Reflecting on the year that was

At this time of the year I like to reflect back on the year that was.  The things we did, the experiences we had, and how much our family has changed. 

Last year at this time, I had just had my IUD removed in a "'let's see what happens" kind of move.  We also got the chance at an amazing trip to see our college alma mater go to the Rose Bowl and visit with some old college friends we hadn't seen in years plus make a new friend.  This not long after we had celebrated our 10th wedding anniversary the previous October.

The spring brought us to our decision that Mother Nature wasn't interested in a "let's see what happens" pregnancy, and we needed to once again take aggressive action to grow our family.  It was a decision that wasn't made lightly; after all, no one would fault us for not having more.  Having 2 children is more socially acceptable than ever; but it felt like someone was missing in our hearts and in our home.  So we made the dive again into the world of IVF, but this time documenting our experience in this blog in the hopes that our experience would give someone else hope and support.  The world of infertility can feel very lonely, especially if you choose to keep your journey private. 

We spent the summer preparing ourselves with meetings, testing, and again more meetings.  The summer was also a busy one with many activities for us and our children, including another amazing vacation with my husband's family.

By fall we were ready to go.  My oldest started Kindergarten, my youngest started preschool, and I started the process again.  At the end of September we were once again blessed with positive results and the knowledge that we were that much closer to finding our missing piece.

As winter has started (with a bang here in Minnesota!), I am reflecting on what next year will bring us.  I am roughly 3 and a half weeks away from knowing whether I'll need more blue or can think pink.  We'll start preparing for our new arrival come spring shortly after we watch my younger brother get married.  Come late spring/early summer, we'll finally see what we have waited all year for -- our missing piece of the puzzle.

Merry Christmas and a Happy New Year!  May the holiday season bring you peace, love, and joy; and give you time to reflect on the year that was and look forward to the year that will be.

Goodbye Zofran, Hello 2nd trimester!

It finally happened and I barely noticed!  I successfully weaned myself from the Zofran and not one drop of nausea.  I was getting anxious to be done for two reasons: 1) I don't like taking medication when I'm pregnant and 2) I didn't want to refill the prescription (I was down to the last two!).

I'm finally starting to round out a little bit but still in that baby or extra burrito phase, and things are evening  out it seems.  Other unpleasant symptoms of early pregnancy are either fading (headaches and nausea) or easing into more familiar rhythms (exhaustion, weight gain, cravings, and hunger pangs).  Plus, I'm starting to (I think) feel whispers of movement but it's not 100% sure.  I'm in the is it the baby or gas kind of phase, which to me is extremely frustrating!

It's a relief to be finally past all the yuckiness and get into the business of really enjoying this pregnancy.  It is for sure my last and I'd hate to waste any more of it not feeling well.

First trimester coming to a close....

Finally!   The end of the yuckiness is in sight.  Past experience tells me that my 1st trimester woes should be coming to an end in the next week or so.  I tried a little experiment last night and didn't take my Zofran.  I was pleasantly surprised to find that my morning sickness is starting to ease up.  Not quite all the way though so I ended up caving and taking one after dinner (after all, why suffer when I have relief at my fingertips?).

Trying to go about my life as usual has been much more challenging.  I don't know if it's because I'm in my mid-30s now, if it's the onset of winter, or if taking care of two busy boys (and a busy husband), but I find myself struggling more this time around.  Trying to find time to rest has been harder, and just everything in general has been harder.  I'm grateful that I'm at this place in my life when it seemed so far away just a few short months ago so I'm trying to take it all in stride and remember those that are still trying to get to the same place.

Early pregnancy continues....

At just over 11 weeks along I am still suffering/enjoying the trials and tribulations of early pregnancy.  Thanks to the Zofran I've kept the nausea under much better control (it's not 100% effective so there are still some bumps) and thanks to another med that shall remain nameless my stomach is behaving itself much better.

I finally felt well enough to start slowly exercising again.  I wasn't a huge exercise nut but I spent a lot of time on my bike this summer, did a kettlebell class, and kept up with my regular yoga class.  Of course, once IVF started all that had to be put aside.  It just wasn't safe for me to exercise until I got clearance from the IVF doc.  I got that clearance several weeks ago but feeling absolutely crummy does not inspire exercise.  But, finally feeling better, I decided it was time to get moving again, even if it meant a slow walk on the treadmill for a half hour.  It felt good to move again but somehow I felt extra protective of my body.  I have a passenger along for this ride now and it made me more cautious.  Hopefully that feeling will fade and I will get braver about it. 

The numbers are in...

Not just election returns of course (I was very proud to be a part of the process not just in voting but also in helping other people vote as an election judge), but my final shot count.  For my own curiosity, I decided to keep count this time.  Since it was my third time I wanted to see if I could find a way to make this interesting. So, you're asking, just how many times did I get poked in this process?  There are three categories of needle pokes: blood draws, progesterone shots, and the other med shots. 

1. Blood draws = 10
2. Med shots     = 42
3. Progesterone = 55
4. Total             =  107 needle pokes

 

Over 100 needle pokes just to get to where I am today.  The number wasn't a total surprise to me, but still shocking nonetheless.  I am extremely happy to be finally done with it all.  The final ones at the end were really tough, and for some reason a lot more painful than before.

 

The  other news of the week is my first OB appointment.  It was nice to chat with my doctor.  I love this practice really, all female medical staff, and my doctor especially.  She's young like me and very personable but also very competent at her work.  I can ask her anything and she's got answers that make sense to me and my care.  The only disappointing news of the appointment is it was confirmed for me that I will indeed be facing yet another c-section.  I had done some preliminary homework that had indicated that was a very good possibility but I was still hoping the doctor had more encouraging news.  She understood my disappointment though, which made me feel better about the situation.  She also gave me a medication to help with my raging morning sickness since the Sea Bands just weren't cutting it any more.  I'm not real big on taking meds when I'm pregnant but I couldn't take it any more; I need to eat my dinner!  Hopefully I'll only need it for a short time.

 

I didn't get to hear baby's heartbeat but a quick ultrasound confirmed that s/he is in there and growing; a reassurance any fertility patient needs.  Our puzzle is starting to come together, and the missing piece is starting to slowly slide into place.

The end is in sight!

Yesterday I made my final visit to the fertility clinic.  After spending weeks going back and forth, it seemed kind of anti-climatic.  Why am I still going even though I'm pregnant?  Good question.  After my ultrasound, I was turned over to my regular OB/GYN clinic but the fertility clinic monitors my bloodwork for the two hormones I was still on - the estrogen patch and the progesterone shot.  A couple weeks ago I was allowed to stop the estrogen patches but had to continue with the progesterone shot and have the levels rechecked.  That re-check was yesterday.  I still have to continue with the shot but the good news is that my last shot will be on Monday!  So only 7 more "butt" shots to go.

I am also progressing on becoming a regular pregnant person in this world.  Today I had my first official pregnancy visit to my regular OB/GYN clinic.  Granted it was just for bloodwork and health history but it's important step for me.  I got to join the other normal looking people in the waiting room, and then in the early pregnancy class (which they made me take for some odd reason).  It was oddly satisfying.  Next week I take another step in this direction with my first official OB visit.

I am also joining the ranks of other pregnant people in the world with my continued reminders that there is indeed a human being growing in my body.  I'm constantly hot, nauseous, and gassy (sorry, I know, TMI).  It's uncomfortable but reassuring that all is going well.

