First OB Appointment

Tuesday was a packed day! I started off with another weekly blood draw. Thankfully I got my favorite phlebotomist (it’s a little funny that I have a favorite)! Hopefully I should only have one or two more weeks of that.

Later in the afternoon was my first OB appointment at Oakwood Women’s Centre-Seton Williamson with Dr. Rebecca Teng. This is my first time having a female OB/GYN so I’m interested to see if there are any differences. The appointment started off with another book of paperwork, for several of the questions I had to write “Gestational Surrogate” next to them without an answer. Standard with most prenatal appointments is leaving a urine sample at the beginning. I’ll just have to remind myself to wait until I get to my appointments instead of before I leave the house.

Dr. Teng had me go in for a super quick ultrasound to check the heart beat as Doppler can be hit or miss at 10 weeks. Baby was wiggling all over the place but we were able to get the strong heart beat of 169 bpm. We tried to get a couple of pictures too but that proved to be a little more tricky.20170620_130505[1]20170620_130518[1]

There were a few chunks of waiting but I tend to forget all of the things covered during a first OB visit so it didn’t bother me too much. The nurse took me back to get my vitals and to fill in my medical history. Dr. Teng gave me a physical exam then had a lengthy discussion with me about some of the things to expect, some questions for me to relay to Amy and Al, and to discuss her maternity leave (she’s 35 weeks pregnant). One of the things I had expected due to my PCOS, is that she will have me do an early glucose screening test to check for gestational diabetes and then I will repeat it again at the normal time (24-28 weeks). Thankfully, I haven’t had it yet, but I do know other moms without PCOS that had three healthy pregnancies only to have a forth or fifth pregnancy with GD. We will see what the Lord sees fit to hand me this time.

Not too long after finishing the OB appointment, my blood results came back along with Dr. Vaughn’s orders for the next week. My Progesterone was 28 and Estradiol was 1,082, which are excellent numbers! Today was my last dose of Estradiol and Saturday I start to decrease my PIO injections from 1cc to .75cc. I have definitely reached the point that I am greatly looking forward to my last intramuscular injection! With the two failed cycles I’ve had quite a lot more injections this time around than I did last time and I’m running out of non-tender real estate. Hopefully next week after my blood draw I will know when that magical final injection will be.

Ultrasound at 9w3d and RE Graduation

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Monday’s visit to Texas Fertility was full of smiles! The ultrasound went really well. Little one was wiggling all over the place and had doubled in size since the last appointment 2 weeks prior. Isn’t the miracle of growth in utero amazing to witness?! Dr. Vaughn did a quick sweep to make sure there was just one happy little one swimming around in there, which there is. I took video of the monitor again for Amy and Al and uploaded it as soon as the appointment was over. I love that they get to save the videos and watch them as many times as they want.

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Dr. Vaughn officially released me from TFC and said to go ahead and schedule my first OB prenatal appointment. He will continue to monitor my hormone levels with weekly blood draws until my progesterone level is around 30, at that time I will get to stop my nightly intramuscular injections. Today I reduced my Estradiol intake down again and Dr. Vaughn anticipates I will get to stop it completely next week.

Today also marks 10 weeks gestation, here is what is going on with the little one:

Your baby’s growth is fast and furious when you are 10 weeks pregnant. She’s nearly an inch-and-a-half long and the size of a prune, but not nearly as shriveled (even with all the time spent in water). In fact, your baby is really taking a human shape now. Bones and cartilage are forming and small indentations on the legs are developing into knees and ankles. The arms, complete with elbows, can flex already (how’s that for magical?), but don’t run to the store for a baseball bat just yet. Though your baby’s arms are taking shape and getting stronger, each one is still teeny-tiny.

