***Trigger alert: pregnancy loss is mentioned/described in this episode.***

Early in the podcast’s first season, in episode 5, Julie shared her baby’s birth story. She returns today to share her fertility journey whereby it took several years of perseverance to successfully conceive and give birth to her healthy baby boy.

The path to conceiving her son via IVF included unsuccessful IUIs, a chemical pregnancy, early loss of twins, and switching care providers and hospitals along the way. She explains how her Christian faith created a bit of conflict within her at first about this pursuit, and she also describes some different opinions her family had about trying to conceive in alternative ways. Julie also goes into other emotional and relational aspects of the journey and for her, how valuable it was when she was able to shift toward feeling at peace with whatever the outcome. She wanted to share her journey in hopes that it can encourage others on a similar path.

Episode Topics:

Meeting her future husband in London
Getting married
Buying a house in Astoria, Queens, fixer upper
Deciding to casually try to conceive
Going to OB for hormonal testing
Low AMH levels/undiagnosed infertility
Trying IUI w/ clomid
Moving to IVF when IUI doesn’t work
Morning monitoring almost daily
Explanation of her protocol - Put on highest dose of Follistim for daily injections to stimulate egg growth and also taking Menopur
Egg retrieval surgery while partner is providing sperm sample
While working with Columbia, got a positive pregnancy test, but it was a chemical pregnancy
Going in every day or every other day to monitor HCG levels
Had her on progesterone vaginal suppositories with a positive pregnancy test
Had a D&C after the chemical pregnancy
2 subsequent rounds of IVF with 2 embryos inserted each time, neither worked
She was taking a drug called Lupron via injections to control ovulation
Dr. Glenn Schattman at Weill Cornell -- switching from Columbia
Similar protocol of high doses with some important tweaks: had a double trigger for ovulation, estrogen patch on top of progesterone
Got 10 embryos, 6 were usable (“juicy”)
They decide to do double IVF because of her age
Got pregnant - identical twins - 2 heartbeats for 2 appts, preparing to travel to UK for Christmas, miscarries while in UK -- she flies back to her doc at Weill Cornell for the D&C
Cian was conceived a few months later
Comparison of Weill Cornell to Columbia
Recently tried the last two frozen embryos, but it didn’t work
Family dynamics and opinions

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Interview Transcript

Lisa: Hi, Julie. So good to see you again.

[00:00:02] Julie: Thank you very much for having me back.

[00:00:03] I know you shared your baby's birth story in the first season, and I asked you back because you have an IVF fertility journey story to share with us, right?

[00:00:13] Yes I do. It was quite a journey to get to our little boy Cian. So yeah, I'm happy to talk about that a little bit. Should I just launch right in?

[00:00:21] Lisa: Go right ahead; sure.

[00:00:22] Julie: Okay. Well, I figured to start, I should sort of explain a little bit of my background and my husband's background and how we met and like our sort of family planning, original idea. So I met my husband, Bob when I went to London after I graduated from college and we both work in theater. I was doing props and painting and he's a carpenter. And so I actually met him at a scene shop in London. And that was it. We dated and then it was just sort of like about a month later, he was like, "Oh, maybe I should think about moving to New York when you move to New York," But neither of us were in a huge rush to have a family; there was about two and a half years of back and forth dating.

[00:00:59] He was in London, part-time, in New York part-time. And we got married when I was around 25. So we met when I was about was 22 and I was about 25 when we got married. And you know, at that point, I was living in New York; he moved to New York. We were both here, both, still working in theater and just, it didn't seem like a huge rush, right, to have a family. We kind of talked about it early on, like, what are your thoughts about this? And I feel like I was like 70/30 pro and he was like, 70/30 con or something like that, but I felt like, you know, ultimately we probably will have a baby, you know? And so time goes by, we bought a house when I was around 29 and it's a huge project house needing lots of renovation work, which we're doing ourselves kind of in a really old house and kind of disgusting renovation work.

[00:01:41] And so it was obviously that wasn't the time, right? But as it started to get closer to 32-ish, I was like the house is still under renovation, but like, you know how they say that there's never the right time to have a baby, right? And so I'm like, well, you know, the house really still isn't done, but maybe if we just start trying, then maybe we can just rush and get the house ready.

[00:02:00] So it was around then when I was 32 and Bob's a bit older. He's about seven and a half years older than me. We decided to not necessarily try but not prevent things from happening. And that was actually kind of difficult because we're one of those couples that don't tend to like, you know, we're not like an everyday having sex kind of couple.

[00:02:20] You know, we're both busy and tired and whatever. So it was actually kind of hard work as much as I'm like, "Oh, we'll just see what happens." Like in my mind I'm starting to track things, right? Like I'm starting to track my cycle and like, okay, I know this is the time of the month and I'm starting to pay attention to my cervical mucus, and pay attention to these things. And so then it would be close to the time of the month and I'd be like, you know, the time to try, and I'd be like, "All right, Bob, like let's have a nice dinner." And he's like, "Uh, really?" You know? There were many, many months of sort of you know, it was work and as more time went on and we were actually sort of making attempts at the right time, but then things weren't really, you know, nothing was coming of it.

[00:02:57] So it was around. I think by the time I was 33, we were probably actively trying most months. And then

[00:03:04] Lisa: Can I ask you a quick question, Julie?

[00:03:05] Julie: Sure, yeah.

[00:03:06] Lisa: You mentioned checking cervical mucus and whatnot. I'm assuming that's the natural fertility awareness method.

[00:03:11] Julie: Yeah. Well, it's been awhile since I was doing that. So I don't really remember. I'm not the kind of person who takes painkillers when I have a headache, you know, I just don't like, I tend to try to do things naturally through diet, through, you know, through health, like whatever.

[00:03:26] And so I think I just started I think I read, Oh, there's some famous book that now I can't think of what it's called.

[00:03:33] Lisa: Probably Taking Charge of Your Fertility would be my guess?

[00:03:37] Julie: Probably, yeah. That's probably what it is. And so I started to learn about some of the like temperature tracking, cervical mucus tracking.

