Frozen embryo transfer #4: Am I ready?

Calendar from the infertility clinic

That’s right, we’re at it again. Frozen embryo transfer number four is underway! Will we have more twins?

If history is any indication, yes. The clinic says each frozen embryo transfer has a 25% chance of twins, 50% chance of a singleton, and 25% chance of no baby. If those probabilities apply to us, we had a 1.6% chance of having three sets of twins in a row. I think it’s more likely that we are in the upper end of the success rates they see.

We are transferring two embryos again. We should find out if anything stuck on August 11 or 12. Assuming the pregnancy test then is positive, we will find out number of babies sometime in the last week of August.

Am I ready for frozen embryo transfer #4?

Ummmm, sure. I’m as ready as I’ll ever be. Full steam ahead!

First, let’s back up. We don’t just show up at the clinic and have embryos transferred. It requires several weeks of preparation.

Stage 1 prep: birth control pills

Calendar from the infertility clinic
The clinic sends me this calendar at the beginning of a frozen embryo transfer cycle. The calendar tells me when I have to visit the clinic, among other things, so I can plan childcare.

I started birth control pills (BCPs) on July 2, three days after cycle day 1 of a natural cycle. This time I took them for 15 days. The number of BCPs can vary with each frozen embryo transfer depending on the clinic schedule.

Sometime while taking BCPs I go in for a hysteroscopy. During that procedure, the doctor inserts a small camera and shoots sterile saline solution into my uterus to check for abnormalities or anything else that would impede implantation. This is probably the most painful procedure of the entire frozen embryo transfer. I once forgot to take the recommended ibuprofen beforehand. That was a bad idea.

Stage 2 prep: estrogen pills only

Then three days after I stopped birth control pills, I returned to the clinic for a baseline check. In that appointment they check hormone levels and use an ultrasound to make sure that my ovaries are not producing follicles for ovulation. The goal of birth control is to suppress the natural hormone cycle so that the clinic can completely control the cycle in which they transfer the embryos.

On the same day as the baseline check, I start 2 mg of estrogen three times daily. In this cycle I’m only taking them for seven days before the lining check. I’ve taken them for longer in prior cycles, but I guess this time they decided I didn’t strictly need more than a week.

Stage 3 prep: add progesterone

This might sound like no big deal. I just add another pill, right?

Progesterone in oil vial, syringe, and needles
Progesterone in oil comes in a 10 mL vial. Each dose for me is 1.5 mL right now as an intramuscular shot in my hip. The syringe takes a 22-gauge, inch and a half long needle. The needle has to go into my hip up to the gray base that screws on to the syringe.

Nope. Progesterone comes as a solution in sesame oil and I don’t mix it in with my stir fry. Progesterone in oil (PIO) is an intramuscular shot with an inch and a half long, 22-gauge needle. I estimate that I’ve done at least 225 of these shots between the three prior frozen embryo transfer cycles and the fresh transfer after the egg retrieval. After doing it so many times, I still cringe a little every night and try to find some reward for myself afterwards.

PIO starts the evening after the lining check. That same evening, I give myself a subcutaneous shot of HCG (human chorionic gonadotropin) in my stomach with a half-inch 27-gauge needle. That one isn’t too bad, but I still hesitate every time. (I have to respect insulin-dependent diabetics who do that every day with insulin.) These shots are meant to simulate ovulation.

When to take a pregnancy test?

One of the complicating factors in using a pregnancy test during a frozen embryo transfer cycle (or other types of assisted reproduction) is that HCG is also known as the “pregnancy hormone.” It’s the hormone that pregnancy tests detect. As a result, it is easy to get a false positive if one tests too soon after the HCG shot.

Ye olde 25-pack of pregnancy test, delivered to my door the day I need them because I planned ahead.

To get around this, infertility patients commonly get a big pack of pregnancy tests. No, we’re not test happy (at least not all of us). Starting on the day of the HCG shot, I can take one pregnancy test that I know will be positive because it’s detecting the HCG from the shot. The next day, I take another one and it might be a bit lighter. I can take one test every day until the second line goes away or mysteriously starts getting darker. (Note that the darkness of the line is not a quantitative indicator of HCG level, but it might qualitatively indicate if levels are going up or down.)

