IVF Takeaways and Insight from Five Years On

Editor’s Note: If you’ve been following my journey, you’ll have read our .recent news about Baby Kircher. The post  shared below was written in April 2022, prior to my most recent successful IVF transfer, when I still had no idea whether this transfer would work. I held on to it as we wanted to go through this most recent round – our first round back in two years – a bit more privately after the previous round ended in an ectopic pregnancy. Below are my genuine thoughts and writings from prior to the transfer.

Despite being a travel-focused blog, one of my top-ranking posts on The Wanderlust Effect is my post on IVF for First Timers: 30 Questions & Answers – it’s consistently in the top 3 – 5 posts each month which makes me hope and think that some of that insight as a newbie to IVF has helped with someone going through their own journey, looking for insight or perhaps the comfort of knowing that others out there are navigating similar waters. I wrote that post in 2017 when I was beginning my journey with fertility processes and had just undergone our first round of IVF and transfer with a fresh embryo.

Five years later I’m going back yet again for another transfer (a frozen embryo transfer this time), still navigating the uncertainties around IVF but simultaneously more at ease with the whole process and benefitting from the added comfort of ‘the known’ as compared with a first-time process.

I hesitated to write this post but I genuinely believe sharing and cultivating a culture of transparency around fertility conversations is the key to taking away any shame with the process (like, really? What’s shameful?) and also hopefully continuing to create spaces where we share our insight unabashedly and provide comfort to others out there going through their own journeys.

Below I’m sharing my tips and takeaways from five years of IVF, sharing some of the biggest struggles, and more. If you’re going through this process, I hope this provides a glimmer of insight. If you have a friend or loved one going through this, please share – the more we share on these matters, the better!

What Happens When IVF Doesn’t Work at First (or at Second, Third, etc.)

Statistically, it’s normal for IVF to not work in the first round. I think we’re being better about bringing awareness to IVF and fertility challenges, but it can be difficult and confusing when we see someone online talk about their ‘IVF challenges’, only to go through one round and have it stick immediately. I get it. It’s easy to look at that and compare the level of difficulty or note that someone else’s ‘struggles’ really aren’t struggles because their process was relatively easy. It’s also easy to think that a failed round or two of IVF isn’t ‘normal’ or that a failure (or three!) means that it won’t work. Some people will get pregnant on their first round and yay for them! That’s an amazing relief that it works that way. For others, it takes longer and it can take further tests. I’m sharing my full story below but after my first three failed rounds I went in for many other tests: two SIS tests, an ERA, an NK Killer Test Assay, mock transfers, and a heap of other things (all of which insurance did not cover as this was IVF related and that was explicitly excluded). A couple of tests did point to issues that needed to be resolved while a few showed nothing. The number of tests available for a whole heap of potential issues can seem daunting at first but my biggest piece of advice is to take it one step at a time, one day at a time. Break it down into bite-sized chunks because it can be intimidating, overwhelming, and scary.

Comparing Your Struggles to Others

I’ll always say that I think sharing is important for an open dialogue and enhanced conversations around fertility but I think it’s worth noting that those same conversations can backfire when we hear the ins and outs of people’s journeys. While it provides us comfort in hearing about other’s situations and experiences, it can also cause an unhealthy foundation of comparison.

All of our struggles are struggles and I think that’s important to recognize. You guys, I get it. I’ve seen folks start their process far after me and now have 2+ kids running around at home. I’ve heard women who’ve gotten pregnant naturally talk about how hard it was to get pregnant; that it took “six months of trying”, which was stressful for them and their marriages. Sometimes I fall into that comparison trap…. Like, it took you a few months of trying before getting pregnant naturally and you’re talking about that being stressful or trying on your relationship? Come back to me in five years and we’ll chat. The comparison game never serves anyone in any situation and this is no different. We all have our own journeys and comparing our personal journey to someone else’s is a dangerous and sad game to get into. Well-meaning friends will try to lift you up by telling you about a horror story of someone who went through 10 rounds before getting pregnant but they did it! Even comparing in that direction is fruitless because your journey is yours, it’s not someone else’s (and damn if I don’t want to know about the person that took 10 rounds, thank you!)

Being Pragmatic During IVF

I think I’m an optimistic pragmatist. I’ve said from the beginning of our journey that above all, I’m action and solution-oriented. I don’t need to marinate on the issue, I want to know how to resolve it. That’s how my mind works and how I operate in virtually every aspect of my life. Fertility was no different. Test me, give me the results, tell me my options and let’s choose the best available option to move forward. Pair that with the fact that I’ve never been the most maternal person naturally. Scott and I want a family and hope that will happen, but my goal in life has never been to be a mother; it’s been to have a family with someone that I love so we can create an amazing life together. I realize that many women going through IVF are focused singularly on the mission of becoming a mother and that my approach and mindset probably isn’t helpful in this situation.