[00:03:44] I had been going to acupuncture and you know, I had a friend who had just recently gotten certified for it. And so I was like, "Oh, I'll go to her." And then it turned into like, "Oh, I'll go to her to try to increase my fertility." But I think we talked about some of that stuff too. Herbal supplements, things like that.

[00:03:59] So yeah, so I think it was probably Taking Charge of Your Fertility. And there's like charts at the back that you can track things like your mucus consistency and the temperatures. So then, you know, when your temperature shoots up, it's actually your cervical mucus changes consistency so that it's like, kind of like creamy, it's sort of wet and then it's creamy. And then as it's getting closer to when you're about to ovulate, it's stretchy. Right. Kind of, like they say, like egg yolk or whatever. And so I was doing that. And then, but then your temperature also spikes up, but sometimes it's a little too late once it's spiked up.

[00:04:31] And sometimes it's after you've ovulated, as opposed to like when you're about to. So at that time I've kind of, I went back and forth month to month, like I was trying not to obsess, but of course I was kind of obsessing and like, you know, I was like, well, maybe I just should stop tracking these things and just try to relax about it.

[00:04:46] Cause everyone says, if you just relax will happen. But then at the same time, it's like, well maybe I need to keep better track of it, you know? So it, it was actually -- it was difficult to know what to do. I'm naturally a problem solver, project manager type of person. I feel like I'm used to figuring out how to make things happen and I found that whole period very frustrating.

[00:05:06] It felt like I was grabbing at straws about what was going to be the magic thing that was going to click and mean that I could get pregnant. So it was around when I was 34, I think, that I finally went to the OB/GYN. I hadn't really been going. I just gone to my like primary care doctor who was doing pap smears for me, you know, I hadn't been to like a proper OB.

[00:05:27] But I went to the one I was going to at that point did some, was able to do some hormone testing. I probably could have gone sooner, but I also was kind of like, well, if I just wait long enough, I try these other methods, then it'll just happen. And I won't have to go on this route of, you know, IVF or whatever -- of help. So yeah, and then when I went to get tested around 34, so there's a few different hormones that control fertility. There's like your LH luteal hormone, your FSH, your follicle stimulation hormone. Then there's something they call the AMH level and it's the Anti-Müllerian hormone. And it's I think it's named after Dr. Müller who discovered this. It's something that fertility doctors look at and it kind of tells them your egg health, the age of your eggs, you know, it just gives them a sense of what that is. And so when I got tested at 34, my levels were low enough as if I was already 40.

[00:06:21] We all kind of thought maybe because libidos were low, that maybe there would be an issue on Bob's end as well. But it turned out that his was like amazing and high. So it was really just unexplained fertility, probably on my end, based on these levels of hormones.

[00:06:35] Lisa: How did that feel getting that news?

[00:06:38] Julie: Well, again, I was like, "Oh, okay, well, there's a reason, I guess why this isn't working." But then I also just, I don't know. I never really, I just kind of always felt like, well, maybe it doesn't matter what that is. Maybe it'll just happen anyway. You know, it'll just be the magic month when it happens. So I didn't feel too bad about myself, about that news. I think in general, it was difficult because it felt like my body was kind of letting me down, you know, like somehow I was failing or my body was failing me, especially when friends at that age, people are just having babies and I didn't have very many friends who were going through the same thing. A few, but a lot of people were just, it was no problem, you know? And then it's this kind of like, "Oh, well, why, why me? You know, why is this--" You end up, especially as someone who's used to solving problems, right, just feeling kind of like upset about yourself.

[00:07:28] Lisa: And from what I understand from a lot of people, it can feel so isolating because a lot of people might've had those struggles, but they might have just not shared those struggles a lot.

[00:07:36] Julie: Because it's as confidence -- or not a confidence, but like a -- feels like shame or failure.

[00:07:42] Yeah. It's, it's hard. Even my friends who were going through similar things, not all of them really wanted to talk about it, you know, with me. That's part of why I'm glad you're doing this. And also I'm really happy to share. 'Cause I'm a talker and I think it is helpful. Those are common feelings and it's good to get them out and then sort of see ways that they're not true, even though they are the valid feelings, but you know, it just sort of have a -- at least know that someone shares those valid feelings, I guess.

[00:08:09] Lisa: Sure. Can I also ask if I heard you right. It sounded like they identified an issue, but then they also called it unexplained [in]fertility. That sounds mutually exclusive, but

[00:08:21] Julie: No, I mean, the AMH level, it's not a conclusive thing, right? It's a test that kind of gives them a general idea of what's going on, but I don't think they consider it -- it's not like a sperm count where you can be like, Oh, you have a really low sperm count. That's like conclusive and evidence-based in a way. I think that the hormone levels, because hormones can change because things are [?].

[00:08:42] I think that it just ended up being a diagnosis of unexplained.

[00:08:46] Lisa: And that is such a common thing I'm hearing as I'm doing more of these interviews is so many people get that label of unexplained fertility and the mind games that that can play. I don't know if it played mind games with you at all, but

[00:09:00] Julie: Yeah, I mean, again, I sort of found myself like clinging to this hope like, well, it's not a given, right. Like 40-year-olds have babies. Even though I'm only 34, like it's not a given. Yeah, it didn't, I don't know if I'd say it played mind games, but it definitely was vague enough that it left room for hope that I didn't have to go through the whole process I ended up going through.

[00:09:23] So that was odd and made it harder and awkward and sort of, you know, if it had been like, "Oh, it's clearly this, and this is how we're going to treat it," then it would have been maybe a bit easier or more straightforward or maybe I wouldn't have waited quite as long, you know, to actually do it.

[00:09:38] And also I'll mention here, I wanted to bring it up at some point. I think this is about when I was thinking of talking about it. But I come from a Christian family and I am a practicing Christian. And so there were quite a few issues or concerns surrounding like how much do you just like, wait for God's will, wait for it to happen. If it's meant to be, then it will happen. And how much do you actually put the money and the effort and, you know, consult doctors and the science to have it happen. And that was definitely, they were things that I thought about a lot.