Breaking out the maternity jeans (8 weeks)

It was going to happen eventually I knew but I had hoped for a couple more weeks at least before I had to break out the maternity jeans.  People keep reassuring me this is a good thing; you show sooner and sooner each time you're pregnant and this is my 3rd go round at this.  People that know my story also say to embrace it since I worked so hard to get here. 

But it's tough to swallow.  I worked very hard after my second son was born to lose weight (35 pounds!) and get past that phase where I was really unhappy with how I looked (not to mention how unhealthy it was for me to be carrying around all that extra weight).  And since I changed my mindset about food and exercise, I'm relearning what it means to be a healthy pregnant person.  It's been harder than I thought.  Raging "morning" sickness and exhaustion are not great motivators for exercise or eating right.  So I'm hoping that in the next few weeks, as these symptoms ease and I can feel a little more normal, my motivation will return and I can find a way to balance the need to be healthy without obsessing over the scale.

And the result is....

POSITIVE!

Yes, once again we were successful with our IVF cycle.  I'm not sure how we've been blessed to have this work 3 times, each on the first try.  But rather than trying to guess as to why, I'm thankful that I have been blessed with this joy yet again.

I am 7 weeks along today and due June 3rd, 2013.  Here's the first picture:

Of course not to much to see at this point but what's important is that there is someone to see in there, including little heart flutters! 

Now comes transition time for me.  Technically I have been released to my regular ob/gyn clinic but the fertility clinic is monitoring my hormone levels. I'm in the home stretch of my meds and have 3 weeks or less to go before I can just be a normal pregnant person dealing with the ups and downs of being pregnant yet again.

I want to take a moment to thank my readers out there.  This has been an amazing outlet and a great way to educate people on the trials and tribulations of IVF.

I'll of course continue to update the blog because of course, the story isn't over! 

Returning to normal life

After all the excitement of the previous weeks, all of a sudden it seemed to stop.  Normal life was suddenly not interrupted by bed rest, shots, blood work, surgery, and numerous trips to the clinic.  I was able to get into a solid routine with my kids and get used to taking them back and forth to school.  It's been a lovely feeling after all the weeks of chaos!

I want to thank my readers for their continued patience!  Just a little while longer before we'll reveal to the world our results....

All hot on the Western front

So far life has returned to normal, complete with colds for the 3 men in my family.  I've been doing my best to rest and relax, get enough rest, and just generally take it easy.  I am getting antsy to return to exercising but I know it's for the best that I don't.

The one thing that's new?  Hot flashes.  It seems that I'm hot all the time.  And maybe flash isn't quite the word.  They seem to be more like waves for me.  Ugh...I can't tell if it's a sign of good things to come or just a side effect of the the hormones I'm on. 

Yesterday I started my estrogen patches in addition to my daily "butt" shot of progesterone in oil.  The upside to getting poked in the butt every day?  I get to moon my husband!  (gotta find the fun somewhere, right?)

The things we do for our children!

Returning to normal

Strict bed rest officially ended for me today.  It was nice to move around more (and more importantly take a shower!) and see other parts of  my house besides my bedroom and bathroom. I'll still be resting quite a bit but at least I can get back to a somewhat normal routine.

There is always some debate as to whether or not this increases my success rate.  Having done one cycle each way, it's not a certain things for me at all.  But, as I've always said, I'll do whatever I'm instructed to in the hopes of success.

I'm now allowed to resume normal activities minus working out and I'm not allowed to do anything that will irritate the stability of my uterus. (Use your imaginations here, folks -- I'll spare you the details of that one.)

I feel as though I should act differently with this precious cargo.  Like I should walk differently, etc.  I hope it's not written all over my face that something is up, but really it's the truth.  Something is up (or "in" if you want to get technical, lol).  IVF gives us too much knowledge in this department.  If I had gotten pregnant the old-fashioned way, I wouldn't have any clue what my body is doing (or trying to do); I wouldn't have any clue that this little being is trying to establish itself.  I would be blissfully unaware. 

This is where I need to ask patience of my readers.  I will know my results sooner rather than later but will not share them here on my blog for a little while.  I know I've shared so much with you all and received so much support, love, and prayers in return.  But this one thing is something I need to keep to myself for a short period of time.

And then there was 1...

From 8 to 5 to 3 to 1.  I got the news yesterday that of the 8 eggs retrieved of which 5 were mature of which 3 successfully fertilized, there was only 1 left.  The other 2 had slowly stopped growing.  The one remaining did not quite make it blastocyst stage but very close to it.

This is sobering and frustrating, but I am still cautiously optimistic. 

Here are some pics from the days events:

Our embryo

Making his/her trip into my uterus





 

 I will now spend the rest of today, all day tomorrow, and into Monday morning enjoying the comforts of my bed and my bedroom.  Then somehow I need to resume my life back to as normal as possible, and hopefully resist the urge to over-analyze every little thing my body does.



Embryo update #2 and transfer date

As promised the lab called again with an update on our embryos and with my transfer information.  Unfortunately, one of the embryos stopped growing and we are now left with just two. 

My transfer is scheduled for tomorrow (Saturday) at noon unless the lab calls back to move it one more day.  They want to get the embryos to what's called a blastocyst stage.  Here are two very good articles regarding blastocyst transfers: Article 1  and Article 2 .

Trying to stay positive in the midst of all this has been very challenging.  I had expected very different results given my previous cycle.  It is a sobering reminder that even though I'm only 34, the results of this cycle confirmed what the blood work early on had already told us:  reproductively, I am aging faster than normal.  And now I worry about egg quality.  Am I rolling the dice on bad eggs?  It's a hard thought to process.

Adding to this stress has been the fact that scheduling all of this has not been very favorable to my schedule nor to the schedules of the people that are helping us.  Luck has not been on my side in scheduling all of these procedures.  What's even more frustrating is that there is little I can do about this.  I am at the mercy of the clinic. 

The same is true when it comes to fate of my embryos.  I am putting them in the hands of my doctor and the embryology lab team.  I can only pray that the Lord gives them guidance to make the right decisions for me and for them.

Embryo update, transfer date, and new med

It's been a quiet couple of days since the retrieval.  Recovery took a little longer than anticipated but I'm all good to go this morning aside from a very ugly bruise on the inside of my arm from the IV.

I've been waiting with baited breath since Monday for the call from the embryology lab on what's been happening with the 8 eggs they retrieved.  I finally got that call this morning (bless fully while my monkeys were both at school).  Of the 8 eggs they retrieved, 5 were mature.  Of the 5 that were mature, only 3 fertilized.  This is disappointing in my eyes since I had hoped for better results.  It's also a little scary for me because the doctor wants to push them to day 5 to get the best of the best.  Given that I only have 3, I'm taking a big risk that at least 2 will make it this far.  It also means that there's a very high likelihood that I won't have any to freeze, making this my only shot to find that missing piece to our puzzle.

This is where I have to really trust the judgement of my doctor.  If she's sure that all will be well, then I have to be too.  This is also where the support of my friends and family and my faith in God is very crucial.  Knowing so many are rooting for this to work and praying for guidance lifts my spirits and keeps me going when I want to wallow in self pity and fear.