Here’s the thing though – even for folks out there like me – the ones who are going through IVF, optimistic about starting a family but not necessarily banking their life’s happiness or future identity on it, it’s still emotional. Of course it’s emotional! Add to the fact that they’re pumping you up with gobs of hormones and even the most stoic person out there will cave from time to time.

Emotions are normal, feeling stressed is normal, feeling happy, scared, uncertain… that’s all normal (at least I hope so because I feel all of those things). The one thing that I’ve learned though during this process is the one thing we must get away from is feeling guilty or feeling like a failed round means that you did something wrong. Even if we have the world’s most loving and supportive partner, the person physically going through the IVF process bears a lot. Not only do we have to actually deal with injections and the actual hormones and whatever comes with that, but we’re responsible for the timing and process: take your Estrogen pills at 8AM, 2PM, and 10PM, don’t forget the aspirin and folic acid, take your 25mg shot of Progesterone at 9AM but make sure you don’t forget the shot 135 hours before transfer because it’s critical. Take that Clexane shot in the evenings and don’t miss your daily Prednisone, too for added measure. GAH. That’s like a full-time job, especially when most of us are working and juggling actual careers.

I’ll tell you a story that I hope gives some comfort: I’ve lived on a small island in the Caribbean for virtually this entire process where having access to necessary meds was virtually impossible and all had to be flown in. It’s basically a nightmare situation for someone going through IVF. When I was short on my normal progesterone injections at about 6 weeks pregnant (more on that below), I freaked out. The pharmacist wouldn’t help me as nothing was available on the island and, by the way, the prescription needed to be by a local doctor but no local doctors could help. I was stranded, newly pregnant, dealing with IVF in my own little bubble with no support and no medication. You can imagine how helpless that would feel but simultaneously the guilt I felt for almost certainly ruining this pregnancy if I couldn’t get the meds in my body at the exact time they were due. I mean, didn’t I have a schedule that instructed medication down to exact hours and minutes each day? When I spoke with my doctor, her words stuck with me… if it was a truly viable pregnancy that was strong and meant to last, me missing one shot of progesterone wasn’t going to be what ultimately did it in. I wasn’t to blame and a failed pregnancy wasn’t about me; it was about the viability of the pregnancy on a broader scale. Now, I’m not saying to skip your pills – don’t do that! – but if you’re a few hours late don’t beat yourself up. If you’re concerned about having missed a dose, talk to your doctor for guidance!

When Your Friends Are Getting Pregnant

Okay, this is a topic that I think is probably useful for both groups: the folks struggling with fertility issues and the friends of those struggling with fertility issues. I’m not sure everyone feels this way, but I’ve shared my pragmatic approach to this and I think it’s important for us to realize that these things (fertility) are out of our control. When you’re a Type A overachiever, it’s tempting to think you can somehow outsmart it all; that you can surely figure out the secret answer and make it all work. Fertility is a humbling thing – it doesn’t discriminate. You may be the smartest, hardest working, top of your class, life of the party, have the ‘perfect life,’ and still be faced with these struggles. You can pay for top doctors but you can’t buy your way out of the process. I say that to say that understanding that makes you also realize that there are plenty of people out there who get pregnant naturally – sometimes quite easily! – and your friends may be those people.

My friends may not admit it, but I know that many of them have taken the time to be extra thoughtful when telling me about their pregnancies. They’re conscious of the fact that we’ve been trying (it’s clearly not something I’ve hidden) and I suspect they’re afraid to hurt me unintentionally. As a sidebar: none of them have told me this but I think this is true. I respect that and appreciate it – these are friends who care about me, care about my journey and my feelings and want to make sure that their happiness doesn’t cause me some sort of pain inadvertently.

As I talk about comparison, it extends here. Just because our life journey has brought us this obstacle, it’s not something I wish on my friends (or enemies for that matter). I’m thrilled when my friends don’t have those issues; when their journeys are easier and when they get to go through the process happily. I’m happy to see their children and know that there’s a new generation of wonderful little humans being crafted by people we love. Now, look, I have the normal struggles everyone deals with. Anyone else scrolling through their Instagram feeds to see pregnant belly after pregnant belly after baby pic? It’s normal to have a moment of frustration, not with them and their happiness but with your own challenges. I just try to focus on all the positive things going on in our lives… and then sometimes I book a trip that I wouldn’t do with a baby. 😉

So, What’s Actually Happened Since that First Round?