[00:10:08] And, and I think that also contributed to my like, well, maybe a miracle will happen and it will just work, right? Yeah. And my parents, my dad was kind of like, well, you know, I was like, "Should I do this? Or should I not do this? Like, should I go down this route of science?" And he was like, "Well, you know, I don't know, but, but God likes babies and families and like, you know, there's, there's no reason you shouldn't try as hard as you can to see what happens," you know, and my mom was kind of against it and she was sort of more of the camp of like, "Well, you know, this is it's too much." And like, "You should just trust." And, and my sister was also-- she was kind of like she's fallen away a bit from faith, so she came at it, I think more from the science end. And she was like, "Well, look, if you got a diagnosis of something like cancer, would you just sit back and be like, 'Well, I'm not going to treat this and just let God heal me, or would you go and get treatment?" You know? And I was like, well, obviously I would go and get treatment, you know? And I found that actually quite helpful in thinking about the IVF too, because ultimately I think you'll probably see from the story, but, you know, ultimately you can't, the doctors can't make it happen.

[00:11:11] It's still, ultimately [If] going to happen, God's going to allow it to happen, or it's not, you know? As much as they do as many interventions as they can make, they can't guarantee that it's gonna work. So, so I also felt ultimately that they weren't wrong choices somehow to then pursue the IVF, you know, the science route.

[00:11:30] So yeah, so let's see... So then after I got the the low AMH reading from the OB/GYN, that particular office. So there's a couple of things that you do, like couple of steps, right? You don't just jump straight into IVF usually, unless there's bigger, you know, the thing that they know about. But so the first step that you take us to do IUI, which is intrauterine insemination, which some people call the turkey baster method, because I think some people at home maybe do like, use turkey basters or shoot the sperm in there at the right time and then it just works. But when you do it through a doctor, it's a little bit more controlled. But that was essentially the first thing that they recommended at my OB. And they could do everything leading up to that, like all the monitoring that has to happen. And you take an oral hormone -- they could do that through their office. And then I just had to go to a different facility for the actual IUI procedure. So I was like, okay, well, that's fine. And so we talked about that and the doctor had said -- and she must've even prescribed the oral hormone that you can take, which is called Clomid I think is usually what they use.

[00:12:30] And I must've misunderstood her because she gave me this prescription for this and she was thinking it was going to be in conjunction with doing IUI. I thought, Oh, I'm just going to take this. And like, we're going to try at the right time of the month and that's going to -- so I ended up like for two or three months, I took the Clomid and then we just made good efforts at home. And when I ultimately went back to the doctor, she was like, "Oh, that's not what I meant at all." But she was like, "Okay, well, you know, so you tried that." So once that didn't work, we did, I think maybe just one round of IUI through my OB.

[00:13:03] And that was covered by the insurance because it's not considered advanced reproductive technology and fertility methods. I think most insurances will cover IUIs, but then when it comes to IVF, the majority don't cover it because

[00:13:16] Lisa: Yeah, and even if they do, I've heard that you have to do IUI first before moving to that.

[00:13:22] Julie: I think so. Yeah, because then they're like, well, if that'll work, then you don't need to go to that. Which makes sense. And yeah, the IUI, I mean, it was quite a while ago now, but just the leading up to it you're taking the Clomid orally and they're checking the follicles in both of your ovaries; I forget how often. Every few days maybe. Just to see how they're growing, see how many there are to get a sense of like what's going on and then they have you take a trigger shot of the hormone that triggers your body to ovulate naturally, you have to do a shot of that at a very particular time the day before you are going to go in for the IUI. And that way they know that you are ovulating. They're semi controlling your ovulation by telling your body now's the time to release the egg. And then you go in the next day.

[00:14:04] And they just use a little catheter and like, and then Bob had to do his sample. You can, you know, you can have a fresh sample, which is like him, they're doing it. Which puts a little bit of pressure on him to perform in the moment, which is a little tricky. But he didn't want to talk about it.

[00:14:19] So I think they take into a room with some magazines, but I don't really know. Or if you had a donor sperm then it would be, you know, then obviously it's just there and waiting, but and then you just wait. And so we did that with the OB and didn't have success. And so at that point they had given me a list of different places that will do advanced reproductive treatments.

[00:14:39] And so of the list we went with Columbia because it was, the office was close to where I was working at the time. So that was convenient. And also they offered like a cheaper introductory rate of like, I think it was $7,500 for IVF. We did do an IUI with them first, I believe. One or maybe two just to see, and didn't have luck with those either. So yeah, each step of the way I was like, "Oh really? I have to try something else. Like this is not working?" So then I'm like, "Well maybe if we just do the cheap introductory rate, like maybe I'll just be like instant, right? That's all I need is just that little extra, like whatever." Yeah. So that started us on the sort of trajectory of... and this was when I was 36, I believe? 35 into 36, maybe.

[00:15:23] Lisa: And did you say you started to sort of just casually not trying to prevent around 32?

[00:15:28] Julie: 32 was when we were kind of like, not preventing. Although I was on birth control very briefly for like a year maybe and then I went off of it cause it did weird things to my body. So we'd always been kind of doing like a rhythm method anyway. But yeah, 32 and then maybe 33 started like being more active, trying 34. Went to the OB and got, did the Clomid, did the IUI. And then around 35, 36 went to Columbia.

[00:15:52] And you know, it wasn't a horrible experience at Columbia, but it definitely felt compared to where I ended up at Cornell where I had success and had m y baby, Columbia looking back felt a little low grade. But the whole process is just kind of, it feels a little like I don’t know, when you start on IVF, like a round, if you're actively taking the hormones and growing the eggs, then it's called like a fresh cycle.

[00:16:16] And then resulting in like when they retrieve the embryos and they put them in without freezing them, then that's, that's the fresh cycle. And then any that are leftover, they freeze and then you have subsequent frozen cycles. But particularly for a fresh cycle, when you're injecting the hormones you're having to go in almost every morning for what they call morning monitoring.

[00:16:34] Where they're doing a trans vaginal ultrasound and looking at both ovaries, checking the sizes, they measure the diameters of each egg. They can see and the number on each size. And they're just tracking how they're growing. They call it your protocol, the hormones that you're taking, the amount and which ones.

