IVF Answers

Today was the big appointment! We left this morning anxious and excited and came home a bit overwhelmed and emotional. I keep forgetting that every step we have is like this: overwhelming and emotional. Our appointment was great, though. We were able to meet with one of the main OB/GYN Nurse Practitioners at the clinic, and I love her. She had been one of the few gals who did all of my ultrasounds and even IUIs there. Kind and patient, she explained to us what our next steps are.

She was on the same page with us as for not wanting to do anymore IUIs (we've done five) and skip to IVF. She recognized that even though my fallopian tubes appear to be open, we have no way of knowing the extent of the damage which is in those tubes. The little "hairs" (cilia) that pull the egg along to get fertilized--if that is happening--may themselves be damaged.

This bit of info was a strong confirmation for me to hear. I'm not sure if I shared on this blog but in August of 2011, Rob and I went to see a new fertility specialist, mainly to get a second opinion on our whole situation. He was great and spent at least a half an hour with us just talking about our entire journey. He said that he felt we had done everything "correctly," all of the steps there are available to do, and his guess was that the problem lay in my fallopian tubes. Incidentally, he also knew my doctor and the clinic, and said that would the place he would have recommended, the only other being a referral to Stanford.

Back to the appointment today. There were four main things we wanted to discuss:

1. Am I still a good candidate for IVF, and if so, what are the chances of conceiving?
2. What are the steps of IVF?
3. What is a cost estimate of the whole thing?
4. What about our own ethical and religious beliefs, specifically concerning the embryos?

Am I still a good candidate for IVF, and if so, what are the chances of conceiving?

I am most likely still a good candidate based mainly on my and my husband's age, health, and medical situation. Rob needs another analysis done, and I have to do three tests again, two that check all sorts of hormone levels, and one that gives a clear picture of the state of my uterus. This one is like the HSG I did a couple of years ago, which basically is an x-ray of the uterus and tubes. This new one, called an SIS, focuses on the uterus, though, and gives a clearer assessment of the health and shape of my uterus. This is better if you're not as concerned about the tubes, which at this point, we're not! Read about the procedures for and differences between the HSG and SIS here. 

The chances with IVF sky-rocket compare to those they gave me with IUI. A textbook answer is at least a 30% chance of conceiving, but the NP told me it is more like 50% if one embryo is placed, and 65% if two embryos are placed inside the uterus. These statistics are based on a blastocyst stage embryo transfer, which is an embryo that is five days old instead of three. (More on that in the next section.) I was on Cloud Nine when I heard these stats!

What are the steps of IVF?

Any research will tell you there are four steps: Stimulation, Monitoring, and Triggering; Egg Retrieval; Fertilization; and Embryo Transfer. Our NP broke them up in different ways, though, so I'm going to use what she said:

1. Suppression: This is the first step in the process, and it definitely feels like you're headed in the wrong direction. Before any stimulation of the follicles occur, you are put on birth control to encourage suppression of the follicles. This is because each month, there is always one follicle (potentially mature egg) that is a little bigger and that sucks all the follicle-stimulating hormone (FSH) the body produces. We want all the follicles to be the same size when starting so that more than one will get to grow because of the FSH.
2. Stimulation: After a cycle of birth control, you are ready to begin the real process! Follicles are stimulated by injecting FSH into the body. This is something our bodies produce naturally each cycle, but we want more than one mature egg. Naturally, just like in a normal situation, eggs may "die" or fertilization may not occur, so the goal is to get a good number of mature eggs. This step also includes a medication that triggers ovulation. Timing is everything, whether fertilization is occurring inside or outside of a clinic! This "trigger shot," as it's called, ensures when the woman ovulates. Once ovulation has been triggered, it's time for egg retrieval.
3. Retrieval and Fertilization: Because IVF means that an egg and a sperm are coming together outside the body, the egg has to be retrieved. In the case of IVF, there are multiple eggs being retrieved. Now, we can't see eggs -- they are smaller than a single piece of dust. Basically, the fluid from the follicle (which we can see in an ultrasound) is withdrawn and examined. At that point, the embryologist can see if the egg was retrieved, its size, and even its health! This is done one-by-one with the embryologist examining each bit of fluid and ultimately each egg. The woman, by the way, is completely sedated, so she doesn't feel any pain and often doesn't remember anything. The eggs are then placed in an incubator. Within a couple of hours, the eggs are fertilized using the cleaned sperm sample. 
4. Embryo Transfer: The fertilized eggs, now embryos, "grow" for a few days. A typical IVF places three-day-old embryos in the uterus, but it is possible--and higher success rates come--from giving the embryos a couple more days to grow. At five to seven days after fertilization, the embryo is called a blastocyst. All kinds of factors may go into whether a three-day-old or five-day-old embryo is placed inside the uterus, but the NP definitely favored the five-day-old guys. The main reason is there is a higher chance of implantation and survival, as well as a better way to control the chance of multiples. In typical IVF, more embryos are placed inside the uterus, but with the blastocyst embryo transfer, only two are placed inside the uterus. The transfer is straight-forward: the embryos are placed inside the uterus at the appropriate time, and the woman is on bed-rest for 24 hours. Fourteen days after the transfer, a blood test lets everyone know whether the IVF was successful...and hopefully it was!

