Thirteen is Not an Unlucky Number!

Oh such great neglect on the blog front! Apologies all around, but I’ll blame a consulting trip overseas to East Africa and getting wrapped up with friends in my ‘home away from home.’ In the midst of these travels, there has been some fabulous news on the fertility front.  I think my last post on infertility (Baby Drama in the Single Lane) brought you up to speed on my struggles to date. To recap, four inseminations, 3 IVFs and 1 miscarriage within a 2 1/2 period had left me gasping for air with a very real sense of being doomed to fail. But given that I am a type-A personality, who doesn’t like to take no for an answer — after each disappointment, I got up, brushed myself off and forged ahead to the next step. What’s it going to take to make this happen and I’ll do it. I will admit that over time, I’ve become emotionally detached from the end goal of pregnancy and motherhood,which in a double-edged sword kind of way makes me feel like a bad mother. I don’t plan or think about what pregnancy might bring and I certainly can’t think about what happens if this doesn’t all work out. Surprisingly, I’ve discovered that I can compartmentalize just as well as any man. Honestly, the idea of never being a Mom or having my own family is too difficult to contemplate. And every disappointment chips a little more away of my hope and belief. If I crack open the door to the serious emotions, I’m afraid the door might be wiped out by a flood and I won’t be able to push it all back into the nice little compartment I’ve created. But the end appears near….

After the 3rd failed IVF late last year in the US, I wanted my next move to feel more definitive with win-win situation. My doctor proposed that I could attempt another IVF. Sometimes you get better quality eggs in another cycle, but I didn’t believe it was worth the financial and emotional risk. Which left me with three options: egg donor, surrogacy and adoption. Adoption is my last resort, so to speak. As a single woman in her early 40s, currently unemployed and unhoused I couldn’t even think of applying until I got those ducks firmly in a row, plus I could be looking at a process of 2-4 years. Surrogacy – I didn’t see the point, because the doctor keeps saying that he sees no reason why I can’t get pregnant. So that left donor egg. I struggled with it for a month. Since I am the only parent in this scenario, a large part of me really wanted that genetic angle. That’s my legacy, what could be carried on. Giving up that idea was tough. I also thought that now I would bring into the world a ‘different’ baby than the one I would have brought in using my own egg. A friend helped me to overcome this fear when she told me, “Margaret, your baby girl’s soul is up there waiting for you. It doesn’t matter how she comes – with your egg or someone else’s. It still the same soul.” I found that comforting, so after a month of dragging my feet, I opened up the egg donor database.

This egg donor database was established through my clinic, so it provided a limited group of 60 women, all between the ages of 22 and 33. The women are tested left, right and center for every possible health issue that impacts the reproductive system. The clinic provided an extensive family medical history, physical attributes, baby pictures and a full barrage of interview questions that explained the donor’s current job, likes/dislikes, personality traits, activities and why she’s a donor. It was more challenging to pick the egg donor than the sperm donor, because in this case I was looking for someone just like me. And let’s face it – it’s hard to find your own doppelganger, let alone someone close to that in a group of 60 women.

I finally picked one donor who turned out to be no longer available. Back to the drawing board. I thought I hit the jackpot with the second donor because she looked even more like me as a child. The clinic contacted her, she agreed and 48 hours later called back to say she had a family emergency and had to leave the state for 4-5 months. Ugh! Picking this donor was not a straight forward endeavor, but the third time was the charm.

Since I was traveling overseas, I decided to retrieve the eggs from the donor, fertilize and then freeze the embryos. There is relatively no difference in pregnancy success rates between live transfers and frozen transfers and freezing allows you to store the embryos until you are ready to go. So I authorized the medications for my donor and somewhere in the state of Colorado, a woman began injecting herself with hormones to ramp up egg production. I learned that the donor I selected had donated three times before (the max is six) and she also had 2 children of her own, so I was informed about her past history of egg production; ‘anticipate 18 eggs,’ the nurse told me. After having only ever produced 4 mature eggs myself, 18 would be like hitting the jackpot. So when the embryologist called to inform me that the total number of retrieved eggs was 35…well, I was a little dumb-founded.

One of the continual debates I had been having up to this point, was the ever present ‘Should I plan for the possibility of a man in my future? a.k.a. a man that wants children.”  It’s the never-ending, hope at the end of a stick, what if scenario. What if I meet some guy down the road (ok, at least in the next quarter mile of the road) and we hit it off, become a couple and he wants kids? This dilemma presented itself to me in the form of a choice: I had the option to freeze some eggs and then fertilize the remainder which would be frozen as embryos. This would cater for that What if? factor. But it really depended on the total number of eggs and considering that ultimately, when the eggs are chosen for fertilization – you don’t know which eggs are the best and will ultimately end up fertilized. So it’s a bit of a risk on all fronts. In the end, I chalked it up to “Carpe diem!” and fertilized the whole batch.

