How I Knew I Lost My Baby: Miscarriage After IVF

On Thursday, July 12th, we came back from our three month long trip to Spain, and I was pregnant. The day before my mother, sister, MH, and I all squeezed into our doctor’s consultation office in Valencia to celebration my successful IVF transfer. We learned our due date, received a printed picture of the growing sac as a memento, and I had my blood drawn one last time. Little did I know that days later I would suffer from a miscarriage.

Restraining My Optimism

I had been feeling cautiously optimistic. I knew there was a risk of miscarriage, as there is with any pregnancy, and that we had many more milestones to pass before we could fully embrace the certainty of a child coming into our lives. However, I was content with the adrenaline rush-like excitement from having a successful first transfer, and from knowing that this dark chapter of stress and hopelessness was behind us. I also felt pregnant-starting from 24 hours after our transfer-I felt an external life growing within. I knew that after our week-long stopover in NJ to stay with my family, we would return to San Diego as expectant parents; the last two years would become a distant memory eclipsed by the promise of having a family of our own.

The First Miscarriage Symptom

On Saturday, at 5 weeks and 3 days, I woke up drenched in a cold sweat. I panicked, since this was exactly how I felt when I was about to get my period. I tried to keep my worries at bay and stay off Dr. Google, but later that morning I broke down in tears as I told MH that I could no longer feel my baby. My morning nausea seemed to have subsided, and felt like the water weight I had accumulated since the transfer had disappeared overnight.

As the day went on, I rested and slept, and gradually felt better. I felt more sensation in my abdomen, and the following morning I had a little more nausea. However, as the days passed the night sweats continued. I tried to remain calm, and told myself that what I was experiencing was likely a new set of pregnancy symptoms.

The 6 Week Scan

On Wednesday morning when I woke for my 6 week scan I was feeling optimistic, and was finally allowing myself to feel excited about what was to come. I was so focused on arriving for our 8 am clinic appointment that I failed to realize that I had no morning sickness whatsoever, and other than an occasional strong period like cramp/contraction, I no longer had that sensation of life within.

MH and I arrived to the RMA clinic in Eatontown, preparing to officially make our baby a US patient. Although the clinic is affiliated with our IVI clinic in Valencia, it lacked the warm greetings and our doctors enjoying their afternoon coffees (which we had grown accustom to). When the exam began and the doctor started taking my measurements, he verbally noted to the assistant that there was fluid. He then asked me when my last scan was and what they saw. At that point I knew no good news would follow. In the nicest way possible, he informed me that there was no growth since last week. And in the most supportive and professional way possible, he said “Miscarriages are a part of what we do.”

Surrendering to the Process

I never thought I would find comfort in those words when learning my pregnancy was ending, but hearing the reiteration of fertility treatments being a process, and that all along this was one of three expected outcomes, gave me great comfort in that moment. It allowed me to keep my faith and surrender.

After they left the room, MH was stunned, but was still holding on to hope that the next scan would give us positive news. I explained they should have seen something by now; a larger sac, a yolk, a fetal pole, a heartbeat maybe. But to have no growth, when I was already measuring on the small side of normal, meant that our blastocyst would never become a baby. I cried a little, but felt a little relieved. A loss at 6 weeks I could handle. At 8 or 9 would be harder; at 20 weeks, unimaginable. I had wondered if the little one growing inside me was really MINE, and I got my answer sooner rather than later. Before leaving the room we embraced, and came up with our game plan – Valencia in the fall. In the fall we will reunite with our baby.

Battling Resentment While Trying to Conceive

While riding my bike to the clinic on my seventh day of stims I was overcome gratitude. “Wow,” I thought, “I don’t feel the anger that I used to… I am so lucky to be here and to have this opportunity… we are so lucky…  we have flipped this IVF process on its head and are living this amazing adventure.” It was a beautiful and sunny day in Valencia- a quintessential spring day- with birds chirping and fragrant flowers adorning each tree. I gave myself a pep talk and recognized how far I have come from my darkest moments. I realized only then how I had let so much of my deeply held anger and resentment go. On this trip to the clinic my heart was filled with excitement and my mind was content. I had stopped comparing myself to others, stopped worrying about what the future holds.

