be a drastic improvement. That afternoon my nurse called to say that Dr. K had given me the green light for treatment. We could start!

A tidy look at one day’s worth of stim medication.

Throughout stims, I’ve continued my lupron injections each morning, and as of Monday, I mix three little vials of Menopur powder with 1cc of diluent to inject into my stomach along with 225 iu of Gonal-F each night. It’s been longer than I’d hoped since my last treatment cycle, but muscle memory has benefited me greatly when it comes to administering the medication, and with a lowered dosage of lupron, I’m relieved to be experiencing less nausea and fewer hot flashes. I do still feel as though my emotions are wildly out of control, and most days I just want to sit and cry while eating a box of good chocolates and ordering things online, but that will probably last a while longer.

Waiting…

Yesterday I went back to the clinic for more blood work and another ultrasound to check on progress. There’s not much to see yet, but I did have at least one measurable follicle. Tomorrow morning I have another appointment, at which point I’ll be on my sixth day of stim injections. I’m hoping to have off on Sunday morning but will likely be back at the clinic every day throughout the next week as I wait for my egg retrieval.

I’d like to say that I have no expectations of this cycle, but if I’m being honest, that is not the case. I suppose that I am at least expecting to do no worse than last time. Only time will tell…

IVF #3: Begin Again

After spending the afternoon on Christmas Eve trying to untangle the latest snag from our insurance, I wasn’t very hopeful that much would be accomplished the day after Christmas. But, I attempted it anyway, and for several hours throughout the day, I made and answered phone calls between the on-call nurse, the fertility pharmacy, and the insurance company. As the day went on, it didn’t look promising.

Then, while in the car that evening on the way to celebrate my mom’s birthday, I got a call that things were starting to come together. By the time we got out of the car, the nurse called one last time to say that my insurance had finally agreed to cover a significant part of the medication. So, while my family enjoyed some outdoor Christmas lights, I sat to the side on the phone with the fertility pharmacy trying to get my order processed. By 7pm I received word that my lupron injections should arrive just in time. It wasn’t until later that I found out my nurse had stayed late that day just to make sure everything was taken care of for me, and it is only because of her that I had a chance at cycling in January. It’s been a long time since I felt like someone was fighting for me, and her determination gave me the boost I needed.

First thing in the morning on the 27th, I had my Cycle Day 18 blood draw and ultrasound to confirm ovulation. As I walked through the office, it struck me just how little thought I gave to being there. No one had to show me where the rooms were or explain what to expect; everyone already knew who I was. It was strange to realize how completely comfortable I had become with this world that had once seemed so intimidating. And, when the test results came through that afternoon, I was given approval to start treatment for IVF. At the very end of 2018, we found ourselves at the beginning of a brand new cycle.

Medication for IVF #3: A small glimpse into one of many difficult things we have to do just to try for a baby.

I started my injections the following morning, a single lupron shot into my stomach after breakfast. I haven’t hidden this part from Ross, figuring that I can at least model a lack of fear around needles for him in hopes of making his shots at the doctor go a little smoother. He likes to help me pick where each one will go (though he sometimes gets a little bossy about it), and he carefully studies my face while I inject the medication, waiting to see if I flinch. Then when it’s finished, he likes to say, “See, that wasn’t so bad!”



Likewise with the comfortability I now have at the office, I also don’t give much thought to the injections. It’s strange to remember back to my very first one four years ago, and how it felt like sticking a needle directly into my own stomach went against every instinct I had. Now I think it might be the easiest step of the entire process, and I would happily do this every day for the rest of my life without complaint if I could have another child, especially if I could carry that child on my own.

I’m relieved to have finally started this process again, but while so much of it has become easier with repetition, it’s not without its hardships. My body has never done well with lupron: last treatment cycle I passed out with my first injection, and when I was on it in high school I struggled to get through the day at school. All of a sudden, memories of the nausea, motion sickness, crying, and hot flashes have come flooding back. Today was my 10th day of injections so I likely have a handful more before I can begin the actual stimulation cycle injections and monitoring appointments, but I’m getting closer.

