A whole new vocabulary

Recently, I have realized that both marrying an Army man and now our struggle through infertility have required a whole new set of vocabulary terms.

The military is famous for their acronyms. For example,

MRE: meal ready to eat

FOB: Forward Operating Base

ACU: Army Combat Uniform 

DFAC: Dining Facility

POV: Privately owned vehicle

MOS: Mode of service (job in the military)

PT: physical training

BAH: Basic Allowance for Housing 

I can remember driving around Ft. Campbell when husband and I were first dating and not having any idea where anything was located because everything is assigned an acronym and numbers. There is no map, and if I didn't learn the lingo, I wasn't going to understand half of the orders we were given through the FRG (Family Readiness Group) when he deployed such as "wheels up and down time" (expected time for the plane to take off/land) and what he was supposed to wear to a certain event which would affect my attire accordingly.

In our journey through IVF and surrogacy we have been learning these terms:

RE: Reproductive endocrinologist

GC: Gestational carrier

IPs: Intended Parents

IM: Intended Mother

IF: Intended Father

ICSI: Intracytoplasmic sperm injection 

PGS/PGD: Preimplantation genetic screening or diagnosis

AMH: Anti-mullerian hormone

FSH: follicle stimulating hormone

LH: Luteinizing hormone

E2: Estradiol 

CD: Cycle day

LMP: Last menstrual period 

DPO: Days past ovulation 

LP: Leutal Phase 

ER: Egg retrieval 

OHSS: Ovarian Hyperstimulation Syndrome 

ET: embryo transfer

FET: Frozen embryo transfer 

DPT: Days post transfer

PIO: Progesterone in Oil

Beta: HCG level pregnancy test

PG: Pregnant 

PBO: Pre-birth order

Apologies in advance if I have confused anyone when talking to you about all of this. Learning as we go along and praying that soon we will be IPs with a GC that has a successful FET by our RE and is PG. Currently we are just in acronym purgatory.  

Matchmaker, Matchmaker

Deciding to pursue surrogacy seems easy next to actually pursuing surrogacy. I don't just have baby envy now, I have uterine envy. I marvel at my pregnant friends and long for the organ that allows them to grow miracles inside of them. The ladies that are surrogates are no different. They're like women with the super power to grow not only their own babies, but a baby for a deserving person or couple, to actually feel a baby develop into a tiny human that they are loving and caring for for only a small period of time. Some describe it as extreme babysitting. I consider it a miracle.

Ideally, I have prayed for our gestational carrier (GC) to be done bearing their own children, as the risks of pregnancy are there, and I would never forgive myself if someone lost their own dreams while trying to fulfill mine. I have also wanted someone who was nearby if able so that I could participate as much in the pregnancy as possible - attend appointments, help out as the pregnancy progresses, and be able to be there on time for the hopeful full-term delivery. I have wanted someone who was open with communication and responsive, and is wanting a relationship with us and the baby even after our journey is through. I'd like this child to call this woman "Aunt" and for her kids to be like cousins to ours.

Many people have asked if I would consider asking my sister or a family member to carry for us. My sister currently has no children, so that automatically means no as surrogates need to have been pregnant before so the doctor has an expectation of how it should progress. My mom and mother in law are not appropriate candidates either. Knowing this led hubby and I to start research on surrogacy agencies and independent matches and we are currently going through the screening and vetting process with a lady we met through an independent match. Fingers and toes crossed.

One step forward, two steps back

When we started the IVF process there were tons and tons of statistics thrown at us constantly to estimate response and success rates - age, AMH levels, FSH levels, antral follicle counts, estrogen, progesterone, clinical success, drop-offs through retrieval, fertilization, and ultimately blastocyst creation. So many numbers and so many statistical probabilities. I felt like my life and my body were being put into a calculator and out popped percentages for the likelihood of a happily ever after. It's a shame that all of this ultimately comes down to statistics and success rates, but I understand where they were coming from and why these are important particularly in the world of assisted reproduction and reproductive endocrinology.

One of my biggest traumas from the delivery disaster was feeling like I was asking for help and not receiving it. Through the IVF process, our RE was very careful to monitor everything to a T, for one because my percentage once computed through their statistical analysis showed a high probability of response to stimulation and also because she knew how terrified I was of having something overlooked again (and the potential disasters that can ensue.)