Ultrasound at 7w5d and Sick During First Trimester

Hi there! We had the first big ultrasound/sonogram… which leads me to a rabbit hole. The terms ultrasound and sonogram are interchangeable in most prenatal examples. The ultrasound is the actual procedure using high frequency sounds waves, and sonogram refers to the picture of the baby created from that procedure. Which term do you prefer or use? I like ultrasound for some reason. OK, back to my original train of thought. The first big ultrasound was Wednesday, May 31st just over a week ago and right as I was coming down with a behemoth cold. It zapped what was left of my depleted energy, then took my voice for a few days, and finally settled into an ugly sounding “get away from me now” cough for a few more days. Thankfully, today was a good day and looks like the worst is over. Yay! Due to being in my first trimester, I was pretty limited on remedies. So, I drank as much water as I could along with a little vitamin C, Zinc, and plenty of naps/earlier bed times. I’m very thankful my girls were relatively good for my several randomly timed naps and they only made normal messes, nothing lethal.

On to the good parts! The ultrasound went really well. I told Dr. Vaughn that I was going to be taking video for the parents and he said “Go for it! Do whatever you want.” He found the little one (singular) pretty quickly. After taking a few key measurements it was time to get a heart beat confirmation recording. This little one was drumming right along at 163 bpm. After a brief discussion about what to expect next, I was free to dress and start uploading my video so that Amy and Al could get an instant replay and pop the champagne. 20170607_194348[1]20170607_194358[1]

For now, I will continue my weekly blood draws to monitor the two hormones that I am putting into my body, Progesterone (P4) and Estradiol (an estrogen), and to follow-up with a growth ultrasound about two weeks out. If numbers continue to look good and the ultrasound goes well, I will begin to wean off of hormones and “graduate” to my OB/GYN’s office for “normal” prenatal care. It is exciting to get to that point but it will be a bit of an adjustment for Team B as we go from constant detailed monitoring to monthly prenatal appointments. The next big thing won’t be until the anatomy scan around 20 weeks gestation, which would be the second half of August. It sounds so far away but I know it will be here before any of us know it.

In the meantime I am definitely fluffing up. It’ll be fun to see how quickly I go from “fluffy” to “pregnant”. There is a difference! I’d rather look pregnant than look like I ate a whole platter of burritos and have the gas gut to match. With each pregnancy it seems the body pops faster so I have a feeling it won’t be long before I’m sharing weekly comparison pictures.

In the world of baby development, this Friday will mark 9 weeks gestation.

Here are some fun facts about the 9 week mark:
She’s now about one inch long, the size of a medium green olive (but no martinis, please). The head has straightened out and is more fully developed and the ears are continuing to grow, making baby look more human. Plus, toes are visible, and all of baby’s essential organs (heart, brain, kidneys, liver and lungs) have begun to develop.

What was I doing?

Oh! I was going to write a blog post, right.

That’s right, I’m in the throws of the first trimester. For me that means exhaustion felt all the way deep down in my bones, All the smells, and I eat like a toddler. How does a toddler eat? One second bananas are their favorite and that’s all they want so you go buy two bunches only to come home to a fit throwing child that now HATES bananas. There is no rhyme or reason. And there is no warning. I can sit down to a meal that sounds good but one bite turns the tongue curling yuck vibes on. Since I’m an adult, I try one more bite to be sure. Yup, still tastes like a clod of dirt my dog brought in, run away! This fun phenomenon is called food aversion. The things that do consistently taste good at the moment include anything sour, but especially: old fashioned lemonade, bread, a real fresh from the grill cheeseburger, nachos Loaded with jalapenos, medium dairy queen hot fudge sundae with all the toppings, pickles, topo chico (“bubble water”), and peanut butter. Other things trickle on and off the menu too so I’m still getting my nutrients but some days I take the bagel with cream cheese because absolutely nothing else sounds appetizing. I fully embrace each and every change though because they all point toward a healthy start to the pregnancy and continued growth.