In the meantime, I feel fragile. I know that what my brain is telling me right now is not necessarily true… but I feel very alone, too. I don’t know what will come of treatment this time, but I am trying to keep my expectations low after the disappointing turns we experienced the first two times. Any past success is not a reliable indicator of continued success; so much of it is up to how my body decides to respond to the medication, the doctor’s decisions for my individual situation, and a fair amount of luck. People who are unfamiliar with IVF tend to view it as a magic bullet that ends with a baby, but really it’s just a treatment that can give you a chance that you otherwise wouldn’t have had.

I’m hoping this gives me a chance.

Missing You at Christmas

It’s been more than four years since I started writing here. Enough time that I can look back to what our lives were like the first time around, before we were in the car headed home with a newborn.

Lately I’ve been thinking about a post I wrote around Christmas 2014 and how much of what I wrote then still applies to our lives now, despite everything that has changed in that time:

When you live with infertility, every day is difficult in its own way. There is never a day that is easy, but there are some days that are worse than others. Holidays are always among the hardest. I never thought it would be possible that I would dread going through the motions of the holiday season, but infertility has changed so many things for me and Christmas is one of them. 

In general, holidays are hard for those who have lost a loved one or are grieving, but for some reason most people seem surprised that it would be the same for those with infertility. Although we have not lost a loved one in the usual sense, there is a similar void in our lives that is impossible to ignore throughout the surrounding celebrations. But instead of time ‘healing all wounds,’ this pain has cut deeper with every year that passes, and each Christmas hurts more than the last.

The holiday season is full of painful reminders that we are infertile in a fertile world. Every December Christmas cards pour into our mailboxes with photos of happy families and updates of new babies or pregnancies. The majority of Christmas traditions that I love so much all revolve around children. Then, at the center of all the celebrations, we focus on the birth of a baby. The words behind nearly every seasonal hymn– or sometimes just the sight of a quiet nativity scene– feel like a punch to the stomach. Getting through the holiday season is now more an act of survival than reflection, peace, gratefulness, or enjoyment…

We passed this Christmas by being dragged through the motions by our families, while inwardly we focused on the surrogacy process in order to avoid hurting too badly. We’re hoping that this past Christmas was the last one that we’ll celebrate without having a child of our own, but this is not the first time we have held onto that hope… nor is it the second, or even the third. Christmas 2011 was meant to be our last just-the-two-of-us Christmas, and now every one that follows serves as another reminder of how incomplete our family of two feels and just how much time has passed since we first felt that way.

December 28, 2014

A year ago, Ross helped me pick out a small polar bear, which I’ve been carrying with me, just like I carried a Paddington Bear while we waited for Ross. It’s been with us for all of our fertility appointments, every weekend away, and each holiday– a physical reminder of our embryo and the potential of the baby we are currently fighting for.

Knowing the gender of our embryo has made the wait harder in many ways. We’re better able to imagine that child and our life with them– but we remain barred from both. This Christmas there is someone out there who is missing from our family, a void that we’ve lived with since first getting the call. But it’s not as easy as scheduling an embryo transfer in order to give that child a chance at life, and the reality is that we don’t know if this child is “for keeps” yet. We will carry it in our hearts for all this time and still the chance of a failed transfer is high– maybe as much or more than 40%.

A new ornament as we wait and hope.

Tomorrow morning I am scheduled for my next blood draw, the beginning of my third IVF cycle. If the results confirm ovulation, I can start 2 weeks of daily Lupron injections before adding in my stimulation injections and ending with an egg retrieval in the latter part of January. Last week I spent nearly an hour scheduling the delivery of all the needles, alcohol swabs, and medication I’ll need over the next month. The only hurdle left was to run everything through insurance to determine whether any of it would be covered. Saturday we expected to receive everything, but instead, nothing showed up. It was never sent, and the fertility pharmacy never called to inform me or tell me why. Without that box, I will not be able to start my injections, and because of the timing of Christmas, this cycle will likely be canceled– again.