What is the cost estimate?

I won't go into the breakdown, but if you would like it for your own knowledge and benefit, please ask me. Basically from initial visit to pregnancy test a couple is looking at anywhere from 12,000 - 15,000 dollars at our clinic. This includes all the ultrasounds, doctor visits, tests, medications, hospitalizations, sedation, embryologist fees, clinic fees, lab fees, doctor fees...you name it. There is the slightest of chance that our insurance may pick up some of the non-fertility labs, but I don't like to count on them. They haven't helped much in the past.

When I looked into this a couple of years ago, the cost alone sent me running. But now--especially after multiple IUIs and many dollars poured into this--my view on it is simple: it is worth it. If it works, and we have a baby, it is worth it. If it doesn't work, and we don't have a baby, it would still have been worth trying because the potential is so wonderful. Plus, I always like to tote that this cost is less than what most people our age are spending on cars...and we don't have a new car and would gladly go without in order to have a baby.

Although the clinic doesn't offer financing, they do have a few companies that they recommend, so we will research that if needed.

What about our own ethical and religious beliefs?

This ethical issue is so huge that entire books have been written on the topic. What we believe is this: Life occurs at fertilization. Those embryos are not little cells that we view lightly; we believe they are life, and we will treat them as such. This means that we will limit the eggs fertilized and ensure--to the best of our ability--that the embryos have the best possible chance of survival.

I won't lie, friends. This is tough for us. This was the hardest part of our appointment today. We were honest with the nurse, though, and she assured us that they act based on our beliefs. I'm not going to go into too much detail yet because Robby and I need to formulate this together. There are many different opinions, even among Christians (perhaps more among Christians!), and we plan to continue with prayer and counsel. We already have our key beliefs which will be the foundation; there are just some other trickier situations that may arise.

I had picked up a small book a few months back published by Bethany Christian Services. It is called Christians and IVF: Wise Choices and Life-Affirming Options. It has been very helpful! I would encourage everyone to read this as IVF and other forms of AI are part of our culture today. 

Robby also reminded me that this is not our first choice as the way to have a baby. How we wish we could be "normal" and get pregnant on our own! But this is where we are, and every step of our journey has been drenched not only in tears, but in prayer, as well. 

The Big Question

As I shared the Cliffs Notes version of this with my mom this morning, she was of course concerned with the big question. When will this happen for us???

We chose not to rush into the next IVF cycle that the doctor is performing, which is in November. (To which my mom responded with a sigh.) This is, as I've already said, huge. No rushing is necessary! The following IVF cycle will be in January, so our plan, our tentative plan, that is, would be to begin our cycle at the beginning of the new year. This gives us time to get all of our labs done and discuss the outcome of each, budget the cost, and spend lots of time together in prayer.

We are excited, friends! We are also overwhelmed and a bit terrified. We desperately need your love, support, and prayers. Thank you for caring enough to read this long thing and stay updated on this huge step in our journey!

