So one of the biggest questions Jonathan and I have had to discuss and make a decision about involves how many embryos to transfer into my uterus after they are fertilized. Any good RE (reproductive endocrinologist or fertility specialist) won't transfer more than 2 at a time unless you are well past 35 and have many more contributing factors to your infertility. Even then, I'm not sure I would trust a clinic that was willing to transfer more than maybe 3 embryos at a time. THAT, my friends, is how you get an "Octomom" situation. In the womb, any egg has the potential to split into two babies. So if you're transferring 4-5 eggs, you have the potential to get as many as 10 babies out of that deal. While it's unlikely that all 5 of them would split into 2 babies, you can never be certain (hello Jon and Kate +8...). Any multiple pregnancy comes with risks. The vast majority of twin births don't make it to a full 40 weeks. And with 3 or more babies, you'd be lucky to make it to 30 weeks. Now we are talking more risk factors for the babies AND the mommy. Not to mention the costly price of a stay at the NICU...multiplied by 3 or more!
The doctors who will be handling our IVF will not transfer more than 2 eggs at a time no matter what. So 1 embryo or 2, Rachel? Well, after spending lots of time poring over this question, we have decided to go with 2. For several reasons. Not the least of which is the fact that this is our one and only shot for a long time. If it doesn't take, it will be 2-4 years before we are able to try again. We are in med school, after all, and starting September 15th most of our funds will be going toward traveling to Jonathan's clinical rotation locations and saving for the very costly process of applying to residencies. And don't forget there are quite a few costs involved with traveling to and from those interviews!
So we are putting all of our eggs (all 2 of them) into one basket and praying for a miracle here. I'm actually giving my little eggs a pep talk right now...
Big question here. And one I can't really answer definitively as we are still months away from beginning the process. But in an attempt to sort of "let you in" on what we foresee the steps being, let me shed some light on what a round of IVF might be like for this "first cycle" couple...
1st Appointment - Fortunately for us, the doctors we are working with already have full access to our past medical history. Both infertility-wise and otherwise. They will have a preliminary knowledge of what they're "up against" before we ever step foot in their office. This is the appointment where we will talk to them about our hopes and intentions, discuss options, ask questions, etc. We've already got a pretty extensive list of questions to ask! We will also meet with people in the financial department of OU Infertility to talk with them about what our insurance may or may not cover. We will most likely be sent for blood work at this appointment. Then I will be scheduled to have some or all of the following procedures within the following 2-4 weeks:
HSG (Hysterosalpingogram) - This is a procedure that I've had done before. They inject dye into your uterus and fallopian tubes to see if your tubes are blocked and/or if there is any scar tissue or other damage. This procedure also helps the doctors note the size, shape, and placement of your uterus. When I had one done in November of 2010, everything was seemingly normal. Barring any unforeseen complications that have arisen in the last 3 1/2 years, I'm assuming this test will once again be normal.
Hysteroscopy and/or Laparoscopy - This is where they put a tiny little camera right into my uterus or abdomen to check for fibroids, endometriosis, blocked tubes, and/or other abnormalities. Usually if they see something during this exam they go right ahead and remove the fibroids or scar tissue that might be blocking the tubes or otherwise hindering a successful conception/pregnancy. I'm not gonna lie...it's *this* procedure that scares me some. Because it's the procedure that could uncover things that could prevent both IVF *and* our chances of ever conceiving. Yep...I get anxiety just thinking about it...
Semen Analysis - Just what it sounds like. Jonathan gives a sample, they put the little guys under a microscope, they give them a score. Simple as that. This is another test we've had done before and should return normal again.
Sonogram - To check my endometrium (the lining of my uterus) and my ovaries for cysts or abnormalities. I'm a pro at this procedure since I've had more of them than I can even remember. Thankfully, unless something drastic has happened since March 2013, this reading should be normal.
Mock Transfer - This is new to me, but I think it's pretty cool (even if the procedure itself harkens to a bad experience I had in March 2013 with an endometrial biopsy...eesh...). Basically the doctor is going to perform the IVF transfer procedure right up until the point of actually transferring the fertilized eggs into my uterus. Why? Because every woman is different and they have to make sure they are using the right size and length of catheter. Also they want to make sure they are able to place the fertilized eggs in the most optimal place in my uterus for implantation. This procedure is done while the doctor looks at an ultrasound image to make sure everything is just perfect for when it's time to transfer those Womack Embabies for real...