Coming to that realization, now the sixth time we’ve had to cancel a cycle, was devastating. Defeated and fighting back tears on Sunday morning, I started to process yet another delay, wondering whether this is a sign that I will never hold that child in my arms in this life. That maybe we’re meant to give up and start the process of acceptance so we can heal in whatever way possible, rather than continuing to leave this wound open. We keep pushing on and keep hitting road block after road block: at the clinic, with the surrogacy process, from our insurance. The obstacles feel endless. I’m heartbroken, and I’m angry. I don’t know to keep finding the strength to do this.

The last few months have been especially difficult, even without the grief of infertility and stress of the surrogacy process. For as much as I think I can shield Ross from the effects, he is often far more perceptive than I give him credit for. Recently he surprised me one morning when he paused while eating breakfast and asked, “This is a hard time, huh?” And it is. Every day is so hard, but I don’t want him to carry that too.

In the meantime, despite the pain of this season, I am so grateful for the distraction of watching Ross experience the wonders of the holiday. We didn’t have that before and it changes everything. Throughout December, we have been opening daily windows of his Paw Patrol advent calendar from my mom. Every window reveals a new little toy– sometimes one of the dogs or another animal, sometimes a tiny tree or snowman. It’s the first thing he wanted to do each morning when he woke up as we counted down to Christmas. Then, on Sunday, the day I was faced with the possibility of canceling our cycle, he opened the last gift before the final one on Christmas Eve: a polar bear.

There is not a day that goes by when I don’t think of you and wish you were here.

Explaining Surrogacy… to a Child

The first time I had to explain surrogacy to a child happened when Ross was 8-months-old and we were staying with family friends. Their young daughter had asked to look at baby pictures on my phone, and, for several minutes, she scrolled through my camera roll– normal photos, pictures of Ross trying sweet potatoes for the first time or playing in a pile of brightly colored leaves– before stopping at a photo of him as an embryo.

FullSizeRender (8)
This will always be one of my favorites pictures of him.

It was easy enough to explain the embryo photo without going into the details of gestational surrogacy, but I knew we were likely headed into complicated territory. The concept of surrogacy wasn’t something I necessarily wanted to get into, but I didn’t want to lie to her either. As I watched her swipe, I wondered which photo would be the one to give us away, but a picture of us with Elle during the second trimester went by undetected. It wasn’t until she saw Elle holding a newborn Ross while still in a hospital gown that she hesitated.

“Did she give birth to her baby in the room next to you?” she wanted to know.

“No…” I started, not sure how forthright I should be, or even really where to begin.

At first I tried to give a vague answer, something simple, but it only led to more questions until eventually, without intending it, I had her full attention. After she’d absorbed the basics, she wanted to know how surrogacy was possible, why Ross wasn’t considered to be Elle’s baby instead of mine, whether getting pregnant (by taking Ross from my body and transferring him to Elle) had required surgery, and how long Elle had been a part of our lives. They were all questions I’d answered many times with adults, but finding the words to make the answers accessible to a child made the conversation difficult in a new way. To start, I referred back to the embryo picture and told her that although my body could make babies, it wasn’t able to carry them. I explained that someone else had offered to carry Ross for us until he grew big enough to be born and come back home to us.

It took her a few moments to process and accept it, but then she surprised me by asking in a rather matter-of-fact way, “So… now you guys are like sisters?”

“Yes,” I answered, shocked by her immediate understanding of our deep gratitude for Elle and the amazing thing she had done for us. At 9-years-old she had grasped on her own what most adults struggle to understand about our surrogacy journey.

On the other hand, explaining the way we became parents to our surrogate-born child presents further challenges. We don’t just have to reveal it to him, we will have to help him process his own feelings about his birth and choices that were made before he was even in existence, including our choice to write openly about it. We will also need to give him the ability to explain it, refuting on his own the common misconceptions and stigma. It’s not something we will do once; we will work through this issue for and with him throughout several phases of his life and understanding. I don’t doubt that at some point he will come across detractors. I imagine there will be someone who tells him that we were selfish for not adopting, that I am not his real mom, or that he is the product of his dad’s physical relationship with someone else. I know this because I have witnessed and experienced it myself.