Instagram’s Punch in the Gut

That night I went on Instagram and I saw a “big announcement” post from someone I follow. Several weeks ago she had announced they were going to start trying “to see what happens” and that they were OK with whatever the outcome was.  On this night they announced that they are expecting, and they broke the big news with hash tag #gotitonthefirsttry.

My immediate response was “Fuck you.”

So, I guess I haven’t come as far as I thought.

The Self-Inflicted Pain Caused By Comparison

Trying (unsuccessfully) to get pregnant is hard. There is always someone who has it worse than you, and I don’t mean just from an infertility standpoint. When I look at my other TTC sisters, I see women who have been trying longer, who feel more hopeless, and who have a smaller chance than me to conceive- even with all of the best medical technology in the world. And I want to acknowledge that struggle, and feel thankful for the access to options that MH and I have that others don’t.

However, in some moments I still have that visceral self-pitying response of “Why can’t that be me?” Why do I have to spend $13,000, administer injections and go through a three month (at least!) process after trying for almost two years? Why can’t I have fun and spontaneous sex and then 3 weeks later realize my period is late, and voila, see two pink lines staring me in the face?

Permission to Feel How You Feel

When I was having a particularly tough time, one of my best friends told me that it is OK for me to feel this way. Those words- that permission- took a huge weight of my shoulders. I had felt shame for having negative feelings like jealousy and resentment. And I think that shame made me feel worse about myself than having the actual feelings. Yes, of course it isn’t healthy to bask in a cauldron of negativity. But it is also not healthy to deny how you feel; these emotions tend to fester more when you disclaim them. They also can inflict real damage in a very subversive way.

By acknowledging how I feel, and allowing myself to feel those emotions, it was easier to loosen their grip and make space for how I want to feel: grateful.

10 things that hurt more than giving yourself an IVF stim injection

I tried not to think about what it would be like to give myself the first injection. I knew I could do it, and I knew I would do it, but quite honestly… getting blood work done used to make me pass out, so I definitely had some trepidation about inserting a needle into my belly over and over again during the IVF process.

However, I wish I had known how little a shot in the stomach would hurt. Like, “Wait, is it even in me?” little.

The List

So for you ladies out there who are looking for some reassurance prior to your first injection, here is a list of 10 things that hurt less than giving yourself a subcutaneous shot.

1. Acupuncture

2. Popping a pimple

3. Plucking your eyebrows

4. Pulling out a single piece of hair from the top of your head

5. A papercut (these hurt sooooo much more)

6. Dealing with an annoying hangnail

7. A mosquito bite

8. Ripping off a Band-Aid

9. Sneezing (I don’t know…sometimes sneezing hurts!)

10. Picking a scab

Of course, injecting yourself in your muscle is going to hurt more. And, certain medications can really sting from what I have heard from my other IVF buddies.

I would love to hear your experience… can you think of any others? Let me know in the comments below!

Current Update – My IVF Consultation and Protocol in Valencia

ivi clinic valencia

I cannot believe how quickly time has flown since we have arrived in Valencia! We arrived on Tuesday, April 17th, and on Friday, April 20th we had our first consultation with Dr. C* at the IVI clinic.

Our initial consultation

Our hotel was a short walk to the clinic, and when we arrived at the modern and bright facility we were directed to go to the international patients’ check-in desk. Here we were greeted by an English speaking coordinator, who took our photographs, documented our passport information, and then explained that we would be assigned a “tutor.” Tutors at the clinic are medical professionals who guide international patients through the initial consultation and the IVF process.

We waited in the waiting room for only several minutes before our tutor introduced herself, and then she ushered us from one room to another to complete the intake process. During this process we submitted all of our recent bloodwork, semen analysis results, and other diagnostic test and health history information. We reviewed and signed the treatment paperwork, and then were directed back to the waiting room to wait for our appointment with Dr. C.

