PUPO

PUPO is a infertility phenomenon.  It operates on two levels, allowing infertile couples (and women especially) to hope and celebrate while simultaneously acknowledging the fragility of our pregnancy experiences.

PUPO is Pregnant Until Proven Otherwise.

Today, according to my nurse, I am “very pregnant.”  Any Human Chorionic Gonadotropin (HCG) level over 30 is considered pregnant, and my clinic considers anything over 50 to be good.

My number is 542, and we’re at the first level of PUPO–celebration!

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I’m also 4 weeks pregnant today.  Traditional calculations rely on menstrual cycles, adding two weeks to the date of the last period (since ovulation typically occurs about two weeks after one’s period).  My embryo(s) is 15 days old (we transferred 5 day embryos on November 20).  Then we add the two week cushion as with natural conception.  (It is important to use the same calculations and be on the standard timeline to measure growth; this is also why pregnancy is calculated at 10 months rather than 9 1/2.)

With an HCG result greater than five, the lab was also to run a progesterone and estradiol test to make sure those levels are appropriate to sustain a pregnancy.  I just called the local lab because my clinic hadn’t received those results, only to discover that the lab misread the orders as “less than.”  They’re running those tests now.

In the meantime, we’re making only one minor change to my meds.  I’ll stay on my daily thyroid medication, baby aspirin, and vitamins.  I’ll also keep changing my four estrogen patches every other day and doing those very fun progesterone injections every other day.  (My nurse, the best nurse ever, is mailing me more short needles–she rocks!)  The only change is increasing the vaginal progesterone from twice daily to three times.

Saturday, I have another HCG test.  The number needs to increase by 53% (essentially doubling every two days), so we’re looking for 829.26 or higher.  We’ll also test my TSH level to make sure my thyroid is behaving.  Should everything go well, my first ultrasound will be around Dec. 17, with the second two weeks later.

However, the second layer of PUPO is still here; those who struggle with infertility always live in the shadow of what-might-go-wrong:

  • The numbers might not double because the embryo(s) could still arrest.
  • Or one of two could arrest.  (We transferred two, but there’s really no way to know what’s going on in there until the ultrasounds.)
  • We could have a blighted ovum (when the embryo attaches and the yolk sac that provides nourishment to the embryo until the placenta develops grows but the embryo does not,
  • or a chemical pregnancy (when early cells that will become the placenta attach to the uterus and start producing HCG, but the placenta and embryo fail to develop,
  • or an ectopic pregnancy (when an embryo implants somewhere outside of the uterus –usually in a Fallopian tube but sometimes other places like the cervix),
  • or a heterotopic pregnancy (when one embryo attaches in the uterus and another, outside).

But, for the moment, I’m PUPO.  And we’re celebrating, y’all!

When all You Want is to Test

I’m 7dp5dfet (7 days post 5 day frozen embryo transfer) and two days from my beta (first pregnancy blood test), and all I want to do is take a home test.

Clinics routinely tell patients NOT to take home tests during the two week wait.  HCG (human chorionic gonadotropin–the pregnancy hormone) levels are often too low for a home test to detect, resulting in a false negative. They don’t want you to be disappointed when the result isn’t guaranteed.  (It is almost impossible to get a false positive. However, a positive does not guarantee a viable pregnancy.  It could be a chemical or ectopic pregnancy or a blighted ovum or could miscarry.)

p-3017-early-pregnancy-test-strips-49.png.pngThat said many, many women test at home.  Several of the women in the various online infertility support groups I frequent share their HPTs (home pregnancy tests), some showing positive as early as four days post transfer.  Others are insistent that a positive result will be visible by day 7 or 8.  Yet others report that they still had negative home tests even after their positive beta.

With our two previous transfers, I didn’t want to test at home.  I was fine waiting until the official result, and even then, I didn’t really want to know.  This time, I just want to know its negative (again), so I can just quit waiting and wondering.  I just want it to be over with.

That said, I haven’t and won’t take a home test.  Not because I’m holding out hope for a positive or because I don’t want to hear that it’s negative.  No, I’m too practical for that.

I won’t test because I still have to go work on tomorrow and Thursday.  They’re the last two class periods before finals, and I have to help my students prepare.  If I get a negative result, I’ll want to be in bed for days.