From the beginning, we decided we wouldn’t hide the surrogacy from anyone, especially Ross. But there is no model to work from or book to consult when it comes to an explanation, nor is there anyone in our lives who can relate. We don’t want it to be something he remembers learning, but that means talking about it well before he is able to grasp the concept.

So, when Ross was a newborn in the fits of a colic episode, and I’d spend hours just rocking and talking to him as he squalled in my arms, sometimes I would tell him his story. Later on in his infancy, we bought every surrogacy book available for kids (so, basically, all three of them) and kept them in the rotation. My favorite, The Very Kind Koala, tells the story of a special koala who carries a baby koala in her pouch to help another couple become a family.

After he’d passed his second birthday and we began another cycle of IVF in the spring, we started talking about it more in depth:

“Did you know that when you were a teeny tiny baby, the doctor took you out of Mommy’s belly and put you in Aunt Elle’s belly so you could grow big?” I asked him casually one morning.

“Ohhhh,” he replied very seriously. And then, to my amusement, he added, “That’s cool.”

Shortly after the move this summer, we read Sophia’s Broken Crayons together. When we got to the part with the woman who had a broken belly, I stopped reading and placed my hand on my own stomach, telling him that the same was true for me. The words tasted bitter even as I forced myself to say them, and I shared that it was something that made me very sad.

“That’s why Aunt Elle carried you in her belly,” I carefully explained, “She made Mommy and Daddy so happy, because now we have you!”

After finishing the book, we moved to another activity, but he wanted clarification.

“Is you belly broken, Mommy?”

“Mmhmm,” I answered, nodding in encouragement of his understanding but not really wanting to repeat it.

“I will carry you baby, Mommy! I will carry you baby!” he said brightly. Not knowing what to say, I hugged him tightly and thanked him while blinking back tears. “You’re welcome,” he responded simply.

Since then he’s been the one to bring it up on occasion, like the other week when he started talking about it at dinner or Saturday when we ran errands and he randomly asked me if I remembered when “Aunt Elle carried Ross in her pouch.”

Yes, Sweet Pea, I remember.

IMG_6192 4

 

 

Where Have We Been?

Since receiving and sharing the results from our second full IVF cycle in May, a lot has changed. Life was busy at the time and, despite my best intentions, I stopped posting altogether. The week following my egg retrieval, with a belly still swollen from treatment and a roller coaster of emotions made worse by unnatural levels of hormones, we celebrated Kyle’s graduation. It was a culmination of the previous three years of our lives, and as his name was called, I couldn’t help but think back to everything he’d been through in that time. After weighing multiple job offers in varying states, Kyle accepted a position, and a month later we put an offer on a house just 15 minutes away before beginning the enormous task of moving for the fifth time in less than nine years.

It was difficult to close that chapter of our lives, and I wasn’t ready to leave the apartment where our dream of becoming parents had finally come true. That was where Ross had taken his first steps, the only place he had ever known as home. All of his friends lived there– right outside his door and always ready to meet on the playground. It was also the last place our dog, Orion, had known as home, the last place he spent the night curled up beside me. I didn’t want to put distance between us and those parts of our lives.

These three years haven’t been easy by any means– the sacrifices we made, especially financially, of leaving behind an established life and starting over so Kyle could pursue his graduate degree, will affect us for a long time to come. The final months of 2015 following the move were terrifying, and for a while I believed we’d made the biggest mistake of our lives. Some of that time was devastating: the sudden and unexpected loss of Kyle’s mom followed by the loss of three of our aunts & uncles to cancer (all of whom were between their early 40’s to mid-60’s and still had so much life yet to live), the painful reality of the third trimester as I faced not being the one to deliver our child, the decision of putting our beloved dog down just two weeks after Ross was born, and the never-ending challenges of navigating a chronic illness that seeps into every aspect of our lives. But, we also gained so much in that time: we developed friendships that are more like family after these years of living in student housing together, we learned to live on so much less than I ever thought possible (and I think we’re better for it), and we finally, finally got to bring our baby home. Together, the three of us built a life filled with fun adventures and amazing experiences.

