Sunday, July 31, 2016

(6) Her Buns - My Oven

It’s transfer day!  After a restless night the prior evening, Tom and I met Holly and Darren in the OHSU lobby around 10:45am.  We’re all super-excited and super-nervous.  When the medical folks finally call my name, I can see that Holly can hardly contain her emotions. 

Casting modesty aside (again!), I decided to have everyone (Holly, Darren, Tom) in the room with me.  Darren was reluctant to go in, thinking I’ll be fully exposed or something.  But I insisted.  We were about to put two of their babies in me, and I didn’t want him to have any future regrets about not being there for the start of it all.  I assured him I’d be covered up, and that I was completely comfortable with it.  He agreed, but still seemed uncomfortable.  Now, I won’t lie and say it wasn’t weird.  It was.  This was clearly not an everyday occurrence -- more like once in a lifetime. 

Dr. Patton came in to check on us.  He could tell we were ready!  Then the embryologist came in to talk to Holly and Darren.  He gave them an update on the two embryos that have been defrosting for the better part of the morning, after having been frozen for over 9 months.  He tells Holly and Darren they are doing exactly what they should be.  Both are growing and expanding perfectly!  Science is amazing!  We are transferring two five day old Blastocysts (embryos).  This means, when (if?) they implant, I will effectively be 5 days pregnant.  These Blastocysts are microscopic:  only about 0.1-0.2 mm in diameter, and only containing 200-300 cells.  A few minutes later it’s the moment of truth.  Dr. Patton places a catheter into my cervix and signals for the syringe with the embryos.  There is a nurse at my belly with a sonogram so Dr. Patton can see the fluid from the syringe flow into my cervix.  I kid you not, Dr. Patton said “I sure hope this works”!  It was an awkward moment for sure. 

Just after the transfer, I had to lie still for about 20 minutes.  Holding my feet in the air was optional…  It was a surreal experience, having 5-6 people witness the very moment I possibly got pregnant.  After the 20 minute wait, even though I knew that getting up and walking wouldn’t cause any harm, all I could think about was sitting or lying down.  Why fight gravity, right?  And, since I ate all those pineapple cores and Brazil nuts, my uterus should be peanut butter sticky!  By now it’s after noon, and we all have lunch together, dreaming of the future with high hopes.

Holly and me 30 minutes after the transfer
Tom and I head home for a leisurely rest of our day.  Kaela is at home (she’s on spring break) when we get there.  I make myself comfy on the couch in the prone position.  My servants/minions (Tom and Kaela) are handy to get me anything I need, or just to keep me company.  

So far, Kaela is the only one in my family (besides Tom!) who knows I am attempting this.  Her college is fairly close to home, so she’d definitely witness my physical changes.  We all decided to not inform any other family members at first.  With my family in Arizona it was simple.  They wouldn’t be seeing me, so I wanted to spare them the worry if this didn’t work.  Holly didn’t tell her family for the same reason.  After all her prior struggles, why subject her family (again) to the grief of any failure.  In a way, this was also simple for them, because Tom and I have never met Holly’s family or Darren’s family.  Right now, we are strangers to their families.  Before informing others, Holly wanted to successfully pass several pregnancy milestones: 
  • Positive home pregnancy test.
  • Blood test with HCG levels.  A positive home pregnancy test could still be wrong.
  • Ultrasound with a visible heartbeat.
  • Achieve 12 weeks gestation.   Because your chances of going full term increase significantly!
  • Reach “external viability” point -- 24 weeks!
The doctors recommend waiting 10 days until taking a pregnancy test.  These 10 days are crawling by.  I lay low the first few days after the transfer, and then I resume my normal routine.  Going to the gym is something I do routinely (and the Doctor said it was OK), so I go back.  I avoid any extreme physical exercises like a Zumba class (duh!).  But I do use the elliptical and weight machines.  It helps pass the time for my early Friday morning visit to the bathroom (we decided to get an early read with a home pregnancy test).   Friday is just 8 days after the transfer, but Holly can’t wait.  I’m not sure I can either.