So I’ll wait for my beta on Thursday.  I’ll go to the lab at 8 a.m. and be in class by 9:30 (before I can cheat by checking the results auto-released into my online patient portal) and well before my nurse calls with the result (which is usually later afternoon).  I won’t get out of class until 1:30, and if, by some chance, she calls during class, I’ll let it go to voicemail.  Then, I can go home.

I’ve already warned my bosses that I may be sick on Friday.

“How Are You Feeling?”

Today is 3dp5dfet using de (three days post five day frozen embryo transfer using donor eggs).  And every day since our transfer, I’ve been asked, “How are you feeling?”

From the sometimes brief, sometimes elaborate conversations that ensue, most people are asking about my physical well-being.  Some assume that I’m in some kind of discomfort or pain from the transfer procedure.  I’m sure this is because they don’t really understand how the transfer works, and when they hear “Valium,” they assume it is for pain.

In all reality, the transfer itself is no big deal, especially compared to all preceding tests which include vaginal ultrasounds (requiring the use of a quite large internal ultrasound wand–think large adult “toy” minus the fun), repeated labs (leaving arms bruised and bloody), tube dye tests (blasting dye through the uterus and Fallopian tubes which can be excruciating for women with any kind of a blockage–so painful, in fact, that some clinics perform the test under general anesthesia), and the ever-wonderful ERA (a uterine biopsy where they literally pull out a chunk of the uterine lining for testing) which is the only test to ever leave me in tears.

The transfer itself only takes about ten minutes.  The ultrasound tech uses an external ultrasound to make the uterus visible to the doctor who threads a tiny catheter through the vagina and cervix.  Once the catheter is in the exact right place (which may require some adjusting and readjusting) the fluid (sometimes called embryo glue) containing the embryo (or multiple embryos) is injected through the catheter.  The catheter is then removed and checked by the embryologist to ensure that the embryos have cleared the tube.  Then, the next hour is spent on one’s back slightly declined.

The worst parts of the transfer are the speculum (which is inherently uncomfortable regardless of procedure) and the ultrasound pressing on the partially full bladder.  The Valium isn’t for pain.  It’s to help patients relax and prevent the uterus from contracting, allowing the embryos to (hopefully) settle in before the mother-to-be leaves the clinic.

“So how are you feeling?” also refers to my physical condition post-transfer.  There’s not much to report other than the daily game of pregnancy symptom or hormone side-effect. My boobs are sore although less than previously, but now the swelling has spread to the patch of tissue above my boob next to my arm pit–my arm pit fat?–(pregnancy swelling or hormone reaction?).  My estrogen headaches are gone, but the nausea still comes and goes (too many meds and not enough food or morning sickness?).  I do have some minor cramping and my joints hurt (burrowing embabies or pre-menstrual symptoms?).

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(Photo from “What is the Two-Week-Wait (TWW)? at https://www.invitra.com/en/what-is-the-two-week-wait/)

“How are you feeling?” can also reference my emotional and mental well-being, but no one asks that specifically, especially when I follow-up the question with the explanation that there aren’t really any noteworthy physical effects or symptoms.

This version of the question, though, is less straight-forward.  One moment I’ve completely forgotten that I’m in the two week wait, and the next it’s all I can think about.  One minute I’m grabbing for something heavy before I catch myself and remember that I can’t lift more than ten pounds.  Most of the time I’m living my daily life, grading papers, reviewing textbooks, doing house chores, and then I randomly cough or laugh and worry for a split second that I might have jostled the embryos loose.  Sometimes I’m planning how to manage upcoming events with all my restrictions, and then I remember that none of them may even matter by the end of next week.  One minute I’m wondering how in the world we would manage twins (and what in the hell we’re going to do if they’re girls since we only have boy names), and the next I’m steeling myself for what feels like yet another inevitable negative result.

Asking a woman in the two week wait “How are you feeling?” is a question that’s answer literally changes second to second.

Day 1 of the TWW

We had our transfer this morning around 11:20 mountain time.

We transferred our two highest grade embryos. The embryologist  said they thawed beautifully, twice.  During the procedure, the ultrasound tech did mention that I have a retroverted uterus (it tilts back instead of forward), but this is a non-issue.

After an hour on my back (and one bedpan visit later), I’m back in the hotel on bedrest for the rest of today and all of tomorrow.  My nurse just called with my lab results and they’re “beautiful.”  My estrogen is 942 and the progesterone is 52, so no med changes are needed

On Thursaday, life mostly returns to normal except for the anxiety and stress and paranoia about every little twitch, twinge, and decision between now and our November 29 pregnancy test.