Today is also my birthday!  And on this day, my present is.....a shot in the butt!  That's right, today I start my progesterone in oil shot.  This shot will help support the embryo when it's transferred and will also support any pregnancy that may occur.  It's one I anticipate that I will be on for awhile, and while not an easy one by any stretch of the imagination, totally worth it.

Years ago when I had thought about how my future family would look I had said I wanted to be done having children by the time I turned 30.  This was a good possibility since I got married at 23.  Today as I turn 34, I am reminded very clearly how our life plans can change and that it's okay to revise that plan to include things that you never thought were possible.

Retrieval Day

Today was retrieval day.  I reported to the clinic at 11:30 am as instructed and waited until they called me back.  Surprisingly enough, I wasn't nervous. Changed into my hospital get up complete with paper booties over my socks and a hair net over my hair.  Then I met with the nurse, anesthetist, and doctor (not my own but still a wonderful doc). It turned out that the anesthetist was one I had worked with on my last cycle so she remembered my issues with anesthesia and was able to reassure me that all would be well again.

With one last trip to the bathroom and I was off to the procedure room to get hooked up to my IV.  For some weird reason the procedure room smelled like cookies and it made me giggle a bit.  The anesthetist said the last woman had said it smelled like Cocoa Puffs.  It was odd but a good way to break the ice.  She hooked me up to my IV and off to dream land I went, waking up approximately a half hour later in the recovery room with my husband sitting in the same chair I had left him in (even though I knew he had gone to another area to do his part).

Another half hour to wake up, monitor my vitals and finally have something to drink, and I was pretty much good to go.  Half hour car ride home, stop for a smoothie, and I was back at home ready to rest for the afternoon.

The doctor appeared for a brief minute to let me know he was able to retrieve 8 eggs and that I'll hear from the embryologist on Wednesday with a status update on how many we have and how they look.  Hopefully they'll be able to give me a transfer date but they are projecting either Thursday or Saturday.

I am back on meds again but at least it's just an antibiotic, the easiest med of all in this process.  Wednesday I start my progesterone in oil.

Now to continue to rest (Tylenol is all I'm allowed to take and it's not quite cutting it) and cross my fingers for good embryo results.

Day 11: Finally, a retrieval date!

I finally got my retrieval date today!  This morning's appointment revealed 6 follicles that should be ready to go on Monday morning.  I say should because the doctor will do the best s/he can to retrieve as many as possible.  In my first IVF cycle, they were not able to retrieve them all so that is a possibility.

My hCG trigger shot (the shot that will complete the maturation of the follicles and get them ready to ovulate) is at 12:30 am tonight.  Yep, 12:30 am!  Never before have I had to trigger this late but because they need to time my arrival and retrieval at the clinic to be a specific time, that is when they need me to do this particular shot.  This is also the point where I am done injecting myself.  Since intramuscular shots need to go into my backside and I'm just not flexible enough (despite a couple years of yoga) to bend that way, it's my husband's turn to help me out.

Tomorrow is then my most favorite day of this process -- no meds at all!  I have nothing to do at all; no shots, no oral meds, nothing!  A short, but much deserved, break in the process.

On Monday, I report to the clinic at 11:30 am to begin prep for the retrieval at 12:30 pm.  Egg retrieval is a surgery appointment, complete with anesthesia, hospital gown, and recovery time.  It is my least favorite thing about this process because I'm really not a fan of surgery (really who is?) and anesthesia and I just don't get along well.  It also means that I'm not allowed to eat or drink past midnight on Sunday night.  Monday morning and early afternoon will be very long!

Not only that but I am placing myself in an extremely vulnerable position.  See, in order to retrieve these follicles, they need to go up through my vagina and into my uterus.  They will go through the wall of my uterus with a needle and into each follicle to retrieve the mature egg.  Plus there's no guarantee that my doctor will be the one doing it  (they rotate weeks).  So I am constantly reminding myself that these people are professionals and will be professional in their work.  During this period, my husband will head to another part of the clinic and do his part in the process.

I will then go to recovery for a short period and then head home where I plan to spend the majority of the rest of the day in bed.  The clinic will call to check on me and the next day, they will call with how many they were able to fertilize.  I'll get a couple more updates with the status of the embryos and when they plan to transfer them.

Less than 2 days to go!

Day 10: the good, the (not so) bad, and the ugly

Today was another progress check to see what's going on with my ovaries and their little follicle friends. 

The good?  They found 3 more follicles growing in there! They are on the smaller side and may not catch up in time but they may surprise us and be ready to go. The biggest is still hanging in there waiting for her friends to come along for the party.

The (not so) bad?  I still don't have a firm retrieval date.  I had hoped they would say, Yes!  You're ready to go, trigger tonight, and we'll see you Sunday morning.  Sunday morning was the optimal morning for all things considered.  It was the easiest day for childcare (no one going to school) and for the two adults that would be helping me out (no one would need to take off work).  But, alas, it seems that Mother Nature had another thing on her mind.  While they are not 100% certain right now, it's pretty much a given that I'll be triggering tomorrow night and retrieving Monday morning.  I have another clinic appointment tomorrow morning to check progress and blood work.

The ugly?  My belly and arms.  After so many shots and blood draws, it's not a pretty site.   Hopefully I'm not drawing too many glances at my upper arms.  It is still late summer/early fall in my area so I can't really hide these marks on my arms.  I didn't have this problem before because it was winter the last two times I did this.   Yet another thing that's different this time around.

At this point I'm getting tired of this.  I'm tired of being crampy and bloated.  Tired of being cranky and emotional.  Tired of poking myself with needles twice a day and getting poked for blood draws.   And just tired of being tired.  I'm ready to move on to the next phase of this process.

Just two more days to go.....

Day 9: Just for fun

Since this is my 3rd IVF cycle I thought I would have a little bit of fun and collect some data about my shots.  Might as well make it somewhat interesting, right?  And I was curious too.  I knew I was doing a lot of shots, but I wanted to know exactly how many times I was poking myself.

As of this evening's shot, I have officially poked myself 35 times.  Yep, that's right -- 35 times!  Holy smokes, I knew it was a lot but I had no idea it was that much.  Throw in 3 blood draws and I've been poked nearly 40 times.  And I've barely just scratched the surface.  If I am successful, I am facing shots until somewhere around 10-12 weeks of pregnancy; another 70 - 80 more shots plus what I still have to finish up with the stimulation meds.  That's a grand total of over 100 needle pokes.

You really can't be needle shy when you do IVF!

Tomorrow: progress check and hopefully my retrieval date.

Day 8: Progress check

The problem with having done IVF before is that you start to learn what the different numbers and measurements mean for your cycle.  Today's appointment and blood work was not as upbeat as I would've hoped for.  At this point they start to measure and see how many follicles I have growing. 

Based on how uncomfortable I've been feeling I had expected a big number.  That was not the case however.  The ultrasonographer was only able to measure 5 follicles -- 3 on one side, and 2 on the other.  There are number of smaller ones but too small to be counted and more than likely they won't catch up in time to be retrieved.  This is not the best news but definitely not the worst either.

