My Mind's Ink

OK, you three have done so well up to now, the lab lady said you are all perfect. This isn’t a sprint though, it’s a marathon. Stick around, would ya, I make bitchin cookies.

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The timeline of this website does not always sync to the calendar. That may be a blogger sin, I don’t know. If it is, then I am guilty, but it is certainly not the worst of my wickedness.

I bring it up now because people following the narrative of our IVF cycles are feeling bad for us, but it’s old news. I wrote about the experience of IVF from the beginning, but we kept it a secret from family and friends until the second round. All those silent months created a backlog of articles that were important to the story, but this week I can finally bring you up to speed.

The last embryo implantation actually took place on Mother’s Day, but the cycle did not end in a pregnancy. That sucked, and we cried, but as my sister likes to say, “Rub some dirt on it.” We are already deep into cycle number three, and things are looking great.

Michelle’s Egg Factory is back in business and running at full production. In all likelihood she will be triggered for Egg Retrieval this week, Embryo Transfer will be next week, and the pregnancy test will be mid September. Now we are all on the same page. Future posts will more or less follow real life. Oooh the drama.

We are doing a few new things for this cycle I will tell you about in the interim weeks. We did an experimental biopsy on the science side of things, and have seen a holistic hit squad¹ of professionals to cover every other facet. We feel good. Ready for the title fight.

Footnotes

1. I envision cool uniforms for the HH Squad. Acupuncture Girl’s has all the sexiness of Wonder Woman, but, you know, 100% hemp. [↩]

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The extraction goes much better this time. They retrieve 14 eggs from Michelle. We are thrilled. Not all of the eggs will be mature, and not all of them will fertilize, but no one can tell us any of that now.

I ask if I can be present during fertilization, but I am firmly denied. This is what I expect and it is definitely for the best. The last thing you want in a lab, where delicate life-changing tasks are underway, is me standing in the corner pointing at equipment, “Cool. What does that do?”

Day One – Good News

The news from the embryologist the following morning is terrific. Thirteen of the fourteen eggs were mature, which is above average. They used a frozen sample of my sperm, which apparently knocks some of the pep out of them, so getting ten of them to fertilize is also great news.

Day Two – My Zygote is an Honor Student at the IVF Clinic

One of the embryologists phones each morning to give us an update on how our embryos are progressing. This morning she starts by explaining the system for assessing embryos. “We grade each embryo on a scale of 20. A score of 15 to 17 is the average. Exceptional embryos score 18 and 19. Perfect embryos are a 20. We don’t give those out very often. I’d say we’re pretty mean about giving out 20′s”.

“At this point we like to see the embryos at the two or four cell stage. All of yours are there. We have graded them, and they all look good. You have one graded 18, seven graded 19, and two embryos we have graded a perfect 20.”

Michelle starts to tear up. I don’t know if you could call it parental pride yet, but that’s what if feels like, excitement, relief, and pride. Not many parents get to tell their kid they had cause to be proud of them when they were still a zygote.

The embryologist informs us that we will not be doing a day three transfer, but will wait until day five. The disadvantage of growing embryos to day five is that some of them won’t make it that far. The advantage is that the extra couple of days gives more time for the exceptional candidates to stand out, and the odds they will develop into a pregnancy are higher. The improved odds decrease the number of embryos that need to be transplanted back into Michelle, thus reducing the chance of twins.

Day 5 – Transfer Day

Four of our embryos are ready. A few others are developing more slowly, and may come along far enough to be frozen, but that is not today’s concern. We must decide how many embryos to transfer.

We must balance the desire to have at least one of the embryos take hold, with the risk that more than one might. We want to maximize the chances of getting Michelle pregnant, but we don’t want a multiple birth, which would increase the health risks for her and the babies.

The doctor tells us Michelle’s egg reserves are excellent for her age, she reacted well to the ovarian stimulation, produced more eggs than average, and our embryos are star performers. Michelle looks 30 on the outside, and the doctor says her insides look about the same. She has grown fond of saying that she has the reproductive system of a thirty year old. Well, I’ve cleaned that up a bit, she doesn’t actually say “reproductive system”, but you get the idea.

We try and factor in all of this unscientific conjecture into our decision. In a thirty year old only one embryo of this quality might be used, but the statistics take a drastic turn for the worse when you are in your forties, like Michelle. The doctor suggests we select either two or three. We decide on three and the doctor and his team leave the room, but a short time later he walks back in and says, “The number of embryos is a big deal guys. We all have to live with the consequences, so you need to be comfortable with the choice.” I suspect he may have the same hesitancy we do. We talk it over again, and bump the number down to two.

