The Waiting Game: Acupuncture, Perinatal Psychiatrist, Side Effects of Estradiol and Progesterone, and Fear of Either Result on the Pregnancy Test

Current mood . . .

Waiting is difficult. Normally, staying busy would be a good remedy, but it's hard to stay busy when my activities are limited post embryo transfer and the side effects from the hormones that I'm on are really making life miserable.

I'm providing an update as to what I've been up to since the embryo transfer, how I'm feeling, and what it's like being only a few days away from the pregnancy test at the lab (it's a blood test to test my level of hCG to determine if I'm pregnant or not), which will determine whether or not the embryo that we had transferred on October 5th implanted or not. If it did not, then this leaves us without a pregnancy out of our first cycle of IVF and facing more decisions.

Acupuncture
While I've been waiting to take my pregnancy test (October 17th), I've been going for acupuncture once a week with Stephanie at Elements of Health. Since the embryo transfer has occurred (October 5th), no acupuncture needles go into my lower stomach or abdomen anymore. Instead, they are in the wrists, lower legs, feet, and head. The needles are supposed to go in the meridians that lead to the uterus and help support the body in trying to create a fetus/ aid in implantation of the embryo. She also put some needles in my head for the migrainous headaches that I continue to get from the hormones.

From talking to Stephanie, I realize how lucky we were to have all eight embryos survive to day five, to have had a day 5 grade 20 hatching blastocyst to transfer into my uterus and then five embryos high enough of a grade to freeze so that we can use them in frozen embryo transfers if this embryo transfer doesn't work, if I have a miscarriage, or to have a second child. Many women aren't fortunate enough to have many or any embryos survive to day 5, or even day 3, and might not have any to freeze after a transfer. I feel very fortunate in that regard. I think it's an added bonus having an acupuncturist who has been through the process of IVF herself. I find it comforting to finally have someone to talk to who has been through IVF, as I don't know anyone else.

#BathroomSelfie

Ready for acupuncture.

Lots and lots of needles all over me.

I returned this Wednesday, for another round of acupuncture at Elements of Health. Stephanie put extra needles into me in my upper stomach and outer forearms, on top of the regular points in the lower legs, chest, and head. The extra points were to aid in side effects that I'm suffering from like bloating, nausea, and constipation.

She told me to follow up with her in one week if I'm pregnant (this would be two days after my pregnancy test on Monday). She said that if I'm not pregnant then I can come in to work through grief or I can take a break for a while. I asked her how often I'm supposed to get acupuncture leading up to a frozen embryo transfer if I have to have one of those done (if this embryo didn't implant and I'm not pregnant or if I miscarry). She said that leading up to a frozen embryo transfer they recommend acupuncture two times a week for four weeks. I asked her if there are a lot hormones required to prepare the body for a frozen embryo transfer. She said that there are definitely some hormones that the woman must take, but not near as many as they must take for a full IVF cycle (at least this is comforting news).

In front of some poor guy with flesh eating disease at the acupuncturist's office.

Perinatal Psychiatrist
Waiting for my appointment with the perinatal psychiatrist was uncomfortable. First there's the drive out of town to Victoria General Hospital on the congested highway. Then there's waiting around in the child and family ambulatory area with crying babies and pregnant women everywhere. I had my usual migrainous headache. But at least my appointment wasn't cancelled this time. Five months after my referral, I'd finally get to see a perinatal psychiatrist after almost completing a full cycle of IVF (and the first part of another IVF cycle in the spring) with its hormones and ups and downs, having gone through part of a pregnancy, cancelling an IVF cycle, and then suffering from a miscarriage earlier in the year. It's been an eventful five months and I've had virtually no oversight from a psychiatrist. At least I made it through, but some aren't so lucky and I would have felt better if I had had some oversight and someone to ask questions of to prepare for emergencies if they arose (plus blood tests for my medication level being regularly ordered and reviewed to make sure my lithium levels are all right and my kidney function, etc. is okay). I have a diagnosis of bipolar disorder with co-morbid anxiety disorder and I have no desire to disintegrate and end up in a psychiatric facility again. I haven't been hospitalized in three and half years and I never want to be again (this means being compliant with medication, self-care, receiving regular oversight from a doctor or psychiatrist, keeping my stress level as low as possible, getting enough sleep, etc.).