The nurse initially then said she was slightly concerned about one follicle in particular because it seemed that it was growing faster than it's 4 other friends.  She told me that rather than waiting until Friday, she wanted to see me tomorrow.  Upon talking with the front desk, the appointment times they offered were not compatible with my schedule.  See, my older son, my first IVF miracle, is due to start Kindergarten tomorrow!  I had already interrupted his life enough with this process and I just couldn't do it to him again.  It was bad enough that I would miss the second morning of school by being at the clinic.  When I realized this, I unfortunately (and surprisingly to me and the receptionist) burst into tears.   Once she got out of me what was wrong (I swear the staff at my clinic are angels!), she was able to find me a time that would work.  I would have to wait, but I would be able to be there for my son.

Fortunately, after the doctor reviewed my blood work and ultrasound results she decided she did not need to me to come in tomorrow after all.  Friday's appointment would be enough.  I'm hoping that I will be able to get a firmer idea of when they would like to do the retrieval but I'm not positive they will be able to.

So for now I remain cautiously optimistic.  I had hoped for better news, but I am trying to remember that all is not lost, and all it takes is one....

Day 5: Pincushion!

It's now Day 5 of my meds and I've officially reached Pincushion status.  Up until now I hadn't really felt that way but with 4 pokes a day, I quickly achieved this rather undesirable status.  I'm also having to be more strategic about my needle pokes.  I'm allowed just about anywhere on my belly that I can pinch up some fat and I'm no skinny-minnie so I have a decent amount of territory to work with.  However, after 5 days of pokes with a total of 15 needle pokes as of this morning, I'm starting to have to work harder to find places that I haven't poked myself.

Today was also Bonus shot day.  What's that you ask?  It's the day where I have to change out my Follistim cartridge mid-dose.  See, my Follistim comes in this neat little cartridge:

Technically it is supposed to hold 900 units of medication, but the drug company ever so helpfully tops it off with a little extra.  How much extra is not known for sure, but it's usually at least 100 units more.  So each vial generally holds about 1000 units, sometimes a tad more.  My daily dose is 225 units, twice a day.  So roughly every 2 days I hit the 900 unit vial mark.  After that, since I don't know how much is left exactly, I know that I will have to change out the vial mid-dose on the 3rd day.  It's not as complicated as you think.  See the Follistim pen is handy in that you turn a dial for your dose.  Once you've poked the needle in, you push the little plunger down and your dialed in dose goes in.  If your vial runs out mid-dose, the dial holds the number of what's left.  You pop in the new cartridge and keep on going.   The fun part?  It means a brand new needle, and a brand new needle poke.  Hence why today is Bonus shot day.  It means that today I'll get 5 needle pokes instead of my usual 4.  Oh joy!  (sarcasm at it's finest)

I'm also starting to feel that things are cooking in my ovaries.  This morning's bike ride was uncomfortable and my tummy is starting to also reflect the changes brewing within.  Bloating and pressure are the norm now, and not just in my sinuses.  The Neti pot is still my best friend and sluggishness and cravings are slowly taking over my life.  But it's nice to have some sign that all of this is working.  Only about another week to go until retrieval.....

Day 3

I'm now on Day 3 of my medications.  With the exception of some wicked dizziness and nausea the first afternoon (made worse by the heat), things have been going relatively well -- until yesterday.  I developed some extreme sinus congestion.  I'm not entirely sure if it's the season (peak allergy for me)  or the hormones or both but it felt like my sinuses were going to explode. With limited resources at my disposal and maxed out on what meds I could take, my last resort was a Neti pot.

 Hallelujah!  Relief is spelled N-E-T-I-P-O-T !  It's a freaky concept I admit, and I hate shooting water up my nose but it worked like a charm and I am able to function again.

Today was also the day I started my second medication, the stimulation medication Follistim.  So now my twice a day shot regimen went from this:

to this:

Twice the pokes, twice the time to get it done.  Which means more time to dwell on each shot.  The tiny little insulin needles barely pinch whereas for some reason the Follistim Pen needles seem to hurt much more.  I often wonder if it would be easier if I didn't give the shot to myself.  Having to watch what I'm doing seems to make it hurt that much more.  And I'm the type that doesn't watch when I'm getting blood drawn or getting another kind of shot.  But having someone else give me shots means twice the anxiety (me and the person doing it) and I'd rather keep the anxiety contained to one person for as long as possible.  After all, if I groan or yelp in pain, I'm not surprising anyone else or making anyone else feel bad for hurting me.  It's all on me in that moment.

I prefer my husband's support right now the way it is.  He's been a saint so far; offering DQ ice cream, running to the pharmacy for my sinus stuff, and preparing hot compresses for me when I was so uncomfortable last night.  And of course holding me just because I need it at that moment in time.  All this is so overwhelming but in those moments, I am calm; and in IVF being calm makes a world of difference.





Day 1

Last night I didn't sleep well at all.  Between the anticipation and anxiety of today, the effects of the Benadryl that I had to take to combat my allergies, and Mother Nature paying me a visit at 3 am, it was hard to rest.  Needless to say I didn't have much use for my husband's 6:15 am wake up call.

Today was the day to begin my shots. I am beginning with my suppression drug. This drug, Micro-dose Lupron, will keep me from ovulating. The needle is very tiny; technically they are insulin needles and are injected into the fat of my stomach (subcutaneous).  It was probably a good thing I was running right on time; I didn't have much time to dwell on this initial poke.  I gather my materials (alcohol prep pad, needle, and paper towel) and pulled my Micro-dose Lupron from the fridge.  Unseal the bottle of meds, swab, poke, draw up my prescribed 20 unit dose, swab my belly, and in we go. 

All over in a matter of minutes with barely a pinch felt.  Drop the needle into my Sharps container and with a few last minute instructions to my mom about the kids, and I was off to the clinic for the next part of my morning.

Forty minutes later and I was taken back to the ultrasound room to get a baseline reading of my ovaries.  The ultrasonographer was friendly, professional, and gentle.  I really have to commend the staff at my clinic.  They have found the best of the best; not only in skills, but in bedside manner.  I am always put at ease with them. 

Exam complete and the nurse is satisfied that my ovaries are nice and quiet.  Off to the lab for a quick blood draw and I'm headed back home to the rest of my day.

I can't help but be hyper-aware of my body now.  I'm not one to take a lot of medication; an allergy pill and vitamins are really the most I do.  Occasionally I'll take ibuprofen for a headache or migraine but I try not to unless I really have to.  Pumping my body full of hormones and sticking myself with needles is a foreign feeling despite having done this twice before not to mention all the drugs I took before that. 

I feel like I should look different and I wonder if I'll be able to stop myself from over-analyzing every little twinge.  I know I shouldn't or I'll make myself nuts.  I'm already anxious and edgy; why add to it?  I have to make this a part of my day; just something else I do right now, for the next 10 - 11 days.

It's almost go time!

Tomorrow I will take the final birth control pill and in 4 days, give myself my first shot. Also on the 29th, I will have a clinic appointment to get a baseline reading of my ovaries by ultrasound and by bloodwork.

In the meantime, I thought I'd pass along this article by LiveScience titled 5 Myths About Fertility Treatments .  By no means is this a fully comprehensive list.  I'm sure I could come up with several more to add, but it is interesting reading; and a good jumping off point for those that have not had to endure fertility treatments.

The $3300 UPS package

Today one of the most expensive and curious looking UPS packages arrived at my door.  UPS is at my house on a fairly regular basis (at least 2 or 3 times a month) to deliver books (I have a mild Barnes & Noble addiction) or clothing items that I've ordered online.  However, I can only wonder what the UPS delivery man thought when he saw this box on his truck.

