Take what you need and we'll disappear
Without a trace, we'll be gone, gone
The moon and the stars will follow the car
And then, when we get out to the ocean
We're gonna take a boat to the end of the world
All the way to the end of the world
Oh, and when the kids are old enough
We're gonna teach them to fly."
--"You and Me," Dave Matthews Band
Sunday, July 15, 2018. Fairfax, California. I had spent much of the day chilling in the sand and walking up and down Stinson Beach. As relaxing as that sounds (and it was), there was a huge part of me that really wished I was with my honey riding bikes all over Marin County. Legitimately, the #1 and #2 things besides people that I (we) miss about living in the Bay Area are 1) riding in Marin and 2) riding down the Peninsula. If only we could rent the entire house and not just a 400 square foot apartment in Palo Alto. But sigh, I digress.
(Hubby) had been riding most of the day, and I drove down from (Aunt's) house in Forest Knolls to meet him in Fairfax for dinner. We were grateful for (Aunt's) generosity in letting us stay there while she was on a road trip. It was a calm and relaxing place, and we had many awesome memories of visiting (Aunt and Uncle) there and riding together. Staying there was part of our recipe for success.
I had biked Bolinas-Fairfax Road dozens of times but never once stopped anywhere but the Roastery or the Police Station (coffee and bathrooms, duh), so I was kind of excited to find a spot for dinner. Fairfax is the kind of place where, if we win the lottery and California figures out the wildfire situation, I'd want to live there forever.
We chose a place at relative random. I ordered a salad with arugula, goat cheese, and pepitas. Because, of course. They had a GF beer on tap that (Hubby) ordered, and I drank half a glass of rose before making him drink the rest. Never you fear: the Marine always makes me drive even if he's had just one. It took a while for us to notice what was happening next to us, but the tables were quite close together, so once we allowed their boisterous conversation to find our ears, eventually our eyes wandered over as well.
One baby, in mama's arms, looking about 4 months-ish. My eyes locked on. But wait.
Another baby. In daddy's arms. Looking about 4 months-ish. One baby dressed in hues of blue. One baby dressed in hues of pink. My eyes widened.
"DO YOU SEE WHAT I SEE?" I spoke in a whisper scream to hubs. When we locked eyes, we both had to fight the water welling in them.
"I don't believe in signs," he said. "But that's a sign."
I couldn't stop looking at them. I'm sure my staring became obvious. Eventually I gave into my magnanimity and I told them why I was staring. Why we were freaking out and almost crying. How crazy it was that we should sit down at a random table at a random restaurant the night before we were going into our fertility clinic for an embryo transfer of one male and one female embryo and sit next to opposite gender twins. How everything we hoped for was sitting right at the table next to us. Yes, of course, I'd like to hold the babies. I still remember their names: Oliver and Paloma. It was so hard not to comment that a paloma is like one of the best cocktails ever.
Monday I woke up and took myself on a hike through redwoods in Samuel P. Taylor park--another place I've only ridden through. I hugged trees.
When I got back to (Aunt's) house, I ate and showered and put on a tank top that was a gift from a dear dear friend that says, "The Time is Meow."
Meow, indeed.
The second half of the IVF process is harder than I had allowed myself to believe. I had convinced myself that the egg retrievals I had done in 2015 and 2016 were "the hard part." Sort of like deciding to do a second Ironman, you have to convince yourself that "this time won't be as bad" before heading into it. Honestly, having known women who went straight from egg retrieval into embryo transfer I can't help but feel shock that anyone would do it that way. Five days after my retrievals I still felt like absolute hell and I couldn't imagine being in the right state for a transfer. Holy hell.
When we lost an unexpected pregnancy in October of 2017, we had a lot of decisions to make. Hubby's proposal just days after we found out that the pregnancy was not viable had been planned for months, and the timing was beautiful in so many ways. But what would we do? Try again the old fashioned way, knowing that the risk of another loss was high? Use the science now? Get married first? Try to start a family first? If you wondered why we planned our wedding in just four (!) months (!), it was because the process of that loss helped us understand how much we didn't want to wait any longer to be parents.
After our (beautiful and glorious!!) wedding, we decided to get the ball rolling with the baby science. With my frozen eggs in SF in (NOT THAT CLINIC!), we had decisions to make. Ship the eggs? Fly to SF? The thought of LITERALLY putting ALL MY EGGS IN ONE BASKET was overwhelming. Not to mention: the packing and shipping costs were like $5000, and I freaking loved my doctor in SF.
So. I called my doctor and arranged for my eggs to be defrosted. "All of them?" she questioned. "Yes, all of them." I said. All 37. We were all in for this. We flew to SF and confirmed that we had arrived before they took the eggs out of the freezer. All of this made me nervous. I prayed that there wouldn't be an earthquake that day.
Making embryos out of eggs means fertilizing them. The male "retrieval" process is less challenging than the female retrieval process. I'll spare hubby any embarrassment and leave it at that (LOVE YOU, HUN). My doc ran a few tests on me to make sure that everything looked good after my miscarriage 6 months prior. After her evaluation, we were cleared to start.
