We passed!

Today was a big day.  The big exam.  We went in for our 12 week genetic counseling / ultrasound appointment.  This appointment was at the hospital, since my midwife's office does not have an ultrasound.  Basically, it was meant to check for chromosomal disorders, but we were there more to see the baby on the screen than anything else.  Given our history, it was absolutely nerve wracking and I was on the edge of my seat all day. 

The appointment started with genetic counseling.  The midwife thought talking to her was a good idea, given some of the genetic concerns we had.  Basically, the counselor went over our history and talked to us about the different tests we could have.  There are now a few different tests (Panorama, Harmony, Maternit21, that un-invasively check for risk for the most common disorders such as trisomy 18, trisomy 21 (Downs syndrome), and triploidy.  If it comes back high risk, then they recommend you do a more invasive test (cvs, amniocentesis) to get a better picture.  But even better, it checks for a y chromosome, letting you know the gender with 99% accuracy about a month earlier than you were traditionally able to know.  There is little to no uncertainty what the gender will be with these tests.   I'm not going to lie....we were interested in it more to learn the gender as soon as possible.  There were a couple of good things to come out of this appointment.  First of all, the counselor saw no red flags in our history, including my previous miscarriage or our struggle with infertility.  This was a huge reassurance.  Second of all, because I will be 36 when baby arrives (ie advanced maternal age), we qualified for the blood tests.  We chose Panorama.  They test for the same things with the same accuracy, but Panorama seems to have a marginally quicker turn-around time.  The results will come back in a 10-14 days and we will know whether the baby is a boy or girl!  We left genetic counseling feeling reassured and relaxed and ready for our ultrasound.

Next up, ultrasound.  The purpose of this ultrasound is to measure the fluid behind baby's neck.  There is a correlation between the amount of fluid and chromosomal disorders, like Downs.  While I would want to know, so I could be prepared, it wouldn't change anything - we really just wanted to see the baby.   With seconds of the wand going on my belly, baby appeared on the screen.  He or she was showing off big time.  We watched as our little baby did flips, somersaults, waved, sucked its thumb, and did all kinds of tricks.  We're going to have our hands full, this one is active!!!  We were able to start to see some of its features.  It had a cute little nose, and we could see the ears.  The tech didn't say much other than that the baby looked like it was right on schedule.  The techs are not really supposed to say much.  She left the room, and it was a while before the doctor came in, and that lag time made me nervous!  When he came in, he announced that everything was perfect.  Baby was measuring a couple of days ahead, estimated due date is still Nov 7th, and we had passed the Nuchal Translucency test with flying colors.  Looks like a healthy baby.

So for the first time in nearly 4 years, we walked out of a doctor's office with smiles on our faces and tears in our eyes.  These were tears of joy, instead of the tears of heartache that had streamed down my face after many previous appointments.  For the first time, we had passed the exam.  Today felt like graduation day.  In the time it took us to conceive this child, we could have earned a undergraduate degree!

We are over the moon.  It is all starting to become real.  Now we can march into the second trimester, heads held high.  For the next 28 weeks, I plan to do nothing but enjoy every moment of growing this baby.  I've always said that when I became pregnant, I planned to enjoy pregnancy.  So far, other than the exhaustion, I haven't had a hard time, but I am still very happy to see the first trimester end.  I feel like I am turning the corner.  My energy has started to come back and I'm feeling good.  I ran today, not because I felt like I had to to stay healthy, but because I wanted to.     

Here's our bouncy baby, waving to the camera:

    

National Infertility Awareness Week - My Story

We are 1 in 8.  I chose to start this blog today in honor of all those who have suffered from infertility, are still suffering from infertility, or have beat infertility.

I do not plan on going public on facebook for a few more weeks, so some of you may be reading this retroactively - Welcome!

