On Pregnancy

Yep, it's about what you think it is!

I won’t be coy or bury the lead. We are celebrating the fact that somehow, miraculously, on our first attempt with IVF, we are pregnant! Today marks the completion of Week 13. We’ve safely made it through the first trimester, and we ask that you add your prayers to ours for continued health and development for both me and the being my body is helping to grow. Prayers, too, that we make it all the way to May for a safe and healthy labor and delivery.

That’s the headline! Praise and celebration! If you’re interested in what happened back in August and September and the steps we took to get here, read on.

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Retrieval & Insemination

Way back in August, after about ten days of stimulation via subcutaneous belly injections, my ovaries were swimming with mature follicles the size of boba bubbles. The doctor said, “Go!”, we awaited our call time from Iowa City, we timed my “trigger shot” exactly 36 hours before the retrieval was scheduled and drove on over.

We were in first thing (which I was grateful for. I’m a believer in breakfast but/and, since I would be under sedation for the retrieval, no food or drink past midnight the night before). The nurse, doctor, and anesthesiologist all spoke with us about the details of the procedure: a needle guided by ultrasound would be inserted through the wall of my vagina to extract as many eggs from each ovary as possible. I would be sedated and would have some pain medication to help me through the few days after. While I was in the operating room, Lucas would be on the other side of the building providing his sample. My eggs and his sperm would then rendezvous in the lab, and we prayed that insemination would lead to fertilization for a good number of eggs. From the beginning, the whole team prepares you for the natural selection that you bear witness to through this process. At each stage of development, roughly one third of the candidates drop out naturally through arrested development of one kind or another.   

I don’t remember a lot from that morning. Being in a hospital gown, hair net, and bright yellow “fall risk” bracelet. Being surrounded by competent and kind people who I could genuinely feel pulling for us. Scooting my bottom down into a “donut” on the procedure table. Laying back and looking up into a ring of kind faces and warm light. Waking up sometime later with Lucas beside me in the room.

Closeup of Lindsey in a hospital bed, masked, hair net on her head, hospital gown and cape swaddling her, proudly displaying her yellow “FALL RISK” bracelet.

When I was able to make it to and from the bathroom with a chaperone but without assistance, we were free to go. I was still wobbly on my feet, but I was starving. So we took our retrieval report card (with the good news of how many eggs had been retrieved and inseminated that day, and the breakdown of likely embryo outcomes based on that), and we took all our best hopes and prayers for all our inseminated eggs in the lab (that they might become fertilized and grow into healthy little blastocysts), and we got a spectacular brunch. My eyes may have been bigger than my stomach, but I wasn’t sorry then and I’m not now.

Lindsey and Lucas seated on the patio of Iowa City’s Bluebird Diner with a delicious spread of breakfast foods on the table in front of them.

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Fertilization & Transfer (Part I)

We came home with some codeine laced Tylenol for me, an encouraging report card, and a lot of hope. We started daily intramuscular injections of progesterone to prep my body for potential implantation. (These continued daily through eight weeks gestation.) And about 48 hours after our procedure, we got a call from the lab that, true to expectations, roughly two thirds of the inseminated eggs had been fertilized and appeared to be developing normally. The lab would tuck them away until transfer, five days after the retrieval. We were thrilled and hopeful and I found myself whispering under my breath, “Go, little blastocysts! Go!”

As I referenced in On Infertility, Definitions and Statistics, Part II, we had a few different options concerning transfer. We opted for a “fresh transfer” to take advantage of the fact that my body was primed and pumped full of hormones already. This meant that five days after retrieval, we would go back to Iowa City and the doctor would take the best growing one or two embryos from the lab and transfer it/them into my uterus using a catheter laced through my cervix (very much like an IUI) but guided by ultrasound. Any remaining embryos would be biopsied and frozen, and the biopsies would be sent away for genetic testing to find likely candidates for a later transfer in the likely event that this first transfer didn’t implant or resulted in a miscarriage, OR in the much happier event that it resulted in a child that might want a sibling someday.

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A Quick Digression…

…is necessary to explain the strange circumstances around what happened next.

Earlier in the summer, I’d made plans with my covenant group (pictured here) to spend a week in the upper peninsula of Michigan in late August to share in life and ministry and glory in God’s good creation. When my period didn’t come as expected (that story is here), I let them know that the timing of our fertility treatments had changed, that I wasn’t sure where we’d be in the process at the time of the scheduled trip, but that I was sure I’d need to be close to medical care. I told them, “You should go on without me.” They said, “We don’t want to do that. If you’ll have us, we’ll come to Iowa.” So, I cancelled the place in the UP, found a house on Lake MacBride, about 20 minutes from the clinic where we got care in Iowa City, and a new plan was in place. Everyone was scheduled to come into town the Monday of the week of the transfer. I went over to Iowa City early in the day to meet my friends for lunch and get us checked into the house on Lake MacBride. Lucas was going to join us at the house that evening after work and be present with me for the transfer the next day. That was the plan.

