The Hardest Decision I Ever Made

"Our trials help us discover and prepare for the work Heavenly Father has for us.... Like the Savior, whose atoning sacrifice enables Him to succor us, we can use knowledge gained from difficult experiences to lift, strengthen, and bless others." - John C. Pingree, Jr.

Before my little William was born, I decided to go semi-public about my husband's and my struggles with infertility. To avoid judgment, I left out a lot of detail about what treatments we decided to pursue.

After hearing this quote in General Conference two weeks ago, however, I was prompted to share more.

Namely, Michael and I exhausted every possible course of fertility treatment and finally, through the absolute miracle of in vitro fertilization (IVF), became parents.

I have only confided in a couple of people how scary this decision was for me. IVF was something I had decided I would never do - way back in college when I took a class involving making decisions about tough issues - because of some details I'll explain below. But when it became clear that this was the final option standing in the way of our being biological parents, and I was so hopeless and at the end of my rope (spiritually, mentally and emotionally), after much prayer Heavenly Father let me know that it was OK that I don't have all the answers, and that He approved of this step for us.

I hope that me being open about this journey will help someone else. If you have a friend struggling with this decision, please PLEASE share. My heart aches for my fellow mothers-at-heart who are scared to ask these questions. I was that woman. I understand. I want to lift them up as Christ lifted me up (though I do it so much less perfectly!).

So here goes nothing.

(Note: Crap gets real here, folks. Don't say I didn't warn you!)

IVF: The Process

First off, a little summary of what IVF is.

(Here is a link to the short medical explanation of the process: https://seattlefertility.com/treatment-options/in-vitro-fertilization/ And for the really interested, a link to the very long medical explanation - down to the nitty gritty: http://seattlefertility.com/wp-content/uploads/sites/4/2015/10/IVF-Consent-Patient-Information.pdf)

My Background

In normal ovaries, one egg develops and matures per menstrual cycle. I have polycystic ovarian syndrome (PCOS), so in my case so many underdeveloped follicles (sacs that contain eggs) line my ovaries that my body does not release a mature egg during menstruation.

Ovarian Stimulation

In the first stage, follicle-stimulating hormone (FSH) is injected into the abdomen once a day for 8-12 days to encourage multiple eggs to develop within the ovaries. 

During this process, every 1-3 days I went in for blood draws to check my level of estradiol (a form of estrogen) - an indication of how the eggs are progressing. The nurses also perform vaginal ultrasounds to monitor the eggs' progress, especially toward the end of this period.

Egg Retrieval

Once the eggs are ready, you don't want the body to release the eggs it worked so hard for. So an injection to prevent ovulation (usually Lupron) is given  at a specific time so that the egg retrieval is scheduled correctly.

36 hours after the Lupron injection, a doctor performs the egg retrieval. Shortly before the procedure, the husband provides a sperm sample. General anesthetic is used for the egg retrieval, and while you are under, a vaginal ultrasound is used to guide a needle biopsy of both ovaries in order to remove the eggs.

Egg Fertilization

The afore-agreed-upon number of eggs are fertilized the same day as the egg retrieval. (Any extras are frozen/cryopreserved to bypass the egg retrieval process in later IVF cycles). Fertilization occurs either by simply putting sperm next to the egg, or by using intracytoplasmic sperm injection (ICSI), where an individual sperm is selected and placed inside each egg to help the fertilization process. The eggs are then incubated overnight. Over the next few days, doctors examine the eggs for signs of fertilization, and growing embryos are tracked as they divide and grow. Your nurse calls you every other day or so to update you on the embryos' progress.

Embryo Freezing

5 days after fertilization, the embryos that make it to the blastocyst stage (an embryo with 80 or more cells) are either implanted or frozen (cryopreserved). In my case, my doctor didn't want me to immediately become pregnant because of the risk of ovarian hyperstimulation (OHSS).

So the embryos were frozen, and I waited a month to do a frozen embryo transfer.

Embryo Transfer

The final step in IVF is to transfer the embryo(s) into the uterus. This is done when the bladder is extremely full, allowing the catheter to be placed more accurately via the vagina. The embryo is placed into the catheter, which is placed inside the uterus with ultrasound guidance. Once the embryo has made its way into the womb (which is seen via the ultrasound), the embryologist checks the catheter with a microscope to make sure the embryo has left it.

Two Week Wait/Testing

After two weeks of waiting, a blood draw is taken and, later that day, the nurse calls with the results - pregnant or not.