Those of you who are close to Chris and I know that we have been through the ringer.  We were married in May of 2006, almost 8 years ago.  This time 4 years ago, we were starting to make plans to grow our family.  We were ready.  I had just run my 5th Boston marathon and was starting to train for my first (and only, so far) half ironman.  Our plan was to go off birth control in June with the hopes of conceiving sometime in the fall for a spring baby.  This is what worked for our schedule.  Boy, were we naive to think we could plan something like that.   I truly believed that it would be easy for us.  We were the picture of health, I was as fit as I could be, my periods were like clockwork.  In October of 2010, 2 months into truly trying, I got my first BFP (Big Fat Positive)!  We were psyched - it had been so easy!.  4 days later, my period arrived.  I had experienced what I learned was a chemical pregnancy.  A chemical pregnancy is a very early miscarriage.  Basically, the egg is fertilized and begins to implant, allowing your body to produce the pregnancy hormone, HCG, but the embryo is not viable and terminates before it can grow anymore.  This usually happens around 4-5 weeks.  If tests weren't so sensitive, I would have never really known I was pregnant.  I was sad, but it didn't devastate me.  We jumped back in the saddle.
The months started to tick by, and I started to become anxious.  I signed up for another marathon even though I said I wouldn't.  I knew the training would help distract me.  I was hoping I would be unable to run this marathon.  In March of 2011, I completed the Shamrock marathon.  At this point we had been trying for 6 months.  I booked an appointment with the midwife I see to discuss why things weren't happening.  A preliminary diagnosis was that I had a short luteal phase, which meant that the time between when I ovulated and when my period came was shorter than average.  This can sometimes cause a problem for implantation because your body releases the lining too early, causing your period to arrive.  She put me on progesterone suppositories for a couple of months.  She also suggested I take the fertility drug, Clomid.  Neither worked for me.  At my annual visit in September, she suggested Chris get tested.   She made him an appointment for a semen analysis at Reproductive Science Center in Lexington.  This is a local fertility clinic.  The test came back and she called me at home on a weeknight.  It was a Tuesday night.  I remember it clearly.  The news was bad.  Chris had 0% morphology.  This meant that they couldn't find any regularly shaped sperm.  She told us we would not conceive on our own and that we needed to see a specialist at Reproductive Science Center (RSC).    I was devastated, but called the next day to book an appointment.  The doctor she had recommended was not available until December.  I didn't want to wait, so I asked the receptionist who she recommended.  She set up an appointment for early November with Dr Samuel Pauli.
We met with Dr Pauli for the first time on Nov 1, 2011.  We were immediately struck by how kind and gentle he was.  I knew we had come to the right guy and was almost happy the other doctor had not been available.  He was very upbeat and positive.  He thought there was hope for us.  Because our insurance didn't require us to try any preliminary procedures like IUI (Inter Uterine Insemination), he recommended we go straight to IVF (In vitro insemination) with ICSI (Inter cytoplasmic sperm injection)  Basically, they pick the best sperm (important when only a percentage of sperm have the proper morphology) and they inject them straight into the egg so that they don't have to rely on the sperm to do the work. He set us up for all kinds of mandatory tests.  Chris gave some blood and another sample, I was poked and prodded everywhere.  For the first time, I saw the inside of my body through some of the tests.  I saw my tubes (they looked great), my uterus (it was beautiful, according to the tech), and all sorts of other things.  It was fascinating, but  I would have been happy never seeing those insides.    My results came back 100% normal, and Chris' morphology had improved to 1%.  We blame the bachelor party trip to Vegas in September for the 0%.  Anyway, the ball was rolling.
We started the process for IVF in January, giving us the holidays to enjoy.   For those who don't know, IVF involves A LOT of injectible medications.  First I took birth control to suppress ovulatory function to prepare me for stimulation.  Then I started taking an injectible called Lupron.  Then the heavy duty meds - Menopur, Gonal-F.  The injections weren't nearly as bad as I thought they'd be, but by the end of my cycle my belly was all bruised and battered.  In addition, I had to constantly go in for monitoring.  This involved driving to the clinic at 6AM, having blood drawn and getting a vaginal ultrasound to see how the follicles (which hold the eggs) were growing.  Then I had to take 128  and 93 to get to work (can be a nightmare at rush hour).  There were a few times I worried if I would make it.  Anyway, after stimulation, the retrieve the eggs.  This involves being under anesthesia while they go in a pipette out the eggs.  I grew a fair amount of eggs and we had a decent fertilization rate, but the embryo quality was so-so.  The next step is transfer.  They have you come in an hour before your transfer to drink lots of water and  fill your bladder.  Then you in a room and you watch on the screen as they pipette the fertilized eggs into your uterus through a catheter.  Then, the two week wait (tww).  Torturous.  In this time, you have to assume and act like you are pregnant.  You take pills and progesterone to support the potential pregnancy.  Then you go in for the blood test.  I decided I wanted to know in the comfort of my own home and not be told on the phone by a stranger, so I peed on a stick (POAS) before my blood test.  BFN (Big Fat Negative)  I was not pregnant.  Once again, I was naive and thought it would happen the first time.
So we licked our wounds and took a vacation to sunny St Martin.  We gathered ourselves up and started cycle 2.  More of the same.  And once again BFN.