[00:16:50] And so they just, I think are keeping track of making sure that that's working, you know, that, that things are looking good. But that morning monitoring at least pre COVID you know, back, back in those days it was just like a free for all, you know, it felt a little like -- I don't know if meat market is the right thing, but there's just, there's no timeslot. You can get to the office anytime between 6:30 and 9:00 AM.

[00:17:12] And then it's like, first come first serve. So you end up on a list based on when you arrive. And so like the earlier the better. Unless you can't, and then in that case, you could be waiting for hours just to go in for your blood work as well, blood work and the transvaginal ultrasound. And it's just a room full of like, kind of sad, desperate women, like they're over their morning monitoring and you know, it's just really like, cause everyone's like not sure if it's going to work and there's just so much like emotion and yeah, very loaded. And it's really hard.

[00:17:42] Lisa: How frequently were you having to go?

[00:17:44] Julie: Well, when I was doing a fresh cycle, you have to go if not every day, every other day. And then as you get closer at the time that you're going to ovulate, then you're going every day. So because they're seeing like when, when, when. Yeah, so it was intense. A lot of early mornings.

[00:17:59] And then also, you know, if you have to get to work, like it's fine if it's like, "Oh, I'm pre-work." But then if you end up having to wait for two hours, then you'll be late for work. And then that just throws everything off.

[00:18:07] Lisa: And a lot of people are trying to be discreet and not let work know what's going on.

[00:18:12] Julie: Exactly. You know, and then sometimes the partners come too, which is great, but then also that's hard on them too, but then they want to be supportive and then, it's tricky. I have found, I will say we just, we did a frozen cycle, actually. We had two more embryos left and we just did a frozen cycle, without success, unfortunately.

[00:18:29] But it was just in August. And so it's entirely different now post-COVID because they actually give you an appointment time slot, for any monitoring. So that you can kind of guarantee that you're only going to be there for like half an hour max, which is really great. Anyway, but so when we went to talk to Columbia and the doctor, you know, she looked at everything from before with the IUI and my, they again took a lot of the hormone levels again -- my AMH again, like all these different things. Before we did a cycle, I had to go in a couple of times of the month so they could take my levels.

[00:19:02] Do blood work and see what the levels were on like a regular month for me to get a sense of what the protocol should be. And then, so she ended up putting me on the highest dose of the follicle-stimulating hormone, which is the main there's a couple of different drugs that typically you inject in the course of an IVF cycle.

[00:19:21] And then some of the names are gonna escape me, but Follistim is the one that's like it's comes in a pen that like clicks and it's cold and it's kind of weird, but that's the one that's the follicle stimulation hormone. And then there's another one that's called Menopur. And there's a few different brand names that are pretty much equivalent.

[00:19:37] I think Follistim the equivalent was there's another one called like Gonal-F or something like that. And so before you start, once they tell you what your protocol is going to be, you, the patient has to call around to various pharmacies to see what the different pharmacies charge for the different drugs.

[00:19:52] And if they charge like this much for Follistim and this much for Gonal-F and then like one is cheaper than the other, then you can just go with, you can choose that way. But then there's levels that you have to take depending on how much help you need in stimulating your eggs to grow. But so she put me on the highest dose of the Follistim, which of course it gets more expensive, the higher the dose.

[00:20:14] So it ended up being quite a bit of money overall. And then you're injecting that every day at the same time, every night into your abdomen or your legs. I don't love needles, but Bob is definitely afraid of needles. So I ended up doing it myself. I know some partners are able to do that for their partner, but not in my case. You have to do like a little training about how to do the injections. Like they have classes with like 10 couples or whatever before you start a cycle and learn how to do it. And the needles are short, but you know, it's still annoying.

[00:20:49] And then some of them, there's another one called Menopur. I'm not exactly sure what that one does, but that was also part of my protocol. And so that come in little, it was like a powder. So you had to take saline from one second into the needle and then. Shoot it into the bottle and mix and like however many bottles, like you mix them together into the thing and then inject that.

[00:21:06] Like, it's just, there's a lot of like, you know, again, for someone who like doesn't even take Advil, it was kind of a lot of medical... But anyway, I got fairly good, I think, at injections. I'm glad I'm past that now. But I didn't have as bad of issues as some people with like bruising and stuff like that.

[00:21:24] But some people get really beat up with the, over them, with the injections.

[00:21:29] Lisa: Yeah. I wanted to ask back to like you mentioned Clomid and then with these things, did you have noticeable side effects?

[00:21:36] Julie: It's been so long, Lisa. I'm not really sure.

[00:21:39] Lisa: I mean, if you don't remember, that probably means they weren't too bad, I would think.

[00:21:43] Julie: It wasn't. No, it wasn't too bad. I mean, I think I feel like it, you know, maybe I felt more kind of like period-y, right in my uterus and my abdomen like and maybe twinges and you know, but there weren't other side effects, at least for me, no nausea, no like things like that. And Clomid was nothing like there, I don't remember anything with that. But with the others I think because I was on the highest doses, I think it was more the stress of the injections, honestly. And also, there's quite a bit of stress around the time and you're supposed to, at the same time every day, you need to make sure everything's clean. I was like, you know, had to clean my kitchen at like 10:00 PM or 10:30 PM, like clearing off the table, sterilizing everything like doing the thing. And so there was a lot of like [gasp] around that, you know. And then also they again, you have to do a trigger shot before they-- so you spend the first half of the month, like growing the eggs with the hormones and injections and then monitoring how things are going.

[00:22:38] And then when the eggs are big enough and it seems like it's the time you add in a third injectable medication as you get closer to ovulation, I think to prevent you from ovulating too early. So they're building, building, building the eggs and then at some point they're getting really big and they're like, oh wait, don't ovulate yet, so then you add in this third one, and then when the time is right, then you do another trigger shot ; that has to be at an exact time.

[00:23:02] They call you like the day of, to be like do it at 11:00 PM. Because based on when you do that is when they'll have you in the next day to do the egg retrieval which is an operation. You're under, right? Yeah, you're under anesthesia for it.

[00:23:15] Lisa: It sounds like, like if somebody doesn't already have anxiety... or if they do, oh my gosh.