Now, here we are again, starting a new chapter.

As always, one thing has remained the same: the struggle to have a child. Nineteen years after diagnosis, it feels as though fertility (or rather, the lack there of) is still the thread of my entire life. In more than seven years we haven’t taken a break from actively working toward having a baby– not even when Ross was born. We’ve spent so many years just trying to put together the ‘picture’ of our family despite missing so many necessary puzzle pieces.

The injections and ultrasounds came to a halt following my egg retrieval nearly 6 months ago, but in the meantime, the surrogacy process trudges on. We knew this would be roughly a two-year journey, but the strength and determination I once felt is waning due to complications with beginning my third IVF cycle. The fertility treatment aspect, which is one of the more straightforward and uncomplicated parts of the process, has been a greater hassle than we anticipated, taking up valuable time and energy that could be used to focus on something else.

When we went through IVF for Ross, we were given a 3-year window to focus on treatment for another child. It wasn’t a guarantee that it would even be possible, but the recommendation was not to wait. We anticipated going through another cycle in early 2016, but surrogacy complicates everything, and I didn’t start injections again until two years later after postponing twice more (Summer 2017, January 2018). At the end of my cycle last May, we looked forward to another attempt in August. But again, we were unable to proceed with IVF as planned. It was a hard to accept, but October didn’t seem too far away…

I should be in the middle of my injections right now, but I’m not. It’s a story for another time, but we were forced to postpone treatment again, meaning that over the last two and a half years, we’ve missed out on completing IVF cycles a total of five times due to circumstances beyond our control.

The new hope is for January 2019, but I am feeling wary of hope, especially since that will be the same month that marks the end of the original 3-year window.

In the meantime, I don’t know what else to do other than to keep trudging.

IVF #2: Snowflakes in Spring

Two weeks ago I answered the phone with a mix of dread and anticipation, hoping for the best but expecting the worst. The results, it turns out, were somewhere in the middle:  3 AA embryos with my name on them were tucked away in the freezer. As far as grading goes, each blastocyst (5-day-old embryo) receives two letter grades from the embryologist– one for the outer cells (which become the placenta) and one for the inner cells (the baby). The grades work the way you’d expect them to, with A being the best, B for “good,” and C for “fair.” However, even an embryo with an AA grading is not guaranteed to result in a pregnancy, nor is one with a lesser grade destined to be unsuccessful. During our first IVF cycle, both blastocysts were given AB gradings and transferred within 6 weeks of each other, but only one resulted in a baby.

Aside from the first three, there was another embryo that had failed to divided properly and four more that could go either way. My nurse said they would continue to monitor the rest and call the next day with an update. Immediately I told Kyle not to expect anything, that our final number was going to be three.

The next morning ticked by slowly. Despite trying to be realistic the day before, I had started to feel hopeful that we might get to keep just one more. I remembered back to getting the final update call in 2015, the morning of our fresh embryo transfer. In 48 hours we’d lost more than a dozen embryos, but we did have one blastocyst ready to transfer, as well as a few that might still pull through. A few hours later, as we sat waiting to be taken back to the surgical room, the embryologist had come to inform us of one last embryo– a straggler, who was now safe in the freezer. That straggler was Ross; the others failed to develop. As I went over the memory, I realized that I only knew about Ross that day because we had been physically present in the clinic, waiting to transfer his sibling. He was too late to be included in the update call that morning, and if we hadn’t happened to have been there, I wouldn’t have known about him until Day 6. I started to believe that we would have a straggler this time around, too.