Meeting Dr. C

Just before our scheduled time to meet with Dr. C, our friend Phillip (who is a friend of Dr. C and arranged for us to be seen at the clinic) met us to say hello and to make sure we were having a pleasant experience so far. He then walked us into Dr. C’s office to personally introduce us.

During our meeting with the doctor MH and I reviewed our health histories, the doctor performed a transvaginal ultrasound and a trial transfer (note, this was quick and painless, and I did not take Advil prior to my appointment), and then we discussed next steps. I had several more tests to take, which I would need to do the following Monday since I needed to fast beforehand. MH would need to have another semen analysis and we would also do a freeze.  Thankfully, all tests are performed at and processed by the clinic, so waiting time for the results were just a matter of hours (as opposed to days or a week when compared with my experience in the USA).

Consultation surprises

There were a couple of surprises during this consultation. One, we learned that I would need to complete an ERA test. This is a test that evaluates the ideal time for implantation, and based on these results, will determine the optimal day for the FET. Unfortunately, this test means we have to do a “mock cycle” in between the retrieval cycle and the transfer cycle. Therefore, it will extend the amount of time before we could actually become pregnant. We were planning on taking a month off in between regardless, but since we have to a mock cycle with a biopsy for the test, I will need to be on medication and have to stay close to Valencia for several doctor’s visits during this time. We considered traveling back to the USA to perform the test there, but the cost of the test would be at least double than what we would pay here in Valencia.

The second surprise was according to testing I had completed in the USA, my AMH levels had dropped significantly from June 2017 to April 2018. Dr. C was not happy with the latest number, but his concerns dissipated when he conducted the ultrasound and counted about 17 follicles. He said that AMH was just one of the parameters he looked at when evaluating ovarian reserve, and the drop in levels could have been due to a faulty test. To be sure, he wanted me to get my levels retested prior to my next appointment.

We also learned that Dr. C was going to put me on a “short protocol“. At first I was disappointed to learn that we couldn’t start treatment in my current cycle. I had assumed that I would be on a protocol that was similar to what my previous doctor had recommended, which was referred to as a “long protocol.” A long protocol requires about two extra weeks of medication and it starts during the menstrual cycle preceding the ovarian stimulation phase. However, Dr. C explained that the clinic’s approach is to use the most gentle protocol as possible, so there was no need for me to be on medication prior to my next period. With a short protocol, I would start my stimulation medications on day 2 or 3 of my next cycle, and if all goes well, have the retrieval 10-12 days later. Since I was dreading the shots and how the medication would make me feel, that sounded good to me!

Follow up visit

The following Monday we went back to the clinic for blood work and our follow up visit to discuss next steps. Dr. C confirmed that my AMH levels looked great, and we would start treatment on either Day 2 or Day 3 of my next cycle.

Dr. C did have concerns about MH’s semen test results from Friday. Due to the low count, low motility, poor direction, and poor morphology, Dr. C recommended that we PGS test the embryos. He explained that there is a correlation between poor parameters and genetic issues (which we were aware of because we were recommended to have the DNA fragmentation test performed in the States). Since we are at a higher risk of having genetically abnormal embryos, he wanted to mitigate the risk of transferring an abnormal embryo as much as possible by screening them out.

A different kind of TWW

After our last appointment we excitedly awaited my period… for over two weeks! We visited the clinic several times to pay for services, pick up my prescriptions, receive my first tutorial for administering the medication, and have my questions answered about timing of the ERA test and the FET. On the first day of my cycle I walked to the clinic to inform them I was ready to start; luckily, I already had an appointment on the books for the following day, so I returned to meet with Dr. C and officially started my protocol.

Overall experience

We have been beyond pleased with the clinic and the service so far, with the exception of being able to easily contact an English speaking operator during peak hours. Luckily we are only a 25 minute walk or bike ride away, so we have been able to simply “show up” and speak with someone who can answer our questions.

Everyone at the clinic- including Dr. C- is so friendly, helpful, and efficient. Despite coming from thousands of miles away, we feel completely at ease. I learned that approximately 50% of the patients are international patients, many of whom come to Valencia specifically to be seen by Dr. C. Based on the “concierge” level of service we have received, the clinic is clearly set up to treat a global patient population .

