The IVF Chronicles: The Transvaginal Ultrasound

I don't really remember my first "lady" appointment (is that even a thing that any woman remembers on purpose?); you know the one where the doctor gets all up in your business when really it's just been you and possibly tampax for several years.  But doctors, nurses, and techs, I have learned especially going through IVF and pregnancy, are super chill about lady parts that I don't even want to talk about with my mother or sister (I know there are some women who are really cool with their vaginas-not one of them right here).  Like I will never understand and always be in awe of the women of RHS on Rodi Road who were able to make chit chat and casual small talk during my several transvaginal ultrasounds.

The first one caught me by surprise which is not exactly how you really want to go into the procedure.  With our IVF plan, we were to call RHS when I started my period; because honestly, they are the only excited people when Aunt Flo visits you because that means it is time to hijack the hormone system and begin growing eggs.  I could have sworn that day 3 was supposed to be just a blood draw day where they evaluated my estrogen levels and other baby making hormones before putting me on birth control to get the timing just right.  Nope, I was poked first like I had anticipated, a bunch of blood was taken, and then I was sent back to another room and put in a special lady chair where I met my first of several friendly ultrasound techs.

If you are a lady, you know the speculum business from a Pap smear is one of the most uncomfortable experiences ever.  If you are not, I'd recommend comparing it to if a dentist had a crank to open up and keep your mouth from clamping down so they could see down into your esophagus (but in a body area you generally don't allow people to stare or let people poke).  Ladies, the poking, coldness, even the clicking (for me it's the clicking that is bothersome) of that damn machine being inserted and adjusted is a strange hell as a woman.  The transvag ultrasound thankfully doesn't use a speculum, however, there is a wand (that's right, expecto patronum, because making a baby without sex is so freaking magical).

The tech explained that today they were going to be observing the baseline size of my ovaries and making sure they and my uterus were in tiptop shape for egg growing and embryo housing.  Then I was handed the damn wand and told to go ahead and insert it then the tech would take over guiding it to do the procedure.  What in the hell?!  I have new appreciation and hatred for all of those antiabortion laws now that force women who are seeking to end an unwanted pregnancy who are forced to go through this first (like, I hope there is a special place in hell with a male version of this wand for their dicks, but I digress).  Anyways, this was my choice and I gladly obliged in the hopes for my future children.

Perhaps this tech was just down to business, or perhaps she was just not as small-talky as others would be, but this first go-around with the transvaginal ultrasound was super awkward because she didn't talk the whole time after getting started until about 30 minutes later.  Seriously, I stared up at the dark ceiling (why are these done in dark rooms?!) and observed the beautiful leaf patterns on the room curtain while listening to the camera clicking what I assume were pictures of my ovaries and uterus.  Later, techs would share the images with me of growing eggs and the two coffee stains that would become my babies, but for now there was really nothing to see but two quiet, broccoli shaped ovaries and a vacant yet healthy and welcoming uterus.

Gentlemen, if you are a loving member of your relationship and you know a woman who is going to have your baby, please respect the amount of embarrassing positions and moments they will endure on behalf of your progeny.  Get that lady some flowers to thank her for allowing so many to peek and poke and her being mostly good hearted because that is what is necessary to bring a healthy child/children into this world.  And ladies, hang in there, the transvag ultrasound is but an awkward stepping stone to some amazing and unbelievable moments.

The IVF Chronicles: WTF is IVF

There was a cute, fun conversation I had with my boss when we were just about to start hormone injections and the shit just got real business of IVF.  PAG and I had confided in our family members of our intentions on pursuing preggo-hood and we wanted to allow our employers the opportunity to know what emotional roller coaster we were embarking on so we didn't show up to work basket cases with no context as to why.  So I emailed my principal about two weeks before our beginning of school in-services to let him know what would be happening and how that may affect me at the beginning of the school year.

I remember going in and doing some basic small talk about summer and preparing for the school year before saying that I was there to tell him that we were doing IVF.  He gave me a curious look that told me the information didn't land quite right so the teacher in me went about delivering the message a different way.  I told him we were trying to get pregnant which has no shades of other possible meanings so the wait time on that understanding was much shorter.  He laughed and said he was worried that what I had said before was some kind of relationship counseling and that our marriage was in some kind of trouble.

How can there be marital discord; we have a SPAM selfie together.