I stopped sharing our journey at some point not because I felt any shame about a lack of ‘success’ with transfers but I feared friends and family would start feeling sad for me, which has never been my intention. I’m not even sad for myself so I don’t need friends bearing that burden!

So, let’s go back a few years here. My first egg retrieval was textbook. I was 31 years old, I responded perfectly to the entire process and my body seemed at ease with being loaded down with fertility meds. I’d read horror stories about women gaining 8 pounds in two days and dreaded waking up to that situation… it never happened. I felt so thankful and proud of my body for carrying me through the process – being poked, prodded and cajoled for weeks – and bearing the weight of that without too much of a fight. When I went for my retrieval, we had ample eggs which turned into a plentiful stockpile of embryos. There was no reason for me to assume the first round would fail and I rather naively assumed that it would work the first time around based on my good fortune up to that point.

When it came back negative I was bummed and confused; my ‘perfect IVF journey’ was showing signs of being a regular IVF statistic. Then came the second round and third round, using 3 more embryos between the two cycles, and still no positive test to speak of. By the third round, my doctor suggested further testing given everything seemed like it should have stuck at that point.

In hindsight, I wish I would have gotten more tests to begin with, but I suppose it’s a futile debate. If everything seems perfect, there’s no reason to assume you need further testing. The reality is that you may have to go through a few failed rounds before anyone suggests taking the extra steps (read: extra time, money, and stress) to see if there’s anything else at play.

The next two years took me to multiple countries and a number of doctors who assisted along the way: I had two saline infusion sonography tests (including one that almost made my husband pass out) which pointed out a previously undetected uterine issue, then had loads of bloodwork run to verify whether my body was producing NK killer cells that could be killing an embryo. The tests cost thousands of dollars and required logistics on another level being based in Anguilla (overnight FedEx is virtually impossible, and sending blood requires careful handling). I followed that with another egg retrieval, a uterine surgery that required a hefty dose of hormones to heal from, a ‘mock transfer’ to test my body, and an endometrial receptivity test to help doctors pinpoint my exact window for transfer. Phew, you still with me? After that retrieval and multiple failed rounds prior, we sent our embryos in for genetic testing (yes, we coughed up thousands of dollars for it, eek) and happily found that all of our embryos were in good condition – an astounding statistic given they suggested at my age only 50% would be good quality. All of that led to our most recent transfer in November 2019 using one of these genetically great embryos.

And let me pause there for a sec because the process of ‘choosing the embryo’ for transfer is funny to think about. Even at this literal embryonic stage, we’re grading these embryos and pitting them against each other – which one has the best shape, the best potential, the best cells? Let’s go with that one. Okay, cool, yes, let’s go with that one.

So, on this fifth transfer I was armed with all of the info I could possibly have; not really any ‘closer’ per se but perhaps more ready. I was shooting up multiple times per day with progesterone and blood thinners, then popping pills at a rate that makes my grandmother’s pill schedule look amateur. When the transfer worked and we got a positive pregnancy test, we celebrated. I had tempered my expectations throughout this process and I continue to do so – it’s a bit of self-preservation and protection – but it’s normal to celebrate a positive test after years of letting your body be poked and prodded into submission. The doctor advised going in at Week 6 for a scan and just enjoying the process.

My previous doctor had always suggested HCG tests every other day to monitor the pregnancy hormone in my system via blood work. I decided I wanted to do it this time, too. Another sidebar: do what makes you feel right. I chose to get those every-other-day HCG tests. I drove to the hospital every other morning, had blood drawn, and then drove BACK to the hospital to collect the results. Every. Other. Day. It’s not fun, not easy, and it’s very time-consuming but after so many failed rounds I wanted to monitor what was happening in my body, and in hindsight, I’m very happy that I listened to myself.

When You Get Pregnant… and Lose the Pregnancy

I know it seems cruel and there are some of you out there who’ve probably gone through this too. You’ve been through multiple rounds, you did all the things, you took all the meds, and you finally – finally! – got there. You got the positive pregnancy test you were waiting for. You celebrated. How could you not celebrate? Then something happened…

My numbers didn’t look great. Over the following weeks, I would continue to go back for blood tests and watch as the number stagnated, popped up, and then plateaued again. It wasn’t a healthy pregnancy – the doctors looked at the numbers and rather plainly explained that I should expect a miscarriage in the coming days. That didn’t happen – the numbers continued to grow but no pregnancy was found.