But, in the meantime, I have papers to grade and a new semester to plan while we wait to see what these two little hatchlings do.

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Tomorrow is Transfer #3

Tomorrow is transfer #3.

I’ll wake early, so my husband can stab me with my every-other-day progesterone shot. Then I’ll kill several hours (and take two more meds) before we arrive at the clinic at 9:45 (10:45 central).

We’ll check in, and I’ll have blood drawn to check my estrogen and progesterone levels then head upstairs to the surgery area.

Meanwhile, I’ll sip my bottle of water, filling my bladder, so the ultrasound can guide the doctor’s placement of our embryos. The clinic thinks I need a full bottle of water between the time I arrive and the time we do the transfer. They’re clearly unfamiliar with my bladder. I’ll pace myself.

(Our first transfer required an undignified experience with a bedpan during the hour long post-transfer wait–try to do that while lying flat on your back.  Our second transfer required me to partially empty my bladder before the transfer because it was too full and a speedy trip to the restroom the very second my hour was up.)

Once upstairs, I’ll change, and the nurse will run through our information again and give me  Valium.  It helps recipients relax and prevents uterine contractions.

Then we hang out until transfer: 11:45 (12:45 central).  The ultrasound tech will come and go checking my bladder, and we’ll meet the embryologist responsible for the shipping and handling of our microscopic embryos.

Eventually, our doctor will arrive, and our room will be filled with the many people we need to make a baby.  We’ll see our two embryos on the screen and confirm and verify (again) the number to transfer and the number remaining.

Then the doctor will thread the tiny catheter through my cervix and into my uterus, depositing our embryos, and I will spend the next hour flat on my back with my head tilted slightly down.

When the hour is up, we will go back to the hotel where I’ll remain on bedrest for the remainder of Tuesday and all of Wednesday.  I’ll be on my back or side, leaving the bed only to visit the restroom and take meds.

Thursday we go home, and my life mostly goes back to normal.  I won’t lift more than 10 pounds; I won’t raise my body temperature–so no baths or hot showers and no electric blanket.  I’ll keep taking all my meds.

And we’ll wait.

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7 Days to Transfer #3

We are one week from our third embryo transfer.

And I’m in a really shitty mood.

Between work, my personal life, and infertility, it’s been a very stressful couple of weeks.  And now with all the “family” holidays here, the obligations and socializing and holiday stress is mounting too.  All I really want to do is go to bed and sleep until the new semester starts in January.  And even then I might pull a groundhog move: peeking out from under my covers and determining I need six more weeks of sleep.

I’m sure part of it (probably most of it) is the hormones, and I’m not even on that many yet.  Currently, I’m on a thyroid pill, 4 estrogen patches (changed every other day), lupron injections, baby aspirin, and prenatal vitamins.  Thursday, I stop the lupron and add the vaginal progesterone (twice daily), medrol, and doxycycline.  Friday, I become the human dartboard as my husband starts giving me the progesterone injections.  Then November 20, we transfer.

And no part of me is excited .

Why would I be?  I’m sure it’s going to fail again.  We’ve been here, done this.  Twice.  And we’ve failed twice.  And that’s after we failed trying to retrieve my eggs which came after we failed to get pregnant on our own. Why would this time be any different?  Sure, we have ten high-quality blastocysts, nine of which tested normal.  But plenty of people CCS test and still fail.  And the latest stats I’m hearing say it takes three to four transfers using donor eggs to get pregnant.  So why would this one work?  And if it doesn’t, I’ll find out at the end of November, ruining both my birthday and Christmas again (our first transfer fail was confirmed on December 26 last year).  Better yet, what new thing will go wrong?  There’s always another infertility shoe.  And if it does take, there’s no guarantee that it won’t be a chemical pregnancy or result in a miscarriage.

And there’s literally nothing I can do.

Okay, so that’s not quite true.  But I’m not buying into the wives’ tales and infertility myths.

I’m not eating pineapple core (*gag*).  And I’m not wearing custom-ordered “sticky embabie” socks (I’ve spent enough money on infertility already) or subscribing to a special infertility transfer package (but kuddos the woman who made that into a business).  I’m not doing any acai plan (nope, not happenin’) or eating only vegan, vegetarian, keto, or some other diet (really?  y’all know how much I hate cooking, right?).  I won’t be taking the two week wait off of work to “take it easy” (hahaha).  And I’m not eating McDonald’s french fries immediately after transfer (okay, I might actually do this one just because yum).