My current surrogacy related routine consists of taking a handful of pills every morning (1 estradiol, 1 giant prenatal, & 3 metformin), an intramuscular injection every evening rotating each night between left and right upper outer quadrants, 2 estradiol pills every evening, and a weekly blood draw. The blood draw checks three levels to keep an eye on the growing baby: Beta-hCG, Progesterone (P4), and Estradiol. After the blood draw I send a message to “Team B”, as Amy has dubbed us, letting them know the stab session is over. Then I send an email to our amazing RE Nurse to let her know to expect the STAT results in a few hours. After the test results are in, we all receive an email from our nurse with the numbers followed up with the RE’s orders for the following week.

The last two blood test results have continued to be excellent! And it is so reassuring to watch that Beta climb and climb.

Monday, May 15 results:
HCG 7,001
Progesterone 23
Estradiol 185 (normal to fluctuate and is not a concern)

Monday, May 22 results:
HCG is 33,448
Progesterone 21
Estradiol 428

This Monday is Memorial Day in the U.S. which is a federal holiday. That means the lab will be closed so I will be going in on Tuesday instead. The next morning will be the first prenatal ultrasound at the RE’s office! We’re all pretty excited. Hopefully at close to 7 1/2 weeks we will be able to confirm a strong heart beat. I will be taking video of the ultrasound monitor to immediately share with Amy and Al, that way they can save it and watch it as many times as they want. 🙂

Beta #2

I went in for the second blood draw to check the level of hCG in my body. Ideally you would like to see the number double at a rate of every 48-72 hours. My first blood draw was on Friday morning so that put today’s test almost exactly at 72 hours.

First beta-hCG at 9 days post transfer: 126 mIU/ml

Second beta-hCG at 12 days post transfer: 490 mIU/ml

Woo! This little bean is growing! Now, we just wait to hear from Dr. Vaughn with what his orders are.

Here is some information for a reference point on what those numbers mean:
This table shows the normal hCG levels during pregnancy for each week from your last menstrual period, according to the American Pregnancy Association:

Weeks from last menstrual period Normal hCG levels (mlU/ml)
3 5-50
4 5-426
5 18-7,340
6 1,080-56,500
7-8 7,650-229,000
9-12 25,700-288,000
13-16 13,300-254,000
17-24 4,060-165,400
25-40 3,640-117,000

Under the Radar

Sometimes, there is comfort in flying under the radar. People mean well in asking what’s next or how I’m doing but I just wanted to stay in a quiet bubble while the cyclone of life was ripping around me.

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So, what have I been up to over the past month? A lot! I have a few volunteer jobs (I said yes, one too many times) that all got busy at the same time March through April on top of navigating the surrogacy waters. Let’s dive into my surrogacy world April through today, shall we?

The week following the news of the loss I shifted my focus to my health. I really focused on nutrient dense food and high protein while tackling an amazing 30 day fitness challenge by Betty Rocker and walking several miles daily. In the midst of that, “Team B” as Amy has dubbed us (and I love it!), was able to turn around immediately and jump right into another transfer cycle. That’s right, we didn’t have to wait and I didn’t have to go back on birth control (YAY!). We were so quick in the turn around that I made it through day 25 of my 30 day challenge which was still an awesome accomplishment! I highly recommend the free challenge and have already gotten my husband and several others bit by the bug. Ha!

At the beginning of April I went in for my third Baseline monitoring appointment. Dr. Vaughn was happy with the way everything looked and said he was good with us continuing on with the transfer cycle. Of course that meant we had wiped off all the checks from our previous list and needed to start working through it again, but it was still a great start to round three. One of the things our previous nurse had forgotten was to put my husband and I on a z pack antibiotic to ensure a clean environment, so we knocked that out and I refilled medications.

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Through the tests and the weeks without any major updates, Team B has kept in constant communication full of faith and silly banter. This journey has been such a wonderful thing to experience, I’m so blessed.