We were now two years into our journey.  Neither of thought it would ever be this hard.  It was not only emotionally hard, but for me, it was physically challenging.  When you are going through IVF, you are unable to exercise.  As an avid runner, this was a big challenge, because this is how I relax.  Between being basically sedentary and all the hormones coursing through my body, I began to put on weight.  I was an emotional disaster area.  I didn't often let it show on the outside, but inside, I was wrecked.  I stopped going out.  I didn't want to see friends.  On top of our struggles, this was prime time for many of our friends.  We listened, smiled, and congratulated each of our friends as they announced their pregnancies, many of them telling us how easy it was.  They went off birth control and boom!  Pregnant. At the time, few of them knew what was happening with us, so they had no idea how painful this was.  They were excited and we didn't blame them, we were just grieving inside.  In the time we were trying, there were at least a half-dozen of these announcements, if not more.  We were happy for each of them, but another little piece of me died each time someone else said they were expecting.  Looking back on it now, I am happy to have been the sacrificial lamb so that only one other of our friends had to endure this, but at the time, I was afraid to go out because I was afraid another person would tell me they would pregnant or I would have to see their growing bellies, a testament to what I couldn't have.  I went to a few of these baby showers and then realized that I'd come home miserable and that it was too much for me to endure.  I started to politely decline and just send a gift.   
Fast forward to April / May.  Cycle three, we decided to change a few things up.  We changed medications and did a few other things different.  Things went smoothly and after retrieval we learned that we had two beautiful embryos!  Things were looking up!  The tww seemed longer than ever, so I tested a few days early.  OMG - BFP!  It had finally happened!  We were beyond thrilled  We found out on May 25th - two days before our 6th anniversary.  The perfect anniversary present!
However, I was never comfortable with this pregnancy.  I was constantly anxious. We were so excited, and at this point so many people knew what we were going through, that we told a lot of people.  We went for our first ultrasound at RSC at 7 weeks 1 day.  This was meant to be graduation day.  I couldn't shake this feeling that something wasn't right and I was nervous.   As my favorite ultrasound tech located the embryo, I was in awe.  There was a baby in there.  And a heartbeat!  However, the baby was measuring small at 6w2d.  Almost a week small.  In a normal pregnancy, this isn't a concern, but with IVF they know the date of conception and Dr Pauli was worried.  He gave us a 25% of losing it and booked us to come back in a week.  When we came back a week later, we saw the baby had only grown a day or two worth and the heart had stopped beating.  We listened as the tech said she was looking for a flicker, but couldn't see anything.  She was so sorry.  Our baby was gone.  We were booked for a D and C 5 days later(where they removed the embryo and the tissue from your body).  They were able to get a sample of the tissue from the baby and have it tested.  The baby had suffered from an extra chromosome on number 22.  Trisomy 22.  This is a rare condition that is incompatible with life.  Our baby didn't stand a chance.  Over that weekend, I spent time with my running friends, drank a lot and tried to cope as we untold all the people we had told.  One friend booked me an appointment at a salon  for a pedicure and we had pedicures and lunch.  This was one of the nicest things anyone did for me in this time.  Another friend sent me a tray of mac and cheese.  A couple of friends sent flowers.  My cousin, who had also recently suffered a loss, sent me a bracelet.  There were many phone calls but for the most part, I didn't have the strength to talk to people.
Fortunately, summer had just begun, so the day after my procedure, I got in the car and drove to Ocean City.  I stayed there for a while where I didn't have to see anyone but family and I could just sit on the beach by myself and not talk about it.  Honestly, I don't remember much of that summer and I was happy to see it end and go back to school, where at least there was a distraction.
Fall of 2012.  We took the rest of the summer off to heal and get back in the right mindset before beginning the fight.  By October, I was ready.  Insurance covered 6 rounds of IVF, so given we had conceived in cycle 3, we were encouraged and ready to begin fighting again.
We followed the same protocol as Cycle 3, thinking we had been successful then. However, Cycle 4 might have been the worst quality yet.  Another BFN in November 2012.  Knowing we still had two more cycles, I was disappointed, but I was ok. Now that we had failed carry to term after 4 cycles, Dr Pauli wanted to get the opinion of the rest of the doctors.  He gave us the holidays off.   
We started cycle 5 in January and were following a whole new protocol.  I was the most hopeful I had been.   Once again, poor embryo quality.  By then I had been diagnosed with DOR, Diminished Ovarian Reserve - basically my eggs were at the bottom of the barrel and most of them were of poor quality, resulting in poor quality embryos.    I still remember the day of the phone call with my blood test results.  As usual, I had POAS, so I knew what the result would be.  It was the day of the blizzard of 2013.  We were off of school, but it hadn't started snowing yet.  I was at a cafe with a friend doing some school work.  The phone rang.  It was not the nurse.  It was Dr Pauli himself.  He had gotten in the habit of delivering bad news to me himself instead of having one of the nurses do it.  It was really touching to me that he went this extra mile and it is what makes him a great Doctor.  He gave me the news that it was yet another BFN and he was sorry.  I could tell he was as devastated as I was.  He had never had a patient not conceive in 5 cycles and it was frustrating.  He wanted me to take some time while he tried to figure out what we should do for our "Hail Mary" cycle.  The last cycle.    I sat in the cafe crying and finally made my way home to tell Chris we were officially out.  Minutes later (around 2:00) I came down in my running clothes.  Chris asked where I was going - I said I was going for a run.  He asked how far.  I said I didn't know....forever?  He told me to be careful, that the snow was going to pick up soon.  And it did.  But I ran.  6 miles.  In a blizzard.  It was just what I needed.  I sobbed for the rest of the day.  This was by far the hardest cycle to fail.  I knew there was only one more try and it would mean having a kid of my own or not having one.  I was at an all time low.  Not only had I been through 5 emotionally trying rounds of IVF, but I also had gained about 20lbs.  I was out of shape, me the marathon runner and half-ironman triathlete, I was out of shape.  I felt awful.
Fortunately, a week later we were booked on a trip to Mexico to an all-inclusive with Chris' family.  It was the best thing possible.  We sat on the beach, ate, and drank.  

