Have Needles, Will Travel

This weekend we went to Texas. Aaron has business in Dallas today and tomorrow, so we decided to squeeze in a visit to friends and family before his conference. It was a truly delightful time. In the span of 24 hours and 200 miles, we had fellowship with long-standing friends, ate a tasty breakfast with my mom, dad, brother and grandpa, surprised Adam & Brooke (see sidebar) for their much-anticipated baby shower, and enjoyed some Tex-Mex. I flew home this morning, while Aaron stayed on for work. Thanks to all who hosted us, laughed with us, encouraged us, stayed up late with us...

I took my last BCP and started Lupron last night - which meant I traveled cross-country with needles! With cooler pack, medicine vials, alcohol wipes, needles, sharps container, and note from my doctor in tow, I passed rather uneventfully through all the airport security lines. As the PA system blared about the elevated security level, TSA employees basically ignored my explanations and waved me on. One X-ray inspector asked, "Is that food in your bag?" Yes, you know me, I love ingesting sharp, pointy objects... Yesterday evening, we left from Waco at about 8:30 p.m. to head up to Dallas. As we started up I-35, I realized that we would not make it to Dallas before 10 p.m., thereby missing the 7-10 p.m. window in which I was instructed to take the Lupron. I contemplated injecting myself in the car of a 7-Eleven parking lot where we stopped at one point, but ultimately I determined that it was probably okay to take the medicine a little late. Ah, adventures! Nurse Answers said that my next cycle could start any day after I start taking the Lupron. Then I feel like we'll really get started with this IVF.

By the way, we decided to ask the clinic to attempt to fertilize only four eggs. Thanks to all who prayed for us as we made this decision.

IVF #1, Suppression Day 22

Today was the mock embryo transfer/saline sonogram; it went quite smoothly and I hardly felt anything. Dr. Peppy had no problems navigating the catheter through my cervix, so that bodes well for the actual embryo transfer next month. (Random note of interest: "saline sonogram" is the #1 search term that leads people to my blog, to this post.)

Yesterday I received the huge box of all the meds for this IVF. I currently work out of my pastor's home, and his kids are always very excited when I receive packages. When they asked what was in the box, I told them it was medicine. The oldest said, "That must be enough medicine for a whole year!" To which I replied, "Nope, it's only enough for about a month." Awed silence followed... When I looked at the receipt, I praised God for our insurance. The total cost of all the meds: $2153. What we paid: $153! This IVF really would not be an option for us without such excellent coverage.

We would covet your prayers as we finalize our decision about how many eggs to attempt to fertilize. Dr. Peppy and Nurse Answers informed us that the embryology lab recommends that we attempt to fertilize six eggs in order to end up with two embryos to transfer and none to freeze. Six seems a little high to us; we had originally thought to try to fertilize four. We are praying for wisdom, getting counsel from others, and trying to weigh out biblical principles and medical advice. For most of this week, I have been tempted to anxiety about all the decisions and all the procedures. I need to trust that God will not let me be overwhelmed...

IVF #1, Suppression Day 19

Yesterday's "injections lesson" with Nurse Answers was, well, much more than that. It was very informative, if the definition of "informative" is "an overload of overwhelming reams of forms, list of medications, and varieties of very long and sharp needles."

We set the tone well when, about to walk out the door to drive to the appointment, we remembered that we forgot to read through and sign the consent forms. So while we were in the car, I sped-read each one and summarized the options for Aaron. Some choices were rather obvious for us - like initialling the box that says we will not agree to multiple-fetal-reduction. Some were rather morbid - who would have legal ownership of our embryos if one or both of us were to die? Taken as a whole, though, I am glad that the consent forms put our wishes for IVF in writing - things like limiting the number of eggs fertilized, not granting permission for any viable embryos to be destroyed. It is assuring to have legal documentation that this IVF will be carried out within the boundaries that we feel are pleasing to God.