Holly has requested that I text her Friday morning no matter what time…. I secretly laugh to myself because I don’t think she realizes how early I get up!

Friday, July 29, 2016

(5) It doesn’t hurt yet…

The day has finally arrived after multiple Lupron shots and daily estrogen pills.  It’s finally time to find out if we can move forward with the scheduled embryo transfer.

Holly wanted to join me for this appointment, but was almost too shy to ask.  I said: “Absolutely!  This is for you after all.”  She said she’d sit in the waiting area while the medical folks take the measurements.  Really?!  I thought we were far beyond traditional modesty by now.  Besides, we’ll be in a clinical environment, where all my “bits” will be covered up.  Holly has done this several times, so I think we both know it’s no big deal.

Nevertheless, I assure her “you are going to be right by my side” (after I get situated on the table, of course).  She is thrilled!  So Holly and I met in the OHSU lobby that morning.  Before the appointment got started, Holly picked up the scary PIO needles.  Eek!  If my lining measurements are good, then I get to start injecting Progesterone in my butt this very evening.  Or should I say Tom gets to…

The lining measurements looked great, so it’s a go for the March 27th embryo transfer.  Eek!!  We shed some happy tears then Holly thanked me for letting her be there.  I thought this was strange, because it was always my intention to include Holly and Darren in all aspects of the process.  If things work out (and they will – remember B positive!), this is still fairly early in what will become an epic journey.  I want them to be right next to me.  I want them to experience everything with me.

Holly and I leave OHSU that morning with huge smiles on our faces, knowing we are that much closer to T-day.   The four of us plan to have dinner later, followed by my first PIO shot at our house. 

Since my ovaries are now “sleeping” (from the prior Lupron injections), my body is not producing the hormones necessary for new life to take hold.  Progesterone is vital, and it’s time to start the intramuscular injections.  An intramuscular injection is used to deliver a medication deep into the muscles.  This allows the medication to be absorbed into the bloodstream quickly.  Guess where the best spot is?  Yep, your Gluteus Maximus.  More small sacrifices! 

Upper for the PIO - Lower was for Lupron

These shots now need to be given every day, at around the same time each day.  We picked 8pm, since Tom is usually home from work by this time.  Usually!  8pm arrives, and we’re gearing up for the first shot.

Holly has done this many time before, and she’s right there to remind me of her routine.  She typically iced the lucky spot, while also warming the syringe with a heating pad.  It is recommended to warm the oil-based Progesterone, otherwise it’s almost too viscous to inject.  But don’t make it too hot because…yikes!  We warm the syringe, taking a guess for the optimal time/temperature (we chose 10 minutes).  I decide not to ice the area.  I’m generally pretty pain-tolerant, and I want to see if ice is really necessary.

Okay, here we go.  Darren leaves the room.  I guess he thinks I’m going to just drop my pants for all to see.  Holly is by Tom’s side just in case he needs back-up.  I pull the top edge of my pants down and prepare the “SPOT”.  I take an alcohol rub and clean the area and pull the skin tight.  Tom is nervous, but I have confidence in him.  He jabs the needle in, and slightly pulls back on the plunger to check for blood.  Seeing none, he gently pushes the plunger of PIO in.  Perfect.  It absolutely DID NOT HURT!  I felt nothing.  That’s how smooth Tom was.  Holly cannot believe that I didn’t feel anything, but she’s happy because she doesn’t want any discomfort for me.  So sweet!  Immediately afterwards, I gently massage the area to help move the Progesterone around to assist absorption. 

Cool, only 77 more of those – assuming a successful transfer and a positive pregnancy test of course. 

Now just 6 days until the transfer…

Thursday, July 28, 2016

(4) Sleeping ovaries and small sacrifices

Starting this “transfer protocol” is such a huge relief.  The fact that all of us were able to get all the required preparations done in about a months’ time is astonishing!   All four of us are extremely excited but we’re also guarded, because we’re told this upcoming embryo transfer has only a 50/50 chance of working.  So while we are staying positive (especially me), we know that it might not work.  Actually B positive is my blood type, so I also started using it as my motto.