[00:23:21] Julie: It's so not conducive to conceiving a baby. No, but yeah, it's, it's very anxiety driven. And so then of course, the doctors know what they're doing, but then in my mind, it's like, "Okay, I have to do the shot at this time because then I'm going to ovulate. But what if I ovulate too soon and then they don't get the eggs and then..." So you get to the facility the next morning to have the egg retrieval and then, you know, you have a time to be there, which is like really early in the morning, like 6:00 AM. But then you're sort of sitting there waiting and you're like, "Oh no, what if you're missing the window? Like, what if they don't know?" You know, it's very stressful.

[00:23:53] So egg retrieval is an operation, so you're under anesthesia and then you come out of it and when you're and it's an outpatient thing, you know, at Columbia, they actually did it in the clinic there.

[00:24:04] With Cornell, I had to go across the street to New York Presbyterian hospital. But so then, as I'm recovering like an hour-- it was half an hour, an hour after they come and tell you how many, they were able to get how many eggs they got. Oh, and then at the same time that you're having the retrieval, your partner is doing his sample, right.

[00:24:21] Again, a fresh sample, again, pressure. But so once they say, you know, we've got X many eggs, and then they put them in the dish with the sperm and then you wait. And I think it's pretty common now that you then have the transfer of the embryos, whichever eggs fertilized then you see like how many make it to embryo stage.

[00:24:42] And they can either wait three days or five days. I think it's less common to wait three days, because five days is a more mature embryo; it's actually called a blastocyst at that point, because it has divided into, I think it's more than 50 cells or something like that. They base it based on how much it's divided within. And I think they tend to have more better success rates with five day embryos. So anything I did was always with five-day embryos. So I think with Columbia, I think they got 10 eggs during the retrieval. And we ended up with five embryos. And they, at Columbia, they gave them grades, which they didn't do at Cornell; it's sort of funny.

[00:25:18] They gave them like two letter grades and the first was for like size and the second was for like amount of division or something like that. So, but basically of the five numbers that we got, the best one was a BB. And then the other four were CCs, so they weren't very good.

[00:25:33] Lisa: So is it similar to academic grades where like A is the best quality?

[00:25:36] Julie: Yeah, I think so. But they can only tell quality based on-- again, no one can say if it's going to be a viable embryo or not, but they can look at the size and they can look at how much the cells have divided or how good the divisions are looking, you know, and at Columbia, they give them these grades.

[00:25:50] So I was like, "Oh, well, you know, So BB that's not terrible." And so in that first cycle at Columbia with the fresh cycle we ended up just transferring the one baby embryo. I was again nervous. I was like, well, maybe it just took this little bit and like, I don't want to have twins.

[00:26:09] So, you know, let's just put one in. So we transferred the one and that I did actually get pregnant. It ended up being what they call a chemical pregnancy. But I didn't, you know, I didn't know that at first, so, so we got a positive pregnancy test. You go in, you know, eight days later or 10 days later after the transfer for the pregnancy test for a blood pregnancy test.

[00:26:30] And then after that, you go in, I think every day or every other day to check your HCG levels to make sure that pregnancy hormone is getting higher as it should. And with that pregnancy, it did get higher and higher, but then when it came time to have the ultrasound for a heartbeat, which they do around seven weeks They couldn't find a heartbeat.

[00:26:50] And it looked small. Like it looked like at the size, it should have been at like five and a half weeks. I should have mentioned after the embryo transfer at Columbia, they had me just on progesterone like vaginal suppositories. And you take those, it's like supporting the pregnancy.

[00:27:06] So with the positive pregnancy test, you continue having the suppositories. But so when I went for the ultrasound and they couldn't find the heartbeat I like, again, my mom's opinion and things came into play. Like, you know, it was like, well, maybe it's going to be there.

[00:27:21] And it's just isn't there yet. And my mom was sort of like, "Yeah, you know, I can't believe that it didn't, that it didn't work like there wasn't a heartbeat. And you know, your sister's her little, her first boy, like they couldn't find it until 10 weeks, the heartbeat. So then I was like, "Uh," and it was December and we were just about to travel back to the UK for Christmas.

[00:27:40] And so the doctor at Columbia sent me to another facility where they had a better ultrasound machine before I left and they did another ultrasound and they still couldn't find a heartbeat, but because I was so loathe to like give up on this in case, maybe it would miraculously work out, the doctor kept me on the progesterone supplements, which meant that I didn't get a period until, and then when I came back from the UK in early January at what would have been like 10 weeks at that point it was clear that there was nothing. And so then they had me stop the supplements and then they recommended having a DNC to sort of clear everything out. So I did that.

[00:28:20] So that was my first IVF round. And then there had been four more embryos. So we did two subsequent frozen rounds and we put two embryos in each time. And there was no even a chemical pregnancy as a result of either of those. And another thing at Columbia with the frozen embryo transfer cycles, FET cycles. They had me take a drug called Lupron, which basically means that they control your cycle.

[00:28:45] They prevent your body from ovulating that month. So I was again having to do injections before I went in for the frozen embryo transfer. When you're doing a frozen embryo cycle, like you don't go through the whole process of injecting hormones to build your eggs. Because that's already been done in the fresh cycle, but after you've ovulated, they wait five days and then you go in for the transfer, which is more like the IUI where you're not under anesthesia, they just put a catheter in or they just, you know, somehow get the embryo or embryos mechanically into your uterus.

[00:29:16] So it's much less of a thing. But I did find at Columbia because they wanted to control my ovulation and make sure I didn't ovulate that I was still having to do injections of the Lupron. So Cornell was different, but I'll talk about that in a minute.

[00:29:27] Lisa: If I understood correctly at this point at Columbia, you had had three rounds of IVF?

[00:29:32] Julie: Three rounds, one fresh and two frozen.

[00:29:34] Lisa: Okay. And if you don't mind answering this question, you mentioned something about seventy-five hundred dollars is that every single round of trying?

[00:29:45] Julie: It's cheaper for the frozen embryo cycles because you don't have to have as much monitoring.

