The IVF Letter

Because of popular demand, I'm posting the e-mail I wrote to walk my friends and family through the in vitro process when we decided we were going to let people know we were doing it. We knew we would need the emotional and spiritual support, which everyone provided beyond anything we could ever have imagined. So fresh from July 2005 here it is:



Okay, here’s the deal:

Many of you have expressed a certain amount of curiosity about what exactly our in vitro procedure will entail. As most of you know, I am not offended by direct questions, nor am I afraid to tell you in breath-taking detail- more detail than you could ever have hoped to learn about my reproductive health. Given my inability to discern who really wants to know what about what I’m doing and who wants to just pray vaguely for us in the days to come, I decided to write this out so that you would have a handy reference, leaving you more free to devote precious brain cells to thinking and talking about how I’m feeling emotionally, what’s really going on with Brad Pitt and Angelina Jolie, the earned run average of each Atlanta Braves player, etc., rather than what exactly each of the (on average) three shots a day I will be taking does.

The Suppression Phase
“why are you suppressing me?”

I started the birth control pill on July 4. I will take three weeks of the active pills. Basically, the purpose of this is to trick my ovaries into shutting down, so that my doctor can more precisely control my hormone levels and not have to deal with any cysts leftover from a previous cycle, which might throw my hormones out of whack. Rather than take the placebo pills in my pill pack, I will start a new pack on the 25th of July. On that same day, Robert will begin injecting me every twelve hours (within an inch of my navel) with low dose Lupron, which will, as some put it, shut my brain down. In reality, just the part of the brain that makes eggs grow and waits around until an egg is producing enough estrogen and makes you ovulate (the hypothalamic-pituitary axis, if you are keeping track at home). That way, when I’m maturing a number of eggs (God willing), my body won’t cause me to ovulate prematurely or screw up the hormonal environment in which the eggs are growing. After a week on Lupron, I will stop taking the pill and just continue having my twice daily shots.

Egg Stimulation
On August 8th, we’ll go into the doctors and have our first ultrasound and blood draw, to make sure my ovaries and brain are sleeping appropriately. If so, that next day we’ll start stimulation drugs or “stims,” as the hardened IVF veterans call them (these are also abdominal injections). We’ll also drop back to one shot of Lupron (the “brain control” drug”) each morning and I’ll get a dose of stims every twelve hours. After a couple of days to let my ovaries get going, each morning, I’ll go in and have my blood drawn to check my estrogen levels and an ultrasound to take a gander at my ovaries. The average woman requires 9 to 10 days on stims, but my previous experience with injectable fertility drugs suggests that I am a slow grow-er of eggs, so for me it might take longer. It’s just important that you don’t have to stim longer than 14 days, because, well, the eggs don’t like to and everyone wants happy eggs.

Egg Retrieval
When the estrogen level in my blood and my daily ultrasounds indicate that my eggs are mature (I’m assuming they’re whining less and not having door-slamming snits anymore when they get grounded for violating curfew?), Rob, my trusty shot giver, will give me a shot of hCG, the pregnancy hormone, which tricks the eggs into thinking they will ovulate in 36 hours. If all goes according to plan, at that point we go in 35 hours later and have a minor surgical procedure to retrieve the mature eggs (“egg retrieval”). With a needle. I cannot emphasize that point enough. A needle. In my ovaries. Should you want to discuss this procedure in more detail, please phone me and I’ll gladly give you additional information. Fortunately for blood and needle hating Rob, he will not have to participate in this little activity, except for the part where he drives me home, because DO NOT BE DECEIVED, I WILL BE SEDATED. Hopefully, my eggs will be of good quality. The embryologist will play some smooth jazz and fertilize the eggs we want fertilized with Rob’s sperm, which, fortunately for him, are about the only things not retrieved via needle in this whole process. They’ll call us the next day and let us know how everyone is growing. Any leftover eggs will be frozen, because I’m taking part in a little experiment. (I would LOVE it if every thing that we’ve been through might allow some of my single friends, who have been faithfully waiting for God to bring them the right person, not to have to grieve the loss of the dream of ever being able to have a biological child with Mr. Right, should he happen to come along when they’re 41 instead of 36). Meanwhile, once I’ve slept off my sedation, I plan to drink Coke, shoot up heroin, ride roller coasters, run marathons, eat shellfish, smoke cigarettes and all the other things you’re not supposed to do in the pre-ovulatory phase for fear of damaging egg quality and in the post-ovulatory phase for fear of hurting a baby. Because my eggs and embryos will be somewhere else and I will be blissfully free of responsibility for 72 hours. Because, as you all know, if there is a phrase to describe how I’ve been throughout this whole process, it’s “laid-back” or “blissfully calm” or “very Zen.” And probably, I will not be worrying at all. Then again, I may just lie on my couch whining to Rob about how my giant, bloated ovaries hurt, so he had probably better bring me the remote control because I don’t want to get up. Who’s to say which I’ll feel like? Lucky, lucky Robert.

Embryo Transfer
Whichever, 72 hours later, we will go back for “embryo transfer,” wherein all the embryos who feel no bitterness about being conceived in the lab will be returned to my uterus. We don’t care if they’re boys or girls; we just want them to have 8 cells and not a lot of fragmentation. Humor me and pray for this when the time comes. Our prayer is that there will be three of them. I am told that this part of the procedure involves no needles, just lying perfectly still for an hour with a full bladder. (Which reminds me- the day after egg retrieval Rob will start giving me injections of progesterone in my hip, which, from what I understand hurt like, well, a shot that takes 60 seconds or more to give, due to the fact that the drug is the same consistency of heavy olive oil and has to be given slowly. I’m really excited about that. Another fun progesterone side effect is anxiety and sadness). For the next 48 hours, I’ll be on bed rest. If you’re in the Atlanta area, please feel free to come on over and listen to me complain about how bloated and anxious I feel. Probably also sad. It’ll be a great time that really reminds you why you decided you wanted to be my friend in the first place.

Results
Anyway, about two weeks later, we’ll go in, have a blood draw, and get a call that afternoon letting us know how everything turned out. It’s seems strange that it took so long to write all of this down and that the finding out whether the time, the physical, emotional and financial investment that this is for us has really paid off or not takes just an instant. And I’ve been thinking a lot about what that instant will be like for us, either way.
I appreciate so much everyone’s love, support and prayers for us during this time. Thanks, too, to all for you who have touched my heart by reading up on in vitro and watching clinical documentaries and all of that. (And to all of you who feel like they could open a gynecology practice because they’ve gone walking with me on a day I was feeling chatty.) As I know you can imagine from what I’ve written, so many things can go wrong at each step of the way and I feel nervous about each and every one, but most of all the last one. I’ll try and keep everyone updated what we’re doing every little bit, so that you’ll know better how to pray. If you don’t want regular e-mails, please feel totally free to let me know. Several of you have asked if you can forward this to others who are praying for me- if we’ve had that talk, please feel free to do so. Thanks again for your faithfulness in lifting us before the Lord.