I recently listened to “The Retrievals,” a Serial podcast that tells the story of a situation at Yale’s fertility clinic where hundreds of women underwent egg retrievals with limited to no pain medication because a nurse was diverting fentanyl.  I have quite a bit to say in response to the podcast, but thought I’d better start by picking up the thread of my own story and talking about our egg retrieval.

Our doctor in Seattle recommended we try in vitro fertilization (IVF) after our 4th miscarriage. Her hypothesis was that poor eggs or sperm had led to embryos with chromosomal abnormalities, thus causing our losses.  By testing embryos prior to implantation we could potentially prevent that type of loss. I can’t say I necessarily believed this, but at that point, I was willing to try anything, so I agreed. 

Much has been written about the IVF process, so I doubt I have anything unique to add.  But it’s an important part of our journey that needs to be told.  There are several steps in the IVF process.  This post will only focus on the first step, the egg retrieval, which, for me, was AWFUL.

Ok, so, mini-biology lesson… Picture my little misbehaving uterus.  She has two “arms.”  Those arms are her fallopian tubes and on the end of them are her ovaries.  Ovaries contain follicles – small fluid filled sacs containing immature eggs.  Usually just one of these eggs matures over the course of a menstrual cycle.  Once mature, the follicle breaks open and sends the egg down the fallopian tube to be potentially fertilized.  But, for IVF doctors want lots of eggs to mature, and they don’t want any of the follicles to break open otherwise they can’t go in to surgically retrieve the eggs. 

The process starts with birth control.  Birth control serves to “quiet” the system and prevent any follicle from maturing on its own. (I still find this ironic since the only reason I subjected myself to IVF in the first place was to get pregnant.) Then, once the ovaries are quiet, they need to be woken up – LOUDLY. 

I had to give myself a daily injection of stimulation hormones to help the eggs mature, and wow, did mine mature. I’m what they would call a “good responder.” On the day of my egg retrieval, the nurse told me my ovaries were the size of small grapefruits.  Read that again… grapefruits!! 

What did that feel like? B L O A T. Everywhere I went, I felt like a slug dragging my bag of eggs behind me like a slimy ball and chain.

I was also taking medicine to prevent my ovaries from releasing those grapefruits full of eggs – another daily injection – and my slug-self had to visit the fertility clinic every other day for a blood draw and transvaginal ultrasound. 

Every woman’s body responds slightly differently to the stimulation medications, so doctors have no way to predict exactly when an individual will be ready for retrieval other than monitoring egg development via hormone levels and ultrasounds. It’s not an overstatement when women say IVF feels like a second job. It was a LOT of appointments. I got on a first name basis with the phlebotomist and the front desk staff. 

I don’t have many precise memories about this part of my journey. Honestly, a draft of this post has been written for about two years. I think I’ve avoided finishing it because I still feel pretty negatively about about my IVF experience. I remember being overwhelmed by the sheer number of medicines my body was being asked to consume.  I remember growing tired of the regular drive into the city for appointments. I remember being supremely uncomfortable. But mostly I remember feeling resigned.  I was trudging diligently along, like the little engine that could, doing anything the doctors told me if it promised to bring me a baby at the end.   

When you haven’t gone through it, IVF seems so simple.  Science! Wham! Bam! Baby! 

In reality, IVF is a constant effort of physical endurance and expectation management.  Everything has to happen around your cycle.  If you have an important meeting, a work trip, an important personal event which can’t be moved, it’s not like you can reschedule your egg retrieval or your embryo transfer to the following day or week. You wait another month.  We started the IVF process in February.  Our retrieval was in May.  Our first transfer wasn’t until September.  It is a long, expensive process with huge personal implications no matter the outcome.

On May 1st, 2018 I presented myself to the clinic to have my eggs harvested. Does that sound clinical? It should. An egg retrieval is a surgical procedure.  I was fully sedated for it. I was in stirrups, strapped to a table, with a needle going through my vaginal wall and into my ovaries, meanwhile, my husband was several doors down producing his “sample.” (The juxtaposition of this visual image still confounds me.)

My retrieval itself was incredibly successful; they collected something like 25 eggs.  I was overjoyed.  Unfortunately, the feeling was short-lived.

After the procedure, I developed what’s called Ovarian Hyper Stimulation Syndrome (OHSS).  My ovaries swelled, and fluid that had surrounded my eggs leaked into my body and had to be reabsorbed. It was the most discomfort I’ve ever felt.  I was bloated, nauseous, and couldn’t lay down because I developed plural effusion and became short of breath.  None of my clothes fit and I wanted to absolutely crawl out of my skin. 

To combat OHSS, I was told to increase my protein intake and drink electrolyte fluids.  For days I pretty much subsisted on protein shakes and Gatorade – it was disgusting.

I still probably should have been happier. A lot depends on a ‘good’ retrieval, and I had a great one. Not every egg that gets collected is usable, you see.  In fact, most of them are not.  After my eggs were retrieved, they were evaluated.  Immature eggs were immediately discarded.  The mature eggs were then individually fertilized through a process called Intracytoplasmic Sperm Injection (ICSI).  It’s a more science-y alternative to putting the eggs and sperm in a petri dish and just letting them go at it.  Any eggs that weren’t successfully fertilized were discarded. Then we waited to see if the fertilized embryos survived.  Embryos that stopped growing before five days were discarded.  Then, on day five, they extracted a small number of cells from each embryo to evaluate the number of chromosomes.  Abnormal (‘aneuploid’) embryos were discarded, and the rest were frozen.  Seven of them to be exact, which we lovingly referred to as our “seven dwarfs.” 

This is a fantastic number of embryos.  Many women endure rounds of egg retrievals and don’t wind up with any usable embryos.  This is why people call themselves “IVF Warriors.”  It takes real Xena Warrior Princess balls to step into that hormonal sh*t storm more than once. I should have been excited, but I wasn’t. When our doctor told me we had seven genetically normal embryos, I believe my immediate response was, “So, I guess egg quality wasn’t the problem then, huh?”  

My doctor was surprised; she was delivering good news, something fertility doctors don’t always get to do.  But I didn’t see it that way. In retrospect, my response demonstrates how distorted my thinking had become because of recurrent pregnancy loss.  Good news, like positive pregnancy tests had become terrifying. Promising test results became areas of anxiety.

I want to be clear, it’s not that I wasn’t grateful for my embryos – I was.  But by this point, I’d had four miscarriages even though, to quote my doctor, “nothing in my test results gave any indication that I couldn’t successfully carry a pregnancy to term.”  I wanted embryo quality to be the reason because then IVF would be the solution.  Instead, it felt like just another thing we were going to try. 

The biggest irony in all this is that the day of our egg retrieval is the day my daughter’s embryo was created – her date of ‘scientific conception.’ It should be a day I mark and celebrate. Yet it lives in my mind as a physically painful lull amidst an emotionally painful storm. It was a period where there was a lot going on, but nothing was happening.  I was impatiently waiting for what would come next. And what came next were two more losses. To be continued…