Not only is it a big box but it's marked Perishable and taped closed with tape that read "To be opened only by addressee" and "Open immediately and store items in the refrigerator".  To add to it, I also had to sign for it (not something that I need to do with the other packages that usually arrive at my door) and the sender's name was only listed as an acronym -- WSP (Walgreen's Specialty Pharmacy).  He was clearly curious and somewhat taken aback at this box.  However, as my UPS delivery people usually are, he was professional about it and once he confirmed my name, he was on his way back down my driveway.

The box arrived during lunchtime which meant I had to set it aside for a little bit.  Of course my kids were instantly attracted to this box (with my youngest seeing how well it would work as a chair and my oldest asking if he could play with it once I took the stuff out), but fortunately for me, lunch won out and they forgot about it.  I, however, had a harder time ignoring the elephant in the room.  I'm one of those that love to get mail and packages but for some reason, I was dreading this one.  Just another step closer to acknowledging that this was really happening again.

Once lunchtime passed, dishes were done, and my kids were again playing in the other room, I opened the box and took inventory.  Here's what I had inside:

The big red box on the left is my Sharps container for my used needles, the two vials on the left are my one Valium (for my embryo transfer) and my antibiotic (to be used after my egg retrieval).  The 4 blue boxes are my Follistim (stimulation medication), the two small boxes are my progesterone in oil (used post transfer), the bigger narrow box is my hCG (trigger shot), and the last vial on the right is my Micro-Dose Lupron (suppression medication).  Last but not least the pharmacy very helpfully organized and labeled all the different needles I would need to use.  They also included (but not pictured) a helpful DVD and handouts regarding all of my medications and how to properly use them.  I can't get any more prepared really.  Well, okay, maybe I could be more mentally and emotionally prepared.  But I have everything I need to help us find the missing piece to our puzzle....

Only 8 days to go until the first shot.....

Paperwork

For everything even remotely important in your life, there is paperwork.  And while we are slowly moving towards a more digital environment, I'm positive there will always be paperwork.

Over the years I've accumulated my share of it, and with 2 IVF cycles under my belt, I knew what I was getting into when I committed to this 3rd one.  Today was the day to review the paperwork, pay the money, and order the meds.  We were pleasantly surprised to find that our prepayment was not the close to $12,000 we were expecting but rather a much easier to swallow $8,444.  We were also pleased to learn that it might be possible that the monitoring section of the cycle might be cheaper than previously thought.  Also, we did not have to pre-pay for any frozen embryo storage.  Since they don't know for sure if we'll need it, they don't ask for that money upfront.

In addition to this portion of our clinic visit this morning was a full review of the cycle.  While still seemingly far away, it also seems like it's right there.  I found myself feeling overwhelmed right off the bat.  I keep thinking that I should be more used to it at this point; that I shouldn't feel this way.  It's all old hat, right?  I should be more prepared.  But I find myself feeling like it's the first cycle all over again.

Only 19 days to go 'til the first shot.....

T - 2 days to B-day

No, it's not my birthday(lol) but I am finally on track to start my birth control!  For some strange reason Mother Nature decided to play with me one last time.  She decided to show up 2 days late which in the grand scheme of things isn't all that long but just long enough to make me wonder and hope.  Such a tease she is and not the good kind!

Just to explain a little about the birth control.  I've been getting a lot of confused looks and questions about it.  After all, I'm trying to get pregnant, why would I be put on birth control?  Simple answer: timing.  The clinic needs to force my cycle into a rhythm that will work with the meds I need to take in order for me to have my egg retrieval around the time I am aiming for.  I will only be on it for a very short time -- 22 days.  During that time, my ovaries will shut down so we can then artificially ramp them up with the stimulation meds.

It's the first step of many and one of the only drugs that does not require a needle to take.  Time has passed by quickly on this road and I'm hoping that it will continue to do so for the next 6 weeks it takes to complete this process.

This IVF cycle made possible by....

We are not one of the lucky ones with insurance coverage that will pay for IVF.  Our insurance has covered some of the preliminary work at a discount but stops at IVF and medication coverage.  We are fortunate to have been able to easily find financing the two previous times -- the first was through a very generous line of credit through Wells Fargo bank.  It was one time where having a really good credit score paid off tremendously!  The second time we were able to fund ourselves through a patchwork of HSA accounts, credit cards, and bonus money.  It was a little more complicated but we made it work.

We are fortunate this time to have someone close to us lend us the money outright.  Using a contract that includes a generous repayment plan for us and a modest interest rate for him, we are able to make our pre-payment (with some leftover) without any worries at all.  For the difference, we have been lucky to have had enough time and ability to put aside the money.

I know many people desiring IVF are not so lucky.  I am very grateful that this part of IVF has been fairly easy and without a lot of worry or stress.  So thank you to our kind benefactor....your generosity is appreciated beyond words.  Rather than being a large boulder in the way, you've made it possible for it to be a very tiny bump.

IVF in the news

Yesterday there was an article in the New York Times regarding a very serious complication of IVF called Ovarian Hyperstimulation Syndrome (OHSS).  (The most famous recent example I can think of is when Giuliana Rancic did IVF. She unfortunately ended up with this condition and had to be hospitalized.) 

According to the article, there is some debate about the high level of medications used in some IVF cycles and whether or not they are needed to have a successful cycle.  This article intrigued me because my particular protocol, designed by my doctor, is very medication heavy.  It requires high doses of stimulation meds and very fine tuned doses of suppression medications. 

While this concerns me, especially since I ended up with so many follicles the last time (22!), I trust my doctors and the monitoring they do.  At the height of my cycle, I will be making clinic visits nearly every other day.  At these visits, I will have blood drawn and an ultrasound done to check my progress.  Based on these two tests, my doctor will determine if my medications need to be adjusted (they frequently are).

I would advise anybody considering IVF to do their homework very carefully.  While it's important to trust your doctor, it is also important to be educated, and ask questions.  The low dose method of IVF that is described in this article would not be appropriate for me, but it may appropriate for you.

One last chance

No one aspires to do IVF; at least no one I've come across in all my years of fertility treatments.  It's expensive, painful (emotionally and physically), and down right draining.

Those of us that are facing IVF, whether for the first time or like me, a third time, always hope for that one little miracle.  That surprise pregnancy that means IVF isn't needed.  We've all heard of those people; the ones that tried and tried for years and years, only to stop or take a break and suddenly find themselves pregnant.  I've known a few of these people in my life and of course wished to be one of them.

Given that both my husband and I have fertility issues, I'm fully aware that the odds are very much against me.  To be one of these people, I have one more shot at it.  One more cycle before it all begins again.  One last chance for Mother Nature to cooperate.

You really can Youtube anything

You know the old saying, if you want to learn how to do something, go look on Youtube!  There are thousands, if not millions of how-to videos.  Wanna learn how to put on make-up?  There's a Youtube video for that!  Wanna learn how to French braid your hair? There's a Youtube video for that!  And yes, if you want to learn how to give yourself your IVF meds, there's a Youtube video for that as well.