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COVID Interrupted

Late Monday night, with the transfer procedure scheduled for 10:00 a.m. the next day, Lucas called. “I don’t want to tell you why, but I can’t be there with you tomorrow.” “What?!” It took me a while to catch on to the information he was trying to protect me from. After two and a half years, at this critical moment for us, he had tested positive for COVID-19 and he didn’t want to further risk our chances of being able to follow through with the transfer by burdening me with that information.

My mind started spinning: “We’ve gone through so much to get here already we can’t turn back now. But how can I do this without you? We’re supposed to do this together!”

It was too much to hold.

I wept.

Lucas switched the call to facetime and we both just sat there and wept, face to face, over tiny screens.

Lucas said, “This is the saddest facetime I’ve ever been a part of.”

It was true. But those tears were also healing and clarifying. That moment was so, so sad. And it was also pregnant with our best hopes.

There was also no way around the facts. Lucas had COVID. I would test and, pending a negative result, call first thing in the morning, disclose what had happened, that I had been exposed, and ask for their advice and permission to proceed.

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The Glory of Good Friends, redux

The next morning, I worked the plan. I had tested negative the night before, so I got ready as though the transfer would proceed and called at 8:00 a.m. when the clinic phone lines opened. At that point, I had only allergy symptoms, not COVID, so they told me we could go forward as planned. I let Lucas know and made a plan to have him on speaker phone for the transfer itself.

When I emerged from my room, my friends Rebecca and Vince were in the kitchen making coffee and tea. As I said the words “Lucas can’t come, he has COVID,” I dissolved into tears and Reba jumped up to surround me in a hug. I gave them the details and she said, “Let us know if you want one or more of us to come with you this morning.”

It’s strange. After so many years as a pastor, you’d think I would have thought of this. But it still takes prompting for me to ask for help. I was totally ready to go it alone. When I told Reba I’d really appreciate her coming with me, she put on the perfect t-shirt and, both donning masks and with the windows rolled down, we made our way to the clinic.

Lindsey’s dear friend, Rebecca Anderson, wearing a mask and a dark heather t-shirt with a red “metal” rendering of female reproductive organs.

Lindsey and Rebecca posing masked in the waiting room, eyes welling, to let Lucas know we’re here and ready.

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Transfer (Part II)

The details of this day still feel so tender and flash through my memory as though in soft focus. I’m not a public crier (it makes me feel vulnerable and like my insides are on display), but I cried around many strangers that day. (Writing about it is different. I have control over what I share and how.) I was so sad and hopeful and expectant and overwhelmed and grateful all at the same time. So overwhelmed by all that was spinning outside our control. And so grateful that my dear friend was there beside me. So grateful that I had a safe place to isolate while Lucas did battle with the ugly omicron variant. So grateful that medicine was making this possible. So grateful for the kindness, compassion, and care with which all of the medical staff we encountered that day treated me.

When they called us back, all of the medical staff knew why Lucas wasn’t there with me. And they were so kind. I didn’t have to explain anything. They brought us back into the procedure room and walked us through everything that was about to happen. There was a strange little “Wizard of Oz” door the size of a window in the back wall. It led directly to the lab and it was through this door that, once all was set, our embryo would pass. There were ultrasound monitors set up so that I could see what the doctor was doing, even while lying on the table.

Lindsey pretending to knock on the little “Wizard of Oz” door in the procedure room once the transfer was completed.

Once they had given me all the information I needed and asked if I had any questions, they stepped out of the room and things transpired exactly as they described. I undressed from the waist down and sat on the procedure table with a sheet in my lap. The doctor and her team came in with the most recent report card about the growth and development of the fertilized eggs. Based off that information, and the fact that COVID has been shown to have some negative effects on pregnancy, we decided to transfer just one embryo that day. That decision made, everything moved quite quickly.

My care team, made up exclusively of women, bustled around me, and I felt like a little chick surrounded by a brood of protective and capable hens. Lucas was on speaker phone, as present as he could be while running a fever. Rebecca was squeezing my hand. I was trying to narrate to Lucas what was happening in the room. The doctor used a practice catheter first to make sure she was ready to navigate my cervix. Then she knocked on the little door and out popped the head of a staff person from the lab, presenting the most likely candidate for transfer, already prepared in a catheter. It took a little longer to thread the actual catheter and we all held our breath, watching the ultrasound screen for it to show up in my uterus. When the catheter made it through my cervix and she released the embryo at the back of my uterus, I gasped and laughed and wept to see it, the actual embryo, as a bright star against the dark and milky universe of my insides.

