Transfer #2

I guess in a way we were lucky to have a crazy busy summer and fall. Studying for boards, weekend trips to Mason City (while Abe was on rotation for 9 weeks), and what felt like lots of traveling made all of the waiting much more tolerable. 

After the first round didn't work I was feeling like I "didn't know if I could do it again." We went to Orlando shortly after for a conference and I guess the Happiest Place on Earth helped me gather up my courage for a second round. 

This time the hormone injections were a little trickier as Abe was out of town except for a few short weekends. It was a relief that the nurses at work were supportive and willing to administer my injections at the end of each work day (or maybe they gladly took the chance to stab me with needles!). This meant I only had to give myself my shot one time which was a big relief.

Finally mid-October arrived and we were ready for transfer #2.

* * *

From my personal journal on October 15, 2014.

I was really glad Abe was able to come home from Mason City last night to be here for my embryo transfer.

We slept in, walked to the hospital, and checked in. Two doctors different from the last time (but again, a fellow and a staff doctor) did the procedure. This time the speculum and cervical sponge part was pretty painless (last time it was quite painful!). The trial catheter went in the very easily the first shot. But, the doctor did have a little trouble maneuvering the catheter containing the embryo -- enough so that they had to send it back to the lab to put in the warmer to prevent it from over cooling and being damaged. I felt a little bit worried but in the end, it seemed to go well. The worst part of it again was the full bladder. And this time it was even worse because of the delay. The extra poking and prodding certainly didn't help the situation! Waiting the 10 minutes before I could get up was agony.

Our embryo bubble

This time I feel very guarded and matter-of-fact. I know there is a high chance it wont work and that part of it feels real now. So, I'll try to just patiently wait without too much thought about it.

* * *

Unfortunately, our blood test 10 days later came back negative again. I was very disappointed as I started to get a glimpse of the idea that it may never work. But, I could pick the good out of it as I was very worried about the timing. If the baby had come we would have had a 4th of July baby--the busiest time at work for me and also for Abe (this would be his first week as a senior resident with extra responsibilities and new residents to train and perhaps an inability to get much time off).

Probably the worst part about the whole process is the waiting (and the associated uncertainty). We decided to go ahead as soon as possible with the next round. However, the timing would put it the week I was supposed to be in Denver for a board study prep course. Timing, timing, timing! Coordinating the doctors' cycle with your own female cycle can be tricky, so this pushed us back to December. More waiting!

Embryo count: 4 remaining

Transfer #1

I wrote this entry September 2014 just after my first embryo transfer. 

* * *

We checked in at 10 am for a 10:30 procedure. I was so glad Abe was able to escape from work for a while to be there.

I changed into a gown, socks, and hat. Abe was already in scrubs and only had to put on a surgical cap. I continued to sip on water to fill my bladder as this would help with the procedure.

They took us back pretty quickly. One of the staff doctors and a fellow came in after we waited a bit longer. I felt very calm but not very excited, not worried, just relaxed, calm. The doctors came from the lab after looking at our embryo and gave us a report of our embryos. They only thawed one and we were told the quality was excellent. The staff doctor gave us a picture of the embryo -- a round ball of cells. He seemed optimistic about our five remaining embryos in the freezer, which was a relief to me -- I want to have enough left over for more tries in the future.

They started using an ultrasound to guide the transfer. My bladder was so full this was a little uncomfortable. They prepared for the transfer which felt a lot like a pap smear as they placed the speculum and cleaned the cervix with what they called a sponge but felt like 2-3 sharp needles. It was uncomfortable just long enough that I started to feel a little worried. I was told it wouldn't hurt. I started to feel a little emotional thinking, "This isn't how it is supposed to be!" Meaning this way of getting pregnant. (It's supposed to be easy and non-painful!) I was a little surprised to have that thought as I have been pretty at peace with the idea of IVF thing lately.

Just as I had this thought, they told me there were ready and it didn't hurt anymore. They did a trial run with the catheter and seemed to have a little trouble. Then the doctor told the lab they were ready for the embryo. They passed the catheter through the pass-through window as they yelled "Sheffield 1 embryo." I found myself really hoping it was labelled correctly and we were getting one of our embryos and not someone elses.