First, I have to wait for my next cycle to start.  Not something I usually look forward to.  Tick-tock, tick-tock, and finally it happened!  Then I was able to start taking my birth control pills.  Yes, birth control.  It seems like the last thing you’d want to do when trying to become pregnant is to take birth control pills, but it is the first step in the fertility doctor’s process of taking complete control of what my reproductive organs do.  Oh fun!

Meanwhile, as the birth control kicks in, I’ve been having serious thoughts about quitting my job.  I started working at a new company back in October.  It’s in a cleanroom environment, which means wearing a full bunny suit for a 12 hour shift (with breaks of course).  They hired me as a temp (along with 15 others) and I’m having concerns about the stress of this job affecting my “very important project”.   Tom and I decided that this “project” is much more important than my “temp” job.  So I’ve decided to give my 2-week notice, leaving open the possibility of returning at a future date.  In my mind, this is a small sacrifice.   I also didn’t want to worry Holly about it, so I told her I took a leave of absence (he he).  A little white lie to help ease someone else’s concern was okay in my mind.

As I begin the early stages of the protocol, I start thinking about everything that goes into my body.  I want to give these two embryos the best chance of “attaching”.  Even though in the back of my mind I am quite confident I will become pregnant.   I stopped consuming caffeine, which wasn’t as difficult as I thought it would be.  I just switched to decaffeinated coffee.  Easy!  I don’t drink carbonated drinks anyway, so easy-peasy!  I stop eating anything with artificial sweeteners.  Now, anyone close to me knows I usually eat everything “diet”, but this wasn’t as hard as I thought either.  Yay for me!  These two embryos have been frozen for 9 months, so I will do everything in my power to give them the best start possible.  Again, to me it’s a small sacrifice.

At day 14 of my birth control, I get to start injecting Lupron into my belly fat.  Yep, I said belly fat, and I said inject!  Lupron is a drug that shuts down all ovary production.  Essentially, I’m putting my body into the first stages of menopause!  It’s all part of the process to make sure my own biology does not interfere with the embryo transfer and attachment.  I was a little apprehensive the first couple of times, but I was using a “diabetic” size syringe, so I hardly felt it.  Then an idea occurred to me.  In a few weeks I will have to start using a much larger needle, and it has to be stuck in my BUTT!  Obviously, that will be a little difficult for me to do on my own.  I think to myself, TOM!  Now Tom has known about these “bigger” needles and the need for someone to give these daily shots.  He has been trying to find anyone but him to do them.   So I think maybe if he starts doing the Lupron shots, he’ll be more comfortable doing the big-needle PIO (Progesterone In Oil) shots.  Reluctantly, he starts giving me the Lupron.  Go Tom! 

Holly told me about a few old conception wives tales out there in the world of Google.  So I happily research some more, because why not?!  I came across many, but only tried a couple that I thought wouldn’t be too bad.  Pineapple core:  It is said that it makes your inner uterus nice and sticky!  I like pineapple, so again, why not?!  Raw Brazil nuts:  It is said to thicken the uterine lining.  Well, I’m having my lining measured 1 week before transfer, so why not?!  Plus, I like Brazil nuts (salted of course).    

We are only a week away from transfer now, and my next appointment is for an ultrasound to make sure my lining is at the correct thickness.  If the thickness isn’t acceptable, then it’s back to step one -- which is to take birth control again after I have another period.  Ugh.  Let’s B positive about my upcoming measurement!

Monday, July 25, 2016

(3) Doctors, Lawyers, and Psychologists – Oh my!