Hormone Testing - There are a few tests that have never been run on me during fertility treatments. Why? I have no idea. There's a possibility, though, that the OU doctors might want a clear(er) picture of my hormone levels throughout a natural cycle. We will be seeing them right in the middle of a natural cycle, so they may want to see how my body is producing estrogen, progesterone, FSH (follicular stimulation hormone...the hormone that tells your body to produce eggs), LH (lutenizing hormone...the hormone that tells your ovaries to release the egg(s)), etc. These are just simple blood tests, but some have to be checked on precise days in your cycle. We will be seeing them on or around Day 18 of my natural cycle, so who knows where these evaluations may or may not fit in...
Then starts the fun part (please read the sarcasm there) ;). We have no idea what the exact timeline for this will be (we are hoping a transfer date sometime between August 1st and September 10th will be possible), but here are the steps we will likely be taking between the evaluation stage and the actual transfer:
Step 1 - 2 weeks of birth control. Ew. I'm not a fan. But hopefully it will be 2 weeks of yuck in exchange for years of awesome, so I'll do it. There's a chance I may not have to do this since I've got a normal cycle going now, but we also don't want to take any unnecessary chances if we don't have to.
Step 2 - Sometime around the middle of the cycle I will begin taking Lupron injections daily which will suppress my natural ovulation.
Step 3 - "Stimming". This is a term used in the IVF world for stimulating your ovaries to produce lots of eggs. At the start of my next "cycle" I will take daily injections to make my ovaries mass produce. I will take these injections for anywhere from 7-10 days.
Step 4 - Ovidrel (which I've taken before). This is an injectable drug that stimulates your eggs to mature before "release". In our case, the doc will be going in to get those mature eggs before my body releases them naturally.
Step 5 - Retrieval. This is done under general anesthesia like an outpatient surgery. This is when they will use a needle through a speculum to poke through the walls of my lady parts and retrieve all my tiny little mature eggs. Then those little eggs go straight to a petri dish and into an incubator to await their "knights in shining armor". During retrieval they will take as many eggs as they see and are able to get to. So it can be anywhere from around 15 all the way to 35+.
Step 6 - Jonathan gives the docs a "sample" and his soldiers are then deployed into that fateful petri dish with "marching orders" to "attack the hill". We will get daily phone calls about how many eggs were fertilized and how our embabies are growing for the next 3-5 days.
Step 7 - On Day 3 or 5 after retrieval and fertilization our embryos will be "graded" (exactly like they grade chicken eggs actually...AA, AB, BB, etc.). The highest graded embryos are slated for transfer and/or cryogenic freezing. On Day 5 I will go into the office and they will put our Womack Embabies (1 or 2...hopefully we have 2 good ones) into my uterus in the same way that they did the mock transfer in the beginning. This is done without anesthesia but I will likely be given something to relax me (i.e. Valium or the like) so that I don't get too tense and cause my uterus to contract which could hinder our chances of a good transfer and hopefully implantation.
Step 8 - 2WW (Two Week Wait). This is only about 9 days after the transfer happens rather than 2 full weeks, but I'm told this feels like an eternity. It is during these 9 days that we will need some SERIOUS distractions and encouragement. Say prayers for me, yes, but mostly Jonathan during this time. Because I will likely be a basket case...
Step 9 - Beta pregnancy test. I can take a home pregnancy test if I want to (who am I kidding?? I will probably take several...), but no matter what I will go in 9-11 DPT (days past transfer) and they will draw blood to check my hCG (human chorionic gonadotropin...the pregnancy hormone) levels. If they are rising, I am pregnant!
Step 10 - I will continue working with the OU Infertility docs until around week 8 when a heartbeat (or heartbeats!) are confirmed via ultrasound. I will then be released to my regular Ob/Gyn for the remainder of the pregnancy.