[00:29:52] And then also because you're not going through the egg retrieval. So I forget what that was at Columbia, but it was maybe more like three or $4,000 for the cycle. But don't forget like with the fresh cycle -- so it's the $7,500, that was the introductory rate. I think a normal rate, like for a second round of a fresh round would have been more like $9-10,000.

[00:30:12] And then but there was the cost of the hormones on top of that, the injection, you know, the drugs probably like $8,000 on top of that. Because I was on the highest doses. So they were the most expensive, I think I was looking at like, something like $500 a day or $800 a day of drugs alone for the fresh cycle.

[00:30:34] I don't really remember what the cost of the Lupron was for the frozen cycles at Columbia, but so it was a significant investment of money at that point. But then I've always felt like, you know, once the frozen embryos existed. I couldn't just be like, well, they're CCs, let's not bother. That's just not who I am, you know? And also I'm like, well, God gave me these, so I need to give them a chance, you know? So yeah, and that definitely came into play. Cause we, we don't have a lot of extra money. So in terms of like making the decisions of, do we do this or not do this, but it felt like we needed to-- I felt like I needed to once I decided to go the route of science I needed to do the best I could give it the best try I could, you know, that I could afford to. So that I would know that I had done my best, whatever happened, you know ? I would hate to regret or feel like I hadn't done enough somehow, you know?

[00:31:20] So that's kind of what-- actually speaking of that. So after we'd gone through all that at Columbia I was kinda like, well, you know, what do we do now? Is this the end of the road? Like, what do we do? And I just, I felt like, we had had success, even though the baby never had a heartbeat, like it had worked.

[00:31:39] So it was possible for it to work. And we ended up getting a check in the mail from Columbia for like a couple thousand dollars or $3,000. I don't remember why it was some sort of a refund. I didn't even know why. But when it came, I was like, "Oh, this is crazy." And I right around that same time, some other people at.

[00:31:56] Work, not with friends of mine, but people that I knew had gone through IVF and had success and they were older than me. There were two people actually, and they had both used Cornell. And Cornell had been on my original list and they were among, I think they and NYU were the most expensive of the batch. But these acquaintances from work just spoke so highly of it. And then I just got this big check from Columbia and I was like, "Oh, well maybe this is like a sign that we should give it one more chance and just go with Cornell and just see if it's better or different.

[00:32:28] So the doctors that these acquaintances had used didn't take my insurance or something, but I ended up seeing Dr. Glenn Schattman at Cornell and we had an initial meeting with him and he was a little like not terse, but he just was kind of a little offhand, but I was like, "Well, maybe, you know, this is what happened and maybe it's this, or maybe it's this." And I think he was kind of a little like, "Hmm, well, you know, let's not hypothesize," you know, and it just felt like he was not really paying too much attention and I wasn't sure how it was going to go, but we kind of, you know, I was like, well, okay, let's just try this and see. And in the end, like he was just an amazing doctor. Like, I can't speak highly enough of him. I'm not sure why that first meeting was a little off, but overall, like even shortly after I was like, "Oh, he's doing well." And then by the end of our time at Cornell, I just, I can't speak highly enough of him. Now

[00:33:15] Lisa: Were you able to take frozen embryos from Columbia?

[00:33:19] Julie: I think I could have, but we used them up at Columbia. So with Cornell we did another fresh cycle and that was in 2016. So I was 38 at that point.

[00:33:32] Lisa: And you didn't have to start over with IUI, did you?

[00:33:35] Julie: No. No, cause once that didn't work, then it was just like, okay, well that didn't work.

[00:33:39] It's not gonna work. And you know, we had kind of been trying on our own in between, like, just in case that miracle happens. But anyway, so then Cornell was like, it was just such a better experience overall. Same kind of deal with the morning monitoring being kind of a free for all, but a much nicer facility kind of, not quite the like, you know, vibe of Columbia.

[00:34:02] It was busy, for sure, but it just was more pleasant in that regard. And I often was seeing Dr. Schattman for the ultrasounds in the morning monitoring, which I found nice. And he actually was the one who ended up doing some of the procedures as well. And I just felt like I kind of developed, like, he got to know who I was, you know, I wasn't just like another person there, so that was good. He ended up giving me the same protocol in terms of the highest doses of the various drugs. But he made a few tweaks to it, which I think really made a huge difference. I don't know why, but, so he ended up, I have to think back.

[00:34:38] So I was on the same protocol in terms of the stimulation hormones. This is for the fresh cycle. But then he had me do a double trigger shot. So two shots to trigger the ovulation. I don't remember why, but I really think that, that it was like an extra boost or something like that.

[00:34:54] But so they did that. And then once I'd had the transfer, they had me on an estrogen patch as well as the progesterone. And so like, it's just small things, but we ended up with I'm pretty sure he did the egg retrieval actually Dr. Schattman, but we ended up with I think 10 eggs or something like that.

[00:35:11] But then we ended up with six, really good looking embryos

[00:35:14] Lisa: Without grades.

[00:35:15] Julie: Yeah. Without grades. And at Cornell, they give you pictures of the embryos, which is very interesting as their transplanting them in, like little photographs of the little round blobs, so no grades, but pictures. But anyways, so we ended up with six, what he called, I think at one point he called them juicy embryos.

[00:35:32] Lisa: That sounds better than an A.

[00:35:34] Julie: Yeah. And that was great. And then, so we decided to transfer two, 'cause I was that much older. And also statistically, I mean, of course there's more of a chance of twins with two embryos transferred, but there doesn't seem like better or worse necessarily to do two at once, you know in terms of the success rates, I guess.

[00:35:52] So we put in two embryos that first fresh cycle. And I got pregnant again, but this time what they found was that it was identical twins. So only one of the embryos had worked, but they were identical twins. It split. And they were sharing a placenta, which is a high-risk situation.

[00:36:10] So that was a whole 'nother kettle of fish. That wasn't really what I was hoping for in my ideal pregnancy. I think with that kind of situation often you end up on bed rest for the whole third trimester. I'd kind of hoped for like a natural childbirth or something like in a birthing center.