First Steps...Again

Yesterday, Rob and I arrived home after a week-long trip with our family in Washington, DC. We had a great time and were busy, busy, busy, seeing the sights and savoring the unique time together. As busy as I was though, I kept thinking about a key event coming up on our return home.

A few weeks ago, I felt a strong peace come over me about pursuing IVF. It came out of nowhere, like a sudden storm, and I knew it was the Holy Spirit. We pray about what to do with our infertility all the time. Not only do Rob and I pray, but our families and friends also constantly lift us up. I knew it was no accident that I felt this, but I simply tucked it away for a few days. This wasn't what we had planned, you see. We had decided a few months ago that this year would be a year of saving, and next fall would be the time to act. However, as it was very clear to me that God was speaking, I finally told Rob that I thought we should look into IVF sooner than we had been planning. There wasn't even a discussion about it -- he said he had been feeling the same way.

The next day, I called my doctor in Clovis and set up an appointment. It has been a year and a half since my last visit there, so I have to do another major appointment with all the initial tests and talks. It's scheduled for tomorrow, Monday, October 8, and we're hoping to find out if I'm still a good candidate for IVF, what the cost estimate is, and when I could begin the process.

It's exciting, terrifying, and all the other adjectives in between. Not doing any treatments this last year and a half has been good in many ways, lessening the physical and emotional strain. But it also feels like I'm starting all over, and that is hard. I thought that there would have been an "end" by now. I had hoped that we would have already had our baby.

And, strangely enough, starting this again throws a wrench in the groove we've finally settled into. We are never truly content with our family of two, but we have tried to be positive and recognize we have worth as a couple even if we don't have children. I'm enjoying my job, and Rob is at a great place in his ministry. Starting all over means shaking things up, and that's scary.

Finally, IVF is just plain huge. It's a huge financial, emotional, and spiritual commitment. It's something I recognize we cannot do without the support and love of our family and friends. That means that people need to know, and that means that people will ask, and that means that we'll have to share news, even if it's heartbreaking. It's hard to allow others to bear that burden with us, and it's hard to open myself up to that vulnerability when so much of our struggle is private and personal.

So, tomorrow is a big day. There are all sorts of unknowns, and my stomach is in knots just thinking about it. Providentially, yesterday when we got home, there was the latest newsletter from Stepping Stones on my counter. The cover article is called "A River of Optimism." I love what the author wrote:

The hope of a Christian is not just positive thinking; it is absolute certainty about who God is, His goodness and love, and ultimately, His plan of salvation in my life. While the path I am walking is certainly not one I would choose--maybe one I will never understand, already filled with heartaches and disappointments--I know that I will ultimately not be disappointed. This is not because God answered my every prayer according to my wishes but because He drew near to me in my time of deepest need and loves me with an unfailing and sufficient love.

I don't know how any of this will turn out. I may find out I'm not a good candidate for IVF anymore. We may be overwhelmed by the cost. We may go through the process unsuccessfully in countless different ways. But I am certain, as that author wrote, about who God is, His goodness and love, and ultimately, His plan of salvation in my life.

Stepping Stones Newsletter -- Hey, that's me!

I was so excited to receive my Stepping Stones Ministries e-newsletter last week. I immediately began perusing and felt my little heart skip a beat when I saw my name at the top of page three! Stepping Stones had published my article, "The Tree of Life"!

The article was actually a blog post from August of 2010. I submitted it to them earlier in the year and was told it would be showing up sometime soon. You can read the original post here or hop over to the newsletter here. And if you have not given this resource a good looking-over, now is the time! It has been such an encouragement to me and so many other women I know.

Maybe...

My husband and I spent the last week in New York celebrating our seventh wedding anniversary :) It was a fantastic time, packed full of sweet memories and moments. It's funny but I always find I learn a lot of lessons while vacationing, perhaps because I'm out of our normal routines and comforts. I tend to come back inspired and invigorated, which I guess is exactly what a good vacation should do.