The embryo catheter seemed to go in easier than the trail catheter. It went in smoothly and painlessly, guided by the ultrasound. We watched the screen as the embryo was delivered -- a little flush of fluid was all you could see which looked to me like a little spaceship deploying. The doctors seemed pleased with the procedure and checked the catheter to make sure the embryo wasn't still inside before finishing.

Then they instructed me to lie flat for 10 minutes. This was the hardest part of the procedure as my bladder was very full at this point.

Before we left, they gave us a picture of our "baby" on the ultrasoud. The fellow said, "Hopefully this is the first of many to come." I got a little emotional and teary eyed. I'm not sure what I was feeling -- relief? excitement? maybe some anxiety?

I've been feeling fine since. My progesterone* shots aren't fun, but they are tolerable. It will be nice to pass the time while we wait on results in Hawaii!

* * *

* Progesterone injections start about 1 week prior to the transfer date and on a frozen transfer continue for about 12 weeks for a successful pregnancy. These are injected in the muscle of the posterior hip region. They are notoriously painful --painful to inject and painful later.  This is probably related to the fact that the medication is suspended in oil and requires big needles to inject such a thick substance. I have found the discomfort has varied from round to round. The first was the worst. I had big knots in the area and pain weeks later, as well as some numbness in the injection sites. Subsequent transfers have been less painful. Maybe I'm just getting more brave?

injection site

* * *

I was lucky to be able to spend my first "2 week wait" in Hawaii. What a good way to get my mind off of the anxiety of uncertainty as much as possible. I had some low-grade nausea that week if I had an empty stomach. I felt confident I was pregnant until I had a dream that I had to hold my breath for 17 minutes or I would lose the baby. Of course, I couldn't hold my breath that long and even though I knew that didn't make any sense, it shook me up a bit. I was naughty and took 2 pregnancy tests that week (they advise you to not do this as the results are usually not accurate) which were both negative. 

Shortly after arriving home I had my pregnancy blood test which came back negative.

Embryo count: 5 remaining

The big day...just kidding!

My first job!

Normally after an embryo harvest, you wait a grueling (the wait is so hard!) 3-5 days (based on embryo quality) before continuing on to the transfer (where the fertilized embryo is removed from the petri dish--not test tube--and transfer back to your uterus). Transfer day is like Christmas morning. After all of that anticipation and preparation, you are finally ready for the big day. Then again, maybe that's a bad analogy because it's like having your present but not getting to open it quite yet. You know it is there but you don't know what it is. And there is a chance the present may be empty. Regardless of how good the analogy is, that was how I felt that first time.

Unfortunately the timing really wasn't panning out well for me. Despite my best attempts to have everything all scheduled and ready to go, my body didn't quite cooperate and as I mentioned before, my harvest happened later than I had hoped. My embryos grew to blastocyst stage which meant I was set for a transfer on day 5. This placed the transfer on July 7 -- a big day as this was also the first day of my new job and our 7th anniversary.

The day I found out the timing for this I was hysterical. Okay not really, but I cried in front of the nurse at the clinic and she probably felt like I was hysterical. I didn't know how I was possibly going to maneuver the situation:

On one hand, after months and months of waiting, shots, procedures, we were finally ready for our first real shot at pregnancy.

On the other hand, after 13 years of training I was finally ready for my first day at my first real job. And I wasn't sure how to tell them a few days before that I would need my first day off! "Sorry, but I'm going to have to miss my first day to try to get pregnant!" Not what an employer wants to hear. I was super upset and stressed about it for days. I didn't want to cancel patients and staff at the last minute. I didn't want to seem uncommitted or unreliable. I didn't know how to even ask for the day off.

I finally spoke to one of the doctors. He was very understanding and suggested we freeze all of our embryos rather than transfer one fresh and freezing the remaining. He gave me the stats on this -- that a frozen and fresh transfer had essentially the same success rates and that some centers are even going toward frozen only transfers. After the harvest I hadn't been feeling well -- significant bloating, nausea, tiredness, etc, and as these were potential early signs of ovarian hyperstimulation syndrome (which can become very risky and worse with the continuation of the hormones after embryo transfer) he felt freezing the embryos was a good way to go medically and logistically. Besides, if I truly were experiencing OHSS they may cancel my transfer, anyway.