Initially I had planned on taking my clinic's shot teaching class.  It's been several years since my last IVF cycle and I felt a little rusty on the ins and outs of correctly administering the shots.  Given how much is at stake, I didn't want to take any chances of screwing it up.  When talking to the IVF nurse, she was surprised that I wanted to take the class.  She understood but also suggested I could just watch a Youtube video on it.  This week I decided to take a gander myself and see what was out there.  After all, what could it hurt?  And I could save myself another trip to the clinic (each trip is at least 25 minutes each way).

So off I went in search of any videos.  I stumbled upon a couple of really good ones done by a nurse at a fairly well known reproductive medicine clinic.  I have posted the links below in case you are curious.

Subcutaneous shot   Intramuscular shot

As I watched the short videos, it all came back to me and I found myself nodding along, the scenes all too familiar.  Here I thought I had forgotten, but no, the information was stored in the part of my brain that stores the rest of my IVF memories; the things I can rattle off with almost no effort at all.  The upside?  I don't have to make that extra trip to the clinic any more.  I am confident in a way I didn't think possible that I won't screw it up.  I can do this again; the memories are there.  The strength is there.  Right where I left it.

All systems go!

This morning I completed the next step in the process before we officially launch our IVF cycle -- the saline infused sonogram.  A lovely sonographer, Heather, came and got me from the waiting area and actually remembered me from the last time I was there!  She's very kind and gentle which puts me right at ease given what I know she has to do.  Everything looks great; no surprises at all.  The doctor was very satisfied with the state of my uterus and how my ovaries looked.

The doctor also gave me the results of my blood work, specifically the Ovarian Assessment Report.  If you remember, this particular blood test is new to my clinic and is used to evaluate my chances for a successful egg retrieval.  It's a more involved hormone panel than I've ever previously done so I was interested to see the results.  It confirmed for the doctor that I do indeed have Diminished Ovarian Reserve.  Previously the doctor believed that I may not have this condition because there was no solid proof to back it up, only situational experience.  However, this test left no doubt that this is indeed one of the reasons I cannot conceive on my own. 

The test revealed that I do not have as many eggs as I should for my age.  While it sounds discouraging, it only  means that the medication protocol that the doctor is putting me on is right on.  This is a medication heavy cycle, and they will stimulate the heck out of my ovaries to ensure a good response and a good number of eggs.  The good news from all of this is that even though there is no test for egg quality yet, because I have been able to deliver healthy babies my egg quality is just fine.

So all systems are a go! Our next appointment at the clinic is August 10th with the nurse.  There we will sign our consent forms and make our pre-payment in addition to reviewing any last minute details or paperwork.

Happy Father's Day!

Since the burden of fertility treatments falls mainly on women, it is easy to forget the men that are involved in this process.  After all, we can't really do it without them, can we?  Even if you're doing this as a single woman or as a woman in a same-sex relationship, you still need the male half of the equation.

So to all the men out there -- regardless if you're providing just sperm or are an active participant in the entire process from start to finish -- Happy Father's Day!  Even though your role is much smaller, you are just as important.

Re-defining what's normal

Thinking back on how families used to be built "in the old days" makes me realize that it's time to re-define what's normal.  It used to be that a man and a woman met, fell in love, got married, and then had children.  And up until the last 50 years or so, it was assumed that a woman would stay home with the children while the man worked to support his family.

Now, it's not so simple.  Children now come into this world and into families in a large variety of ways.  Women are waiting longer to have children or not having them at all or having them alone.  Children are being conceived and raised in same-sex households.  More families are made up of adoptive children from all over the world.  There are blended families made up of step-children; cousins are treated and loved as brothers and sisters.  There are more mixed-race families.  Fertility treatments are widely used and accepted so that many more loving people can become parents.

This has forced our society to re-define what's normal when it comes to building families.  I used to pine for the old normal and I grieved for the old normal when it came time to begin fertility treatments.  But eventually I was able to embrace the new normal and appreciate the family it's given me.  Not just my own two (and hopefully 3 next year) children but the extended family that I've been blessed with.

So let's embrace the new normal or create our own version of normal, not because we're forced to, but because we want to.

The countdown begins...

This week I worked up the nerve to call the clinic to get my calendar.  I'm not sure why I was avoiding this call but for some reason I put it off a few days longer than I had planned.  Maybe I was hoping I wouldn't need to do this after all.  But Mother Nature again made it clear that I would need to do this again if I wanted to complete my family.

I talked to a very lovely nurse at the clinic who gave me my marching orders.  Amid a flurry of dates and calculations I was suddenly overwhelmed with information.  She very kindly assured me that I had plenty of time yet and that she would send it all to me in the mail.  A few days after I talked with her, a big envelope arrived in the mail. In it were 5 things: my checklist of things my husband and I need to get done with my dates listed, my bound packet with my particular protocol helpfullly highlighted and flagged, our two consent forms (one for the IVF cycle itself, and one for the freezing of any extra embryos we may have), and my first script for the birth control I need to take for 3 or 4 weeks.



The consent forms

My marching orders and checklist




 It was now as official as it could get -- I am an IVF patient once again, complete with a serious case of the jitters (or anticipation anxiety; I'm not entirely sure).  What I do know is that in about 3 months, I will be once again traveling down this road.  One that I never wanted to travel down in the first place but one that has become very familiar.

Payment Considerations by Kurt

This week we are planning out how to pay for IVF.  Since we do not have insurance coverage for IVF, we will need to have cash (or credit) to pay for the services needed.

The clinics we have used have required prepayment for the medical procedures expected to be performed.  This may not be enough to cover all medical bills, but our experience has been it is close or slightly above what was truly required.  Any over payments were refunded for the difference.  This prepayment does not cover the cost of medicines, so those have to be paid at the time of purchase.  Many clinics offer advice on where to buy medicines from pharmacies that are reliable and timely, as sometimes you may run low at key points in your cycle.  My wife used a pharmacy on the East Coast for our first IVF cycle as an example.

Some areas we have used to pay for IVF in the past has been saving in a Flexible Saving Account or Health Saving Account.  The thing I like about these is that they can be funded with pretax dollars.  The main disadvantages of these with IVF are that it can take a while to get there to fund them and paperwork.  For Flexible Saving Accounts, you have to use it that year or lose it and it is capped for amounts not enough to pay for all of IVF.  For Health Saving Accounts, it will take two to three years to have enough funds in them to cover the full cost of IVF.  One other note we have experienced is that you have to "float" the payment on a credit card (or line of credit) first and fill out paperwork with the plan in order to get reimbursement of these accounts.

I am sure you have your own ways you have saved to pay for IVF.  I would love to hear them from you.  This is part of our journey to find the missing piece of the puzzle.

Happy Mother's Day!

I waited for years to become a mother, more years than I wanted to, so I look forward to this holiday every year.  I feel like I'm a part of a very special club, where my every day status is held up high and celebrated.  And I get to enjoy comments like this one from my 5 year old, "Happy Mommy's Day!  You're my favorite mommy!"

So for every mother out there, and for every woman who is a mother in her heart, I salute you and hold you up high.

Happy Mother's Day!

Chaos reigns

Yesterday morning, as my boys were playing loudly in the living room while my husband and I enjoyed the paper and our coffee, we said to each other after the 5th interruption to referee, "And we want to add to this chaos?"

We say this to each other a lot; mainly on days when we're having a tough time with one or both of the boys.  When the questions from our older son have been endless or when our youngest is having a full on meltdown.  Or when I'm overwhelmed with everyone's schedules and the day has seemingly zoomed by without really getting anything done.