Whew! Did you follow all that?? Me neither. :) It's pretty confusing and overwhelming. Thankfully we have some pretty wonderful people in our lives that are A) Praying for peace for us, and/or B) Helping to talk us through this process because they've "been there done that". It will never cease to blow my mind how God has orchestrated this whole endeavor. He made our paths cross with people 10+ years ago, and then now today they are people helping us along this bumpy road to parenthood...
We are so blessed and quite anxious to get this party started man!
If you'd like some video footage about the process of IVF from "the lab"'s perspective, I found this video which is actually pretty incredible. I think it's amazing even if it wasn't done in petri dishes in a lab. How cool is it that these microscopic cells grow into humans??? Mind blown y'all...
First I have to start by showing my appreciation for all the love and support that has been poured out for Jonathan and me in response to this blog. Wow! We are really fortunate to have such wonderful loving people in our lives and I can't express to you how much it means to me to hear your words of encouragement. From people who are right here "in the trenches" with us to people who we haven't seen in years to those we have never met...our cup overflows y'all! A quote from one of our dear supporters and a fellow "sister in waiting" said "I think God prompting you to share your story is His way of giving this struggle a purpose". Wow! Words seemingly right from His mouth actually. In all the years of struggle and heartache and loss, if I'm able to give someone else hope or at the very least a listening ear and solidarity, then it was not all in vain. Praise God...He is good ALL the time!
This post is somewhat of a "thinking out loud" post as someone graciously posed a question to us here on the blog. The question was this:
"Rachel, I just wondered about what you might do with the rest of the embryos if any go unused. I had heard of Christians recently adopting out their unused frozen embryos rather than allowing them to be simply "discarded." You might end up using all of them, but I think as Christians it's an important question as we consider these little creations of the Father."
This question was asked by someone who I highly respect and admire. And I'm SO glad she asked it! It is actually a question I have preliminarily considered. In fleeting moments I've thought about what exactly we will do with any embryos that we don't use in an attempt to achieve pregnancy for ourselves. I say fleeting, only because it's a bit hard for me to look past the actual transfer itself. There's so much to be done first...so much that could go wrong potentially...and I've heard it said that "getting to the transfer stage is an achievement in itself". But I definitely *DO* believe that life begins at conception. If you've not read my post The Morning I Knew..., then you should go read it. Because that post will help you understand my stance on the matter. The minute that sperm meets egg it's a life. And a beautiful one. This is not going to turn into a pro-life vs. pro-choice conversation though. The question is simply, "If the embryos that are viable are lives, what happens to the tiny growing babies that don't get transferred?"
This is of course assuming we will have embryos to freeze. Let's not forget that so many many women don't make it to the embryo stage at all...much less have more embryos than what can be transferred in one treatment. We are hoping and praying for our story to be different, but that is yet another reason it's difficult for me to start considering this question. There is, after all, a chance we could never even make it to this stage. But in the interest of having clear plan for all circumstances...here are the options that doctors/clinics give you:
1) Use all your embryos and have a bigger family than you had "planned"
2) Thaw the embryos and discard them
3) Donate the embryos to science for research
4) Put them up for "adoption" for couples in need
Ok, so put yourself in my shoes. Is there an option that sticks out to you? Is there an option that makes you go "Yeah no way!"? Is there one that you're totally sold on? If you can make that decision in a split second, I commend you! For me, #2 is my absolute NO. Those are my babies and they are not "bio-waste"...
And then there's #1...which for me is the one that "sticks out". But then again, who knows how many "embabies" we will be successful in creating? Because #1 sounds fine if we've got like 4-6 embryos or less. Then you're talking a max of 4-6 kids and that's if every single transfer works. While that's a crazy big number, it's not completely unfathomable. But what if we end up with something in the tens or teens? Oh no. I love kids and I want a big family...but I am NOT Michelle Duggar!
So then there's #3. Controversial to say the least. While I see the merit here, I'm not sure it's for me necessarily. The thought of my babies being "lab rats" is a little unnerving. But the thought of them going on to help cure Parkinsons or cancer or something equally important seems valiant and purposeful. I go back and forth on that option...