Basically, here's the math. It's not kind, but it's real.
37 eggs out of the freezer.
35 survived the thaw.
29 eggs fertilized when injected with hub's genetic material.
On day 3 of cooking, there were still 27 embryos dividing and growing.
On day 5/6, only 16 had made it to blastocyst stage.
Gulp. I remembered the math I had done three years prior that convinced me I needed to do two retrievals. I knew the statistics for 38-year-old eggs. I knew that a percentage of a percentage of a percentage meant that we needed to start with a big number of eggs in order to have a reasonable number of embryos to make pregnancy realistic.
On day 6, each of the surviving blastocysts was biopsied and refrozen, and the 1- and 2-cell samples were sent for genetic testing. The testing identifies euploid (normal, with 23 pairs of chromosomes) versus aneuploid (having monosomy or trisomy chromosomes where a pair should be) embryos. Yes, it can identify Trisomy 21, also known as Down's Syndrome. When our results came back, we had 8 euploid and 8 aneuploid embryos. Yep: from 37 eggs, there were just 8 normal embryos.
I think about this sometimes, and what I think about is the time and the emotional energy that we saved. Probably, money, too. See, transferring most aneuploid embryos results in a pregnancy loss. That's anywhere from 1 to 4 months of waiting, testing, and recovery before another attempt can be made. Not to mention the heartache.
We lost our first transfer attempt. We tried one embryo on June 5, and he didn't make it. We found out it was a male embryo after the transfer. The part about the genetic testing that freaked us out a little was that, in testing all the pairs of chromosomes, the crazy scientists can look closely enough at pair 23 to determine not just that there are 1, 2, or 3 chromosomes there, but whether they are Xs or Ys. For our first attempt, we only transferred one embryo, and we didn't want to know the gender until after it was transferred. We didn't want to choose. When they told us it was male, we kinda flipped out because of our 8, we knew only 2 were male.
The heartache of that loss brought me to my knees. In public. We were walking around the park when my doctor called to give us the test results. I don't even know how long I sat in the grass sobbing. It doesn't even matter.
The process for preparing for a frozen embryo transfer (FET) was more hardcore than I expected. After a month on a super powerful birth control pill to "quiet the ovaries" (which made my face puffy and to this day I can't look at our honeymoon pictures), I started on STRAIGHT UP ESTROGEN in pill form, 8 milligrams a day. They were little blue pills (not THAT little blue pill), and I called it my "bottle full of tears." I mean OH MY HOLY HELL that stuff made me crazy. On the few rare occasions when I completely lost my sh1t and hubs was like "why are you so crazy" I shook the bottle in his face. The purpose of that medication was to thicken the uterine lining to prepare for implantation. After a few ultrasounds to monitor the thickening process and ensure that my ovaries remained "quiet" with no follicles forming, I was cleared for medication #2: intramuscular progesterone injections. Daily. Some clinics use progesterone suppositories (doesn't that sound lovely), but the injections are the "gold standard" in terms of raising the blood levels, and my doc was all about proven science.
Here's where the science gets crazy. I think about it sometimes and wonder what nut person thought this would work, and what nut people went for it before it was proven. "Hey, I have an idea..."
All of these medications are intended to trick your body into thinking you ovulated and then accept an embryo that is released into the uterus. You start the injections 5 days before the transfer to "match" the age of the 5-day blastocysts. Apparently that's about how long it would take a normal fertilized egg to travel down the Fallopian tubes and then implant. Huh.
Arriving at the clinic, we were ushered to a small room with the familiar stirrups and ultrasound machine. There was a heating pad for me to hold on my belly. I had to have a full bladder (good times) so that everything was more visible on ultrasound. A catheter was placed into my uterus by my awesome doc, which we could see on the screen. She then radioed to the lab that they could "load" the embryo, and a few moments later the embryologist entered the room with a syringe with long, thin tube on the end, filled with saline and a single embryo. He announced it: "One embryo for Abigail Sanford. Do we all agree?" After a roomful of yeses, the small tube from the syringe was run through the placement catheter, and all the contents injected. The embryologist returned to the lab to look at the syringe under a microscope and confirm that the embryo had been injected. Once he radioed back "clear," I was returned to my normal state, instructed to use the restroom ("I promise it won't fall out"), and then ordered to relax for 20-30 minutes.
Lest I skip over the injections part, let's differentiate from the retrieval injections. Those were subcutaneous, relatively thin liquid injections that I did myself each night before bed. Progesterone is delivered in a SESAME OIL preparation (it's often abbreviated "PIO" for "progesterone in oil"), and the stuff is thick and you have to use a larger needle to deliver it to a muscle. Thank goodness for hubs, who willingly gave me shots in the bum every night (alternating cheeks). Two nights before our first transfer attempt we landed at SFO and couldn't find a family bathroom for him to shoot me up, so I had to do it myself. I hadn't yet practiced giving myself a shot in the bum, so I went for my thigh. There I was, in a bathroom stall in SFO, pants down, staring and the needle, and then my leg, and then just had to jab and go. Like standing on the pool deck in winter, I decided the water wasn't going to get warmer if I waited. I could barely walk for two days. Ouch. Also PS by the way... one must continue the estrogen and progesterone FOR THE ENTIRE FIRST TRIMESTER if a pregnancy is confirmed. They don't put that in the brochures.