*We have changed the names to protect the privacy of these individuals.

That Time When I Got Zika

Aedes_aegypti Muhammad_Mahdi_Karim

Why traveling to the Dominican Republic was so problematic

Two years ago the Dominican Republic was a hotbed for the mosquito-borne virus Zika. As you may know, Zika is responsible for causing severe birth defects in babies who are exposed to the virus while in their mother’s womb. When I arrived to the Dominican Republic we knew that we would have to put off trying to get pregnant for at least two months starting from the day we left- and that guideline was only if neither of us showed symptoms. If we did have symptoms, and depending on who had them, that period of waiting could increase to 6 months.

However, when I left the USA I also left the Zika hysteria that had consumed the nation behind. In the USA updates and warnings were featured in the news daily, creating the impression that everyone was at risk all of the time. While the risks were real to those who were exposed, the vast majority of Americans never would be. Conversely, there were ongoing outbreaks all over the DR, but very little was communicated to the local population about their status.

Getting a little too “caught up in the moment”

Arriving to the DR (where hardly anyone talked about Zika) and being thrust into medical emergencies and life and death decisions, Zika’s looming threat lifted as well as the concern for waiting to try. Of course it didn’t help that MH’s family members (who had nothing but the purest intentions) would frequently ask when we would start a family, and that EVERYONE had children around us. But when I would voice my concerns about Zika, I wasn’t met with the same ubiquitous anxiety and concern that I had experienced at home.

So as worries faded and the weight MH and I felt from navigating one crisis after another increased, I gradually loosen my stance. Zika seemed like a faraway concern when we had so many other problems to confront on a daily basis. It was a pressure cooker situation, and rather than the stress crack our marriage, it fused us together. And in a city where you can’t do something as simple as go for a run, the best way to release stress was through intimacy. So MH and I figured, “why not just see what happens?”

My first Zika symptoms

After being in the DR for five weeks I decided to head back to the USA for Father’s Day and my father’s birthday. Two days after arriving, I went to the beach, and when I got back I noticed a slight rash on my face and chest. I have lost count of the number of times I have broken out in a rash of some sort after traveling- especially when sun and salt water in the mix. It wasn’t itchy, but my skin did feel sensitive. I wondered if it could be Zika, but at the time I chalked it up to hives from the stress of the trip. That night I took an antihistamine and went to bed.

The next morning I awoke and the rash was all over my body. I felt tired and a little bit of a mental fog, and at this point I knew it was something more. I took a picture of my rash and sent it to MH, who forwarded it to his family. His aunt, who is a doctor, confirmed that it looked like Zika so I started making the calls.

Trying to get tested for Zika

I searched for Zika test locations in New Jersey, but all I could find was a Zika hotline. When I called, I was told the test was only processed at one lab in the state, so I would need a doctor’s referral. The operator recommended that I call a local hospital, so I did. The hospital stated that the only way to be seen was via the emergency room and to be evaluated by the infectious disease doctor on staff. At this point, I was informed that I may or may not be given the test. Since I had already spent a couple of hours researching the tests and their reliability, I knew that the tests available were notorious for both false positives and negatives. Depending on the test used, they also picked up on whether the patient had Dengue or Chikungunya exposure. I decided against spending thousands of dollars to *maybe* be given a test that *might* be accurate. My concern at this point was knowing if I had something else that could be highly contagious.

An hour later I went to a walk-in clinic and was seen by the doctor there. She evaluated me, and ruled out any other infectious disease. I had no fever, the rash was consistent all over my body, and my eyes were clear of any symptoms. She said the only other thing it looked like was Lyme disease, but the timing of my symptoms didn’t align with when I arrived to the USA. I asked if she could give me a prescription for the Zika test, and it became evident that I knew more than she did about the disease and the resources available. I sat on the exam table for several minutes as she researched Zika on her computer. Her diagnosis: yes, it looks like Zika. But to be sure, I should call an infectious disease specialist on the following business day.