[00:36:26] And I wouldn't be able to do that. I'd have to be in a high risk, you know, situation, it would probably be a C-section blah, blah, blah. But you know, that's what it was. So I was like, "Oh, it's great. Pregnant is great." And when I went in for the ultrasound, there were two heartbeats and it seemed like there might be a thin wall between them and the placenta, which is better than there not being a wall and so again, it was December and we were going to the UK for the holidays. I saw the doctors right up until I think eight weeks. I went in for two different ultrasounds, maybe where there were heartbeats. And I didn't see Dr. Schattman right before I left, but I had told him I was planning to travel.

[00:37:02] My mom was thinking, you know, she's kind of hypothesized the whole time about what might be wrong or whatever. She was like, "Well, I don't think it's good for you to fly when you're pregnant, like that could affect things." And I had said to Dr. Schattman, "Is it a problem to fly?"

[00:37:14] And he's like, "No." And then I said to the doctor, I saw right before we left, "Is it going to be a problem that we're flying?" "No, no, it should be fine. We'll see you when you get back." And then I ended up having a miscarriage in the UK. Like two days before we were coming back, which was difficult. And really only knew cause I had it a little bit of spotting which didn't seem like it was anything, but I thought I should go get checked out at the hospital there.

[00:37:38] And so I went and they did an ultrasound and there were no heartbeats left. And at that point it was tricky. Cause it was like, well, here I am in the UK. And they, the doctors at the hospital there were like, "Well, you know, we can't really recommend to you that you fly back, you should really just have a DNC here."

[00:37:52] And I was like, "I don't want to do that. Like, what if you know, what if you're wrong? Like, I can't, you're not my doctor," so I ended up -- this is one way that Dr. Schattman was amazing. I ended up calling in and left a message for the nurses and I fully expected for a nurse to call me back. And he called me back himself internationally to say, like, "Come back. I can see you right away. I'm so sorry." So we did that, then I saw him and he confirmed that there weren't heartbeats and I had another DNC. And that was January of 2017. But I still had those four juicy embryos left frozen. And so July of 2017, we tried two more. And that's what resulted in Cian, who is amazing.

[00:38:34] And one thing that and you know, totally like. Worth the wait and like everything I could've hoped for in a child. And it was an amazing pregnancy. Like it was just what I wanted, you know? And another thing that was really great about Cornell, as opposed to Columbia, was that with the frozen embryo cycle, they actually let you have a natural cycle. They don't control your ovulation. You don't do Lupron. You don't do injections. You just abstain when it gets close to the time that you're going to ovulate. And you did the morning monitoring, not very much in the first week and the second week as you get closer to ovulation, they check to make sure, they're taking blood work.

[00:39:07] They were doing early ultrasounds, but it's just blood work towards the end. And they can tell from the blood work when you've ovulated. And so then five days later they just transferred the embryos. It was very like, no big deal, you know, and I really think that that was part of why it worked for Cian, you know, for that cycle, because it just, wasn't fraught with all the stress and the timing and the injections, and like, you know, it's just easy and I'm so grateful that it worked out. So we had two more embryos, which are the ones that we just tried this August. And you know, I was hopeful cause they were juicy. And also, cause we'd had two thus far out of four that had worked. I was hopeful for a sibling for Cian, but you know, it wasn't meant to be, but you know, we, we we'll probably see what happens on our own, and they say that, you know, especially with the diagnosis of unexplained infertility, once you've had a successful pregnancy, then often people get pregnant on their own, you know, and they don't know why. It's like, your body now knows what to do or something, you know, so it's possible. But we're both that much older now, so we're not like, you know, getting too worked up about it. But yeah.

[00:40:13] Lisa: And I'm guessing you wouldn't start over and do a whole new egg retrieval.

[00:40:17] Julie: No, no. 'Cause we have Cian like, you know, and we can't afford it. Like, I feel like I, I feel like we, we were put through this journey.

[00:40:27] I don't, you know, I was given what I was given. I don't need to push it more, and there are lots of reasons why it would be overwhelming for us to have a second child. We both were hoping it would work and I would really love a little girl, you know, I think Cian would just love a sibling and he's so into babies right now, but he's two and a half.

[00:40:48] But, you know, it's hard and we're still working on the house. It would be hard to find the space; it would be hard financially. We're both more tired, you know, that kind of stuff. So yeah, I feel like this is the answer for now. And that's another thing I wanted to mention. I, this is probably a good time to do it as any, but it may be easier for me because we did successfully have a baby as a result of the IVF. But I definitely see silver linings in the process. And it may be harder to see those if you've gone through cycles and not had success. Right. But even before we had Cian, I found at Cornell --especially that cycle that resulted in Cian, I was there waiting for my transfer and I was there with other women who were waiting and they hadn't done this before and they were worried and nervous and we would chat, and I felt like I was at a place where I was okay with whatever the outcome was, even though I didn't know that it was going to work, you know, and that I could sort of share a little bit of what I'd learned in the process with these other people. And that felt really good. And like, it felt kind of Zen in the right way, you know. I don't know how I feel about reasons for things, but that could be a reason why I went through this so that I could then share this here and share in those moments and help people in their journey.

[00:41:59] It definitely brought Bob and I closer together. I'm already a pretty patient person, but it definitely taught me a huge lesson in patience and also sort of humbleness, you know, that I couldn't do it myself, that I needed to just trust and put it out there, but then try to just be okay with whatever happened and you know, those are all things, obviously the work is not done, but I do feel like this whole process really helped me just trust in God more.

[00:42:28] And Bob too, you know, even though he doesn't share my beliefs, but I feel that he really has come a long way. In terms of being able to you know, try to trust.

[00:42:40] Lisa: Is there anything you'd like to share about your, I know you were saying earlier in the process, there were several family voices you had with different opinions and things. Once you conceived, were they just happy that you were pregnant or what did that look like?

[00:42:57] Julie: I mean, everyone was just thrilled. My mom, she's like, "Oh, he's like your miracle child," you know? And also, I think when we just tried these last two embryos, she was really advocating that we try them. Because of course we could have just been like, "Oh, we aren't gonna even try them." You know, like particularly was feeling quite overwhelmed. Right. And like the idea that maybe even both of them would work was very scary. So that was one way that I felt that we needed to just trust.