I had to pass certain tests to be considered an acceptable gestational carrier.  Volunteering my womb was only the first step.  You don’t just walk in and say: “Oh hey, here I am.  Put an embryo in me.”  Qualification involves many steps, some physical, some psychological, and some legal.  In our case, most of the rules were set by OHSU in Portland, Oregon.  In the “physical” department, you won’t be accepted unless you’ve had at least one successful pregnancy (preferably two or more), with minimal or no complications.  I’ve had two.  Check!  One of my biggest concerns was my age.  I was worried I’d be denied because I was 45 years old at this time.  Interestingly, age is not really a deciding factor (above a certain legal minimum) for gestational carriers.  Yes, I was older than the average gestational carrier, but nowhere near setting a record in this department.  (By contrast, upper age limits are set for surrogates, since a surrogate is using her own eggs.)  To be a gestational carrier, your physical condition is important, and I’ve always tried to stay physically fit.  I exercise regularly, eat in a (mostly!) healthy manner, rarely drink alcohol, and don’t smoke or use drugs.  Check!  Right after making my offer, and even before knowing if I’d be accepted, I started limiting caffeine, and I completely eliminated alcohol.  To me, this was a small sacrifice for this important project.  I didn’t want some minor vice to jeopardize my success.
Medical insurance verification was next.  We were unsure if our insurance would cover a pregnancy started through IVF.  Not all insurance companies do.  Luckily, our insurance company covered pregnancy, no matter how the pregnancy actually got started.  But like most (maybe all?) insurance companies, ours did not cover any of the IVF costs.  This was OK and expected.  Darren and Holly already had that covered.  Check!

OHSU also required a legal contract between the intended parents and us.  Holly found some examples of surrogacy contracts, so we wrote up our own.  It was interesting to see examples of financial demands placed upon other intended parents in these internet examples.  We saw examples of women asking for large fees for their service, and additional compensation for much or all of their living expenses for the duration of the “project”.  We had no desire to impose such fees.  On top of all the other IVF costs, the high cost (a few thousand dollars) of paying a lawyer to validate/notarize a contract that we wrote pushed Darren and Holly to question whether or not to proceed.  It seemed like such a waste of money for a lawyer to do essentially nothing!  We offered to pay this fee or split it with them, but Darren and Holly refused to even consider this.  Holly found a lawyer who quoted a more reasonable rate, so we continued.  Check!

During the writing of the contract, my husband and I discussed two very key topics: (1) how many embryos to introduce; and (2) influencing a future baby name.  For topic (1), introducing just one embryo didn’t seem like enough.  The odds are a coin flip at best.  This might be the only chance for Darren and Holly to have a family.  Introducing two seemed OK.  Odds were increased, and I thought I could handle twins if it came to that.  Introducing more than two seemed dangerous to me, and maybe a bit irresponsible (remember “octo-mom”?).  After discussing with Holly and Darren, we decided on two.  As for (2) naming; in the contract my husband and I officially relinquished all rights to naming any future child(ren).  However, out of concern for a known fascination Darren had with the name “Elmo” (of Sesame Street fame), we added the following sentence to the contract: “Genetic Father agrees not to name any Child(ren) Elmo”.  Although there were some minor revisions to the initial contract draft, the Elmo restriction remained in the signed/notarized version.  Whew.  Our lawyer was so good, he never even saw it!

But there were more requirements to meet.  Below is the “Gestational Carrier Screening Checklist” from OHSU for me (and my husband).  Oh yes, any “partner” needs testing too!
Gestational Carrier:
Step 1 – Fertility Physician consultation
Step 2 – Initiate legal contract
Step 3 – MFM consultation
Step 4 – Certified Fertility Counsel
Medical tests:
Full blood panel (results within one year of transfer)
Pap Smear
SIS/HSG/Hysteroscopy  (Any ONE procedure is fine)
Trial Transfer (only at OHSU fertility consultants)
Mock Cycle (if needed)
Partial blood panel (within one year of transfer)

Medical qualification started with blood tests.  The required blood work was extensive, not just checking if readings are in normal ranges, but also checking for various diseases, viruses, and even STD’s.  The pokes and prods resulted in a clean bill of health for me and my husband.  Check!

SIS test:  The doctors doing the transfer also had to see what my uterus looked like.  Who knew my uterus was going to be so popular!  I underwent a Hysteroscopy, where they put a thin tube through the cervix and fill the uterus with a special fluid.  This reveals the shape of your uterus and highlights any potential problems.  Timing is critical.  This test must occur just one day after you’ve finished a period.  Luckily, my timing was just right for us to stay on schedule.  Check!