This was disappointing to hear that I would have to wait (this is what we had been leading up to for so long!) but I felt so relieved that there was an answer. Looking back now I know some people would say I should have done "what was right for me" despite my job, but I think it was the right decision. Waiting made it so I didn't have to worry about the stress and possible symptoms associated with a possible pregnancy or the disappointment if it didn't work while learning the ropes at my new job. It gave me an opportunity to let my ovaries quiet down before stimulating them again with a new batch of hormones. And I got to take a welcome break from all of the medications.

I was told I could probably proceed the next month. I felt like waiting a month to lower the risk to my own health while also getting established in my job was a good trade-off. Unfortunately when the time came, they made me wait longer than I had hoped as they wanted to give me extra time to make sure to avoid hyperstimulation.

Our transfer day was pushed back until September, which left us with a long wait but able to focus on a very busy summer at work for both of us.

So when do I first take my child to the dentist?

Have you parents seen this article circling the web?

http://www.foxnews.com/health/2015/02/08/7-mistakes-parents-make-with-their-kids-teeth/

I received a question in response from a friend asking about the appropriate time for a child's first dental appointment. (The article is an easy and informative read by the way!) Unfortunately, her dentist had a different recommendation than what was stated in the article and she felt confused. Here is the recommendation from the article:

The first trip should either be when the first tooth erupts or by your baby’s first birthday. Dental visits every six months from the get-go will also help your child feel comfortable—and even excited—to go every time.

This isn't the first time I've faced this question and I understand as a parent it puts you in a pickle. On one hand, the American Academy of Pediatric Dentistry is giving one recommendation (the one quoated above) and your dentist is giving you another.

My personal opinion is consistent with the American Academy of Pediatric Dentistry stance. I have seen children, even infants and toddlers, with serious dental decay resulting in the need for baby root canals (pulpotomies), crowns/caps, fillings, or even extractions of most or all of the teeth and done in an operating room setting under general anesthesia. Imagine going until age 6-7 before having any teeth because they had to be removed! (-- on top of the lasting orthodontic and growth problems associated with these missing teeth.)

An earlier appointment can catch these problems early on before becoming serious.

But, many dentists do not follow this timeline. Perhaps they are unaware of the recommendation. Many dentists are not interested or comfortable seeing children, especially very young children. Maybe they just don't agree.

What is the dentally conscious mommy (or daddy) to do?

Consider a pediatric dentist.

A pediatric dentist can be a great option, especially for those seeing a dentist with less interest in children's dentistry. Pediatric dentists spend an extra 2-3 years of training focusing on issues specific to children in dentistry. Less time is probably spent on learning new procedures or dental techniques and more is spent on the nuances of behavior management, special needs children (and adults), education, etc. I think most dentists would agree their job is one of the hardest in dentistry-- using sharp tools and instruments on squirmy, often unhappy and even uncooperative kiddos all day long-- all while trying to provide as comfortable and happy an experience as possible (I can't tell you how many adults tell me the "I was traumatized as a kid" stories). Because they see kids all day everyday they really are the experts on all of the issues from teething to pacifiers and also on education to help you set your child up for positive dental experiences in the future. They often provide a fun environment and low stress environment and can continue to see your child until they reach adulthood.

There can be an advantage to a specialist's care and early infant dental care may be a prime example.

Talk to your general dentist.

I understand there are instances where a pediatric dentist is not available -- maybe there isn't one in your town, maybe they don't take your insurance, or maybe they simply aren't taking any more patients. Don't despair! Many dentists are great family dentists! They are comfortable and talented in seeing both adults and children. I would place most of my dental school classmates into this category. I think if you have a good relationship with your dentist you should feel comfortable continuing the care of all your family members with them.

Many general dentists follow these early guidelines but if your dentist does not, I think it is reasonable to ask why the policy differs from the recommendations of the academy. She likely has a good reason behind her decision to delay care -- perhaps after knowing your own personal dental practices are good she has minimal concerns; maybe she has seen the dental hygiene of your older children and knows you are doing a good job and your questions have been answered in the past.

Take personal responsibility for your child's oral health.