 

Early Pregnancy!

If pregnant, two additional blood draws are necessary within the next week to make sure that the hCG levels are rising sufficiently. If so, progesterone (and sometimes estrogen) support is needed. (For me,) estrogen is given orally 3 times a day until week 10, and progesterone is given in two forms: twice daily as a vaginal insert, and once daily as an intramuscular injection (shot to the hip) until week 12.

After that, it's smooth sailing! (Wink wink…)

Questions

I had no doubt that my doctors would do everything in their power to take care of me and help me become pregnant, so the whole IVF process as far as physical effects go was not as much of a concern for me as were the ethical/moral questions. It took me prayers, time, prayers, therapy, prayers, spousal discussions, and prayers to come to terms with the answers to these questions. I realize that these are extremely sensitive topics and that I do not have all the answers - but these are the answers I received and had to be OK with. A couple of these are questions I have been asked by close friends, as well.

How many embryos are created during the process?

Because my husband and I believe that life begins at fertilization, this was one of our most worrying questions.

Related: The question that haunted me most about IVF from the moment I learned about it in college was: What is done with the "leftover" embryos? Are they donated to science? Discarded? This is human life we're talking about - I didn't want to play God. But the thing was, God was guiding me the whole way. He didn't think of this decision as me playing God, but as me following Him.

Thankfully, my doctor was extremely understanding about this concern. She made sure that, based on the success statistics of fertilization, we would only end up with the number of embryos we would be comfortable having as children in our family.

What is the survival rate for frozen embryos?

Extremely high.

Related: We will literally have children waiting in cold storage until we can bring them into the world. Is that OK with God? The answer I received? Yes, it is OK with Him, and I don't need to know any more than that. (Wow, this took a lot of faith to accept!)

What about the sperm collection? Isn't that masturbation, which I believe is wrong?

This was something that my husband and I had to talk about extensively. One of the things that bothered me (and still gets me riled up thinking about it) is the fact that pornography is available in the sperm collection room. We knew that viewing pornography is highly damaging, addictive, and repellent to the Spirit of the Lord, so we knew that he would not view it. Thankfully, every time a sperm sample was required (for IVF and the rounds of intrauterine insemination we did beforehand), the nurses allowed me to be in the room with him. I'm not sure what else to say about this bit, because everyone has different comfort levels. I do know that Heavenly Father approved of what we chose to do out of love for each other and while looking forward to the family we were creating together.

Are the injections hard to take?

For me, the worst part was having to stick myself with a needle. Once I decided I'd have my husband do it for me, it wasn't so bad. With the ovarian stimulation injections, the results were uncomfortable (they felt a lot like bloating), but I didn't have any other pain. With the hormonal supplemental injections I have had a bit of muscular soreness, but it just feels like I had a good hip workout (because I do specifically hip workouts… haha just kidding. It feels like a sore muscle does after a workout. XD )

How are the embryos selected for transfer?

Before the blastocyst stage, at which point the survival rate is quite high, the embryologist rates the embryos on a scale of poor-excellent based on the number of cells/shape/etc. The ones that are rated the highest are transferred first, but it certainly isn't a perfect indicator of how well the embryo will survive.  There was also the option for us to do preimplantation genetic screening (PGS) of the embryos, which is a test for genetic disorders. We opted out of this because the results wouldn't change our choice to transfer an embryo, giving that baby a chance at life.

Does this mean getting pregnant will be easier for you in the future?

While we have frozen embryos ready, yes. Afterward, we will decide if or whether we are ready for more children and go through the fertilization process again. Thankfully, with the frozen eggs we have, I will not have to endure the ovarian stimulation and egg retrieval processes again.

Miracles

The thing that amazed me is how closely the progress of our little ones was followed. We knew how our embryos were growing, and how many of them made it. We saw and got to keep a picture of each embryo (2 now!) before they were transferred. (Earliest snapshots ever!)

Besides being really uncomfortable, the embryo transfers have been a super emotional, spiritual experience that I wouldn't trade for anything. Being on that hospital table with my husband at my side, witnessing our little ones being placed into me to be borne, was indescribably joyful. Truly IVF is a modern-day miracle.

"God has not ceased to be a God of miracles. Behold, are not the things that God hath wrought marvelous in our eyes?" - Mormon 9:15-16, Book of Mormon

Did I miss anything? Please let me know in the comments or in a message if you have any other questions.