Once we found out our first transfer didn't work, I was able to stop the medications right away, but then we had to decide: would we attempt another transfer... RIGHT AWAY? Once the body cycles, you can jump right back in taking the estrogen, monitoring lining thickness, and eventually injecting the progesterone. Again. Right away.
Talk about a roller coaster.
We spoke to my doc a few days after the negative test results. She is the perfect doc for me because she is all about the research and she doesn't dumb anything down. She's completely matter of fact about the process--and this is why I loved her from the beginning. I didn't want someone to give me warm fuzzies. I wanted reality and truth. Yes, she is also kind and caring and friendly and warm, but she gave it to me straight.
She said it all looked good. I looked good. The process went well. The embryo was excellent quality. "There are factors we can't yet test for." She said. She wanted to just go for it again, with small changes. She wanted to double my progesterone dose from 1mL per day to 2mL (GOOD LORD), and she wanted to try two embryos instead of 1. "The statistics are really good that at least one will implant. They seem to encourage each other."
We went for another walk around the park to talk, connect, and try to figure out our next steps. After our first transfer failure, we asked to see the genetic testing report. Indeed, those 8 were all high quality, according to the existing tests. The 8 that were aneuploid had multiple complex abnormalities. Of the 7 euploid embryos left, there were 6 female and 1 male. Ugh. What to do? What to do when we've both said we want a child of each gender? What to do when the next few in "rank order" (whatever that means) were all female? Were we bad people to think about this?
Hubs posed an important question: "If they both implant and we have twins, and they are the same gender, would you want to go through this again to have a third child of the opposite gender?"
Wait, what? Oh, no. Heck no. Please, no.
So we asked the what if. What if we pick the best female and the remaining male? Will that decrease our chances?
"There's hardly a difference among them. They are all high quality."
Are we horrible people for doing this?
"Couples do this every day."
Ok then, we'd try. We'd mourn our loss, recommit to the process, cling to each other, and go for it again. So just 5+ weeks later, on July 16, we were back in California, back in the office, with the same full bladder and the same ultrasound machine, and the same 20-something embryologist entering the room with a syringe full of saline and "Two embryos, one female, one male, for Abigail Sanford."
A roomful of yeses, indeed.
Another day of laying on Stinson Beach on July 17th, and a dinner in Pt. Reyes Station.
An attempted sunset watch thwarted by a thick layer of Karl.
When my first beta HCG test came back at 251, my doctor called to congratulate us: we were pregnant. When my second beta HCG just 48 hours later was 637, my friend Heather exclaimed "TWO BABIES!!"
Indeed, now mid-December, I'm nearly 25 weeks pregnant with a GIANT confirmed boy and and GIANT confirmed girl. When the ultrasound technicians comment on their size, I make my husband stand up and demonstrate his height. And I ain't no shorty. Everyone has all their pieces and parts and nothing extra. At this point, we just need them to stay cooking as long as they can and grow as big as possible possible (oh dear lord). March seems both right around the corner and very far away at the same time.
SO WAIT, HOW LONG DID YOU HAVE TO TAKE THE INJECTIONS???
I was actually let off the hook at 11 weeks because the babies had strong heartbeats. Some women go all the way to 13 or 14 weeks. MY bum was very very happy to not have any more injections. 2 mL is a lot of mL, and I had to do it to myself at least 10 times.
OK SO, DID YOU BREAK THE BANK??
I was honest about the retrieval costs, so I'll be honest again. $13,500 to defrost, fertilize and refreeze. $3000 for genetic testing. $3500 for an additional transfer attempt. About $400 for all the meds. I had nearly 3 years to save for this since the last expenditure, but yes, in the end, in total, the whole business was over $40,000, all out of pocket except for the progesterone once I was confirmed pregnant. Apparently, progesterone to sustain a pregnancy (even if it's an IVF pregnancy) is covered by most insurance. Ok, thanks. It was a drop in the bucket, but I'll take it.
WHAT'S IT LIKE BEING PREGNANT WITH TWINS?
That would take another several hundred thousand words to describe accurately. In short, I'll say it's hard--harder than I expected. I'm grateful to that very same Heather (who has had 4 pregnancies: two singles, two sets of twins) to regularly remind me that this is harder than just one and not to be so hard on myself. My current physical job is to get Lemon and Lime here large and healthy, and then I can worry about getting back in shape for Ironman #3.
ANYTHING ELSE YOU'D LIKE TO ADD?
IVF is hardcore. Bring pregnant is hardcore. I'm sure parenthood will be the same. We are excited to find out!