Eventually the morning passed but the update never came. I called in and left a voicemail for the nurse, but two hours later, I was still waiting. By now, everything in me said that we had a fourth embryo, I just had to hear the confirmation for myself. The waiting started to get to me; the build up of pressure felt unbearable. I tried to reason with myself, arguing that nothing would change if I had to wait until tomorrow for the news, that another 24 hours of waiting would still be less than what I’d made it through already. But I couldn’t stay reasonable anymore. So when Kyle seemed unruffled by the delay, I texted Elle instead, knowing that she would be indignant on my behalf. Finally, in the late afternoon, the call came: we did have one more, our straggler. This one had a BB grading, and I felt a special affinity towards it as the underdog.

Four frozen embryos. We had snowflakes in May. I felt at peace with the results, especially since we’d started with far fewer embryos this cycle. We just had one last hurdle to get through yet. This cycle, because of my increased age, my poor results the first time around, and the time and money that go into the surrogacy process, my doctor recommended additional screening to test whether the embryos were normal and likely to result in a successful transfer. Prior to being frozen, each one of our blastocysts had been biopsied, and those cells would be sent to a lab. The results would take another week or so. Another week of waiting.

IMG_5541
The remnants of an IVF stim cycle: several days and thousands of dollars.
Screen Shot 2018-05-21 at 12.19.37 PM
IVF Cycle Results Comparison by the Numbers
Screen Shot 2018-05-21 at 12.25.30 PM
IVF Cycle Results Comparison by Percentage

It was a busy week in the meantime. We weren’t just carrying the weight of our embryo testing, we had family staying in the area and multiple events surrounding Kyle’s graduation from his master’s program on Saturday. The weekend’s blur of festivities was followed by a few more somber days as we packed for a quick trip to Florida for my aunt’s internment. In the 48 hours between our flights we saw family from both sides who live in the area. There was very little downtime and never a moment our embryos were far from my mind; they clouded my thoughts and entered my dreams at night. Throughout the wait I tried to will three healthy embryos into beinge. Elle texted me on Wednesday to say that she was thinking of us ahead of the big day.

Then on Thursday, the call came. And I missed it, by seven minutes.

I fumbled through my contacts as I shut the door to block out sounds from the other room. The line rang, but rather than the expected voicemail message, my nurse answered. My heart started to race through the obligatory small talk– the most agonizing part of each call– and I tried to assess her tone to determine whether or not I was about to receive good news or bad. I couldn’t tell this time.

Well, we had one embryo. Out of four, nearly all of them were abnormal. It was a setback and not one I had been fully prepared for after the triumphant feeling of gaining that last embryo. I’d been warned that roughly half of our embryos would likely come back testing abnormal, but with four blastocysts, that still should’ve left us with two. One put me at a rate of 75% abnormal, well above the expectation. As someone who has been through a failed embryo transfer before, two was acceptable. Three was a miracle. One was not enough.

Back in early February, as we sat in our doctor’s office, having one or less at the end of treatment was the concern. One is not enough to start preparations for a much-needed hysterectomy. It’s not enough to be able to donate unused embryos to couples in need when we finally have a second child. One is not enough to move on in this process. If we were a normal IVF couple, we could schedule a frozen embryo transfer in a matter of weeks, and then, depending on the outcome, we’d move forward with any necessary treatment cycles.

But surrogacy changes everything. We are not a normal couple, and we don’t have the option of transferring this summer. For us, the hope is to simply transfer within the next year, and if that is unsuccessful, my body may be unable to produce another viable embryo to try again at that point. We need to do another cycle while we still can, and that means less time to focus on the next part of the process and more money spent on IVF when we desperately need it for other aspects of the surrogacy. We knew that all of this was a likelihood– from the beginning we were tentatively planning for another round of treatment sometime in August– but then I went and let myself hope that that fourth embryo was an indication that we’d finally found the missing key.

“Do you want to know the gender of your embryo?” my nurse asked, before ending the call.

“Yes,” I replied, wanting to know as much about this group of cells as was possible to know.

But as she told me, I didn’t know what to say in response. Here this potential future child is ready and waiting for us, but there is nothing I can do about it right now.