 I relaxed.  When we came back we got the news that Chris had to go to Paris for work and the dates just happened to be during my April vacation.  This was a real mood lifter.  There were a few stops on this European tour, and Chris snatched up Paris and Brussels, telling his co-workers that I really needed this trip.  I was so excited.  It was planned.  Our first trip to France and Belgium in 10 years!  Europe was just what I needed to motivate me to get back in shape.  By the time we boarded the plane on April 12, I had lost 8 lbs and was feeling better.  I was so excited to be going to two of my favorite places.  We had a wonderful weekend in the 7th district of Paris (near the Eiffel Tower)  

 and that sunday, April 14th we moved to a hotel Chris' work was paying for in the 15th.  The hotel was nice, but the neighborhood was not nearly as quaint.  I spent Monday the 15th (Marathon Monday) trekking through Paris by myself, thinking constantly of everyone back home as they prepared to run / spectate.  That night, around 9PM, we received the text that there had been an explosion at the finish line.  I freaked out.  I knew a close friend had just finished (we had received a text with her finishing time just a few minutes earlier).  I was worried.  It was eerie to us because we had been in Paris on 9/11 as well.    I was far more freaked out this time though because people I knew and my city were in danger.  We hurried back to the hotel and turned on the TV and were instantly met with the familiar scenes of the joy of the marathon finish line muddled by the horror of terrorism.  I was a wreck as I tried to get in touch with as many people as I could.  I was the new president of the Somerville Road Runners and was worried about my team.  Someone sent out a role call.  Luckily, everyone and their family was eventually located and no one was injured.  But all of our hearts were broken.  Not our city, not our race.