If your dentist has recommend delaying care until an older age, it is even more important to follow the tips in the article above (or check out my previous post on this -- link below) as these will help prevent any big issues. Something as simple as being aware of any major issues (for example, holes or black or brown spots in teeth) while brushing your child's teeth and discussing them with your dentist can make a big difference. Don't be afraid to ask questions or for advice if you have challenges (such as how to brush the teeth of uncooperative toddlers), whether by phone or at your own appointment.

And in answer to a few common questions:

So, what happens at an infant dental appointment? It doesn't seem like they could do much!

You are right, there may not be much "dentistry" occurring in the appointment of a six month old. Maybe they only have two teeth!  BUT... it doesn't mean that a lot isn't accomplished during these appointments.

The dentist will take a look at your child's teeth and oral soft tissues (gums, cheeks, etc), to check for any big abnormalities or concerns. This may be a simple visual exam without any tools. They will clean the teeth (maybe just with a toothbrush) and they will likely apply some fluoride to help protect the teeth.

Most of the appointment will probably be spent on education. This is a good opportunity to bring up any specific concerns or questions you have. They can give you demonstrations and tips on topics such as how to clean your kids teeth (even when they scream or move), ideas on snacks healthy for their teeth, questions about thumb sucking and pacifiers, and most importantly perhaps, they should provide positive dental experiences to avoid those horror stories we hear later in life.

Ok, you have me convinced but what if they cry?

Your child will cry, but don't worry, we expect that (don't they cry for most strangers at that age?) and that actually helps us see (open mouths!). Luckily, the crying usually wont last long. Most children perk right up as soon as they are back in Mom's arms.



I think the bottom line is that you should advocate for your child to have the best dental experience possible. Early childhood is an ideal time to teach your child consistent dental care and to find the experience comfortable, easy, and even fun! If you aren't sure how your dentist feels about treating kids, ask! You should get a good feeling from their response if they like or are comfortable seeing children and at what ages. Have a discussion with your dentist to see if he feels he can provide this kind of care and if not, he may have some referrals for a good pediatric dentist in your community.

* * *

*Have you seen my 2013 post on how to avoid inadvertently passing on your own dental phobias to your child and other tips to help your child have a positive experience at the dentist (yep, I said it way before Fox News!)?

Check it out!
http://erinsheffield.blogspot.com/2013/03/open-wide.html

The Differential Diagnosis Always Includes Pregnancy

Here's another one from my past...I'm pretty far past this point but it is interesting to see how my feelings have evolved over time. I thought I would share for those of you who have also felt puzzled by this awkward question.
XOXO...Erin

* * *



I can't REALLY blame you for asking, we look like we'd be great parents, right?

Have I posted about this already? I honestly can't remember, but it keeps coming up, especially in light of my recent bout of illness.

Can people please stop asking if I am pregnant? 

I think I got asked 20 different times the past week, and each time the answer was no. 

I don't think I will ever be at risk of being on one of those Lifetime Original Series type shows, I Didn't Know I Was Pregnant. I pay pretty close attention to my body. I understand that some of the symptoms of early pregnancy are fatigue, nausea, vomiting. But I also understand that those are some of the symptoms of residency, influenza, food poisoning, and cancer. Just because I am hungry or sick or tired or cranky doesn't mean that I am pregnant. And I don't like thinking I am not allowed to feel much of anything without falling under suspicion.

People are probably just trying to helpfully remind me of this option. "Have your realized that maybe pregnancy could be in the differential for how you are feeling?" (For those of you not in the medical field, a "differential," or "differential diagnosis" is a list that includes the top most likely medical problems that are associated with the present signs and symptoms.)

Or maybe they hope to be one of the first to make the baby diagnosis? "Yes, I knew it!" 

Or maybe they are just being hopeful as they must clearly recognize what amazingly beautiful offspring I will have considering my good looking husband. "I hope you are because I can't wait to see your babies!"

Whatever the reason, it makes me feel a little embarassed. Or annoyed. (No, I don't think I'm pregnant unless pregnancy includes fevers, chills, sore throat, and diarrhea, as well.) And it makes me unsure what to say because it almost inevitably is followed by, 

"Are you sure?"

Which really baffles me. I'm not sure what I am supposed to say here. A simple, "No, I'm not pregnant," doesn't seem to be enough.

Should I say, "Actually, it has been xyz since my last cycle, which would suggest that no, I am not?" Or would more information on my private life with my husband be helpful? Can I bring up my calendar app on my phone or should I take a pregnancy test? 