This isn't really a lesson. It is just one tiny thought that emerged, and it happened on our flight home. Our plane sat three to a side, and our third seat was filled by a young kid who was traveling alone, flying for the first time, on his way to visit family in California. He was a sweet boy, a soon-to-be seventh grader, friendly and happy to have an adult nearby to explain the ways of the plane and talk with to pass the time. I too was quite happy to offer my "expertise" and be a friend, even if only for the six hours on the plane.

So, the thought was this: I could love a kid like this. I could be the adult for some child who needs one. I could open my heart easily, perhaps more freely than I sometimes think I could.

And when Robby helped him get his music player out of his bag and was kind and sweet to him, I thought, He could do this, too.


It's a tiny thought, as I said. Adopting or fostering is no small decision, and as I've shared, we never went into our marriage thinking we would be a couple who would pursue that. I still dream of having a child who looks like me or my husband, of carrying a baby in my own body, of experiencing God's healing.

But in the last couple of years, my prayers have included not only pleas for a biological child, but pleas for open, willing hearts to go and do whatever God has for us. I know God is going to answer us, and so I thank Him for the ways He speaks to us, even when His voice comes unexpectedly on a plane flight home.

Book Review: When the Cradle is Empty

When the Cradle is Empty is a book about infertility written by John and Sylvia Van Regenmorter and published by Focus on the Family and Tyndale.  When I decided a few months ago I wanted to read a book on the subject of infertility, I became overwhelmed by the options.  This actually was the first one I had perused before I gave up the search.  A couple of weeks ago, I went back and ordered this book, along with another.

The authors seek to answer tough questions about infertility, including chapters on the journey, the pain, holidays, marriage, family and friends' questions, prayer, treatments, miscarriage, infant death, secondary infertility, adoption, and moving on.  Yes -- it covers the whole spectrum.  In some ways it is an overview of information, but in other ways it speaks directly to the couple struggling to find words and explanations for what they feel.

The first few chapters were the hardest to get through because they were the most painful to read.  Chapter 1, "A Journey Begins," outlines the seven steps most couples go through in their process of infertility and pain.  I read this chapter through tears -- it seemed someone had peered into my life and written down my journey thus far.  Chapter 2, "Pitfalls Along the Path," opened up some wounds I've tried to close forever, such as the guilt over using "the pill," waiting too long to seek professional help, and playing the blame game.  Chapter 3, though only a few pages long, spoke of the loneliness and hopelessness of infertility, attempting to shed light on the question we've asked: "Why Does Infertility Hurt So Much?"

It seems the authors had intended those first few chapters to pry open their readers' hearts--as if this needs to be done!  They quote from Phil Nienhuis, a professional family therapist, who says, "One cannot begin to recover from pain, until he or she is willing to own the pain and acknowledge that it is real" (33).  Hope and help are on the way, they promise, in the subsequent chapters.

Chapters four through fifteen do indeed offer hope and help.  Some of the help is very practical, such as a list of agencies and organizations that provide infertility counseling and services; or the explanation of the different types of ART (Assisted Reproductive Technology); or the steps a couple goes through in the process of adoption.  Some of the help is spiritual, such as verses and stories that encourage and speak directly toward a hurting heart.  Some of the help is just plain common-sense, such as advising couples to recognize their boundaries or giving couples words to say when the inevitable questions come or even setting time-limits to how much time they spend talking about infertility.  And then, thankfully, some of the help isn't really help at all.  It's simply experienced people reminding couples that there may not be easy answers or fix-all band-aids, and that's okay.  We may never know the "why's" of infertility, but God is with us, and He is guiding this seemingly unsteady path.  The reminder of hope is always welcome.

For me, the book was encouraging because--as I already said--the authors provided me with words I haven't been able to find.  They shed light on emotions I haven't taken time to recognize or pains I haven't been willing to acknowledge.  It's all been there, of course, but there is something freeing about reading just what you want to say.