There were so many prayers in the awe and overwhelm and tears of that moment. That I could somehow adequately communicate to Lucas what had happened in that room. That the miracle of that embryo would be compounded by the miracle of a pregnancy. That the miracle of a pregnancy may even be compounded by the miracle of a child. It was a lot to hold. Too much, even. But we did it. And the wonderful sonographer made sure to capture and print an image of the moment of release so we forever have an image of that moment that took my breath away. “Lucky Embryo #7,” on its journey to its temporary home.  

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COVID (Part II)

Over the next few days, I tried to stay positive and test negative. I masked around my friends, ate meals outside, and made space to write, pray, cry, connect with my friends, and rest.

We received some discouraging news from the lab, that of the remaining embryos, only two had continued developing to a level that were likely to survive biopsy, freezing, and testing. It was a grief in the midst of an already uncertain time. We did our best to focus on the positive. And even though I kept testing negative for COVID, I was playing the mind game “Is it COVID?” for every sniffle and throat tickle that came my way.

Within 48 hours of the transfer and after a terrible night of sleep, I indeed tested positive. That test lit up like a National Lampoons house at Christmas. I packed my bags, loaded the car, texted my friends my goodbyes, texted Lucas to expect me, and got on the road. Lucas was waiting in the driveway when I got home. He helped me directly into bed. I spent the next three days between there and the couch, triple digit fever blasting, convinced that my body had become an incinerator for our embryo but not even having the energy to really worry about it because I felt so terrible. My eyelids were swollen for Pete’s sake. It was bad.

Friends showed up for us with deliveries of food and we tucked our best hopes away in our breast pockets and put our focus on getting well ourselves.

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Tumor Marker or Pregnancy?

When it was time to do a blood draw to see whether implantation had occurred, I was a little over a week past my first positive COVID test. Even masked and over a week past infection, they moved us through the fertility clinic quick and told us to expect results later that afternoon.

Afternoon came and I kept refreshing my “My Chart” to see if results had come. Test Results loaded before any communication about them. There were measures of my progesterone and estradiol levels. There was also a test result labeled: HCG – TUMOR MARKER OR PREGNANCY. Apparently, the hormone a body produces when pregnant is the same hormone a body produces when certain cancers, like pancreatic cancer, are present in the body.

I was pretty sure I understood what the results were telling me, but it was surreal and strange, so I messaged my team: “Hello Team, I got a message that the results from our blood work/pregnancy test is in but/and I’m not sure how to read them. Can you let me know what they mean from a lay person’s perspective (pregnant? Not pregnant?) and what our next steps should be? Thank you!”

A message came back in short order: “Hey Lindsey! Yes you are pregnant! All your values look great! Our next step is to repeat this HCG value on Monday. Could you come at 8:30 for that blood draw?”

Of course, I could! We were over the moon! Still tentative in some ways – it was still so early. Only about 4 weeks gestation at that point, just two weeks past conception. So much can happen in those early, early days. But my fevered body hadn’t incinerated our embryo. We still had a shot. We held onto it and awaited our next test for “Tumor Marker or Pregnancy.”

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From Surreal to Sick

Those earliest days of pregnancy were so surreal. It was both better than we hoped for and not quite believable at the same time. I didn’t feel any different. I was fatigued all the time, but that was because I was still recovering from COVID. Wasn’t it?

Monday’s blood draw was similar to the Friday before. Early morning draw, wait for results in the afternoon. I was at Prairiewoods when they came in. Both the results and communication stating that everything looked really, really good. If things continued well, they would have me come back in three weeks for a first OB visit at the fertility clinic. If everything still looked good at that point, they would release me to my regular OB/GYN for standard care. After nearly daily communication and more than weekly procedures with the clinic, three weeks felt like an eternity. But it also felt like a blessing, like a release back to our lives.

I called Lucas from a bench overlooking a reclaimed prairie and a parking lot. We rejoiced together and started to pull our hopes out of our breast pockets and gingerly uncover them. When I got home from my retreat, he had checked out several library books on pregnancy and framed the sonogram of our embryo and set it up on the dining room table where it would join us for every meal. I started being more conscientious about what I ate and noticed a sudden aversion to most sweets, especially chocolate, and all caffeine.

Besides that, I still didn’t feel much different. So I peed on a pregnancy test to reassure myself that the thing the blood test said was happening was really happening. I know the blood test is more accurate, but I figured if there was still enough HCG in my urine to light up a pregnancy test, we must be doing okay, even if I didn’t feel any different. It lit up just as fast as that positive COVID test did. I had tossed the COVID test but I kept the pregnancy one. It’s a little talisman of hope and encouragement in the bathroom.