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Part of the bubble aspect was that I realized I had been unnecessarily putting off making a new appointment with my therapist Dr. Boyd since her practice break in December. Subconsciously I was waiting to have good news to share with her, but that is the opposite of why I continue to seek her very skilled support. The timing of the appointment was especially good though because I went straight from my lining check to Dr. Boyd’s office and was able to fill her in accurately with our timeline.

Did you notice the mention of “lining check”? Well, it was another good appointment with my uterine lining sitting fluffy at 11.2mm. Almost exactly 2mm less than the lining check for the previous cycle but still well beyond the goal of 7mm. The next day was a blood draw to check the level of progesterone. Another pass! Things were flowing along pretty smoothly once more… until we hit a slight hiccup. Our nurse noticed that the lab had not received the eggs yet and they were supposed to start the thaw the next day. Just a little tiny IMPORTANT missing ingredient. Thankfully Team B and our nurse were on top of it and the eggs shipped right away so we only pushed back the timeline by two days. It was a pretty frustrating mistake by the egg bank but I’m so thankful our nurse was on top of things and it didn’t result in a dropped cycle which would have meant pushing things off to the next month. As a result of the snafu I had to go back in for another blood draw two days later to make sure progesterone levels hadn’t changed. Once that result came back we were OK to move forward with thawing the eggs and anxiously awaiting embryo reports from the embryologist leading up to the transfer.

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This is when the news started to get so good that I’m sure we were all doing a lot of self pinching to make sure it wasn’t too good. Even though the cohort of eggs we received this time was six instead of seven like the two previous times. Five out of Six fertilized, woo! The 3-day embryo report showed three (ah!) 8-cell, one 6-cell, and one 5-cell. I was reaching a hopeful state of happiness, not quite full on excitement and giddiness but definitely heading in the right direction. The verse I shared with our team was Psalm 130: 5 which perfectly summed it up for me.

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Wednesday morning, April 26th was transfer day! Another gracious friend offered to take our youngest daughter for the morning and away we went. Unfortunately for me, I took my job of having a full bladder too seriously and arrived to the Austin Fertility Surgery Center with my bladder already full… the transfer wasn’t for another hour and a half. You’ll notice the giant bloated jelly bean of black space in the ultrasound which was my bladder. Yikes! I filled out my required book of paperwork, took the valium pill with thoughts of sound sleep to come later in the afternoon, changed into my stylish digs and waited for the Embryologist. The Embryologist came in with a wonderful update. We were about to transfer a beautiful freeze quality blastocyst embryo and there was one more early blast embryo that may be freeze quality by the following day that they were going to watch. There were happy tears and that is when I finally became officially excited for the transfer!

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We were shuffled off down the hallway to the OR to witness (because I don’t really participate) another transfer. My husband took video of the monitors so that Amy and Al could get front row seats to this amazing process. Everything went smoothly and I heard the magic words, “You may empty your bladder now”. Hallelujah! Sweet relief.

After getting dressed, a nurse came in to remind us of my restrictions over the next nine days before the first blood pregnancy test. No lifting over 15 pounds, nothing that could bounce or jar my uterus (running, jumping, aerobics), a complete pelvic rest, no baths or pools.

And then we waited and tried not to read into every little twinge or food thought or weird dream. But it’s hard to ignore those! I felt some ovulation type cramps around three days post transfer but tried to look past them and didn’t bring any attention to them. Just shy of a week post transfer I cracked open a can of whole beets to make a salad but the smell was so good that I started drinking the juice too, much to the horrified disgust of my husband. And then before I knew it, it was the night before the blood test for pregnancy. I really wanted to be mentally prepared so I cracked open three different home pregnancy tests and watched anxiously as the dye slowly creeped into the viewing panel on each one…. to reveal three beautiful positives. AHHHH!!! I started crying and smiling and shaking. This couldn’t be kept to myself, no way! I messaged the team, “Sooooo… If I did a naughty and peeked… at something… would y’all like to see it too?” Of course Amy and Al were excited to see the tests and Amy even said she was hoping I would do that. Ha! So we all broke our own rules but it worked out for good! It made the test day so much better knowing that good news was on the other side. There was a delay in getting our results too which we didn’t mind at all. Our nurse called in the afternoon to let us know the first hCG level came back at 126! I’ll go back for one more blood draw on Monday to make sure things are progressing but I’m officially pregnant. Which also means Amy and Al are expecting a baby! Ahhhh!!!! SO many happy tears (and earlier bed times and more beets).