They show us the two embryos on a large monitor connected to the lab microscopes, and then they are transferred into Michelle. The doctor points out the white dot on the ultrasound caused by the tiny air bubble they use as a marker. It is crazy to have so much riding on what is taking place right now at that little bright spec on the screen.

Happy Sticky

We must wait twelve days for news. In twelve days a blood test will reveal the results of all that preceded it. In twelve days we will know if either of the embryos survived and stuck to Michelle’s uterus. There is nothing left for us to do but follow the instructions provided as we left the clinic, “Think happy sticky thoughts.”

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Michelle is scheduled for egg retrieval tomorrow. We are hoping for so much. We hope the follicles produce eggs. We hope the eggs are mature. We hope the eggs can be fertilized. We hope the fertilized eggs develop into good embryos. We hope we don’t have to do this again. We hope we end up with a healthy baby. There are so many steps left, and at each one we must add hope. It’s fucking exhausting.

Tonight we inject the HCG, which matures the eggs. This is where we went wrong the last time. The doctor offered to mix the shot for us, and thankfully, we chose practicality over pride, and accepted the help.

I take the prepared syringe out of our refrigerator, warm it in my hand, and inject Michelle. She is intensely nervous, and the injection does not help matters. She is not feeling the stinging reaction that the nurses prepared her for, in fact, she doesn’t feel anything, and she thinks something has gone wrong.

My involvement in getting Michelle pregnant is largely over. The clinic secured a sperm sample from me which concludes my contribution. In IVF, just like a natural pregnancy, after sperm donation, the father is relegated to a supporting role.

I support Michelle by talking her down from ledges. With the odd exception, I keep my nerves in check, and try to portray a calm I don’t always feel. I assure her that everything will go well tomorrow, and I add another hope to the list. I hope that I am telling her the truth.

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Nothing is fucked here Dude – Walter Sobchak, The Big Lebowski

We decided that three attempts is our limit, and so, we begin again when Michelle’s body recovers. This time we are operating on a longer protocol. Michelle takes a birth control pill for twenty one days to calm her ovaries, then starts one set of injections for 10, only then do we reach the point we started the first time.

I am not entirely sure why the approach is different. You need to be informed and ask good questions, but not about everything. If the doctor does not know what he is doing we are truly screwed, so a little faith is well advised.

I had to complete two chemistry classes in Engineering, both had lab components. I always managed to find out what the final solution was from someone who had taken the course before, and then I did all the calculations backwards until I arrived at the start. This was easier to me than measuring and mixing shit in test tubes. I did a full year of University chemistry labs without ever actually doing an experiment.

In retrospect, me fucking up the IVF drugs, was practically a guarantee. I have asked Michelle to double check every move I make from now on. Our new quality control system operates on one axiom, “Dirk is not in charge of anything.”

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The next major step of In Vitro Fertilization (IVF) is obtaining an egg. Actually, the objective is to get several. The process is invasive, and involved, so the best result is to harvest multiple eggs at the same time. To do this you need drugs.

Normally a woman produces one follicle containing one egg each month. The idea is to use chemistry to trick the body into producing more. Several drugs are used to develop multiple follicles, and to trigger each of them to produce an egg at the desired moment. A surgical procedure then removes the contents of the ovaries to obtain the eggs for IVF.

We are given training at the clinic and then administer drug injections at home. I take on the role of nurse, as it seems the least I can do. I give Michelle three injections, in the stomach, each night for a week.

Every two days we go into the clinic for a blood test and an ultrasound. The doctor monitors various hormone levels with the blood, and the state of Michelle’s ovaries with the ultrasound. Her stomach is already bruised from the shots and it now grows swollen and uncomfortable with eggs.

To retrieve the eggs a large bore needle is inserted through the vagina into the ovaries. It is as painful as you expect it would be. Michelle will endure a painful recovery lasting several days.

She gets more drugs for the procedure, but these are more fun. “Are you comfortable?” I ask her. With her legs in stirrups, she nestles back into the pillows, “Ya, this bed rocks.” The cute smile on her face confirms that the drugs have hit her and that she is a little high.

We are anticipating good results. The drugs have stimulated ten follicles in each ovary, which is higher than normal, particularly for a 40 year old. I tease Michelle that she does not have to be an overachiever at everything.

We follow the surgery on the ultrasound. The screen is mostly undecipherable shadows, but you can clearly see the needle as it sucks up the round globules containing the eggs. We are half way through the procedure, everything is gone from one ovary. The pretty young embryologist said she will call out every time she finds an egg under the microscope, but she never calls out, “Egg!”