But I do have this guy.  He lives on the end table, overseeing my meds.

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Because when your GP, who began the conversation with “I know there’s nothing scientific about it all,” offers to bring you the Aztec fertility statue she brought home from Mexico, you take it.  Unscientifically, she and her husband had an infant all but dropped in their laps within months of bringing home the statue, and her hairdresser got pregnant within two months of the statue coming to live at her house.  I do, however, fully recognize the irony in my receiving a fertility statue that has, very obviously, been seriously broken and hot-glued back together.

With so much of infertility and conception out of my control, I’m doing the only things I can.

I’m following my calendar and doctor’s instructions.  I’m mostly not thinking about the upcoming transfer and the following two week wait.  I decorated for Christmas because I know if we get bad news at the end of the month, I will have no desire to decorate, and as much as having no real reason to do so (no excited children or holiday traditions or presents under the tree) makes me sad, the lights and ornaments and greenery are cheerful.

So here’s my view for the next several weeks, just because the “pretty” makes me happy and I need all the happy I can get.

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(un)Happy Halloween

On good days, my level of awareness of our childlessness is a dull background hum punctuated by moments of sheer terror when I remember that I need to take medicine (even though the dose is hours away) or moments of breath taking shock when I’m blindsided by my infertility.  Bad days, however, put our infertility front and center, social media rubbing my nose in it at every swipe, babies and pregnancies highlighted at every turn.  Holidays are some of the bad days (along with the first day of school and every day of yet another pregnancy announcement or baby cuteness overload).

For some, holidays are times of joy and family and memories.  For others, holidays are sadness and missing pieces and unmade memories.  Those of us with infertility know the holidays will be hard.  Some will face never-ending questions about when we’re going to start a family–questions often accompanied by not-so-helpful conception advice and reminders of our advancing age.  Others choke back tears while forcing the socially expected smiles at the happy families creating their own traditions.

For some of us this has been a hard week.  We desperately want our own cute, little monsters and scary ghosts.  We fantasize about the pumpkin carving and costumes we could use to announce our own pregnancies.

Even with our transfer nearing, I’ve felt the spiral starting for some time.  Last weekend, I went back home to take photos; I had to finish up a couple of senior sessions and shoot a 13 month old.  I knew that one would be hard.  Not only was he adorable, but he’s the single happiest child I’ve ever had the privilege to photograph, so when he reached out for me to hold him, my heart broke.

Later, I helped with a Halloween party.  I hadn’t planned on it, and I knew going in that seeing all those children in their costumes would be rough.  It was.  There were superheroes and butterflies and policemen and even Dorothy with Toto in her basket and very polite T-rex.  The kids decorated pumpkins and played games and ate snacks.  My cousin and her children arrived, and I held her youngest while his older sisters ran from game to game.  Really, I only held him until I had to excuse myself from the festivities for an injection.  Another reminder of my own infertility–as if the hoards of children weren’t enough.

The next day, I definitely felt the burnout from over-exposure to other people’s children.  While photographing kids and helping with the party were fun, they were also draining.  I tried to keep it together because I had one more set of photos to take when I finally arrived home, and it would have been terribly unprofessional to show up with mascara streaks down my face.

And then Halloween itself arrived and with it, the facebook flood of sugar-high trick-or-treaters and the Halloween-themed baby bumps.  And I broke.  I sat in my pajamas on top of my floor furnace and cried.  I cried for another year of no little goblins to dress up in themed costumes.  I cried for no trips to pumpkin patches and no evenings spent carving.  I took my personal pity party to the next level and even cried for Halloween chocolate.  (This no-caffeine rule is especially stupid at Halloween with all it’s many delicious mini-chocolate varieties; it’s doubly stupid when I’m all hopped up on chocolate-craving-inducing hormones.)

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Then, as I looked at those pictures, I cried for the other men and women who stayed home with the lights off or avoided being home altogether because they couldn’t bear to see all the costumed kiddos.  I cried for the moms and dads who couldn’t help but see their missing superhero in their trick or treat crews.

And I cried because I feel guilty.

Those of us with infertility endure not only our sadness but also guilt because we know our lack of enthusiasm is written on our faces.  We feel guilty because we don’t want to dampen everyone else’s spirits.  We feel guilty because our joy is, at best, tinged with sadness and, at worst, drowned in sorrow.  We feel guilty because sometimes we want to just skip the holidays altogether. And because sometimes we do.

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