The entire process took approximately 4 weeks. We got insanely lucky that when my initial baseline bloodwork was done they seemed to catch my progesterone levels within 24 hours of an ovulation. Bloodwork a week later confirmed this for sure and I was able to proceed with the traditional long-lupron protocol. Two weeks of 20 mL lupron shots before adding stimulation medications of 75 mL Menopur and 225 mL Gonal-F and ultimately a trigger shot 36 hours before retrieval of Pregnyl. Not to mention daily Lovanox injections to prevent a blood clot.

I honestly didn't mind the shots. The needles were tiny, subcutaneous injections with the exception of the Pregnyl HCG trigger shot which was inter-muscular. On most days, I could hardly feel them other than the Lovanox ones that burned and always left bruises. Shots were to be taken 12 hours apart, with a Gonal-F in the morning along with Lovanox, and then the Menopur, another Gonal-F, and Lupron in the evening. We went down to a drive-in movie the day after I started my shots so I set my times as 5am in the morning and 5pm in the evening. My mother-in-law came down to help with our daughter so that I could make all the appointments and not have to do a lot of bending and lifting while on the stimulation meds.

My levels held steady throughout the entire process and I never had dosages adjusted. Daily instead of every other day ultrasounds and bloodwork monitored follicular growth and estrogen/progesterone levels and I responded the way we all hoped I would. I am so fortunate that a dear friend who is a nurse was willing to administer the HCG shot. The timing of the trigger shot is so critical (exactly 36 hours before the retrieval) and I was terrified I was going to mess it up. As it was, we had some difficulty mixing it and I'm eternally grateful for her expertise and calm in that moment as I panicked that I was going to screw up everything and god-forbid ovulate before they were able to do the procedure. For most people, if the IVF cycle is canceled and there aren't too many eggs to be released, people will be released to try to get pregnant the old fashioned way. In my case, I would lose all that hard work to the deep abdominal abyss and I was panicked at that thought of time and money literally evaporating.

We made it though to egg retrieval successfully. I was warned that I would need to take it easy that week so I had my parents come help with baby girl so that I could heal. I was given an information sheet on the symptoms of Overian Hyperstimulation Syndrome (OHSS) and what to look for in the event that the worst happened but two day after retrieval seemed to be feeling fine. We even walked through Costco. Fast forward to the end of that week though, and I started having a lot of pain in my abdomen above my belly button. Two trips to the ER over the course of the next week confirmed it - I had moderate OHSS. My ovary was 11 cm, basically the size of an orange, when normally they are to be the size of an almond. Fortunately my mother-in-law was able to come back down to help with baby girl because I was again not allowed to bend or pick up anything over 10 lbs and was put on modified bed rest for a week. I am grateful I never had the fluid in my abdomen and that I didn't need to be admitted to the hospital again.

I have been so defeated and frustrated with my body over all of this in regards to health and healing. I've always been super healthy, and never in my life have I had so many medical issues as I have in the past year.  As of now, it's been two weeks since I first went to the ER for the OHSS and I'm feeling better, but still having some residual hormonal effects. The RE had said that once the next cycle kicks back in, it's sort of like flushing a toilet and starting again. The ER doctors though have said it can take a couple months to truly be back to normal after several "toilet flushes". Knowing me, I'll undoubtedly fall into the latter category as we add it to the "incredibly small statical chance" odds I continue to achieve. Lucky, lucky me.

After everything that has happened, I am just ready to get back to my normal life. I'm ready to enjoy going to the new trampoline park or getting back into Zumba. I don't want to worry that I am going to do damage to my incision or my ovary by bending over to pick up my daughter or getting on the floor to play with her. I want to be able to meet my girlfriends for cocktails or coffee and to eat spinach or kale whenever I want to. I know I need to be patient, but I can't help but feeling like I've missed out on some milestones with baby girl because of physical limitations I have never had before. If it weren't for amazing friends and family, I don't know where we'd be. I'm hoping this is the end of taking one step forward and two steps back, and maybe the final step to really healing and getting my life back on track. Onward and upward!

The Next Right Thing

Husband and I got married in September 2009, 6 weeks before he deployed to his second tour to Iraq. Even though I knew he was deploying to a war zone, that honeymoon phase seemed to be a giant curtain over any possible realities we would have to face while he was there or once he came home. The year passed pretty quickly all things considered and when he returned in October of 2010, I thought that we were finally going to have the "happily ever after" part, leaving the worst behind us. Those first couple years after his return from deployment were very, very hard. It took almost 3 years before I felt like we were back to "normal".