When I reported to Lucas that I was feeling nauseous a week or so later, his face lit up. “I know what the tests have said, but this is what the movies taught me is the real sign of pregnancy! You’re really pregnant!”

I was and I am.

I started keeping saltines by the bed and keeping lemon Larabars on my person at all times. I napped a lot. People asked me what I was doing with my time now that I wasn’t working. “Oh, I’m finding ways to stay busy,” I dodged. By about six weeks, I was feeling pretty gross most days and was grateful for the freedom not to do anything I didn’t feel like, to be in bed by 8:30 most nights, and especially not to try and hide how gross I was feeling from colleagues or congregants. I stand by what I wrote [last week] about how pregnancy should never be a punishment for anyone for any reason. If you’re not excited about the outcome of a pregnancy, it’s a pretty rough thing for a body to undergo.

We were counting down the days to our first OB visit when I got an unexpected call from the clinic. The results of the genetic testing for our remaining embryos had come in. It wasn’t good news. Both embryos had tested aneuploid. They had significant chromosomal deficiencies that were “not compatible with life.” I asked the woman from my care team what that meant, what exactly had been missing from these embryos, what this meant for our ongoing pregnancy, and what it might mean for our fertility treatment going forward. Was I a candidate for another egg retrieval, for example?

She walked me through the details. The aneuploid embryos were missing chromosomes. This was more, different, and much more significant than a chromosomal difference like Trisomy 21 (better known as Down Syndrome). These embryos would have been unlikely to implant or would have likely miscarried on their own. She reassured me that she felt confident about the pregnancy I was carrying. Statistics said that at least one in three embryos for someone my age should be euploid (chromosomally “normal”). I set down the phone and had just started to let myself feel the grief of this news when Lucas got home.

“What’s wrong?!” I gave him the news, the bad and the hard and the hopeful and the plan B. We cried together, a strange little grief for what might have been: a sibling or another shot or even the sense that all of our eggs were not literally in one basket. Now all of our egg was in one basket. We were still excited and hopeful, but the anxiety going into our first scan got turned up to eleven.

I now felt sick for a different reason.

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That First Scan

When the day of our scan came, we were both excited and anxious. We were both ready to go more than half an hour before we were expected to report for the appointment. (Anyone who knows me knows this is significant.) So we looked at each other, shrugged our shoulders and said, “Maybe they’ll be ready for us early?”

On the way, I told Lucas what I’d been telling myself and God for the last five days. “If I can just see the heartbeat, I will be satisfied. That’s all I need, to see the heartbeat.”

We were about midway through week 7 at the time of the scan and the sonographer got in quickly. There was no holding our breath or waiting around. “There’s your baby!” she exclaimed.

I had imagined us collapsing into tears a thousand times over the past few days for one of two reasons. And it was just as I had imagined, but better. The tears of joy and relief that exploded out of both Lucas and me were overwhelming. I was crying and laughing and shaking and the sonographer kindly said, “I’ll show you the heartbeat, but you’ve got to hold still.”

As she went about taking pictures and measurements, she described what we were seeing. The shrimp-shaped embryo was roughly the size of a raspberry, just over a centimeter. The little cheerio-shaped yolk sac would provide nutrients to our little bug until the placenta was more developed. The gestational sac was measuring about a week ahead of the embryo, room to grow.

Our team talked us through all that looked good, what our options for care would be going forward, and implored us to share if something went wrong and also absolutely if everything went right. Walking with women and couples through the hardest days, they wanted to celebrate with us, even from afar, if and when things went right. They were releasing us to be regular pregnant people.

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Regular Pregnant

When we got home, I called the office of my regular OB/GYN to set up our first visit. They celebrated with me over the phone and planned to see me in three weeks. That “in three weeks” visit happened over two weeks ago and things continue to look good and go swimmingly and make us cry when we get to see pictures of the now slightly more baby-shaped being dividing cells in my middle.

It’s wild to reflect on this whole process from this moment. A moment of relative calm and confidence, learning new things about and through my body daily, starting to emerge from the blech of the first trimester into more activity and energy and grace. My jeans don’t fit like they used to and I’ve had to buy a new bra. (I’ll write about taking up more space as a woman at some point soon.) There were so many unknowns and so much grief and unactionable information. And they are fading quickly in the rear-view mirror. I write about them now, not to wallow in them, but to remember that this is the way it happened. It was hard and we survived and today we are here. Today I am grateful to be regular pregnant.

Lindsey and Lucas on their anniversary trip in Boston, just regular pregnant and feeling pretty good.

And if you read this far, bless you. I am grateful to all of you who have been praying and traveling this journey with us. We’ve come a long way, and we’re only just beginning.

Much love,

Lindsey