So after Nurse Answers witnessed our signatures to all the various and sundry contracts, she handed me my IVF schedule. Going through that list definitely brought home to Aaron and me how intensive this procedure will be. I thought I had a pretty good idea what to expect, but I was somewhat shell-shocked to find out how many things happen during IVF that I had NO IDEA about. I will be taking a LOT of medications! I knew about the Lupron (which I start on Sunday), the Follistim, the Ovidrel, the progesterone. But the antibiotics (because my body will be invaded by many foreign objects)! The immunosuppressors (so my body doesn't reject the embryos as hostile)! The baby aspirin (to increase blood flow to the uterus)! Oh my! I am about to become a walking pharmacopoeia*. Aaron and I exchanged many wide-eyed looks as we went over the schedule, and Nurse Answers kept reminding us that we won't be doing everything at once. Thank the Lord for that! I certainly don't feel like I will remember all the instructions we were given for each medication. And Aaron sticking a large, long needle into a blue foam block does not seem like enough practice for when he will be injecting progesterone into the muscle in my rear! But we'll take each bit as it comes, trusting God to provide the grace and strength for each day...

This IVF cycle finally feels real. We are actually doing this. We are so glad that we are resting in God's hands, that he is present with us in every moment.

*For the record, I spelled that right on the very first try!

Heard Around Town Last Week

Me to non-fertility-specialist nurse at annual check-up: "What prescriptions am I taking daily? Um, let me see... birth control pills... and prenatal vitamins."

OB-GYN who did not initially take seriously my concerns about infertility, whose office failed to diagnose my luteal phase defect, and who finally referred me to Dr. Peppy a year ago: "Hmm, I thought I'd be seeing you back here before now... Well, if you want to get pregnant badly enough, it'll happen." (Is that what he learned in med school?)

Five-year-old nephew to me: "You're not a real grown-up until you have babies." (This is the same nephew who has offered up sweet prayers for his uncle and aunt to have kids.)

Thank the Lord for a sense of humor!

IVF #1, Suppression Day 14

We had our IVF consult with Dr. Peppy yesterday morning, and it went pretty well. I had previously mentioned to her our preliminary concerns about doing IVF in a way that suits our conscience, and yesterday Aaron and I were able to talk about wishes out with her more clearly. She understands that we do not want to freeze or discard any embryos, and she will work with us to comply with our desires. She e-mailed the embryology lab to find out how many eggs we ought to fertilize to end up with 1 or 2 viable embryos to transfer, and I'm supposed to follow up with her next week to find out the response. Dr. Peppy's guess was that we ought to attempt to fertilize 3 or 4 eggs, which is in line with what Aaron and I anticipated. With an 80% fertilization rate, trying to fertilize 3-4 eggs should yield the targeted 1-2 embryos. (It is so strange to talk about the creation of life in terms of such statistics! I'm thankful that new life is really in the hands of our sovereign God, and not dictated by percentages.) We asked if the clinic would allow us to transfer back 3 embryos if we ended up with that many, and Dr. Peppy seemed pretty adamant that the clinic would not want to transfer more than two embryos, since I am under 30 and this is our first IVF. She didn't rule it out completely, but she copied the ASRM (American Society for Reproductive Medicine) guidelines for us. We also asked if they would be willing to transfer back non-viable embryos (ones that have stopped growing, no cell division) along with the viable, growing ones. Basically, we thought we would be more comfortable letting the non-viable embryos at least have a chance in the uterus, and we figured it wouldn't make a difference to the medical professionals whether those embryos languished in a petri dish or in my womb. However, Dr. Peppy said that is not an option, because transferring back non-viable embryos might interfere with the implantation and growth of any viable embryos. I feel okay with that, since a non-growing embryo is not really alive anymore, and we would not want to harm or hinder the embryos that are alive. The beginnings of life are so mysterious, but all we can do is operate on the principle that life begins at conception and trust God with all the miraculous minutiae.