Ectopic pregnancies are likelier to happen via IVF and I was one of those statistics. There was no ‘decision’ to make per se, but I had to give the doctor permission to administer methotrexate, a high-dose chemotherapy drug used to end a pregnancy in this situation. Ectopic pregnancies can be life-threatening and it’s important to catch them early to avoid a situation that could be incredibly dangerous. The weeks that followed weren’t fun and I found myself upset with my body for a) messing this up, and b) not bouncing back after the ectopic as I thought it should have. I wanted to work out, live life again, and have my body back but the drugs and situation were traumatic and my body took time to recenter itself. More than a month passed before I could do basic things without pain. I missed my barre classes – I would occasionally go and force myself through only to be doubled over in pain afterward, flinching during classes trying to force my body to be ‘normal’ again. When the pain disappeared, it was almost indiscernible. I went back to normal life seemingly instantly forgetting those weeks that had just passed. I chose to wait before going through IVF again (it’s mandatory to wait at least 3 months after administering this shot). My body had been through a lot and I was far from grateful to it for carrying me through and not dying in the process. I was upset and honestly felt like it was a little ‘unfair’. My months turned into years before we embarked on the process again. We waited during a global pandemic and then found ourselves really deciding whether we wanted to continue the process. I voiced concerns to my doctors. After an ectopic, you’re 10x likelier to have another. What happens if you get pregnant with twins and one is ectopic and one isn’t? It happens, and that’s a decision I would hate to deal with. Ultimately, we felt that we wanted to try at least one more time using the existing embryos we have.

What It Feels Like to Continue After Failures and Hardships… Will Pregnancy Feel Happy?

I’ve chosen to continue but I think it’s also important for us to realize that after five years of going through this process, I’m at a different point in my life. I’m verging on 36, I’ve been through many of these rounds, I have built a busy business, and am in the throes of getting Borgo San Vincenzo off the ground in Italy. My thoughts and perspective have changed over the course of five years and if my thoughts took me to a point where I felt that I no longer wanted to continue on this journey, that would be okay, too. This was a genuine conversation for us and I think it’s probably more common than we care to highlight. As time progresses, we get more selfish (I use that for lack of a better term and don’t mean it negatively). Our lives change, our motivations, goals and trajectories may change. I think it’s important to not continue going through IVF because it’s a mission to accomplish; to not continue because it feels like you should after so many years of time, money, and energy being put into it. You should continue because you actually want to continue, not because you feel like you have to.

I will say that I’ve become more at ease with the process. I’ve learned to give myself more grace and have gone into my appointments recognizing that I’ve done everything in my control. When things work – or don’t – that’s not because of something I did or didn’t do, and that knowledge and grace is freeing.

So, what happens if pregnancy does finally happen after so many stressors? One of the tough realities is that I know pregnancy will never feel happy from start to finish and it will be a fair bit into a pregnancy before we feel true excitement. It’s one of the downsides of the process: it strips the joy out of everything because it makes us hyper-aware of the things that can go wrong. I mean, the amount I now know about embryos, genetic testing, endometrial receptivity, hormones, etc. is insane and while knowledge is power, it also makes you acutely aware of the delicate nature of pregnancy.

That’s where those support systems come in. I said it from the beginning and I’ll emphasize it again: have a support system. If you’re married, lean on your partner – they may not physically be going through it but they probably want to be involved in whatever way they can. If you’re single and doing this solo, have a friend or support community to talk with. Even the strongest and most even-keeled of us will have days that feel wholly out of whack or overwhelmed and daunted. Talk to someone – I swear it helps to just vent sometimes, And if you need someone to talk to, email me if you don’t have anyone that you think understands. ✧

The above was written in April and as anyone who’s followed along now knows, ended in a positive pregnancy test with our baby due December 31, 2022. I’m now about to embark on my third trimester and in re-reading this I feel very much in line with the thoughts that I shared above. I will make a comment about happiness though: there was a great deal of uncertainty for me when I got my positive test back and for the first few scans. I was always prepared for something to go wrong. It took many appointments before I feel like I ‘accepted’ my pregnancy and perhaps longer before I felt like I could be happy. Our anatomy scan at 21 weeks was perhaps the most ‘real’ moment that felt like I could actually maybe believe it was all true. Everyone is different in their timeline, I’m sure, but the realities of becoming a mom still haven’t fully settled for me. Each week brings me closer to truly acknowledging the changes to come as we prepare for a new chapter ahead.