The perinatal psychiatrist only works Tuesdays, so this I guess explains why it took five months for me to get in for an appointment. I can't believe that in this country, where we put 50% of every tax dollar to the medical system, we have this poor of a medical system (but that's another rant).

The perinatal psychiatrist didn't have much information on me (ex. no blood serum levels for lithium carbonate, kidney function tests, etc.), so I had to supply a lot of the information (strange when we're supposed to have an electronic medical records system). She was sympathetic to me being on hormones, but said that even more strain is likely created from the uncertainty and waiting rather than just the hormonal manipulation that people go through while undergoing IVF. She said that most people going through IVF probably feel as I do (which is good, I'm not having an episode, nothing is out of the ordinary, I am well for the circumstances).

We discussed the use of my medication, lithium carbonate, during pregnancy as we had three years ago when we first met (for a consultation). She said that while there are risks with any medication during pregnancy, the risk of someone with bipolar disorder who responds well to lithium being taken off of lithium for the duration of a pregnancy is greater than the risk to the fetus if the mother stays on lithium for the pregnancy and stays stable and well (breastfeeding is an unknown for lithium still). She said that past medical literature on heart defect risks to a fetus of a woman taking lithium were overstated and there is really not much of a risk. What does need to be done is monitoring of lithium carbonate levels in the blood regularly while a woman is pregnant (more often than if a woman isn't pregnant) to ensure that the drug is at a therapeutic level (not too low and not too high and toxic either). She said that in the beginning of a pregnancy, blood level testing once per month would be enough, but towards the end of pregnancy, they might need to be done more often. She said that the dose of lithium might need to be increased over the pregnancy as the weight and blood volume of the woman increases, but it is often not by a lot. Prior to birth, 24-48 hours, lithium is usually suspended until after the birth. After the child is born, lithium is restarted at a lower dose and the woman is monitored in the hospital to make sure they are receiving a therapeutic level of lithium (but not too much either, based on the massive exodus of fluids that just happened during the birth).

The perinatal psychiatrist was mystified as to why my regular psychiatrist refused to treat me while undergoing IVF, but said that she would take me on as a patient and follow me. She wrote me a prescription for my medication, lithium carbonate, gave me a requisition for monthly blood tests to check my medication level, and gave me an appointment to follow up with her in one month. I was with her less than 20 minutes, but that was enough. I'm not in crisis and I just need a prescription and blood test requisition and to know that I have someone to turn to if things go off the deep end. One shouldn't have to beg for basic medical care, but in our medical system it seems like if you aren't very proactive and pushy, you don't get the care that you need. This worries me, since most people are probably not as assertive and tenacious as me.

The Side Effects
The last week and two days since the embryo transfer has been difficult. The cumulative weight of six weeks of hormones, bodily strain, bad sleeps, the emotional rollercoaster of the process plus the hormones jerking me around, the stress of waiting for the pregnancy test, and ever present uncertainty have taken their toll. I've been sobbing, having regular and crippling panic attacks, I'm very anxious and rather depressed. Plus the physical side effects from the hormones make things even more difficult and icky.

A combination of Estrace, estradiol at a 50% higher dose than before the injections and the introduction of Endometrin, progesterone, has led to a whole host of side effects that make being alive even more of a chore. Some of the side effects include gastrointestinal distress and severe constipation (despite tips from the acupuncturist regarding magnesium, extra water, dried fruit like dates, extra hemp seeds, and extra fibre like psyllium- progesterone relaxes all muscles and makes the intestines sluggish and the other main remedy, exercise, is out since I just had an embryo transfer), broken sleep and exhaustion during the day, migrainous headaches, dizziness, nausea, and being so unsteady on my feet that I have been randomly falling over, into walls, losing my balance, and it's all been intermittent and unpredictable (so sometimes I feel like I'm fine and then suddenly I'm really, really not well and I never know when it's going to hit, so I never really leave the house except for treatments).