Dr. Peppy said two things at the consult that particularly surprised me. One is that the lab might use intracytoplasmic sperm injection (ICSI) to fertilize our eggs. I thought that ICSI was normally reserved for more extreme male factor infertility, but I guess our fertility center uses it pretty much interchangeably with the more standard practise of allowing fertilization to happen "naturally" in the petri dish. In fact, Dr. Peppy said they could even do a 50/50 split between ICSI and standard fertilization. I had no idea that was ever done! The second surprising bit of information is that our odds of success are not lowered by the limited number of eggs we are allowing to be fertilized. I thought that surely Dr. Peppy would rescind her prediction of a 50-55% success rate for our IVF. But apparently that statistic is based on our ages and on transferring 1-2 embryos, regardless of the number of eggs fertilized. Pretty good news, I thought!

So after the consult, here is our IVF plan:
I continue birth control pills until April 22, then I will start Lupron shots for about 10 days. On April 16, Aaron and I will get an hour-long lesson on all the new injections from Nurse Answers. April 20, Dr. Peppy will do a mock transfer and saline sonogram on me. Sometime around the beginning of May, I will start Follistim injections to stimulate ovarian production, and I will go in for monitoring (ultrasound & bloodwork) approximately every other day. Once the follicles look ready, I'll take the Ovidrel trigger shot. All of the eggs will be retrieved, the lab will attempt to fertilize 3-4 of those, and hopefully we'll have 1-2 embryos to transfer back a couple days later. Then I will start daily progesterone-in-oil (PIO) injections while we wait two weeks to find out if any transferred embryos actually implanted to result in pregnancy.

If you didn't catch all that, don't worry - I'm sure I'll share plenty of details about each step along the way!

Like a Barren Tree, Part 4

Having seen the root of my sinful responses to the affliction of infertility, and having seen the effect of the cross of Christ on my heart, I can now turn to change with freedom and hope. The third tree of the Three Trees diagram has deep, rich, healthy roots and blooms with pleasing, sweet fruit.

Good Root - What SHOULD you desire, love, fear, believe in this circumstance? What truths should you believe about God, yourself, and others? What does Scripture encourage you to desire, fear, and believe?

I should desire that God be glorified through the trial of infertility, as he develops perseverance, character, and hope in me (Romans 5:3-5). I should believe that God is working infertility for good in my life (Romans 8:28). I should love my Savior more than the idea of having children. I should be satisfied in Christ.

Good Fruit - What SHOULD you feel, think, say, or do if you are loving God more than anything else?

I should trust God for my future and my family. I should be grateful for my salvation, my blessings, and my difficulties. I should rejoice with others and extend compassion and grace to others. I should seek refuge in my Redeemer.

Consequences - What are the consequences?

I will experience peace, rest, joy, and hope. My life will bring honor to God and encouragement to others.

The Three Trees diagram has been such a help to me over the course of this battle against infertility and all the sin it unearths in my heart. If you are currently facing difficulty, if you are seeing negative patterns in your life, don't be disheartened. There is a great Savior who has borne the burden of sin and suffering, who extends a lifeline to lift us out of our dark holes. His Word promises hope: "Now may the God of peace himself sanctify you completely, and may your whole spirit and soul and body be kept blameless at the coming of our Lord Jesus Christ. He who calls you is faithful; he will surely do it" (1 Thessalonians 5:23-24).

Like a Barren Tree, Part 3

(See Part 1 here, and Part 2 here.)

So now that I’ve dug up the dirt and uncovered the gnarled roots of my sin, where can I find hope and help? At the cross. At the cross, where God in the flesh was wounded for my transgressions and crushed for my iniquities. At the cross, where the perfect, spotless Lamb suffered meekly in my place. At the cross, where Immanuel - God with us – was forsaken by the Father so that I would never be. At the cross, where grace flows freely with the blood of Christ.

(Continuing with the Three Trees diagram...)

The Cross – How does the reality of Christ’s finished work affect your circumstances and your heart? Will you turn from the lies you have practiced and believe? Will you believe the truth of the Gospel?

The cross reminds me that my worst problem is my sin, not my infertility, and the cross provides the solution for my sin. When I feel like I deserve the blessing of a child, the cross reminds me that I have already received much better than I deserve. Because of my sin, I deserved the just punishment of death; because of Christ, who bore that punishment, I receive a relationship with God and the hope of heaven, and this should be enough to fill me with joy. Through the finished work of the cross, God can change my heart to be content with whatever circumstances he ordains for my life.

