Wednesday, March 25, 2020

mandatory quarantine

I alluded to many stressors in the past few weeks.  Let me tell you about the one I have been dealing with for a week now.  The most important part of this story is that we are all fine.

I often get to spend quality time with my dear friend at Westminster Canterbury.  When I went Monday, March 9th, I had no idea what was to come.  The following Monday it came out in the press that someone at WC was diagnosed with COVID.  My thoughts immediately went to "what if."  Well that scenario, while very low risk, played out.  The health department called Tuesday to confirm that I needed to be on mandatory quarantine for another week, to ride out the 14 days.  Thankfully, I was displaying no symptoms, but would check my temperature several times a day and call them back should I get any of the tell-tale symptoms.

What a week it was.  I couldn't go anywhere.  I had to order groceries in.  I love going to the grocery store - it is like a game to me to get the best deals and still eat balanced.  I keep our freezers stocked when meat goes on sale and the pantry usually has far too many snacks, which I try to stay away from.  Like I said, I had to order groceries - no seeing our favorite 6 am friends at the grocery store.  When I started making the list, I told Jacob that he would have to go.  Much to his chagrin, but with great understanding he complied.  Then, I figured that amidst the quarantine and everything else maybe I would just order them.  Arguments over him not getting the right things on the list have gotten pretty heated in past years and we just don't cross that bridge anymore unless absolutely necessary.  So, I went to order and just have him pick up.  I suppose everyone else in Mechanicsville had the same idea.  There were no times to pick up available.  Thus, I opted for the delivery.  It killed me to pay the fees/tips, but I knew it was the safest option. 

I must say, I was really pleased.  Was it worth the extra $25, I am not sure (much of that was a tip, which helped me realize I was paying it forward a little and that helped a lot).  It was worth my sanity and no arguments in the household over the wrong product/price/etc.

I was able to get off of my mandatory quarantine yesterday and have since gone back to the grocery store for a quick trip.  I must say it is so different.  There are a ridiculous amount of people there at 7 am when it opens.  Their hours have changed and I was typically a 6 am gal, so that is frustrating too.  All in all, it wasn't bad, but I wasn't going after toilet paper and cleaning supplies either.  It was great to see a few of our favorite Kroger friends, too.  Just the little interaction helped my mood.

I say all of this because we are fine.  None of us had any symptoms.  However, this whole experience stopped me in my tracks.  I am not sure I was taking the whole self quarantine seriously until I had to.  Since then, I am much more cognizant of every step I take and how I could infect others or be infected at any given time.  That dose of reality was probably the best thing that could have happened to me, honestly.  I think this helped me come to the realization that now is not the right time to proceed with the surrogacy.  It will happen, in time, when there is less chance for extra unknowns.

Tuesday, March 24, 2020

inevitable "pause"

Yesterday we received the call that I think we were expecting.  Part of me didn't want anything to mess up the schedule and I was set to start meds tomorrow, so we should be good, right?  Unfortunately (or fortunately) no.  Kim called and left a voicemail to say that with COVID and all of the uncertainty, they were not allowing anyone to start meds for an upcoming transfer.  Everything was on "pause" for now.  Understood.  There really is no data to guide physicians with pregnancy and the corona virus.  That must be scary for the doctors and I understand that there is no reason to take risks if everything can just be pushed back a little bit.  While Kim said they would reassess in 4 weeks, I seriously doubt that in four weeks we will have a new timeline.

In processing all of this, I surprised myself in being absolutely fine.  I get that there are so many unknowns and what ifs and it makes sense to delay.  This entire journey has been many unknowns.  There is no need to throw more of those wrenches if we don't have to.  Frankly, they say that conception is harder when one is stressed.  While this will not be a natural conception, I imagine that stress even after transfer can potentially lessen the chance of a viable pregnancy.  I have been extremely stressed recently due to work being crazy, having the kids at home, no real social interaction outside of the immediate family, and just trying to figure out our new normal.  I really do feel in my heart that while dealing with the corona virus will continue to be a challenge minute to minute, we will all be a better, safer, stronger society when it can be put behind us.

I spoke with Bethany about the pause and she agreed that she was okay with it.  The most important thing through all of this is our health, especially that of the sweet baby to be. 

Thursday, March 19, 2020

pandemic effect?

There is so much uncertainty and anxiety in all of us at this time.  I felt so better to speak with Bethany this morning and to continue to be on the same page with our current timeline.  As it is now (and understanding that everything will be fluid), we all are agree that we will follow any guidelines that Shady Grove puts out and will go through with everything as planned, if permissible.