I also was encouraged because of some of the difficulties shared that I haven't had to deal with.  My husband, for example, is right there with me in all of this, which is a blessing.  He doesn't shut down or try to fix things and move on.  He feels the pain and sorrow just as I do.  We truly carry this together, and I know not all women have that support.  My close friends and family are sensitive and careful with me.  They think of me when sharing their pregnancies or joys of their children; they ask me about my hopes and desires; they pray for me.  And, although I hesitate to write this, there is another excruciating element of infertility I haven't had to bear: I haven't had to experience the pain of miscarriage.  I grieve over an empty womb, but not over a heartbeat that stopped.

I definitely recommend this book, not only to couples facing infertility but to their families and friends who may want a closer look into their hearts.  Not everything resonated with me, of course, but enough of it did that I would suggest anyone wanting to understand us better to read it.

I'll take some time over the next few weeks to share some of the things that stood out especially to me, but I thought I'd end with this one line that is just brilliant:

"Any comment beginning with 'at least' is likely to be unhelpful" (121).

How true is that?  "At least you're happily married." "At least you're healthy." Or--for my friends who have tasted the pain of miscarriage, infant loss, or secondary infertility--"At least you got pregnant."  "At least you have one."

Thank you, God, for caring about all, even the least of all.


To order the book from Bethany Christian Services, click here.

The Other Half

It can be easy for me to forget that there is another person intimately involved in this grief and struggle: my hubby.  He is such a rock to me, so solid and strong, that at times I may selfishly focus on how infertility affects me, perhaps broadly how it affects us, but not often how it affects him.  Sure, I write about "our" desire to have a baby and "our" struggles, but, because I am the woman, it naturally becomes more about me.

In fact, if our infertility had not continued as it has, I probably would never have known how much this has pained him.  In the early stages, perhaps the first year or so, I don't know if I once asked him how he was coping.  I was absolutely overwhelmed and could only think how my dreams were being dashed.

The reality is that my process most likely did begin before his.  Even before we knew definitely that something was wrong, I expected it.  I'm the one in my body, afterall, and the problems I have, the issues that have led to our infertility, didn't appear over night.  It didn't take long for me to find myself pedaling full-steam ahead when he was still using training wheels, trying to wrap his mind around our new reality.

I have learned a few things, though, and, because he and I have become better at sharing how we feel regarding this, I continue to learn.  Like any struggle, this is simply what has happened with us and what has worked--for the time being, anyway--for us.  I hesitate to call these "tips" for everyone, so I'll just say these are my tips to myself to keep my husband and me sane together.

1. Ask him how he feels.  Ask him again.  And again.  Then wait patiently, and wait some more.  Know that sometimes I'll get a release of response, and sometimes I won't.  It's the same with me, though -- sometimes I want to share a lot, sometimes I don't.
2. The response of "I just feel sad" is perfectly acceptable.  Sometimes there are no grand ways to explain our emotions.  We know we're sad, and that's enough.
3. Keep him filled in and updated on conversations I have with others.  Naturally, people ask me more often than they ask him how we're doing.  He can easily get out of loop, and that can be hurtful to him.
4. When it's appropriate, remind others to encourage him directly, to ask him how he's doing, to recognize his pain.
5. Embrace his optimism, even when I want to shut it down.  Know that God may be giving him a word or understanding that, for whatever reason, I don't have.  At the same time, allow him not to be the rock sometimes and give him the freedom to question and cry just like I do.
6. Pray together and share Scripture that has been encouraging, even when it feels forced.  And it will feel forced, at times.
7. Know that we will be at different points of grief, understanding, and even excitement throughout this journey, and that's okay.  It's about going through it hand-in-hand, not necessarily experiencing it the exact same way.
8. Take advantage of every "outing" he wants to have, whether it's late night runs to Taco Bell or seemingly extravagant vacations.  We're in this together, and our life cannot be on hold just because we don't have children.  Our life is what it is, and we need to embrace it.
9. Tell him why I think he will be an amazing dad someday.  And tell him why he is an amazing husband today.
10. Let him believe that we really are going to have the little girl he wants even when I think we'll have a boy.