We muddled through the rest of our trip and I was relieved when I finally boarded the train to Liege, where I knew my family was waiting for me.  Jacqueline, my Belgian mom, picked me up at the train station and we spent the day together.  We caught up.  She made me and Jean-Claude lunch, then we went over and visited the Zilles (my other Belgian family).  Then we went to the train station to wait for Chris' train.  We had a coffee in the cafe while we waited and I shared our story with her.  As always, she listened and was so supportive.  I love these people as if they were my blood relatives and being with them was a great distraction.  Chris came in on the train (his first time traveling on the trains alone in Europe!).  We had a quiet dinner that night with just Jean-Claude and Jacqueline.  The rest of the weekend was great.  Lots of quality time with my Belgian family and friends.  Good food, a lot of laughs, a big party where my whole big family was there.  We got to know my little Belgian nephews and nieces.   All that while following the news back home.  Other than the news at home, it was the perfect trip and was just what we needed.

In late May, we embarked on our final round of IVF.  We tried using growth hormone, an experimental drug that is thought to improve embryo quality.  Again, the quality wasn't great and since I had POAS, I was expecting BFN.  When the nurse called, she told me there was HCG hormone in my blood, so technically I was pregnant, but to not get my hopes up because it was low.  This was July 3rd.  So I had to behave on July 4th before having another test on July 5th.  Sure enough when I went back, the numbers had not doubled (and my period had started).  I had suffered another chemical pregnancy.  What a way to end my last cycle of IVF.  In many ways, it was just funny. 
So at this point, I had tried everything.  We had tried several different protocols.  I had been doing acupuncture since December (while it didn't end up getting me pregnant, it was a great tool for getting me to relax).  I do believe acupuncture can help some people, but it just wasn't helping us.  The relaxation part was nice though.  It made those last three cycles much more tolerable.  I had changed my eating habits completely.  I gave up diet coke, high fructose corn syrup, started eating more whole foods.  I was as healthy as could be.  But even, so I was not going to have a baby of my own.  This reality was hard, but I was prepared to accept it.  In August, we met with Dr Pauli again to say goodbye and go over the options we had.  We could do donor embryo, donor eggs, or adopt.  I was not interested in donor embryo.  Chris liked the idea of donor eggs (at least it would be related to him) and I liked the idea of adopting.  We decided to put off the talk until after the holidays.  I did some research over the summer, but not much.  Our plan was to get on with life.  We gave up.
At this point I had lost 20lbs and felt great.  I was running again and had signed up for the Philadelphia Marathon.  As fall came around and the temps dropped, I realized I had a Boston Qualifier in me and potentially a PR as well.  I trained hard...that PR was everything to me.  It was something that was in my control.  I was on fire.  We were going out again, mostly with all the single people in SRR.  Life was good.  I went to Philly and owned it.  I finished in 3:33:39.  

It was a 7 minute PR for me and a huge BQ - I was in to Boston for 2015.  It was a great day and we celebrated late into the night.  The medal is still hanging in my living room.  I kept running through the holidays and my next goal was to break 1:35 in the half.  I was happy with life.   We kept putting the "talk" off.