IVF and infertility in general is not a subject of much conversation.  We just passed not too long ago National Infertility Awareness week where there were several articles and pieces out in the inter webs  explaining that some kind of barrier to having a child is experienced.  I will not pretend to be an expert in infertility stats or the various options and procedures available to couples and individuals trying to conceive (or TTC in the web lingo) as we were fast tracked to IVF because of some insurmountable odds PAG and I would experience without.

We were walked through the routines and the procedures formally twice, once with one doctor who ended up not working with us (I think she was focusing on some other area of doctoring or research, maybe) and then again with Dr. A, who oversaw our case until we were discharged as successfully preggo parents to be.  I remember there was a handout/booklet on the center of the table that outlined, with illustrations and diagrams, the egg retrieval.  The needle was magnified to encourage nervousness that a bubble tea straw would be needed to suck up our grape sized eggs.  This is not the case---please read those pursuing infertility treatments---I am not a doctor and will not describe things accurately at all or without hyperbole; your eggs will be normal sized and I don't even remember the ins and outs of the procedure.

We knew we were doing this so no matter how scary the pokey needles or big the bucket of money we would need, we were ready to sign on the dotted line.  And here's what we knew going into it what IVF was:  I would be on a variety of drugs and hormones throughout my monthly cycle first to chill out my ovaries from producing anything, than kicking them into overdrive to make as many eggs as possible without putting me into estrogen shock (again, not really, but there is OHSS which sounded super painful and highly likely).  Then when the eggs had reached peak ripeness (this thing with being ripe will come up again and again in this process and it is never, not gross) the doctor would retrieve them.  Meanwhile, my partner would supply his end of the reproductive ingredients in a manner not fun or convenient and also involving needles in places most people just don't want them.  The doctors of the laboratory would arrange fixed marriages of sorts via a process called ICSI (it's the one everyone shows with the needle putting the sperm into the egg) with as many eggs and sperms as possible.  Then they would be set to hang out while we fret and hope and begin using progesterone with the needles much bigger than the previous ones.  There would then be a transfer day where I had to have the most water in my bladder as possible and they took the best embryo and introduced it back into my uterus ready and welcoming for the embryo to look around and say "gee, this is a swell place; I'd like to make my home here for nine months." At that point we hope that the odds are ever in our favor and in about two weeks there would be a blood test to check for pregnancy.  Oh did I forget to mention the fifty million blood tests and the 1,000 ultrasounds I would go through for not just an IVF pregnancy, but an IVF twin pregnancy?!  I guess we can talk about all of those adventures another day.

While that is all easy to understand and fairly straight forward, I needed it explained to me in language I most understood, and by that I mean book language.  I absolutely lived with "Get A Life" : A His and Hers Survival Guide to IVF" by Richard Mackney and Rosie Bray.  The couple reference a UK experience of IVF which had some key differences especially when it came to insurance and the payment end of things, but each chapter was designed to give a thorough layperson's experience of both the pitfalls of failure and the joys of success.  Web articles are meh for information about reproductive services, and each individual clinic is going to be different slightly in their procedures and how they arrange things.  We loved RHS in Monroeville, seriously loved them.  Dr. A was the stern, serious straight talking woman I needed getting started and answering my initial questions.  Dr. S did my retrieval and my transfer and I am sure she is an angel sent to earth to help families conceive children.  Even the receptionists and the blood draw technicians made the whole experience as fun and calm and comforting it can be.  I didn't go through the hardships I am sure many families endure, not by anything I did but through sheer luck, but I can imagine they are the perfect staff to console and encourage others in their trials and IVF missteps.

IVF is mysterious and intimidating to the medical novice.  Knowing that babies are made of female eggs and male sperm is just the tip of a big complicated iceberg.  It is seriously impressive that so many folks get preggo so often or with so little effort as the odds of the sequence happening just perfectly so is daunting.  I am glad we went against the odds with our IVF adventure.  We are nearly at a year, even though that conversation with my boss seems like just yesterday.  PAG and I are lucky, blessed, fortunate, and thankful that we now are experts with our own IVF adventure.