It’s amazing to think about the technology around fertility these days and what’s possible. At the same time, it’s also disturbing to watch nature take its course, implementing it’s own survival of the fittest and decrease the odds in diminishing returns.  My first report from the embryologist was the number of eggs retrieved (35) and the number of mature eggs that could be fertilized (25). By day three, the embryologist sent me a report outlining the number of eggs that had survived fertilization (19) and were now multiplying as expected. The cell count should divide and double each day. I was told how many cells each embryo had, as well as the level of fragmentation. Ideally, you want the embryos to have less than 20% fragmentation in this process. Of the 19 embryos, 17 were meeting the ‘good quality’ criteria for day 3. The goal is to take the embryos to blastocyst stage which usually occurs around day 5/6. It’s at this point the embryos are frozen.

My final report came on day 6. On this day, each of the embryos is given a grade just like the chicken eggs – which I actually find kind of funny. It’s a double grade – AA followed by AB, BA and BB. Obviously, AA is the best, but anything else in that grade range is generally considered good quality. By day 6, I had 13 lucky little embryos. Now they sit, frozen and waiting for a chance to become something. Given that the transplant will likely only involve 2 embryos at a go, there are possibilities ahead. It seems motherhood is fast becoming more of a reality! Liftoff this summer…stay tuned.


Baby Drama in the Single Lane

Many parents can tell you about the drama of raising children, but few people talk about the drama of actually trying to become parents. It seems to be this big secret that so many people wrestle with and often, the elephant in the room is only revealed upon a confidential admission of your own struggles. Then the floodgates open and you really start to hear the stories!  Well, add to this mix the element of trying to become a parent as a single woman and you have serious baby drama in the single lane!

In my 20s, I just assumed my life would follow the typical pattern we all grow up on – meet a man, fall in love, have kids, balance your career with your family, grow old on the front porch together and look back fondly on all the memories. Alas, many of us know, things don’t always work out as we plan. The universe has something else in store. Since the right man has not yet made an appearance in my life, where does that leave me? I have always known that I wanted children. As I got older, I knew I couldn’t continue to wait for Mr. Right; the biological clock was starting to run out of time. For a long while, I thought I would adopt. I lived in East Africa and there were many children in need of love and a home from this area, so I thought that would be my path. However, when I turned 37, something changed and I decided that I wanted to experience pregnancy and have my own child, even if I was single. It took me another two years to ‘officially’ tell my family of this decision and begin to move forward with some options. At the time, so utterly naïve, I just thought it wouldn’t be a problem for me to get pregnant. The big decision had been made – I mean, deciding to get pregnant as a single woman is not the easiest choice – so with that  decision made, the rest would fall into place. Even though I had heard a few stories of infertility and I was “older,” I honestly did not imagine that I would have difficulty. Plus, I’m a planner and type A personality, so with the right organization and know-how, I knew I would be set. (Insert evil chuckle here.)

Flash forward two years to present day. Still no baby and one heck of a long and bumpy road. Much harder than I imagined and it’s taken an emotional toll I had not envisioned. My first year, I started with insemination. I had a great time picking out a sperm donor. There was so much information to peruse – health history for generations, baby pics, audio interviews and celebrity look-a-likes. My whole family got into the process, scoring donors for me and giving input. I had four inseminations done in Nairobi, Kenya. (Yes, it is possible. There are actually two infertility doctors in the country.) The sperm was, believe it or not, fedexed, and thankfully, I had relatively few problems with customs – kudos to my doctor. But with no positive pregnancy results forthcoming after four tries, I was advised to have this test – it has a super long name that I won’t bother you with – but essentially, they inject dye into your fallopian tubes to check for any blockage. Concerned about the pain, I decided to do this in the US. Unfortunately, that didn’t make much difference. The results of this fun test revealed my left fallopian tube was completely blocked, probably from some infection I never even knew I had. When a doctor sees this, the immediate recommendation is in-vitro fertilization or IVF.

For those of you on the fertility learning curve, IVF is when the doctor removes your eggs from your ovaries, fertilizes them outside your body, watches the embryos grow for 2-6 days and then transfers them back to the uterus. So I was on to the next step. Eager, ready and willing, even though the technology in Nairobi was – let’s just say – not as cutting edge as the US. For example, in the US the procedure to remove the eggs requires that you are put under anesthesia in a 1/2 day outpatient surgery. In Nairobi, they use an ‘older’ method – shot to the cervix  for numbing and then suction out the eggs while you are awake. This is done in a regular examination room. My Kenyan doctor said the use of anesthesia was really just to ‘ease’ the emotions of the patient and not necessary. (i.e. Americans are wussies!) Shot in the va-ja-jay….sounds like fun, sign me up! In my opinion, I moved forward bravely, since I’m not real fond of pain of any sort, but I felt confident in my doctor. I had two IVF procedures and each was slightly different. There was some pain and it is a wee bit nerve-wracking, to say the least. In addition, services are just not as customer friendly in this developing country. I liked my doctor, but he still had a ways to go in learning bedside manner, along with the nurses. Although a namesake nurse offered me lots and lots of prayers; “God will provide,” she told me with never-ending reassuring pats on my shoulder and hugs. I guess that made up for her inability to provide accurate answers to some of my basic questions on medications or procedures. But I did like her and she was my namesake, so I took it in stride.