I've heard of marriages being torn apart because of infertility.  I can see why.  It is easy for anger, blame, and resentment to quickly creep into a husband-wife relationship, especially since no pre-marital counseling ever prepares you for this.  Communication is tough anyway, so trying to communicate emotions you don't even understand that well can make it nearly impossible.  But with God's grace, a marriage can be strengthened by such a struggle.  Love--the true, patient, selfless, sacrificial, undying love of Christ--must become the key.


Resources:
There are not many resources out there specifically for or about men and infertility, but Stepping Stones does have one article that is worth reading.  It is called "When a Husband Hurts" by Rev. Burton F. Wilbur, Jr.  It actually is about the pain a husband felt through two miscarriages.  Although it is not about infertility in general but is more about the grief of losing two babies, it is honest and helpful.

The Waiting Room

Originally written on June 21, 2011, this study and reflection inspired the song "With the Lord," written about a year ago and shared with you today.

I hate waiting.

If you know me, you probably know this fact about me.  I don't like the feeling that precious minutes are passing by, and we are just stuck until something comes.  I don't like factors outside my little realm of control dictating how I spend my time.  But more than the waiting, I hate the letdown of waiting for something that doesn't work out.  All the energy that went into that week or month or year seems to collapse right on top of me.  

I feel like that has been my life the last few years.  I've shared that we have been wanting a baby for some time, so you could probably guess that my life is lived in months.  A new month comes, a new opportunity, a new waiting game, and, as it has proven so far at least, a new disappointment.  

This whole routine gets me very restless and anxious.  I try to keep busy because that at least gives myself the impression that life is fine, but the truth is, distractions don't last very long.  At the end of the day, I still have to deal with the fact that things are absolutely out of my control.

I guess I shouldn't be surprised that Scripture tells us to "wait on the Lord."  Waiting goes against our human desire to control things.  When we are forced to wait on someone, we are no longer in charge; we are at the mercy of someone else.  Thankfully, we are able to wait on the Lord knowing He is good and kind and merciful.  There is hope involved in our waiting because we have a gracious and loving Father, and we know He will respond.  Nevertheless, it is still hard, which is probably why it is so good for us.  Waiting is what the Great Physician often prescribes to build our character and grow our faithfulness--but this medicine is hard for me to swallow!

As I was looking up Scriptures about waiting, I came across this little study.  It's quite lengthy, but I wanted to share some of the points.  You can read the whole text here if you'd like.  No doubt, I am not the only one playing the waiting game these days.

Waiting on the Lord

Study by J. Hampton Keathley, III

What is involved in waiting on the Lord?

1.  Waiting means confident expectation, so waiting and hoping go together.

2.  Waiting involves an expectation based on knowledge and trust - our ability to wait on God is connected to our confidence in who God is and what God has done!

3.  Waiting involves seeking the Lord, spending time in His Word, in prayer, and in meditation.

4.  Waiting involves resting in God's timing, acting when He is calling us to act and resting when He is calling us to rest.

Why should we wait on the Lord?

1.  Because of who God is and what He is able to do - again, we need knowledge of God through experience and Scripture

2.  Because of who we are and what we are not able to do - we need to have a right view of ourselves and our weakness

What benefits are there to waiting?

1.  Waiting strengthens and enables us.

2.  Waiting strengthens and builds character.

3.  Waiting lifts us out of despair and causes praise to God.

4.  Waiting encourages others and gives greater ability to witness.

I am looking forward to printing out the study and spending some time with it, but the truth is I always know that when I feel restless and anxious, God is calling me to Him.  No distraction on this earth can fix my heart when it's broken.  Only God can lessen my disappointment and ease my pain.  Only He can give me the strength to wait -- to wait with expectancy and hope and love.  Strangely enough, it brings me comfort to know that God wants us to wait.  It brings purpose to this trial in my life, when I am tempted to think it is all for nothing.  There is no trial, no struggle, no pain that God cannot and will not use for His glory.  Praise Him!

Out of the depths I cry to you, O Lord; O Lord, hear my voice.  Let your ears be attentive to my cry for mercy.  I wait for the Lord, my soul waits, and in His word, I put my hope.  My soul waits for the Lord more than watchmen wait for the morning, more than watchmen wait for the morning.  

Psalm 130:1-2, 4-6