The IVF Chronicles: Prelims to Preggo-hood

Bilbo and Wall-E have now been out longer than they have been in if that can possibly be believed.  That saying of the days being years and the years being days is spot on; it is a cruel yet amazing truth that our babies have grown and become people as rapidly as they have.  Seeing my coworker's new baby boy at a few weeks old and B&T's sweet baby girl at three months reminds me how tiny yet fragile they felt when they were below fifteen pounds.  The new baby smell is so nice and those first sounds are so sweet;  I do get the butterflies in my uterus feeling their tiny fingers and hearing their little coos, but I am reminded that those early days I felt very fragile and vulnerable and affected by their every cry and overwhelmed with all of their possible needs that I could not translate.  I know they are forming bonds and learning to make sense of their "people" and how to make their wishes known in ways other than squalling, but I remember it feeling like slow goings as we went through it.

I think back to those beginnings and am blessed to know how lucky PG and I were going through our preggo journey.  We learned a lot a long the way, and I now understand so much more about my own lady hormones than I ever thought I wanted to know.  Due to life circumstances, we were never going to have children the fun and sexy way, bummer I know (especially for you readers who thought you were going to get the 50 Shades treatment of my love life).  We discussed with our doctors the options, and they were confident IVF was our only option to potentially have our own biological children.  I should have written more down as we went through it, but honestly, then and still now, I feel like I am grasping at the strings of my balloons of responsibilities and constantly have this feeling like some are slipping away.  So here I am beginning to jot some of my thoughts on the development of our preggo adventures, and maybe if you are going through your own infertility struggles or twin preggo journey, there are some anecdotes here to laugh at or at least give you one more person to connect to on your way.

Prelims to Preggo-hood

PG and I were put on the IVF path by our urologist, Dr. J.  As part of the UPMC Magee team, we knew were going to see a quality doctor, and he really was knowledgeable, but he had not really a sparkling personality, but definitely a memorable one.  I have learned throughout this whole business that medical professionals need that ability to banter and bond when dealing with people at their most vulnerable or with sensitive subjects (you know, the ones involving body parts that would make my fourth graders giggle).  I learned that these professionals have a level of comfort with body parts that is admirable, yet to the lay-nonmedical person, alarming.  Dr. J. was no different, but was very matter of fact and supportive in what we were trying to do and how we could reach our parental goals.  He had the coolness of an all-state athlete who did not need to remind you of how talented he was and if he were an instrument player, I have no doubt he would have been a trumpet player with his NBD attitude about overcoming obstacles.

We were able to ask questions about alternative options and he gave us the honest odds of the likelihood of conception without the highest level of Assisted Reproductive Therapy (ART).  The numbers were not good (like for some reason below seven percent chance not good sticks in my head), and he told us straight up that we would probably waste a lot of time and money going through those options and not just jumping into the deep end.

I am not a fan of facing odds and numbers.  I don't feel the rush of possibility when the PowerBall comes around with its super mega-millions because I have never felt like a beat the odds kind of person (we'll revisit this later-turns out I was incorrect about my preggo-potential).  I like making confident, calculated decisions.  I like knowing that I have the capability to control variables and therefore outcomes. So naturally, I wanted to have a kid where the possibilities were endless and there would be no control any more!  And we were going to have to do so in the most foreign to us way possible, where the odds were daunting and the cost financial and emotional high.  

As you are embarking on your own tiny-human adventures, a critical component when getting involved in any getting preggo ambitions, you will need people who are convinced that every challenge is conquerable and are willing to cheer you through plan A, B, C and D in your efforts to get to the finish line (or the starting line depending on how you view the successful birth of your child/children).  PG and I needed the team of people we had both medical and non-medical who checked in on us, offered us advice, and gave us emotional support when we most needed it.

Dr. J. was one of those folks who offered us some of our earliest advice when we consulted him about where he recommended we look for IVF services and his combination of professionalism, coolness, and caring stick with me as what we needed at that stage of our journey.  He directed us to Reproductive Health Services out of Monroeville and we fully had faith that he was giving us the best advice.  Trust and faith are big pieces to this reproductive puzzle and we trusted him with this recommendation.  And now we have two couch climbing, belly laughing bubs thanks to his early guidance.

As mentioned, this is the beginning of a series of reflections on our preggo adventures where hopefully I accurately recall and give proper credit to the folks who helped us in our journey and how we managed to handle the transition from married couple to married couple with two bopping boys.  I'll look next time at the "holy crap-what do all of these letters stand for and you really want to take my blood again?!" of IVF.