The doctor looks perplexed, and that is not good. We are involved in a carefully orchestrated series of events. Each step is critical for success.

Thirty six hours before this procedure I gave Michelle one last large injection. This is the first and only time we take this drug. It is called HCG and it matures the eggs. The doctor performs a standard home pregnancy test which will indicate the presence of HCG. There is no sign of it. Another test is done, but still nothing.

Michelle’s cute little smile is gone, and her eyes begin to fill with tears. The doctor tries the other ovary because there are few alternatives now. Nothing surprising happens. No eggs are found. Excited anticipation evaporates and is replaced by overwhelming disappointment. My beautiful wife is in pain, and is heartbroken. She begins to cry in earnest.

Everyone is nice about it, and the doctor relays the facts as gently as he can. “There appears to be no indication of the HCG in your system, that might be the cause of the problem.” They begin to speak to us in the hushed and encouraging tones reserved for personal trauma.

I half listen to the doctor say wonderfully supportive things. We wait to move to the recovery room, and then an agonizing stretch of time until we can leave. I am anxious to get home because there is the answer to the only question I have.

The HCG drug comes in two vials that must be mixed. You extract salt water from one, inject it into another containing powder, and draw out the correct dose of dissolved medicine. Is it possible I set the medicine down after I mixed it, and picked up the vial containing the water?

I help Michelle into the house, and dig the two vials out of the kitchen garbage. They are identical except for fine print on the label. I insert a syringe and withdraw all of the drug I so carefully measured and prepared, but never injected. I had made a mistake and injected Michelle with useless salt water.

She went through it all for nothing. Manage the drugs, that was my only job, and I had insisted on taking it. I did something careless and stupid. I am responsible for my wife’s sorrow and pain, and it is too much to for me to bear.

I begin to cry. I cry like I never have before. I cry big sobbing tears until snot comes out of my nose. My chest heaves, I can’t see, and I hold on to the counter to keep my knees from buckling. Michelle will not rest after her surgery as she should. She holds me and tells me it will be OK, and it is sandpaper across my selfish guilt.

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Fathering a child after a vasectomy is not easy. That is redundant. What I mean to say is that if you change your mind, there are some challenges. The first one is accepting that I am an idiot, because my obstacles are self imposed.

There are two ways to proceed. I can go under the knife to reverse the procedure, which my previous experience caused me to remove from the list immediately. What remains is In Vitro Fertilization (IVF).

The first step is sperm retrieval, which is exactly what it sounds like. I have had two vasectomies and a humorous infection. Getting sperm out of me capable of more than drooling and swimming in a circle may be a challenge. Many men perform this feat armed with only a plastic cup and their imagination. The vasectomy makes that method non-productive, at least from a sperm retrieval point of view, so I must employ more elaborate measures.

When I think of providing sperm samples it is fun to envision a cute nurse. The nurse, her uniform, and the procedure she performs, flagrantly violate proper codes of conduct. Surgical equipment and latex gloves have no reason to exist in this fantasy world.

Just like in the fantasy, I am naked from the waist down, but no other similarities exist. For one thing, the bed in the fantasy does not have stirrups. The procedure extracts sperm from the source with a needle connected to a small suction device. It is not nearly as Spanish Inquisition as it sounds, but Michelle did use the word “digging” to describe what it looked like from her viewpoint.

She sits in a chair beside the doctor, at crotch level, and watches with a pained expression. The freezing is working great, because I can’t feel a thing, but the testicles are hardwired to every piece of the male anatomy, so there are repercussions other than pain.

The nurse looks down at me and asks if I am feeling all right because I look pale and sweaty. She connects me to a heart rate monitor and we watch as I fall into the high thirties. Apparently, that is not good. “Do you know your normal heart rate?” I do not. Everyone starts to get concerned. Even the doctor and his needle pause for a second. I feel like Al Pacino in the opening scene of Carlito’s Way. Everyone is making such a fuss, and I feel fine.

This is the third time I have let someone have a go at my testicles with something sharp, and once again, it is not going well. They should give out merit badges for shit like this. Then you could wear your colonoscopy of ’08 with pride. Badge or not, this kid will hear about what was involved in bringing him into the world.

The procedure is a success. Viable sperm are retrieved and I do not pass out. My heart rate returns to its normal resting rate in the low sixties, a number the nurse says indicates athleticism, which is good, because my sperm have other challenges ahead of them.

Samples are placed in tiny tubes, called straws, and frozen. When the time comes they will be thawed and inspected. One hardy little bastard will be chosen and put into action. The final selection requires the ability to survive to that point, and random chance from amongst all those who do. In this way, it’s just like the real thing.

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