Final IVF Clinic Appointment: Appreciation, Relief, Sadness

Yesterday morning was the end of my six months of infertility treatment, six months that included two in vitro fertilization (IVF) cycles:  the first unsuccessful and the second resulting in my current pregnancy with twin boys.

I have hated driving to downtown Chicago over and over, always having to give myself 90 minutes of travel time, because of varying, unable-to-be-estimated traffic patterns.  My appointments have sometimes lasted a mere two minutes, the time necessary for a blood test, after which I’d climb back into my car to start the long drive home to the suburbs.

I have hated being repeatedly stuck in alternate veins located on my inner arms, opposite my elbows, for these blood draws.

I have hated having my legs in stirrups for countless vaginal ultrasounds to check the growth of my follicles and the thickness of my uterine lining. 

I have hated the dozens of injections that I’ve had to give myself in my stomach, my thigh and my backside, their resulting bruising, soreness, bloating, headaches, exhaustion and other side effects.

I have hated twice having a needle inserted through my vaginal walls to retrieve my eggs from my ovaries.

I have hated the three-times-daily Endometrin® vaginal progesterone suppositories, necessary when ovaries are unable to sustain a pregnancy with their own progesterone production because they were punctured full of holes during the egg retrievals.  The cottage-cheesy vaginal discharge is repulsive.

I have hated the emotional impact of undergoing treatment for infertility, the need to have hope to make it through the process, yet the constant underlying fear of failure, the fear of how I would possibly move forward if I failed.  Not to mention the feeling that failure would somehow be my fault.

I have hated having to dip into my retirement account for the money to pay for our out-of-pocket costs for our two IVF cycles.

I have hated the “you’re-not-pregnant” phone call.

But I loved the two embryo transfers, seeing our babies flickering across the ultrasound screen like shooting stars, as they were released from the catheter and entered my uterus.

I loved the congratulations phone call, confirming my pregnancy.

I’ve loved the three ultrasounds since, when I get to see my little guys, their gestational sacs, their tiny pulsing hearts, their growth.

During yesterday’s ultrasound, my cervix was closed, which the IVF coordinator said is “very good.”  She found Baby A first, and she deemed his heartbeat and yolk sac as “good.”  She said the same about Baby B’s heartbeat and yolk sac. 

She noted that I still have some separation in my uterine lining between the two gestational sacs, diagnosed last week as one of two subchorionic uterine hemorrhages, but, because I’m no longer spotting, “It’s alright.”

Yesterday was the first that she’d mentioned the twins’ yolk sacs, so I asked exactly what they are.  She said that each yolk sac “provides nutrition for the embryo before the placenta takes over.  They provide the blood supply and nutrition to each fetus.  Once the placenta takes over, the yolk sacs will shrink gradually.” 

Near the end of the ultrasound, my doctor stepped in.  He declared, “What we have is not 100% success.  It’s 200% success.” 

The IVF coordinator led him through the ultrasound results for each baby, then he told me to get dressed, then we’d talk in his office.

As she finished up, the IVF coordinator handed me my first ultrasound picture featuring both babies at once, which I held as I walked into my doctor’s office. 

Our Twins: Baby B (left) and Baby A (right)

Our Twins: Baby B (left) and Baby A (right)

As I sat down, I showed him the ultrasound scan, then asked if he’s worried that Baby A’s gestational sac is so much bigger than Baby B’s.  He said no, that what is most important is the size and growth of each embryo and the strength of each baby’s heartbeat, all of which are on track for their gestational age.

I asked him for the exact measurements of each, which were 11.1mm for Baby A and 9.9mm for Baby B.   But the clinic’s ultrasound machine, which he described as one of the best available, has a standard of error of +/- 1mm to 2mm.  With an only 1.2mm difference in measurement between Babies A and B, the reality is that no difference in size may exist. 

He went through my chart, telling me that, for the purposes of calculating my due date, the first day of my last period must be listed as July 17, even though I really got my period in the afternoon on July 18, therefore July 19 was the official first full day of my menstrual cycle.  He explained that, because my cycle was manipulated, because my IVF egg-retrieval was August 1, the first day of my last period must be determined as July 17, regardless of reality, which makes my due date April 23. 

“No one can change these dates,” he said.  He wrote them on his business card and handed it to me.  “When you’re asked for these dates, you give these.”

He told me I can stop taking my once-daily dose of baby aspirin, can reduce my progesterone-oil injections from two to one a day, and can stop both the progesterone-oil injections and vaginal progesterone suppositories on September 26, when I hit my 10th week of pregnancy.

I thanked him for getting me pregnant, and he said, “I told you it would work.”

He was always so positive, even after the first failed cycle, which I had assumed was his attempt to keep my spirits up, knowing that depression doesn’t faciliate success.

Even though the majority of my experiences with the IVF clinic and its staff were negative, the doctor and nurses, the genetic counselor and the reception staff were all wonderful to me.  The torturous treatments they prescribed and conducted were simply necessary to achieve pregnancy in a 41-year-old woman with a uterine abnormality.  Yes, that 41-year-old, six years into advanced maternal age, with an arcuate uterus, is me.

So, although I was so relieved that yesterday was my final appointment, my close-out ultrasound and consultation, I felt sad because of all of the emotions I have experienced at the clinic, with my doctor and nurses, and because I am so grateful to every member of the staff  for helping me become pregnant.

As my doctor escorted me to his office door after our closing consultation, I wanted to hug him, but I barely know him, and our relationship is purely a professional one, even though his profession involves major emotions.  So, I just shook his hand, not wanting to make him uncomfortable.

He told me to come back to visit, to show the staff the babies. 

And, I’ve already decided that I will hug him then.  I will hug every single one of them then.

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