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Looking Up and Looking Forward

One of the bittersweet aspects to the transparency of my blog, is that I share all of the news, whether it is a celebration or sadness. It is the reality of the fertility world. Whether you are taking Clomid, undergoing IUI, IVF, or Surrogacy, there are many ups and downs. But to be on the other side and have that empathetic understanding for someone else is truly a gift. Because nobody will understand their situation quite like you do.

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Yesterday was the beta blood test to check the level of HCG. This is the most accurate way to test if the embryo has resulted in a pregnancy. I went in for the blood draw just before 9 am. We received our phone calls (Amy & Al first, then me) from the nurse at TFC around 2:15 pm. Unfortunately the transfer was not a success and I was to stop all hormones immediately, once again.

I had been expecting bad news, probably because it is easier to expect the worst but hope for the best, so I was able to make it through the phone call just fine. But even when you are mentally prepared to receive bad news, you don’t know what your emotional response will be. I wept.

Over the past several months I have grown to love Amy and Al like family. I have prayed so hard over them and that the Lord would allow me to help them achieve parenthood. We’ve all been praying hard! One of the things we don’t know though is God’s timeline. So, we continue to have faith (looking up) and perseverance (looking forward).

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We are continuing to work as a team and a close-knit support system for each other  while moving forward to the next check list so that we can try again. There isn’t an official timeline yet, but it will most likely be about two months until we are able to try a transfer again.

In the meantime, I am focusing on health and fitness for the next month or so to fight off a few of the hormone induced pounds. And just to tend to my body. You can’t grow a beautiful garden if the soil isn’t happy, healthy, and fertile.

Transfer Day

Monday morning came along and I was in a peaceful state of awareness. Partially prepared for a phone call but also praying for smooth passage to Texas Fertility Surgery Center.

Promptly at 9:30 am I took a dose of Doxycycline with a full glass of water after a hearty breakfast without dairy (eggs with sautéed veggies, breakfast sausage, and half a slice of whole grain toast).

Then we were on our way to drop off our younger daughter at a friend’s house before heading south to the Surgery Center. I dressed in comfortable clothes and a pretty special shirt customized by The Freckled Clover.

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Foster Womb with green baby footprints

 

We arrived to the Texas Fertility Surgery Center a little early and were brought straight back so I could tackle a new stack of paperwork.

Next, we received a visit from the Embryologist to discuss the embryo that we were about to transfer into my uterus. We were expecting a 5 day Blastocyst but the best quality embryo from the cohort was the lovely little one below. It was showing signs of heading toward an Early Blastocyst but was still technically a Morula. The arched cell in the upper left is what will develop into a placenta. Isn’t that amazing?! The Embryologist was confident in the embryo quality saying it was just a little behind schedule, so we moved ahead with the transfer.

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5 day embryo in Morula phase

 

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Early Embryo Development

 

 

Both my husband and I received a set of gowns and covers for surgery. We may have had a little too much fun snapping a few pictures and squishing my fuzzy purple slippers (with grippers on the bottom) on the floor while waiting. The nurse popped back in briefly to administer a Valium pill with water. This was a first for me so I wasn’t sure how it would effect me. I thought I would be nice and relaxed, which I was right before and during the transfer. But then it put me to sleep within a short while of getting back in the truck to go home… and through the better part of the afternoon too! Don’t get me wrong, I’m not complaining at all, the sleep was glorious.

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Ready to Go!