Maternal Fetal Medicine consultation:  I was required to see a MFM specialist, which was even more important because of my age and the fact that we decided to transfer two embryos.  MFM’s specialize in high risk pregnancies.  If I became pregnant, I would automatically be considered “high risk” because of my age.  I met with Dr. Winkler, a smart and witty guy who I immediately hit it off with.  He said that I could absolutely move forward, and that I was healthier at my age than some of his much younger patients.  Check!

Certified Fertility Counsel:   A shrink?  Really?!  Oh yes!  Don’t think you can just walk in and carry the child of another couple like it’s no big deal.  At first I didn’t really understand why we (oh yes, my husband too) had to get this psychological assessment.  After all, we’re just normal people, right?   But after talking to the evaluator, I realized it was a necessary step.  They can’t have people with medical, financial, mental or marital problems carrying such precious cargo.  We got through the joint interview, the individual interview, and the extensive multiple-choice quiz (250 questions) with passing results.  Check!  Holly and Darren were also required to see a counselor.  They passed too.

Trial Transfer:  This is where they “practice” the procedure of introducing the embryos.  They do this with a sonogram, taking video so they can see the best way to insert the tube into my cervix.  They also see where my bladder is, and any other anatomy that might get in the way of their view.  Surprisingly, it wasn’t uncomfortable.  It was a lot like having a pap smear, except with high tech equipment all around.  There were no issues.  Check!  I was also able to combine this trial with the Fertility consult -- Double check!!

Even though the checklist was extensive, we completed it all by the end of January.  Speed was necessary though, because Darren and Holly had a serious time constraint.  They were down to the last of four previously purchased transfer attempts, and the fourth needed to be concluded before early April, per their contract.  But this was only the first phase.  There was more preparation to complete before the embryo transfer.  I’ll call this the “transfer protocol”, which takes about 7 weeks.  We’re cutting it close…

Sunday, July 24, 2016

(2) Will they or won't they?

The very next day, Darren responded to my email offer.  He said that I was very sweet for offering, but they really had not thought seriously about what their next step would be, and that they’d be in touch later.  I understood.  They just suffered an unimaginable loss, and needed more time to recover.  But in the back of my mind I was concerned that I had overstepped.
So as my husband and I waited to hear back from Darren and Holly, we did some research, mostly with the help of our good friend Google.  We read more about IVF, state laws concerning surrogacy, frozen embryos, etc.  We learned that surrogacy is not legal in all 50 states. We also learned that I didn’t actually offer to be a surrogate, but rather a “gestational carrier”.  So what’s the difference?
  • ·         A surrogate is a woman who uses her own eggs to become pregnant for another couple. She would legally be the genetic mother but she would relinquish all rights to the IP (intended parents).
  • ·         A gestational carrier does not supply any eggs.  The embryos of the IP are placed in her womb.  There is no genetic relationship between the embryos and the gestational carrier.  The child(ren) are biologically/genetically products of the parents, just as if they were conceived traditionally. A gestational carrier is essentially the oven cooking someone else’s buns! 

Back to my story:  After 10 agonizing days, Darren sent an email invitation to get together and discuss my offer.  In the email he seemed concerned that I might have reconsidered.  We met for dinner, but somehow the topic never got discussed!  (We each thought the other would bring it up.)  Somewhat confused, we returned home and soon received a detailed email from Holly which outlined the good, the bad, and the ugly aspects of IVF.  I already knew most of this, so I responded quickly, reaffirming my offer.  But then we heard nothing from Holly or Darren. Nothing!  Now I’m worried all over again.  Will they accept my offer, or won’t they?

After a week went by, I couldn’t take it anymore.   I called Holly, only to discover that she never received my email (thanks Yahoo!), and that she was worried about ME getting cold feet and backing out.  Looking back, this miscommunication now seems amusing, but it was pretty stressful for both of us at the time.  We agreed to meet again, this time for a serious discussion.

Our breakfast meeting stretched well past lunch and into the early afternoon.  I think Holly and Darren were giving me every opportunity to back out.  I also think they still had serious doubts that my offer was genuine.  Holly had multiple first-hand experiences with the challenges of IVF pregnancy, and really couldn’t believe someone would just volunteer to do it.  We left the restaurant that day agreeing to proceed.  I was excited, but soon learned there was more to this “project” than I realized.