Can any woman truly know with certainty at any moment that she is 100% sure she isn't carrying a bun in the oven (with a few exceptions)? This is why they do pregnancy tests on all women ages 11-50ish before surgery at our hospital. (And even then, pregnancy tests have to be correctly timed.)

Actually, I am glad I wrote this post because I now know exactly what to say,

"Are YOU? You know many women don't have any symptoms of early pregnancy."

And now we are back to the Lifetime network. (You Didn't Know You Were Pregnant)

When I am pregnant, I anticipate I will be asking myself those same questions without prompting from you. And when the time is right, I would appreciate if you would let me inform you in the way and time that I prefer. Until then, I hope to not have to share my fertility status with any acquaintance I meet who happens to notice I may not be feeing or looking so well. 

And finally, despite how awesome you think it would be for me to have a baby right now, I'm the one that has to make it work. 

Embryo Harvest -- The Ultimate Stay-cation

With the first phase of my board exam behind me just a few wee hours, I am ready for some blogging.

I thought I would start at the beginning of my IVF treatment. Some of these posts were written months ago, some are still unwritten, and others will be a little of both.

I wanted to delay my postings, partially for emotional reasons, partially for privacy, and partially for logistical reasons, like deciding when to tell work. Telling your boss you are hoping to have a baby can be awkward and a little scary.

* * *

Getting ready for some belly shots

After completing my residency at the end of June, I had a choice:

Vacation or IVF.

I had spent 5 years in residency. I felt I deserved a much needed break traveling somewhere lovely and tropical as a reward for my hard work before beginning my life of work at my new job a few weeks later. 

Or I could spend my two weeks off at home nursing my ovaries.

After much deliberation, I felt that as much as I hated the idea, ovary time it was.

I knew it would be the easiest and most stress free way to undergo the treatment which had the possibility of making me uncomfortable and would keep me at the beck-and-call of my doctors for almost daily ultrasounds, blood tests, and appointments.

So a few weeks before finishing residency I started the hormones. This was really great for our end of year banquet. Yes this means I cried.

Proof I was pretty hormonal

Before you get started they send you a medication calendar. This is because things get very overwhelming and confusing without it. You pick up your first of many bags at the pharmacy and have your first little heart attack when you get your pharmacy bill. Thank you insurance! You never quite get used to the receipts but it is more like chest pain than an actual heart attack with time.
 



Your medication timeline.
Just gets more tricky with time as you add more and more drugs into the mix!

Sadly this was a smaller receipt than many others!

The first bag of many bags-- feels like grocery shopping at the pharmacy

The first pharmacy shopping list. Overwhelming?

I give injections to patients all day every day, but I am a bit of a needle-phobe myself (with a history of fainting). So I was quite nervous to begin. Abe was on-call working nights when I had to start my injections so my friend Dr. B. was nice enough to assist me with my shots most days when he wasn't available. 

Friends don't let friends administer their own shots.
At least not at first!

During normal ovulation, usually only one follicle (containing the egg) grows. During IVF, the Docs are in control and they stimulate as many of your follicles to grow as possible. If you are like me (Polycystic Ovarian Syndrome), then you may grow A LOT of follicles. The clinic monitors this with ultrasounds every few days to check on the progress of the growing follicles.

Drugs Drugs Drugs

The follicles have to be over 1 cm in size before they can be collected. Once they reach adequate size, you are ready for the harvest. I was really hoping for a harvest on my birthday at the end of June so I would have plenty of time to have my transfer before starting work on the 7th. Unfortunately, mine were a bit behind schedule and this pushed my harvest and the subsequent transfer back to the 7th (A big day -- our anniversary, my first day at my first real job, and now our transfer). Bad timing and another issue for later.

By my last ultrasound I had almost 40 enlarged follicles about the size of those jumbo grapes you see at the grocery store. So, by my birthday I was feeling pretty uncomfortable and bloated, walking around with two huge bunches of grapes in my abdomen. Luckily I wasn't out and about too much or people would have wondered why I was walking like a 9 month pregnant lady.