 

The actual transfer was very smooth. Brandon (my husband) was able to take video of the ultrasound screen and the microscope monitor for Amy and Al. I  was put on a warm bed with warm heavy covers on top, it was so cozy! Dr. Vaughn explained each step of the way very clearly. We got to see the microscope zoom in on a spec until we were once again looking at the detailed embryo. The embryologist collected the embryo in a catheter, which looked HUGE on the monitor, then brought the catheter over to Dr. Vaughn. He then proceeded to conduct an Ultrasound-Guided Embryo Transfer. We followed the tiny white dot on the screen move to the center of my uterine lining. And that’s it. I was gently helped back off the table, allowed to *finally* go empty my bladder, and be on our way.

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See the white dot in the bottom center?

 

I am on light duty until next Wednesday when I go in for the first HCG blood test. It may sound strange, but relaxing doesn’t come easy for me. My hands are meant to be busy! So I try to compromise with myself by working on projects on my computer and other low key things in the meantime. We are all praying for a positive update next week! There won’t be any home pregnancy tests so everyone will have to hold tight until Wednesday.

Round 2!

The past two months have been filled with a lot of waiting and praying.

Here we are again, preparing for a transfer.

After the first transfer was canceled I began taking Provera to encourage my cycle to start. Once that kicked off with a vengeance, I took 27 active days of birth control. When the next cycle started, I began Estrogen again on day 2 and increased the dosage on day 7.

This week is when things really picked up momentum!

Monday morning I went in for an ultrasound to check my lining. It was sitting fluffy at 13.3 so we were given the go ahead to officially prep for transfer. Woo! It was also the first time my husband was able to come with me because my parents were in town and watching our daughters.


Tuesday I had a quick blood draw to check my Progesterone (P4) level. Once again, another excellent test result came back and we were given another green flag for the next two big steps.


Wednesday was the egg (OOCYTE) thaw. All 7 survived the thaw so now we wait for more updates on the fertilization process over the next few days. I also set my injection station back up for my daily evening dose of Progesterone in Oil Intramuscular Injections.
(Here are a few previous posts about that topic Injections and Transfer, Injections, Embryos)


If we continue to receive good updates, the transfer is set for March 20th. That also happens to be the first day of Spring, wouldn’t that be an excellent day for a new beginning?

All things happen for a reason

Last Wednesday was transfer day and we were all So very excited. All of the test results and updates leading up to the day were great! My husband and I were stuck in traffic making mental calculations about whether we would make it to the fertility center on time when I received a call.

“Hi Sarah, I’m sure you are on your way which is why I wanted to call to tell you
to turn around. We don’t have anything to transfer today.”

Oh no… My heart sank.

I asked a few questions but the nurse couldn’t fill me in on any details because she had yet to reach the parents but had called me because she didn’t want me to waste a trip down. The nurse asked that I not relay any details to the parents as she needed to speak with them directly first. Unfortunately, Amy was teaching and had her phone on silent. After a little bit I relayed to Amy and Al that the nurse was trying to reach them. It was killing me to know this sad news and they were both still blissfully ignorant and basking in the excitement of transfer day. That was the hardest part of the day for me. I was sad for them and this sudden change of events. I cried knowing what a disappointment this would be and how difficult that call must be to hear. It may have been a little bit easier to process and accept if there had been some subpar stats leading up to transfer, possibly. But it was a hard day for all four of us.

The rest of the day passed in a foggy blur. I had planned to take the day and next couple of days on the easy side which meant I had cleared my calendar. It also meant very little in the way of distractions. I don’t think any of us slept very well that night. After a couple of days we started to pull ourselves back up and point our gaze onward.

What’s next? What do we do now?

On Wednesday I stopped estrogen and progesterone immediately. The next day I began provera to encourage my next cycle to start (should be in the next week). In the meantime, Amy and Al have been busy trying to line things up to get a realistic timeline for the next possible transfer. We are hopeful that it will be the end of this coming cycle. Stay tuned.

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