I don’t generally do this because it won’t make a difference in the final result of the pregnancy test nine days after the frozen embryo transfer. This cycle, however, I’m making an exception for all of you lovely readers. I’m going to take at least one test per day starting the day after the HCG shot and track the results. We should see the line get lighter as I test out the shot. Then, if at least one embryo implants, we’ll see the line get darker again.

Who wants to find out with me if this frozen embryo transfer works?

Frozen embryo transfer feels

I am not accustomed to sharing emotions outside of my family, but my twin moms group on Facebook said that they wished they knew more about the emotional side of IVF and frozen embryo transfers. Okay, sure, I’ll share.

I’m not normal

First, I think I’ve had an exceptionally easy time of IVF. We knew the exact diagnosis going in. Many people are diagnosed with “unexplained infertility.” It’s really hard to treat a seemingly invisible problem. Other people are diagnosed with things like diminished ovarian reserve, azoospermia (no sperm at all), or severe endometriosis. All of these have a much higher barrier to success than our simple diagnoses of prior vasectomy with a side of possible polycystic ovarian syndrome (PCOS).

I did one egg retrieval that was ridiculously successful as far as creating viable embryos. Then the fresh transfer may have failed, but I know exactly why. My hormones when completely haywire after the egg retrieval. It may have been a blessing in disguise since I also had ovarian hyperstimulation syndrome (OHSS). That can get nasty very quickly if embryos implant.

Then my first frozen embryo transfer succeeded. From that, I had my first set of twins vaginally. The second embryo transfer was much the same, except the second set of twins was born by c-section because bottom baby insisted on being sideways. The third embryo transfer was again like the first with a vaginal twin birth.

I never had complications aside from a subchorionic hemorrhage (bubble of blood between the uterine wall and placenta) early during the first pregnancy and transient placenta previa (placenta near or over the cervix) that was gone by mid-pregnancy.

Anxieties of infertility

If insurance won’t pay for a frozen embryo transfer, it costs upwards of $4000 once medications and deductibles are included. That’s pretty high stakes, if you ask me. A fresh IVF cycle with an egg retrieval costs at least two and a half times that for a single cycle. When a couple already knows that they have some sort of problem that inhibits pregnancy, it gets pretty stressful wondering if they’re making the right choice.

Will we get any eggs? Will we have any viable embryos to transfer? If we do, will any of them implant and make it to birth?

So many steps can fail along the way. As I said before, we have been extremely lucky in our IVF journey and none of these have failed.

Still, each frozen embryo transfer I hope that at least one embryo survives. I hope that we don’t spend over $4000 only to lower the number of cryopreserved embryos. If a transfer completely failed, would we do another one right away? Should we financially?

After the transfer procedure, I could really let symptoms screw with me. Is that little twinge implantation? Do I feel tired because of a new pregnancy or just because I got to bed late again? Does anything else feel different? It’s easy to flip flop between ecstasy that you’re sure you feel different and despair that it will be a complete failure and you’ll never have a baby.

In my experience, pregnancy symptoms start after I’d see a positive on a pregnancy test, so there’s no point in guessing. Everything kicks in for me around five and a half weeks. If you find yourself obsessing about every twinge, I recommend staying busy. Find a good book or few to get lost in, schedule coffee dates with friends (decaf, if you’re concerned), or become a workaholic for a week and a half until the official pregnancy test.

Right after your scheduled pregnancy test, you may want to plan something special that can be a celebration if you’re pregnant or comfort and distraction if you’re not.

Back to frozen embryo transfer #4

Even though I’ll be testing daily to show you all how it works, my official, quantitative pregnancy test will fall on August 11 or 12. Jeff will be driving back from Ohio on August 11 and the only lab open is in a large regional hospital. If I were to have the test done that day, I’d have to tromp across the hospital campus with all six kids. On August 12, I could leave them all with Jeff and run to the nearest lab about 10 minutes away.

Just because I like numbers and patience is not one of my natural virtues, I might drag all the kids through the hospital. It’s on the way to or from church anyhow.

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