Plus I'm experiencing massive bloating, especially in the abdominal area, despite not a pound of weight gain from six weeks ago. Almost nothing fits me anymore. My breasts are swollen and tender. I feel ravenous, but intermittently sick and nauseous and food tastes weird. I've had intermittent and extreme itchiness all over my body, mostly at night, pruritus (this is apparently a potential side effect of Estrace, no doubt I'm experiencing it now, because I'm on a 50% higher dose than I was before). I had a brief reprieve Tuesday and Wednesday morning this week, when I didn't feel quite as bad and was able to get out of the house and go to the psychiatrist and then the next day to acupuncture. It seems I overdid things, because from Wednesday afternoon onward, I was back to floppy, dizzy, nauseous, exhausted, emotional, and anxious.

My husband brought these home after doing the grocery shopping. I'm so thankful for how loving and caring he is.

But I can't tell if all of these physical and mental symptoms are just hormones (Estrace, estradiol and Endometrin, progesterone) or if something else might be at play (like the early signs of pregnancy).

Estrace (estradiol).

Endometrin (progesterone)

The Wait/ Anticipatory Anxiety
While I feel these physical and mental symptoms that are often similar to what early pregnancy feels like, I definitely don't want to get my hopes up. After all, I'm on a combination of hormones to make my body feel like it's pregnant (to make it more likely that the embryo will implant and then develop into a healthy pregnancy and to maintain my endometrium), so there's no way of telling if there is anything happening besides side effects from the hormones that I've been prescribed post embryo transfer. But I do hope despite knowing the odds, despite having just had a miscarriage a few months ago, despite only having managed to become pregnant once in my life. I can't help but hope. But I won't know until Monday afternoon after I take my hCG blood test at 8:50 AM on Monday. The wait is agonizing. People are right online, this is the longest 12 days ever.

This wait is making both my husband and I want to scream.

I'm also terrified by the alternative though. What if the pregnancy test is positive? Then am I going to have to deal with people peppering me with questions again like do I think it's going to be a boy or a girl, what names do I like, do I have pregnancy books and apps on my phone, etc.. I don't want to deal with these questions and comments. Last time I tried to tell people that I didn't want to get too excited, because there was that definite risk of a miscarriage and yet they were unrelenting and then I too started to get hopeful about becoming a mother finally. When I miscarried, I was more devastated than I could have ever imagined.

I fear being pregnant more than finding out that the embryo didn't implant. I know that this seems counterintuitive, because we just paid $14,000 for a shot at getting pregnant, but after being through a miscarriage (recently), the thought of having another one in the same year is terrifying. But what if everything works out and I have a child? I just fear to hope in case I lose everything again. I barely survived that miscarriage in June and if it happened again, I don't know if I could ever come back. I feel beleaguered and shattered from the years of struggling with infertility, the miscarriage, and the first cycle of IVF with its sickening combination of hormones. I feel like a shadow of myself.

I'll never be able to be one of those women who is happy to see the positive result on a pregnancy test. My past is too chequered. I'm too pessimistic. After the past six years, I feel broken. I'm sad that I won't be able to jump up and down with joy if I ever see a positive result on a pregnancy test again, but perhaps being realistic is better than being falsely positive.

On Monday afternoon, the Victoria Fertility Centre will call me to discuss the results of my pregnancy test at the lab Monday morning and I will be posting an update. Until then, I wait and brood . . .

Even the cat is brooding.

. . . about our embryo . . .

The grade 20 hatching blastocyst that was transferred into my uterus on October 5th.