But at the same time, as I was listening to them roughhouse and play with the couch pillows (for the millionth time), I said to my husband, "As loud as they are, doesn't it feel like someone is missing?"  He stopped for a second, smiled, and said "Yeah, it does.  Maybe a little girl to be playing with them too or another little boy to be roughhousing with his big brothers."

So no matter what happens in my house, no matter how much chaos reigns, it still feels like someone is missing.

The race to the starting line

Yep, we're still waiting.  But at least it is finally May, the month I get to call my clinic and hopefully get my IVF schedule and get this show on the road.  It seems like a million years ago since we decided to embark on this journey again.

My inclination is to just get started so I can be done with the unpleasant parts and jump ahead to the pleasant part of being pregnant (hopefully; I'm still not 100% positive this will work again).  But it's in the best interest of my family to wait a little while longer, get everything organized as much as possible, and then wait for the Go! signal.  I just wish it wasn't such a long race to get to the starting line....

Infertility Coverage researched by Kurt

One of the areas which can make or break IVF is having insurance coverage or the financial means to cover these health services.  This week I am focusing on insurance coverage for IVF.  Since we do not have any insurance coverage towards IVF, we have learned a lot about this topic.  Since my background is in health insurance, I am very familiar with this topic as well as many other insurance aspects which have helped us understand the coverage we have.

Here is where I would start for mandated insurance coverage:

http://www.ncsl.org/issues-research/health/insurance-coverage-for-infertility-laws.aspx

This webpage is from the regulatory industry for insurance.  If nothing is stated, then you will most likely not have coverage for IVF.  If something was stated, you can see how much variation there is between the states.  Please note that you may still have coverage for other fertility services, just not IVF, so please contact your insurance company or consult your benefits manual to see what coverage you may have.

From that website you can go to either the American Society for Reproductive Medicine or RESOLVE webpage for more information on this topic as well as many others.  These are both great resources for many infertility topics beyond just insurance coverage, so please consider reading them further.  I hope this helps on your journey to find the missing piece of your puzzle.

Why can't I see it?

A number of people have made comments about how brave I am or how amazing it is that I'm doing IVF for the 3rd time.  Or how they could never do it or how hard it must be.  I even had a very wonderful friend make me my own Certificate for Being Awesome and Rocking (thanks Cassie!).

I always give them this quizzical look, something like "huh?".  I just don't feel that way.  And maybe I don't because I don't want to build it up in my mind as something that's really difficult (even though it is) and therefore build up my anxiety.  I'm partially afraid of losing my nerve and calling the whole thing off.  It takes a lot of fortitude to stick yourself with needles multiple times a day or to trust someone else to do that to you.  And it's not helping that I have a lot of time to think about this before we get started.

And maybe I don't because there are people who have had much more heartache and gone through much more than I ever had to.  I've been very fortunate to never have experienced a miscarriage, and I'm also very fortunate that I have a fairly good idea of what is causing our infertility.  Many couples have experienced both, and my heart goes out to them.

I'm no hero, and I'm definitely not in line for sainthood.  At the end of the day I'm just like any other person trying to build their family and find that missing piece to the puzzle.

Man's Thoughts

I am not one to normally talk about my thoughts or feelings on this topic, so this is a unique experience for me.  One area I have struggled with is the male part of this process.  While compared to Olivia's requirements, my part is easy, as I have been reminded a few times.  (I cannot disagree with her thinking, because it is so true!)  I struggle knowing she has so much to do in this process, and I do not do very much at all.

For me, the amount of testing a male goes through is very simplistic compared to all of the tests Olivia has to go through.  The initial testing for all men is a semen analysis.  (For more on this test please go to http://en.wikipedia.org/wiki/Semen_analysis )

My take on this test is do you have ample swimmers, good swimmers, and strong swimmers.  Since it only takes one swimmer, having millions of them helps the odds.  Amazingly, with all the math and science it takes to make a baby, it is still very much luck of the draw.  To perform this test you are usually in the physician's office with a cup and some reading material.

My numbers came back low, but not out of whack.  With this knowledge, it makes me wonder why I cannot do "the job".  In order to do "the job"right for us, we have used ICSI and will use it again.  Olivia defined this earlier, but I will say it again, my sperm are put directly into the egg because they cannot swim to the target.  I still do not know why my numbers are low, just that they are, and we needed assistance to complete the task.  I plan to investigate this further before our next attempt to see if more can be learned about me.  This will not alter our attempt, just helps learn more about why this may be the case, and will hopefully help us find that missing piece to our puzzle.

In life there are no guarantees

When you do IVF, no matter if it's your first cycle or your third, you are always reminded that in life there are no guarantees.  Even though this technology has been around since 1978, it has not progressed to the point where a doctor can say with 100% certainty that it will work.  There are still a lot of unknown factors, and differing opinions on what works the best -- which are the best drugs, what is the best drug combination, when is the best time to retrieve, when is the best time to transfer, and so on.

Even with something as simple as bed rest vs. no bed rest post transfer there is no clear answer.  My first clinic in Madison, WI was not a bed rest clinic.  My doctors felt that moving around got my circulation going and blood flowing to the right areas.  And it also meant that post embryo transfer I was allowed to carry on my normal activities (no exercise or other um, "adult activities" of course but anything else was fine).  Of course it's hard to do that when you know that you have these tiny little embryos floating around inside you but I did the best I could.  I was still working then so I went on with my work life as usual as well.  Two weeks later I got the news that it had worked!  A vote for the no bed rest team.

The second time around I was with my current clinic, and their thinking was that bed rest for two full days post transfer offered the best chance for success.  This time was a little more complicated because I had a toddler to care for but with support from my family, I spent two of the most boring days in bed post transfer.  Once again, two weeks later, we got the news that it had worked!  A vote for the bed rest team.  (It also means I will spend another two boring days in bed sometime this September.)

Clearly there is no solid answer as to which way works better.  The arguments both ways are very convincing.

I've heard from several people in different ways the assumption that I will get pregnant this time.  When I express my own doubts, I get the reply, "Oh but it worked the last two times. It'll work again this time."  But there are no guarantees that it will work this time, just like there were no guarantees it was going to work the last two times.  Is it a little negative to think that way?  Maybe.  I see it as being realistic.  There are just too many unknowns, and no way to know how those unknowns play into the success of a cycle.

But as I like to joke, if they told me to do 10,000 jumping jacks and stand on my head I'd probably do it.  Hunting for the missing piece of our puzzle is a bit like doing a scavenger hunt -- each step brings us a little bit closer to finding it.  But I'm also realistic enough to know that the final step is the hardest and completely out of my control.

The boring part of IVF

Believe it or not there is a boring part of IVF -- the money part.  Over the weekend we received a large envelope from our clinic.  Inside was a number of handouts (conveniently highlighted) detailing our financial obligations and how much dough we'll have to fork over in August.

If you are lucky enough to have insurance coverage for IVF, then this part is rather easy.  Just hand over your insurance card to the staff and you're good to go.  But if you're like me, it isn't that simple.  The numbers are enough to make your head spin and trying to figure out how much you owe, who you owe it to, and when you owe it is a little daunting.

I'm essentially handing over enough money for a brand new car each time I do this, and the thought that by the time I'm done I'll have paid probably over $50,000 to have my children makes me a little dizzy.  But it's been money well spent for sure, and not once have I ever regretted it.