On this Good Friday, I remember the cross. I mourn the death of my Savior, and I rejoice in the love and forgiveness he extends to me with outstretched arms and pierced hands.

Like a Barren Tree, Part 2

(Read Part 1 here.)

The Three Trees diagram has a few basic components. One is called the "heat" - the circumstances of our lives that beat down like a desert sun. Next, there is the bad fruit - the crop of ungodly behaviors and thoughts that ripen under the heat. The bad fruit comes from a bad root - the wrong beliefs and inordinate desires that yield rotten fruit. The bad fruit and bad root make up the first tree. The second tree is the cross. The cross represents the Savior's work that frees us, forgives us, and transforms us. Applying the cross to our lives leads us to the third tree. The third tree has good roots - true and right beliefs about God and ourselves. Good roots produce good fruit - actions and thoughts that are pleasing to God, blossoming even under harsh heat.

This post will describe the heat and the thorny tree in my life:

Heat - Describe the situation/trial you are facing. What happened? Who was involved?
My situation is 2+ years of infertility, with no definite end in sight. I have endured month after month of disappointed expectations. I have seen many other friends blessed with children. My husband and I have undergone lots of medical procedures and have been faced with hard decisions about how to build our family.

Bad Fruit - How did you respond? What did you feel, think, say, do? What does Scripture say about these responses?
I have felt jealous of others, thinking that I deserve children or wondering why others seem to deserve children when I don't. I feel self-pity as I watch time slip by and see milestones pass - holidays, birthdays, years, etc. I feel weariness, grow tired of the burden of ongoing affliction. I have fearful and anxious thoughts about the future, often expecting only more difficulty from God's hand. Scripture says that envy, self-pity, fear, and anxiety are sinful.

Bad Root - What did you want, fear, believe? What lies are you believing about God, yourself, and others? What does Scripture say about these desires, fears, and beliefs?
I want a child, and I want one in my own time and way. I fear that God will never give me what I want. I believe that I cannot be content or satisfied without a child. I believe the lie that God is not good or kind. I believe the lie that I need more than my Savior. Scripture says that I have no good apart from God, that I can be content in all circumstances, that I need to submit my desires to the Lord.

Consequences - What are the consequences?
As a result of the bad root and fruit, I experience anguish and disappointment. I lack hope and joy. I let my fearful thoughts spin out of control. I encounter challenges in friendships. I seek refuge in things other than the Lord. I complain. I judge others as insensitive or uncaring about infertility.

Oh, what a desperate sinner I am! But these questions distill the confusing barrage of emotions and thoughts that accompany my infertility into a clearer view of how barren my heart is without grace. Stay tuned for part 3, where the cross provides mercy in time of need.

IVF #1, Suppression Day 5

For the first time ever after a medicated cycle, I am cyst free! After yesterday's ultrasound and bloodwork, I have the green light to begin suppression for our first IVF cycle. For those of you unfamiliar with the IVF protocol, the first month of the process involves suppressing my hormones and ovaries. This will give the medical team greater control over my egg production when we stimulate my system next month, so that hopefully we can avoid over-stimming. For the purposes of suppression, I will be on birth control pills for 21 days (starting yesterday), and then I will use Lupron shots for about a week. I am praying for minimal side effects from both medications.

On April 11, Aaron and I will have a consultation with Dr. Peppy to determine all the logistics of the actual retrieval of eggs and transfer of embryos. I'm working on a list of questions to ask at that consult. One that I am most curious about is if there is an upper limit to the number of embryos they will transfer. If there is, that will automatically determine for us how many eggs we will attempt to fertilize, since we don't want to freeze or discard any embryos. For those who have done or considered IVF, are there any other questions you recommend asking Dr. Peppy?

As we begin this first IVF, we are praying that God will direct us each step of the way. As far as we can tell, it seems possible for us to pursue IVF in a way that honors God and that honors life. If there is some red flag we are not seeing, however, we are asking God to clearly stop us from going forward. During this month of suppression, we are holding our ideas about IVF with open hands and continuing to seek counsel from others. If you are reading this, your prayers, questions, and input are welcome!