We did receive some FAQs from SGF and while so much remains to be unknown, here is what is being communicated (because there were so many, I am only highlighting those that I believe relate to us at this time):

Q: How will SGF manage risks to patients?

A: Risks to patients fall into two categories: 1. that a pregnant patient may become more ill from COVID-19, and that, 2. COVID-19 may affect a developing fetus or change the course of a pregnancy.  Pregnant patients are routinely exposed to viral infection. Some, like Varicella and Influenza can be significantly more severe, and even devastating in pregnancy. Others, including similar SARS-type viruses and the novel coronavirus to date seem to manifest similarly in pregnant women as in other infected patients. While we are still early in the evolution of this disease, there is no evidence that pregnant women are more susceptible to COVID-19.  In addition, there has been no evidence of teratogenicity (fetal damage) from the novel coronavirus. In fact, no coronavirus has ever been associated with this outcome.  Most importantly, no authority has recommended avoiding, postponing, or terminating a pregnancy due to COVID-19. In fact, the guidance from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) has been reassuring regarding pregnancy risks.

Q: What fertility care will SGF provide during this situation?

A: As you know, the situation is changing daily, and therefore, we will continue our due diligence of prevention and adherence to public health guidelines. All care will be subject to the efforts to avoid community spread as described above.
  1. All care is subject to changing conditions as the pandemic evolves.
  2. Consultations are being moved to telemedicine platforms.
  3. We will continue to streamline and limit visits for routine bloodwork as well as hCG testing and OB ultrasounds.
  4. Before initiating procedures or treatments, patients will be counseled about the known and unknown risks of COVID-19 and will sign informed content documents, as usual, in advance of any procedures or treatments.
  5. Our paradigms include: Healthy people should not be denied access to care if it does not unduly threaten public health or drain resources from the healthcare system. Patients have the autonomy to assess and accept reasonable risk. Access to care and having children are fundamental to our mission.
  6. This is not business as usual. We will always offer patients sensible advice. For young patients with a good prognosis, delaying treatment may be the most prudent course of action.
  7. We will continue to offer all of our autologous treatments: ovulation induction (OI)/intrauterine insemination (IUI), in vitro fertilization (IVF), and frozen embryo transfers (FET). Patients will have appropriate counseling before initiating these treatments. Importantly, OI/IUI and FET cycles can be accomplished with minimal visits and resources.
  8. We will continue to offer egg preservation.
  9. We will continue to offer hysterosalpingograms (HSG) within the limits noted above.
  10. We will continue to perform D&C procedures for patients with miscarriage.
Q: How will COVID-19 affect fertility treatment outcomes?

A: According to the American Society for Reproductive Medicine (ASRM), currently, very little is known about the impact of COVID-19 on reproduction and pregnancy. We have no reason to believe COVID-19 will adversely affect the outcome of your fertility treatment.

Q: Should I strive to avoid a pregnancy during this pandemic? 

A: If you have COVID-19 or have a high likelihood of developing COVID-19 (fever and/or cough, shortness of breath, and either exposure within 6 feet of a confirmed COVID-19 patient and within 14 days of onset of symptoms, or a positive COVID-19 test result), including those planning to use oocyte donors, sperm donors, or gestational carriers, you should strive to avoid a pregnancy.  If you are undergoing active infertility treatment, we suggest that you discuss with your SGF physician the option to freeze all oocytes or embryos and avoid an embryo transfer.  Please note this recommendation does not necessarily apply when there solely is a suspicion of COVID-19, because symptoms of COVID-19 are very similar to other more common forms of respiratory illnesses. 

Q: Should I avoid coming to SGF until new coronavirus/COVID-19 infections stop occurring in the US?

A: At this time appointment scheduling is subject to local conditions. We will contact you if there is a need for you to cancel appointments, consultations, or surgery due to concerns about COVID-19.

Q: What is the risk to pregnant women of getting COVID-19? Is it easier for pregnant women to become ill with the disease? If they become infected, will they be sicker than other people?

A: According to the CDC, we do not currently know if pregnant women have a greater chance than the general public of getting sick from COVID-19 nor whether they are more likely to have serious illness as a result.






Tuesday, March 17, 2020

no changes

Amid all of the shutdowns and information we are seeing constantly about the COVID 19 pandemic, I reached out to Shady Grove to see if they foresee any impacts to our timeline, knowing that the  precautionary measures could change at any time.  I was pleased to get this response back:

Currently, we don't anticipate any disruption to treatment cycles for patients. It is an ever changing situation, but we have an active task force that is watching/following guidelines every day.

All of that being said, many patients are still deciding to delay a little bit to err on the side of caution. It is a very personal decision and completely up to you. From our clinical standpoint there is no need to delay and we are ready to proceed when you are.