We learned a lot during that time - about marriage, sacrifice, patience, unconditional love, forgiveness, and as I read one time that marriage "is a journey to holiness not just happiness". That foundation made us face this new challenge from the same approach we did previously: what is the next right thing.

In the hospital, I asked questions about hormones and ovarian function. I asked questions about options and ultimately about the IVF process of egg harvest and surrogacy. We had doctors telling us to not worry about that, that I was young, put it off for another day. I knew though, that the next right steps for me were to learn all I could and pray. Pray for guidance and pray for God's will. 

Praying for the next right thing led us to an IVF egg retrieval that happened July 18th. 2 weeks of shots led us to 4 beautiful frozen embryos thanks to the expertise of our wonderful RE. My active part in this journey is done for now. We pray for these embryos daily over a picture sent to us of one of them. We pray one is baby girl's beloved, and much wanted, sibling. 

                                     

Surrogacy?

Surrogacy. It's crazy how in the moment when trauma is occurring something that at once seemed so foreign becomes a lifeboat. I had a week between my delivery and the hysterectomy. I can remember one of the doctors coming in while I was fighting the sepsis infection and telling me that I was his sickest patient in the maternity ward that night. I can remember him telling me that they thought the source of the infection was still my uterus and that if I didn't get better I would have to have it removed. I remember asking him questions about would they take my ovaries and what would that mean. He was the first to mention the word "surrogacy" and from there it was like a lifeline I held onto after I learned that the worst had been realized a few days later.

I haven't known where to begin. In the weeks and months that have followed, husband and I have been open to sharing our story and our journey with our friends and family. We have felt like only by owning it publicly could we fully heal. I'm not good with keeping things from those that I love the most, and even though infertility is the most painful thing I have ever been through, I cannot imagine doing this alone. I also can't imagine doing it without an amazing group of anonymous online support such as the amazing women on Baby Center and a few Facebook surrogacy groups. I have learned so much about the process from them, and they have given me insight into what this will and should really look like. 

Hubby always makes fun of me but I always do my research. Whether we are buying a car, a carseat, or a can of paint, I am always one to read about 1000 reviews, check for competitive pricing, and make sure that whatever it is has the consumer reports seal of approval. This has been no different. The hysterectomy that I had was considered a radical one. It ended up having to be performed by a gynecological oncologist. I knew that because it was drastic there was a chance that my left ovary would decide it didn't want to work anymore and just retire. I began to read everything I could and research as much as I could as to what we were really dealing with. We had bloodwork to check my AMH levels 5 weeks after and the news wasn't good. AMH was 0.2, basically undetectable. We went to Emory down in Atlanta in January of this year and met with their infertility clinic. I was told to not wait and that they thought I could succeed but that we might be racing against the clock. I came back wondering if I'd only had one functioning ovary and had no idea all this time. At the suggestion of MFM Angel, we met with Vanderbilt's new RE doctor who seemed a little bit less concerned about the AMH level but still told me not to put things off more than 6 months. Her clinic wasn't to open until the end of April so I had time to fully get off the wound vac and then begin.

February came and went. March came and went. Then April arrived and with it, the worst hormonal week of my entire life. I was sure that I was going into menopause and we hadn't had a chance to do an egg harvest. It was awful. MFM Angel encouraged me to check in with my normal gynecologist and gratefully she ran a hormonal bloodwork panel. By the grace of God, everything was normal. I was told it was my cycle restarting after ending breastfeeding. I had no idea of that though because of the hysterectomy, and I wondered why don't more people tell pregnant women what all of this is REALLY like?! I know we don't want to scare women unnecessarily but I truly thought that was the beginning of the end. 

April came and went and the clinic wasn't ready to open. In May, I began to experience symptoms again that were concerning and spoke to my gynecologist again. She informed the RE and RE ran initial bloodwork. I was shocked when all levels, including my AMH, came back perfectly normal. AMH had gone from 0.2 in December to a much better 5.9 in May. I felt like we'd been given a presidential pardon and I wasn't on death row anymore. 

Maybe this surrogacy thing might be a possibility after all. I still had my lifeboat. 

This Is Only the Beginning

On October 28, 2015, at 12:02pm, after 85 hours in labor (both natural and including a failed induction to 9 cm) and an indicated cesarean section, Baby Girl was born. It had been a wonderful and easy 9 months, my body loved being pregnant and I was thrilled when I started natural contractions at 39 weeks and 2 days at a Nashville Predators game.