Come early July, my follicles were finally ready for harvest. Abe met me after rounds for the procedure, performed under sedation. The doctors use a needle to collect as many follicles as they can from the swollen ovaries. Some people complain of pain after the procedure but I luckily didn't experience any immediate discomfort.

Ready to go!

After a short recovery time, you are allowed to go home and rest. You aren't supposed to do any vigorous physical activity, and need to monitor fluid intake and urine output, and watch for any symptoms of hyperstimulation (an uncommon but serious complication from all of the hormones).



Feeling groggy afterward.
 It was weird to be the patient this time instead of the one doing the sedation for someone else

I felt pretty good right after getting home, but by the end of the evening I felt very uncomfortable, super bloated, and I had gained 7 pounds in one afternoon. I felt nauseated and Abraham said I looked like I was already pregnant. After a few days of taking it easy I started to feel back to normal.

A few days later we got our report from the reproductive endocrinologist. I was very lucky as I had a great response!

They collected

33 follicles...

27 went on to fertilize...

25 fertilized normally ...

6 survived to day 5 growth (in a petri dish, not a test tube!)...
leaving us with 6 blastocysts (embryos) ready for transfer.

 
 

 

Bored, Bored, Boards

Some of the books I've been using to study feel off the top of this big stack. 

I started studying for the first phase of my board exam (for Oral Maxillofacial Board Certification) this fall. It feels like that's all I've been doing (even if this post will demonstrate that isn't quite true). I have been wanting to blog for weeks but have felt guilty taking the time rather than studying (silly?). Today it is my day off, the high temperature is -8, and I think I need a bit of me time to blog before hitting the books again. I'm getting pretty burnt-out, with only about a week to go before the massive brain dump of the 7 hour test is upon me!

Life has been crazy since my last post. From mid-October until mid-December Abe was away on a rotation in Mason City, IA, a small town almost 3 hours away from home. He only had a few weekends off when he was able to come home. So, most weekends I would make the 4-5 hour drive from Burlington after work to meet him for the weekend. Not very fun after 10 hours of driving during my commute each week.

Nine weeks is a long time to be separated and I am so glad he is home now! But, his absence did mean I was able to get a lot more studying done.

Visiting the crash site of Buddy Holly while in Mason City

Christmas parade and fireworks in Clear Lake, IA close to Mason City

Part of my board preparation included a trip to Denver in November for a preparation course. The course was quite intensive, the weather unseasonably cold, and the trip definitely business (sometimes classes would last from 8 am -8:30 pm). The best part was seeing old friends from college, the Marsh family and having an alumni BYU Women in Dentistry Club 2005 meeting by going to lunch with Tara Bruggeman and Laura Milroy, the only two women in the club with me at that time. It was so cool to meet up with them and see how far we have all come and to share our common experiences as LDS women dentists. If you live in the Denver area look them up because they are amazing and committed dentists.

We have continued to have some disappointments in the fertility department. During this time we completed two more embryo transfers. This includes daily painful shots in the hips and multiple medications by mouth. Abe was gone for part of this time which made the shots difficult. Luckily I know some helpful nurses. After three rounds of failure, the doctors seem puzzled by our lack of success. Each disappointment has been harder to swallow than the past. I am trying to stay positive and hope we will have success on further attempts, even though even the doctors agree it should have worked by now. It is hard to not ask "How many times do I have to do this, only to find out it wont work?" But I do feel lucky in many ways (we still have embryos left!) and as time goes by I find more and more positivity to go forward.

Medications and supplies from my last round

We were both able to take a few days off around Christmas and the New Year this year. What a blessing after years of holidays stuck working in the hospital. We joined Abe's family in Chicago right before Christmas with his family and spent the New Year celebrating on our own with a staycation in downton Iowa City.

Beignets at Grand Luxe Cafe Chicago-- I was feeling a bit like the Grinch on my shirt after nasty Chicago traffic

In a lot of ways, it has been a difficult past few months. This is ironically supported by the fact that as I was planning this post I found out my grandmother passed away yesterday after a long battle with Alzheimers. 

To be honest, it feels a bit like the bad/sad news keeps coming lately. I also recognize many blessings in my life despite or maybe in relation to the challenges. 

I am looking forward to the New Year with some (tempered) optimism.  I'm hoping for some better news including a passing board score, a successful pregnancy, and some continued improvements in my other goals this year.