And then #4. After some thought, this sounds like a beautiful option. I wouldn't be in the market to "sell" my embryos. Sounds a bit like embryo trafficking! But I think it would be a cool thing to be able to give someone else...especially in light of the struggles we have had. To be able to come full circle and not only be blessed with our own miracles, but to help make that happen for someone else. Cool! The reservation I have is the whole "running into my biological child on the street" kind of thing. There are "closed" and "open" embryo adoption options. I think for us, if we go this route, we would want it to be a closed adoption. There is also the cost of cryogenic storage which can range anywhere from $500/yr. to $2000/yr. We would basically be storing our embabies indefinitely until someone came along to adopt them. I'm not sure where I stand on the ethical implications of "indefinite storage". There's something, and I can't put my finger on it, that doesn't really sit well with me on this. Just a little sliver of something that I need to just pray about and ask God to shed some light on.
So if I had to choose right now today, what would I choose? For me, feet to the fire, it would be #1. Let's just do this. If God breathed life into those cells, then put em' in me and let's see what happens. But that's not my hard and fast answer. For now I think the answer is that the matter needs a lot more prayer and consideration on our part.
Hopefully you've read the Our Journey So Far and About the Womacks sections in the tabs above for some background about our story. It is the beginning of February...on Tuesday of this week Jonathan will turn 31 years old. At the end of May we will be moving from the West Indies back to the USA. And in June we will begin the process of IVF for the first time. There are many many unknowns, yes. But I've felt the need to answer a few questions that I know SO many of you might be asking. Especially if this is the first time you've heard that Jonathan and I have decided to go this route. It's not a "justification"...more just a sharing of information. So that you can help pray for us and support us along the way. There is nothing more valuable to us than the love and support of our friends and family. In the coming months we will need you all more than ever. To help encourage us when the going gets tough, to help hold us up when bad news comes or painful procedures are necessary, and to hopefully share in the unimaginable joy that will be hearing that our dreams have come true finally.
IVF huh?? Shouldn't you try less invasive procedures first? You guys are so young!
Well my friends, we actually *have* undergone several less invasive measures. We have had 1 failed IUI, 2 additional natural cycles with the help of Clomid (a drug to help stimulate my ovaries to produce multiple eggs), 1 cycle with Letrozole (a less aggressive medication to stimulate my ovaries which is actually an oral form of chemotherapy for breast cancer recovery), and one round of Clomid with the intention of IUI which failed 3/4 of the way through the cycle. I have had more blood drawn in the last 5 years than I can even remember. Jonathan's soldiers have been evaluated and found to be more than ok. I was misdiagnosed with PCOS (polycystic ovarian syndrome...the blanket diagnosis for women who have irregular cycles with no other explanation). Blood work just this past March revealed elevated Prolactin (that's the hormone your body produces when you're breastfeeding that signals your body to stop ovulating while you're caring for an infant). That is the reason I was not ovulating without a trigger shot, so I've been taking medication which has restored my ovulation since June 2013. Yet we are still not pregnant. Yes, we are young...sort of. A woman's egg count decreases and her risk factors increase exponentially after 35. I am *only* 29, yes. We want at least 3 children. You do the math! Not to mention, if it can't happen without help anyway, what does it matter what my age is? Bottom line is that IVF was not a snap decision for us. We have arrived at this decision after many years of trying and failing. Many cycles of help from specialists. Many many hours of prayer and consideration. God *has* called us to be parents...it is our heart's desire...and right now we feel Him giving us the go ahead for IVF, and we've seen evidence of His provisions there...
Speaking of provisions...isn't IVF outrageously expensive? You guys are in med school...how are you affording this??
I don't really like answering this question. Or rather, I really don't like it being asked. But the short and sweet answer is that we have been *planning* this. And by planning I mean we have been making sacrifices as necessary to be able to sock away enough savings to be able to pay for this procedure. So no...we aren't taking out credit cards or "going broke". God has provided for us in unimaginable ways in the past 8 months and we are being purposeful about our money management. It's a sacrifice yes...a constant one until we write that check in June. But one we are more than willing to make in our quest to become parents...
Have you guys considered adoption?