I know that this continues to be God's plan and probably a reason why we were scheduled much later than I had hoped.  I will keep up the positive attitude and do my best to stay at home, with the exception of getting essentials and do my job as not to spread anything unknowingly.  

In the meantime, I have been stepping up my walking game.  This past week, I walked 36 miles! (When I first started this journey, I think my monthly goal was 30 miles - what an improvement!)  What else is there to do when we can't go anywhere?  If you're anything like me, you're going nuts and walks do help to ease my mind and get me out of the house.  While I had hoped to get to the gym to weigh in tomorrow, that is going to be put off for now.  I'll keep walking, just outside.  

Friday, March 6, 2020

extra time

I am still wrapping my head around the additional time prior to transfer.  I have to keep it in perspective and remember this is God's will. 

In the meantime, I have set a new goal.  While I have eaten everything in sight over the last week, I am working to get back to my new normal, more mindful consumption of clean eating.  It will never be perfect - but it was bad!  And, let me tell you, a burger from this joint we had never tried before called Four Brothers was well worth it!  All of the tasting of icing as I made a cake and two batches of cupcakes for Meade's birthday were not so worth it.  Eh, it happens.

On to the next stage...

My goal from here is to get down to 175 for transfer. This is totally doable despite the 3 pound gain (to 188) last week.  Also, I asked the nurse if I could let my period come since there is such a lag before we need to start meds.  Thankfully, she was fine with that.  I am so ready for my body to kind of flush itself out verses breakthrough bleeding daily.  I know this will likely affect my weight, but I don't care.  I'd rather feel yucky for another week in hopes to be somewhat normal again because I have felt just gross for weeks now.

Thursday, March 5, 2020

drum roll please

Ladies and gents - the timeline has arrived!  I have had several hours to internally figure out what this means and while I was extremely discouraged at first, I know this is not my plan - it is God's plan and I am just a means to the end. 

The ultimate date of transfer (which can vary based on external impacts) is scheduled for April 27th.  There are so many factors to consider, none of which really are about me.  If you think about it, the donor eggs are coming from one individual and going to three different sets of intended parents.  This means that four people's schedules have to be taken into consideration when the timeline is developed. 

Yes, I want it sooner - I mean I want the damned transfer NOW!  It doesn't work that way, though.  Also, with a transfer date of April 27th, it means that the due date will be mid-January (January 12th - my mom's birthday) based on one calculator I used.  My goal from the beginning was to deliver in 2020.  I have to keep remembering that this is totally God's timing and frankly, it is still very likely that we can deliver this year.  My OBGYN will schedule a cesarean at 39 weeks regardless and for any given factor could take me earlier.  Of course, I will discuss this with them, but for insurance purposes, they cannot elect to take a baby for no reason, earlier than 39 weeks.

I also think a lot about the "what ifs."  What if the embryo splits?!?  Twins are almost never carried to term, so this is a possibility.  What if there are other unforeseen circumstances?  Of course, as long as the health of me or the baby are not in jeopardy, I will take them if it means a delivery in 2020!  For instance, Meade was scheduled to be delivered at 39 weeks.  4 days prior to that scheduled delivery, I went in for an ultrasound and it was noticed that I was leaking fluid and she needed to be delivered that day instead.  There are so many factors that will be taken into consideration and I am not going to let this get me down, even if we do have a January baby!

I wanted to give you all a glimpse into the crazy timeline and all of the intricacies.  I suppose we are lucky that with technology and medicine, IVF can happen, when all of the stars align.  Here is some of the communication I received yesterday:

The protocol is a method for administering medication designed to optimize uterine development. 

MEDICATIONS
1 Birth Control Pills  - 21-day pack (1-2 packs)      
2 Lupron 2.8cc multidose vial (1-2 vials) (Leuprolide Acetate is the generic version)
3 Estrace 2mg tablets 1 tab by mouth 3x per day when directed
4 Endometrin 2 inserts twice each day when directed
5 Progesterone in oil 50mg/ml # 3 vials
6 Prenatal Vitamins 

Please note Estrace, Endometrin and Progesterone in oil will continue following the embryo transfer, please do not alter or change the protocol.

Stimulation and Travel:

Please note the projected date of the egg retrieval and your embryo transfer are estimates. Both procedures may take place 1-3 days earlier or later than anticipated, based on the donor’s response to the medications. In the event you are flying to Shady Grove Fertility Center for the embryo transfer, it is essential that you purchase airfare that allows for flexibility and change, do not purchase non-refundable airfare (we also recommend purchasing travelers insurance).