The next day I called the infectious disease specialist referral, and was informed that their first available appointment was in two months. Since testing needs to be performed within the first two weeks of the onset of symptoms, it was pointless to make an appointment. I was in disbelief that despite the amount of national attention that was focused on this disease, our healthcare system was so poorly prepared. Literally no one knew what to do with me.

My Zika symptoms: rash, swelling, and aches

I was fortunate that I didn’t have the more severe Zika symptoms, such as a fever or conjunctivitis. However, by this point my fingers began to swell and my hands looked really cartoonish. Then the following day my feet swelled and my joints began to ache. My rash lasted less than a week, but my feet and knees continued to be alarmingly tender when I would walk first thing in the morning; it felt like the tissue was super inflamed. Thankfully after three weeks I felt normal again.

Officially having to wait

Although the medical professionals that I spoke with were fairly confident that I did contract Zika, I was never officially diagnosed. Therefore, I was treated as if I did have Zika in the sense that I would have to wait at least two months to try to get pregnant. I would also have to follow the same guidelines has non-infected people and have to avoid re-exposure for as long as MH and I were trying. Based on research at the time, it was believed once you were infected you developed immunity; however, there was so much that the medical population didn’t know about the virus: Were there different strains? Was it evolving? Were you really immune?

At the time, I assumed once we passed that two month mark I would be pregnant soon after and we wouldn’t have to worry about Zika for some time. I never would have guessed that two years later Zika would be a reason for why we would have to pursue IVF.

Photo Credit: https://en.wikipedia.org/wiki/User:Muhammad_Mahdi_Karim

This Week Is National Infertility Awareness Week

This week has been an emotional one. Yes, we just arrived to Valencia, attended a whirlwind of doctor’s appointments, moved into our new apartment, and are adjusting to the 9 hour time change and language difference. But it has also been emotional because it is National Infertility Awareness Week, and in honor of this week I have been doing a lot of reading, writing, and talking about the reasons we are here.

With this transparency about my struggles and my immersion into others’ comes intense conflicting emotions birthed from isolation and community: heart aches and feeling overwhelmed from the outpouring of support, apprehension and confidence in what lies ahead.

According to the National Infertility Association, one in eight women struggle with infertility, and belonging to this club is obviously not something I would choose. My default is to look at the lives of my best friends- the lives that I once felt inextricably a part of- and be keenly aware that I am a shadowy figure on the periphery desperately wanting to have what they do. However, no actual partition exists; in fact, most of my friends have had trouble conceiving, have had miscarriages, or have needed medical intervention to start the family unit they have today. I keep telling myself that while our current realities do not align, our future realities will.

 

The intention behind National Infertility Awareness Week is to “change the conversation around infertility so the public, media, insurers, healthcare professionals and lawmakers understand: The scope of the problem and who is struggling to build a family. (hint: it’s not just “older women” who “waited too long” to start a family); There are many barriers for millions of people who struggle to build a family. These barriers include: lack of insurance coverage, out-of-pocket costs, faith and religion, sexual orientation, and state and federal laws; The impact of infertility is far reaching—it impacts family, friends, co-workers, and employers.”

 

Fertile Girl, an online community dedicated to changing this conversation, created an amazing video reframing how we look at “infertility”:

 

Watching the Flip the Script video resonated with me so deeply because it helps realign my sometimes myopic paradigm with reality. Not only does everyone have a backstory that I can’t see, but we are in a much larger community than just #1in8. Any woman who has lost or has longed for a child knows my heartache. And with miscarriage rates around 25%, the number of women who have suffered is a lot higher that 1 in 8. Yes, the heartache compounds when you have no children, since you are also tending to the open wound created by this void. But I have learned that I am only as isolated as I choose to feel, and I am thankful to have found an amazing network of brave and vocal women who are sharing their stories and offering encouragement.

 

Someone once told me that “Everyone you meet in life is either coming out of a storm, in the midst of one, or about to enter one.” Ain’t that the truth. I think the best advice is to just be kind- and to yourself, especially. Please take a look at the video and share with someone who you think could need a little extra support today.