Yes. Most definitely. We have seriously considered it for a long time. Spent many hours in prayer about it. Asked for prayer about it. Consulted with friends who have adopted. We are actually watching some dear friends of ours go through the process of adopting a child here in Dominica *right now*. We have considered whether God's plan for us to become parents was through adoption. The hard and fast truth about it is that we don't feel the calling. We both feel strongly that the decision to adopt really has to come from a heart for adoption. We feel it isn't right to adopt a child because you want a baby. You have to be called to do it. Called to make the choice to bring a child into your home either from an otherwise bad situation, abandonment, or just the choice of birthparents. We think adoption is beautiful. And we *do* have a heart for orphans and impoverished children. But if we ourselves decided to adopt it would be because we desperately want a child. Not because we have been called to adopt. So for us, right now today, adoption is not the right choice. We are trying to follow the plan!
Ok, but what if you've put all your eggs in one basket and then this doesn't work...then what?
Well...per the title of this blog we are Thinking Positive. But we are fully aware of the fact that a round of IVF by no means guarantees us a pregnancy. And so yes, we will have spent a huge amount of money and invested emotionally in a procedure that failed yet again. If that happens, we will need your prayers and your encouragement. We will need you to hold us up. It won't be the end of the road for us though. Assuming we are successful in creating a number of embryos in this first round, we will freeze the ones we don't use in this first transfer. If this cycle fails we will try again when we've been able to come up with the funds to make it happen. There we go with those sacrifices again! The ultimate answer to that question is that we ask for your positive thinking too...and also for your support throughout our journey...wherever the road to Baby Womack leads...
Doesn't IVF put you at risk for multiples? Will you be the new Octo-mom??
Lord let's hope not! But yes, multiples is a "risk" that comes along with IVF. The doctors at OU know what they're doing. They know their stats and they will help us make educated decisions throughout this process. We trust their judgment and we know that they are a practice of ethical and morally upstanding doctors. The most likely multiple situation is twins. Anything beyond that is not a likely scenario, but yes, it is certainly an outside possibility. Jonathan and I have discussed this facet of IVF a lot and we feel confident that if twins or triplets are in our future, then so be it. We will continue to trust that God will continue to provide as he has thus far. I heard a woman speak at UBC several years ago about her infertility struggles. She said "I prayed and begged God for children for years and His answer was wait. I shook my fists at him and asked Him why. And then unexpectedly I had two sets of twins within 2 years of each other. And it was then that I realized that I wouldn't be able to be a mother without fully relying on Him. I planned and He laughed. And now I have 4 beautiful children!" That speech has been in the forefront of my mind ever since. If I am to be a mother of multiples, I have confidence that my God will hold my hand through it. However if we do end up with multiples...you *might* get called in as reinforcements my friends... ;)
Jonathan is getting ready to start a residency soon right? Where does the whole medical school thing fit into this scenario?
Funny you should ask that. Even within the last 10 days God has closed doors and opened others in this realm. This was a major concern for us too. Not so much the residency thing, but more the clinical sciences situation. Jonathan is nearly finished with his basic sciences, but he still has 81 weeks of clinical rotations to complete in the US before graduation. God has graciously reworked our original "plan" and made the process of IVF and pregnancy even more possible given our new schedule. I know that's probably a fairly vague answer, so suffice to say, for now, that between May 1st and September 15th God has provided an awesome window for us to make this happen. And beyond that we already see Him paving the way...
What can we do to help? What do you guys need?
Right now today, we need your prayer and support. We need your positive thinking! We need your words of encouragement. We want you to be involved in Project Baby Womack however you see fit. Whatever that looks like for you. When the day comes that we bring our sweet baby (or babies!) into this world, we will need you like crazy. We will need your hands and feet. We will need your compassion. We will need your joy and excitement! What we need from you is to join our army of support. Wait patiently with us! Ask us how the process is going! We need you to help hold us up. We want the volley of praise to be HUGE when God sees this through. When He works his miracles and sends us our angel(s) we want you all to be a part of the roar of gratitude sent His way! And we want to be able to tell our children that they had a multitude of people praying for their arrival. It takes a village y'all...
In closing, if you have questions...ask! We won't be offended. Honestly, I'd rather you go ahead and ask instead of speculate or assume. I've been guilty of that myself in the past. So just ask and I'll answer. Jonathan and I are boldly proceeding in the direction we feel God is leading us...come along with us for the ride!