Embryo Transfer:

Based upon the quality and quantity of embryos, your Physician, in addition to the Embryology Team, will decide on the best date to transfer the embryos. Embryo Transfers are completed 5 or 6 days following the Egg retrieval. Patients can proceed with light activities immediately following the transfer, and then normal activity in 3-4 days.

Medication Instructions:

Leuprolide Acetate (Lupron) injections: Taken “Sub-Q” in the abdomen or thigh, using a ½’ needle. Lupron is generally taken for 7 days leading up to the start of Estrace and continuing at a lower dose until instructed to stop.

Estrace: 2mg tablets 1 tab by mouth 3x per day when directed

Endometrin: 2 inserts twice each day when directed

Progesterone in oil: Taken “IM” in the buttocks, using a 1 ½” needle, every day, when directed. The start of Progesterone in oil is timed in accordance to the egg retrieval. Please do not start until you are directed by your nurse.

Prenatal Vitamins should be taken every day.

You think this is detailed?  Check out the actual timeline with medication instructions!


I am blown away by the details and all of the moving parts.  I remain all in to make this work!  Not my ideal timeline, but it must be the perfect one for us!

Monday, March 2, 2020

transition of care

Today, Bethany and I received notification that our nurse would be changing for the remainder of our journey.  We have been so blessed to have the last nurse and while I am really sad, I understand that needs change.  Our current nurse will actually be out for a couple of weeks and it makes sense that because we are where we are, that we have one person on point for the rest of our needs.

The new nurse called both of us and gave her contact information.  She was very nice and helpful.  She also let us know that we should be receiving a timeline in the coming days!  FINALLY!  She did offer that everything will likely happen in April, which kills my personal urgency, but I have to get over that.  Excited to move forward!

Sunday, March 1, 2020

it runs in the family

Several months ago, I informed one of my mom's cousins of this journey.  Her response was that we should never expect such altruism out of her, but that I came by it honestly.  She reminded me of when we were young and my mom decided to be a long term sub for one of her best friends growing up due to cancer treatment.  I went ahead and asked my mom about it - I remember it well, but didn't know all of the ins and outs.  Here's a glimpse into how we were raised:

Growing up, my mom had an across the street neighbor, Rosemary, in which they became great friends.  Even though their lives moved on beyond the neighborhood, they never lost contact.  They both became teachers - my mom in high school and Rosemary in elementary school.  When Katie was born, my mom stopped teaching and stayed at home.  As Ricky and I came along, it made sense for her to continue to stay home. 

Rosemary got sick.  She was diagnosed with breast cancer and was doing everything she could to keep her job and benefits as a teacher with Richmond City Public Schools.  When she needed to take extended leave, my mom offered to help.  The logistics were much easier back in the day and mom was able to sign a long-term substitute contract to take over Rosemary's classroom at Blackwell Elementary. 

What I remember about those days is that there was a class pet - a tarantula named "Goody."  I am terrified of spiders and I still cringe when I think of visiting that classroom and the damn spider.  What I did not know about that time was all that my mom was doing just to be kind.  As part of her contract with RCPS, mom accepted no salary.  Instead, she asked that Rosemary continue to be paid.  This was not an easy commute - she was driving from West Point to Richmond daily.  My dad had to also step in and help more at home with us kids as well as doing overtime to make up for the incidentals financially.  Mom said that before her time at Blackwell was up, Rosemary was subsidizing the gas and daycare costs for us at $10 a week.  That probably didn't even take care of the gas, much less what our neighbor in West Point was getting for watching us before and after school.

My mom has always been one of the most generous people I know.  I am thankful that I have inherited some of her traits that lead me to be more giving each day.  What she instilled in me at an early age is the personal satisfaction one gets from being the giver, instead of the receiver.  This still rings true today for me.  I would rather give that receive ten times over - and this really has nothing to do with financial items.  It is about giving the intangible things that are less thought of and sometimes cost nothing just to be kind. 

All of this goes to say that as my parents had their world turned upside down for a few months simply to help someone in need, they made it work and they did so with grace.  The village around us made sure that everything was fine on the home front and mom worked to help those students in a pretty awful spot of Richmond were learning. 

Villages are so important to have and I know that I could not survive without mine - on this journey or not.  The roads will not always be easy, but we will have each other.  I have grown closer to so many individuals because of the shared end goal and it is overwhelming - in the best way possible.  When all is said and done, I will have the utmost satisfaction in my heart that I have helped to create a family that is deserved beyond belief.  As much as it is about Bethany and Phillip, it is selfishly about me and that feeling of accomplishment that I will have for the rest of my life.