9 months of excitement and anticipation had finally come to that moment and I couldn't stop crying. She was tiny, but she was perfect: 6 lbs even and 19 1/2 inches long. After a few scary moments of learning she'd swallowed meconium, she was whisked off to the newborn nursery with my husband and I was left alone to finish the surgery. 2 1/2 hours later I would join them, the following weekend I would feel like death warmed over as I fought sepsis from a bad chorioamnionitis infection that festered from the prolonged labor, and ultimately on November 6, would be taken back for a second surgery to "fix a tear in the abdominal fascia" that I learned the next morning also meant a radical hysterectomy leaving only my left ovary because the infection was so bad. Two days after the hysterectomy, I developed a DVT in my left arm which hematology told me was "provoked clot" from all the fallout. In total, we spent 3 1/2 weeks at Vanderbilt, I had a wound vac for 11 weeks both in the hospital and at home, and I was left devastated and unable to bear another child.

We couldn't understand how we had gotten to this place. I experienced a completely uncomplicated 9 months. We were pregnant 6 weeks into "trying", breezed through all the milestones, so grateful to not have pre-eclampsia or gestational diabetes, and other than morning sickness the first trimester, I felt great. I hired a doula, attended every prenatal appointment, and read all the books. We had growth ultrasounds, doppler checks, and a midwife team at Vanderbilt that I trusted completely in conjunction with their OB and MFM team if needed. Baby Girl was head down at 28 weeks and so low the last few weeks of pregnancy I walked like John Wayne in a Western.

That Saturday night at the hockey game when labor began, I called the midwife on call, reported how far my contractions were apart, was told to monitor and inform my doula. Timed contractions, consistently coming 5 minutes apart, spent all day the next day on Sunday with the doula walking and using my birth ball until contractions were 2-3 minutes apart and then we went down to the hospital expecting to be through transition. Instead, only 1.5cm dilated, was sent home on "therapeutic rest" with a shot of morphine, only to wake up and have contractions back to 12 minutes apart. That Monday night, same thing, back to hospital, this time 2.5cm dilated, and then sent home on therapeutic rest again. Show up in the clinic Tuesday morning, desperate to know what was going on, and was going to be sent home again when MFM Angel overrode the midwives and called the induction.

I cannot say enough about MFM Angel. As the overseeing doctor for the midwife team, I had met her at my monthly growth scans but not really interacted with her much else. I am convinced she saved not only my life, but Baby Girl's as well. If she hadn't called that induction, I'm not sure either one of us would have made it two more days. It's terrifying to me to even think about.

Nothing and no one can prepare you for that kind of turn of events. As thrilled as I was (and am!) to have my beautiful Baby Girl,  hubby and I have always wanted more than one child. I have spent so much time somewhere between over the moon happy about Baby Girl and in the deepest despair about the loss of what I won't get to go through again. I regret not taking weekly pregnancy photos of my growing belly. I should have kept a pregnancy journal. I feel the deepest guilt about all the plans I had for Baby Girl that just didn't get done- her handprints in ink on the day she was born, I've forgotten to write down what she loved monthly as she has grown, and I lost the ability to nurse at 4 months because my milk dried up within 3 days of ending the 90 days on warfarin to deal with the DVT. I wasn't able to change diapers or walk and hold her for weeks. I still struggle with bending and getting down on the floor to play because of where the incision is that left me with a surgical hernia (that I need to have another surgery to fix soon). I still haven't been able to baby wear.

We started trying to get pregnant when we did because I thought it would take us a little while to succeed. My mom had tried for a few years before she got pregnant with me and we have had so many friends affected by infertility, I just assumed it would be a bit. When we got pregnant so quickly and I had such an easy pregnancy, I assumed we'd be doing it again in a few years without a problem. Assume, assume, assume. As my husband says, to assume makes an ass out of u and me. I have been incredibly humbled by this entire experience, and really come to realize I took for granted how easily we got pregnant and that I had a functioning uterus at all. I have felt guilt and been guilted by others for even wanting another kid. We have prayed and prayed and feel God calling us to pursue surrogacy and to pursue having an additional child. This blog details our journey to give our dearest Baby Girl a sibling. We want to be a family of a mommy, a daddy, and two children: it's what we dream 4. Thanks for reading.