Friday, July 22, 2016

(1) In the beginning

In 2013, I offered to carry a frozen embryo so my friends could start their family.  Here is my story.

First of all, I’ve always considered myself a normal woman living a normal life.  I am certainly not a writer.  Even this experience seemed normal to me at first.  Looking back, I now realize it was anything but normal, and I feel compelled to capture it in writing.

So how did our journey begin?  It all started when my husband and I moved from Arizona to Oregon in 2007. 

My husband began his new job immediately, and I began looking for something new for myself.  I’m a hands-on person, so I enrolled in a Baking and Pastry course at Oregon Culinary Institute.  Although I acquired new skills (and my husband and his co-workers got lots of treats), I discovered that I lacked the passion to make it a career, so I continued to look elsewhere. In 2009 I landed a job at a major retail eyeglass company.  My job was in the laboratory, where we fabricated the lenses on-the-spot for customers.  It was a hands-on position that suited my skills.  Darren also worked in the lab, having recently transferred from another location in Washington State. We became friends as well as colleagues, and often discussed our spouses, along with the all the ups and downs life brings.  Darren and his wife Holly were a young couple, but had been struggling unsuccessfully to have a baby for several years.  Out of the blue, I thought to myself:  “I could have a baby for them”.  I can’t tell you why I thought this, but I did.  Maybe it was fate.  Or maybe it was because I knew I was one of those women who conceives easily, and has smooth pregnancies.  I actually enjoyed being pregnant with my own kids, and never even experienced negative side-effects like morning sickness.  So I casually mentioned to him and another co-worker one day while working that I would be willing to be a surrogate for them.  Nothing came of this conversation.  Darren and Holly were trying everything they could to do this on their own, including IVF (In-Vitro Fertilization).  Using a surrogate (or more correctly a “gestational carrier”) was not something they were even considering.

Fast forward a few years, and Darren and I now work at different companies.  But we’re still friends and get together semi-regularly.  During one get-together, Darren announced that after many failed attempts, Holly was finally pregnant.  It was even more exciting to learn that she was carrying triplets!  I cried happy tears upon hearing the news, and hoped for the best.  As for Darren and Holly, they were now attempting to plan for this major change in their lives.  Despite trying to start their family for some time, triplets were a surprise, but a welcome challenge.  Three of everything, a big enough vehicle to fit everyone, etc….
Just a few weeks later I heard some bad news.  One of the triplets showed no heartbeat at the 9-week ultrasound check.  Sad, yet optimism prevailed, as they still had two healthy babies growing.  At the 17-week point (and one day after her birthday),  Holly felt some liquid trickling down her leg.  The immediate trip to the hospital confirmed more bad news:  the sac surrounding their little girl had ruptured.  Brinly couldn’t survive these circumstances, and was delivered one week later. Holly and Darren were heartbroken but had to stay positive.  They still had a healthy little boy to think about.  But more bad news was in store.  At 21 weeks, just three weeks shy of the generally-accepted minimum external viability of 24 weeks, an uncontrollable infection required Holly to prematurely deliver Jude.  Jude made the ultimate sacrifice to save his mother.  Holly, Darren, and their families were devastated!  From a distance, so was I.

Until meeting my friends Holly and Darren, it had never really occurred to me that getting pregnant could be challenging.  I just figured you decided to have children, got pregnant, and repeated this sequence until your family was complete.  I have two grown children, both of whom were conceived without challenges.  I was lucky.  Holly and Darren taught me that many couples are less fortunate, and struggle with infertility due to various reasons.

The very night of Jude’s passing, I told my husband I was going to reach out to Darren and Holly, and offer my body to carry a baby for them.  I wasn’t really asking him for permission.  My mind was made up.  I knew I had to do something.  Below is my actual email.

It took some time before they wanted to talk about it, and this worried me. Did I choose the absolute wrong time to bring it up? Will they accept my offer?