The medical community here is still learning about the value of comfort for patients – so the ice-cold, old-fashioned, horizontal metal table  with no give and stir-ups that harnessed my legs at a 90 degree angle – became my friend. The table was so high, you had to get on a little step stool to climb on. Once there, the table was so slim you had to balance appropriately so you wouldn’t fall off one side and of course, if you put too much weight on the bottom end, the whole thing tipped towards the floor. Once my legs were harnessed, the nurse would crank down the left side of the table like she was rolling down a car window. The room was always either too cold or too hot (no central air); instruments were often cold and privacy was not a main concern. Picture being spread-eagled at a 90 degree angle towards the only door to the exam room, with nurses and the doctor coming in and out quite freely. There were no warm and friendly pictures of babies or happy women/couples – just stark white walls. The reception area had a TV which usually played a local TV station at the loudest possible volume with gospel music or just bad, bad programming. Did I mention that you can’t make appointments? It’s standard practice – first come, first serve. But this doctor was one of the only successful fertility docs in all of East and Central Africa – women fly or bus in to see him – traveling and waiting an untold number of hours. So the only way to guarantee that you would not have to wait more than 2 hours was to show up at opening time – 7 am. Even then, you were lucky to get out by 8.30 am. Ok, you get the picture. Some days I just had to laugh or I probably would have cried. But I do think that living overseas gave me a healthier attitude or more of that ‘go with the flow’ nature. Time has a completely different meaning in Africa generally and ‘pole pole’ or ‘slowly, slowly’ in Kiswahili is one of the Kenyans’ favorite sayings.

My IVFs revealed that I have a ‘low ovarian reserve.” Ladies, this is not something you want to hear. Trust me. Even after being jacked up on lots of hormones, I was only producing 3 eggs per cycle. By comparison, most women on this regiment would produce 10-16 eggs. But I persevered and I was able to get pregnant on my 2nd IVF. It was so exciting, but surreal. Then the blood tests began to show that the embryo wasn’t growing correctly and the emotional roller coaster began as I underwent blood tests every 3 days and was told to wait and remain hopeful. Unfortunately, the end result was a miscarriage and in the true tactful nature of this developing country medical community, I was placed next to women who had just given birth with their screaming babies. This was a rough time. A miscarriage is difficult no matter which way you look at it, but not having a partner by my side seemed to double the heartache. Even with the great support of friends and family, I still felt very alone. At the same time, it was also a glimpse of what single parenthood would require. Strength and perseverance.

After more research, more sharing of my story and hearing those of others, I consulted with a couple of  doctors in Colorado. Who would have thought that Colorado is the hotbed for infertility in the US? The best doctor in the nation is here with high-end research and he’s doing some amazing things. Miracle-worker, I was told, but also cautioned – no bedside manner and you’ll probably only get 5 minutes. Well, my working in Africa seemed to finally pay off – he really took a liking to me and the work I was doing abroad and after 45 minutes fast-tracked me into his system.  So I did another IVF  late last year. The timing was critical. I was already an older candidate, but once I turned 41, my chances of success with IVF decreased from 40% to 30%. Yikes! Age definitely works against you.

On this final IVF, they comfortably (or at least I was comfortable) retrieved 5 eggs. Four were viable and fertilized. I decided to participate in a clinical study which tested the genetic viability of the embryos. Upside, if viable and implanted, less chances of miscarriage because you know the embryos are healthy. Downside, if not genetically viable, they won’t transplant at all. It was worth it to me to know, especially given my age. This testing process took 30 days and then I received, unfortunately, very devastating news. None of the four were viable. How could that be? I had felt certain I would get at least one, possibly two! Some had too many chromosomes, some had too few. If the embryos had been transplanted, I would have miscarried naturally. Damn my old eggs! That’s the fact of the matter, my eggs suck. Too old, too few, too poor quality. If only I had known 10 years ago, I would have frozen them in advance.

So I am now on the road of egg donation. My doctor has suggested that I could try another IVF, but honestly, I fear spending another $30k and getting the same results. The definition of insanity, right? Doing the same thing over and over and getting the same results. Plus, let’s face it – this infertility route is definitely not cheap and also not covered by insurance. I’m always so amazed by the number of young couples in the center – how the hell can they afford it? Anyway – egg donation has it’s own pros and cons. I’ve dragged my feet a bit, since I’m not real thrilled with this avenue. It wasn’t my first choice. But now I’m here and moving forward. Of course, the drama has continued over the last few weeks. I swear, it feels like the fertility gods are working against me, but I’m remaining positive. I’ll blog about the egg donation turmoil another time…I’m drama-ed out and this blog is already too long. Perseverance and faith, at this point, that’s what is getting me through, barely. Last word of advice: ladies, in your 30s, don’t wait. I understand how hard it is to make a decision. But if you think, even for a moment, that children are what you want in the future, get checked out and freeze your eggs. You’ll thank yourself later.

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