January came and went.  It was cold and snowy, but I had a goal, so I kept running.  I ran a huge 5k PR and came in second for SRR at the Super Sunday 5k.  I was fast!  We were once again booked to go to Mexico for February vacation - this time to Cabo.  That was an odyssey, with canceled flights, a drive to Philly, and a night in Phoenix, but we finally got there and had a great week.  We flew home through San Fran and got to spend time wine tasting in Sonoma with Chris' Aunt and Uncle.
March came in like a lion.  My grandmother got sick and went into the hospital.  Chris had an uncle pass away.  Chris' parents' dog went missing.  It was just the last week of Feb / first week of March.  Meanwhile, I was a couple of days late on my period.  I didn't chalk it up to too much - thought it was just my body messing with me again.  But as each day went by, I started to wonder.  By Monday, it still hadn't come, and a friend urged me to POAS for my own sanity.  I still had one in my drawer, but I was petrified.  I couldn't bear the thought of another BFN.  I took it anyway.  I watched the moisture travel across the screen and within a minute, I watched as the first pink line appeared, then I realized that line was not the control line - that was the test line.  I was pregnant.  And it was unmistakable.  I was very pregnant.  I texted the friend who had urged me to take the test and called my doctor.  They booked me to come in for a blood test the next day.   I was beside myself and wasn't going to see Chris until 8:30 that night.
When we both finally got home, I showed him a picture of the test of my phone.  He stared at in disbelief, then the two of us spent the night on the couch with stupid grins on our faces, discussing all the grim things that had happened the week before, but still smiling.  We couldn't believe it.  This wasn't supposed to happen.  We had been given a less than 1% chance of this happening.
I went in for the blood test the next day.  The results came back the next day.  The numbers were high - 3695 at 4w5d.  Yup - I was definitely pregnant.  They booked me for my first appointment at 8 weeks.  I waited anxiously for those 4  weeks to pass.  At that appointment, I was checked out and we heard the heartbeat.  There is a baby in there.
I believe this was meant to happen only when it happened.  We had been living life to the fullest.  We were happy, we were healthy.  March was one of the shittiest months I can remember.  It was gray and bitter cold.  Winter was never going to end.  My grandmother was sick.  I went home to NJ and spent her last day with her.  We celebrated her life.  I can't believe she is gone and will never meet this baby.   But she knew about it and I truly believe she is up there looking out for us.  This baby is real.  And come November he / she will be coming home with us.
How do I feel?  Confused mostly.  I can't stop thinking about it, yet I can't believe it happened.  I have been extremely tired, but not really sick.  I lost all motivation to exercise and honestly, It doesn't feel very good, so I'm not very good about it.  I sleep a lot.  I've started putting on a belly.
I am 12 weeks today.  I am almost to the second trimester.  On Monday, we will have our first ultrasound and see our baby for the first time.  I'm still tired, but getting better.  Having this week off from school has been a godsend.  Mostly, I've spent the time relaxing and recuperating from March (I know - that was weeks ago - but it really almost killed me).  We're starting to share our news.  I'm starting to get a little belly and look less fat and more pregnant.
I think often of the three babies I lost.  The first chemical pregnancy would be nearly three, the miscarriage from cycle three would be 15 months and the last chemical would be due any day.  I wouldn't be where I am without the doctors who supported me for all those years, especially Dr Pauli.  He was one of the first people I notified, and he called me right back to congratulate me.  My acupuncturist, Tamie Bilazzo, was also awesome and taught me how to relax and take care of myself.  I no longer see her, but we're still in touch. She encouraged me to write this blog. 
I know this was long - I've been meaning to set up this blog forever.  At the urging of my acupuncturist, I knew I needed to record my story for others to read and for me to remember.  I wanted to be able to give hope to those like myself who had lost hope.  I wanted those who know me well to know what going through infertility was like.  I promise my forthcoming posts will not be as long.  I plan to share the journey of this blessed pregnancy.  Follow this blog and watch me grow.  Because as I grow, so will hope, not just for me, but for all my sisters who are also struggling.

11weeks 5 days pregnant!