[00:43:20] But then my mom was also particularly like, "Well, you couldn't just throw them away, you know? And I did feel that way too, but I have to say a lot of that came from her. She also when I had the miscarriages, I think it was hard for her. She almost took it personally, which made it a little bit harder for me too, you know, like kind of was like, "Well, why, how would God do this," but then she also was like, "Well, you'll see those babies in heaven one day." And I was kinda like, "Well, I don't know how I feel about that." Like, especially the ones that didn't even have heartbeats. Like, I don't know if I agree with that, but she seemed to need to feel that way.

[00:43:53] And so I felt it was a lot about her and her needs, which was also kind of awkward, but I'm very close to my mom. I don't know if you can tell, but you know, we're close. And so I think it just made it a little bit more complicated for me, I guess. Some of her reactions to the various stages of the process, but now everyone's just been like so, so thrilled that it worked out for us and Cian, he really is a special little boy.

[00:44:15] And so part of the argument he's just happy, and he's like smart. He's just great. So, you know, and I think, you know, especially when these last two didn't work, a lot of family members have been like, well, at least Cian, he's so great. And like, you, you know, you have that and yeah.

[00:44:29] It's yeah. So it was only really positive regarding him and stuff. Yeah, and you know, but even my mom, she was trying to be supportive in the ways that she could, even though she may not have gone down the same route or felt like it necessarily was the way to go, but she was still supportive and then everyone else in my family was very supportive.

[00:44:47] And then I was gonna mention too. So I do have a few more friends now than I did when I first started on the IVF journey, who went through similar journeys and some with success and some without success. But that's another way, like we were saying at the beginning, I think people often don't want to talk about the, you know, they feel upset or like a failure and they don't want to share, but those friends, I was able to share with them.

[00:45:10] And then, you know, the ones that didn't have successful pregnancies, it's been hard because I did, you know. But then I feel like since I have the knowledge of what we all went through, then it's helped me to be a better friend to them. Even now that I'm a mother and they're not, you know. And I'm glad to be able to understand that and to try to-- I feel like friends who haven't gone through this journey and have had children and not had any issues. Like some of them I am not friends with anymore because it just felt like they weren't sensitive to where I was at or they didn't understand, you know, like, and that was tricky.

[00:45:45] Whereas the friends that I'm trying not to be that person, to those other friends that I know struggled. And, and some of them don't, you know, weren't successful. So.

[00:45:56] Lisa: I would think it would be a little tricky, similar to grief in loss of a loved one where it's very nuanced with each person and very individualized to kind of know how to be sensitive in the appropriate way for that person.

[00:46:12] Julie: Yeah. That's true.

[00:46:14] Lisa: What is a trigger for one person is different for another person.

[00:46:18] Julie: Right, right.

[00:46:20] Lisa: I don't know if that resonates or if you've found with this particular kind of journey that it there's more commonality?

[00:46:27] Julie: I think that that resonates somewhere from before I had Cian and like more in my relationships to my friends who did have kids at that point.

[00:46:35] Now I think that, I mean, I am a bit sensitive to, you know, like the friends who tried and didn't have kids, like in terms of, you know, it is, it is a little bit, there's the commonality of the experience, but then the not commonality of the now, which is kind of what you're saying. And so I, I tried to not.

[00:46:56] I just try to be sensitive to that in that I'm not, you know, like for instance, on one of those friends' birthdays, I'm not necessarily gonna send her a video of Cian singing happy birthday, you know, because I don't know, but I feel like that would be insensitive of me, you know? But I'm, I'm glad that I'm aware of those things to think about it and be like, okay. Or, you know, I try to make time to talk without being distracted by him because it doesn't feel like being a good friend to be like, "Oh, I'm listening to you. But also, you know, my toddler's running around," you know, like instead I'm like, okay, well let's have one-on-one time. That's, you know, and realizing that it's going to feel better for them then even if I was giving them equal time, but with the other, like, yeah. Yeah. But it's hard, you know, and especially like you want the best for your friends and I really wish that I could say, "Oh, it's always going to work out one way or another, but it doesn't always, you know,

[00:47:49] Lisa: Right, yeah. Well, this has been so wonderful. Is there anything that you haven't gotten to share that you'd like to share? And/or are there any insights or tips for someone-- say that someone's listening who is trying to conceive and it's taking a while and they may have to go down this road of conceiving in an alternative way.

[00:48:17] Julie: Yeah. I mean, that's tricky. Like I said, in the beginning You know, it's hard to know what to do in this. And everyone's like, "Oh, just relax. Just take a vacation." Just de-stress, you know? And it's like, of course, as soon as you say those things, that's the last thing you're going to be able to do.

[00:48:34] But I did find, and I think it's easier to say this looking back, but I mean, I think getting to that place where it's okay either way is helpful. I hear, I hear Cian thumping around upstairs actually he's awake from his nap. But yeah, like trying to find, you know, like the place where it's like, like you're trying, it's not hard work, it's not like a bad feeling, but it's like just sort of like, okay, not this month. Maybe next month, but without pinning your hopes on it so much that there's the disappointment when it doesn't happen. Like, if you can find that balance of like, I've got a lot going for me, I'm counting my blessings.

[00:49:10] This is not the end all or be all. I think that is a better place to be in if you can find it. But it's hard to find. Especially because the more months it takes the more angst right.

[00:49:24] Or years in your case, right? Yeah. It was a really long journey for you.

[00:49:28] But I felt like I came to that place.

[00:49:30] Right. And then I, then that was the time when I had Cian. So I mean, not to say that that's like the magic thing, but I do think it's helpful. But just personally for your own, you know, self to just sort of look at what you do have and try to be content with that. And just hopeful, but not, you know Just try to keep it in a happy place, I guess.

[00:49:53] Lisa: Right? Yeah. Yeah. Thank you so much.

[00:49:56] Julie: I should probably go; I hear [Cian] up.

[00:49:57] Lisa: Absolutely. Thank you. I hope to see you face to face before long.

[00:50:00] Julie: I'd be up for that park meet up.

[00:50:02] Lisa: Yeah. Let's try again. All right. Thanks Julie.

[00:50:05] Julie: Bye, Lisa.

[00:50:06] Lisa: Bye.