Jumping the gun a little bit....

Finally received the call today from the IVF nurse team at my clinic!  Of course I missed the call and had to call back with my heart thumping around in my chest. You would think by now (and after two previous cycles) I would be past the butterflies of this stage, but nope, here I am, like I was the first time around.

Apparently I am way ahead of myself in scheduling my cycle!  When I told the nurse that I didn't want to be starting meds until September she very kindly told me they weren't dating that far out yet.  In terms of completing my bloodwork and sonogram, I still have time to get that done.  So I am to call back in May to get my official calendar and schedule of events.

Until then I get to chew on everything and hope that somehow Mother Nature decides to cooperate.

Waiting.....and waiting some more

Seems like so much of IVF is just waiting....and then waiting some more.  It's been nearly a week since our meeting with the IVF doctor, and while I've been busy with my regular things and going on vacation to learn how to snowboard, I've been patiently waiting for the call from the IVF nurse to give me my checklist.

I know I'll still have to do more waiting but at least I'll feel like I have something to do, and feel like we're moving forward with the process.  But until then, we wait.

Housekeeping note:  I changed the settings on my blog so that you can now leave comments without needing to register.  All comments are still moderated before they are posted.

Getting the ball rolling....again

Today was the day to get the ball rolling again.  In spite of the fact that this is our third go round, we were still in for a few surprises. 

Our first surprise came right off the bat -- the clinic had moved!  Granted they had only moved to the building next door and up one floor, but this move is actually very good news for us.  In addition to completely remodeling the waiting area, our doctor told us that they brought in an engineer to help them re-design their labs.  From a new air purification system to updated lab equipment to making the lab more closed off (fewer doors to open and close), the clinic is very state of the art.  This in turn has had a positive influence on their success rates -- a statistical jump of nearly 10%!

Our second surprise was equally as pleasant.  I knew I would have to repeat some blood work, mainly to see where my hormone levels were at, but the good news is that they have a new blood test for their IVF patients -- the Ovarian Assessment Report.

According to the handout provided to me by my doctor "the Ovarian Assessment Report provides women with the most accurate assessment of ovulatory egg supply available through the use of a single blood sample.  Ovulatory egg supply is the quantity of eggs a woman has available for collection through controlled ovarian stimulation, commonly referred to as an egg retrieval procedure.  The report provides women with their Egg Retrieval Score which is a unique index score that more accurately estimates the ovulatory egg supply by combining age with multiple ovary-related hormones." The blood for this test is drawn on cycle day 3 (day 1 being the first day of a woman's period).

This means my doctor will get a better picture of how my eggs are doing and how they are aging.  Very useful when it comes to determining the proper protocol for IVF.

In addition to this blood work, I will also have to repeat the Saline Infused Sonogram or Sonohystogram (SHG).  In this test, the doctor fills the uterus with saline and uses ultrasound to check the shape of the uterus.  In addition, she will take a look at my ovaries and see how many potential follicles there are.  For my age group, each ovary should have 9 to 11 potential follicles.  (One of these follicles develops into an egg that will be ovulated.)  This test is done on or after cycle day 10 but before ovulation occurs.  (Ovulation on average occurs on cycle day 14 or 15.)

Our final surprise was the doctor's assessment of my previous IVF cycle.  In a previous post I had mentioned that years ago I had been given the diagnosis of Diminished Ovarian Reserve. This was my opportunity to ask the doctor more about this condition, specifically to how it related my previous IVF cycles, and what it could mean for my future.  Her opinion was that I did not have this condition, but rather possibly a condition call Ovarian Resistance.  Her thinking on why I was given the previous diagnosis was purely based on a number of characteristics that had occurred.  It was purely a clinical dignosis, based on experiences.  Diminished Ovarian Reserve is lumped in with what's called peri-menopause, the decade or so before menopause begins, whereas Ovarian Resistance is generally what can happen in the decade or so before that.  In her words, ovarian resistance means that my ovaries don't like to play so we are forcing them to with the IVF meds.

This left me with a much better hope and a brighter outlook on the success of the cycle.  My Use By Date no longer seems right around the corner.

So we are ready to go again, ready to hunt for that missing piece to our puzzle, and no longer feeling like that piece will be difficult to find.

Is it Monday yet?

Monday is the big day, the meeting that will get the ball rolling again for the 3rd time.  I'm getting antsy for the day to come and part of me wonders if I'll be able to wait until the fall to do the cycle.  It's really for the best interests of my family to wait until then, but part of me hopes that the doc says we need to go sooner rather than later.

The one thing that made me sad in making this appointment was that I realized this had become routine; almost like scheduling a dentist appointment.  I never thought I would be at that point in my life where IVF is now a routine thing to do.  It should never have to be that way for anyone; IVF should be something rare and unique, not something you schedule like a dentist appointment.

IVF 101: FAQ about IVF

1. Does insurance cover any of it?
1. No, it does not cover any of the costs associated with IVF.  Some states require coverage, but Minnesota does not.  Our insurance will cover up to $2,000 in infertility services up to but not including IVF.
2. Can you make payments?
1. No, all of the money must be paid upfront.  If you don't use all of what you paid in, you get a refund check once everything is completed.  This happened the last time we did IVF.
3. How much does it cost?
1. Our clinic breaks it down as follows:
1. Medications: estimated at $3,000 for a woman under 35.
2. Monitoring (includes ultrasounds and blood work): estimated at $2,436
3. ART services (includes egg retrieval, embryo transfer, anesthesia, and lab costs): $7,444
4. ICSI: $1,000
5. Grand total: estimated at $13,880
6. If we decide to freeze any remaining embryos, there is an additional $1,000 for freezing plus a $550 yearly fee.
4. How long does a cycle take?
1. Approximately 5 to 6 weeks from start to finish, usually on the longer end.
1. My last cycle was like this:
1. Sign paperwork and make pre-payment.
2. Three weeks of birth control to regulate my cycle.
3. Ten to 14 days of shots, with visits to the clinic for blood work and transvaginal ultrasounds.   Meds are adjusted as needed based on these tests.
4. Egg retrieval
5. Depending on how many embryos there are and their quality, embryo transfer is either 3 or 6 days after egg retrieval.  The longer the better because it means stronger embryos.  Some people opt to freeze at this point and transfer later in what's known as a Frozen Embryo Transfer (FET). I've always done a fresh transfer.
6. Another 10 to 14 days before blood pregnancy test.
5. Can any of the meds be taken orally?
1. Unfortunately not.  Almost all IVF meds are shot based.  Stimulation and suppression drugs are subcutaneous shots; the trigger shot and post transfer progesterone in oil shots are intramuscular.  Some women have used progesterone suppositories, but success rates seem to be stronger for the shot based progesterone (at least in the viewpoint of my doctors).
6. Does every IVF patient use the same drugs in the same amount?
1. No, each cycle is tailored to each patient's needs.  Adjustments to medications are even made during the course of the cycle.  There are some standard meds on the market though.
2. In addition, each IVF patient attends a "shot class" where a patient is taught how to mix the meds, and the proper way to inject them.
7. Where do you get these drugs?
1. There are pharmacies that specialize in fertility medications; almost all are mail order and ship FedEx.  I've used pharmacies on the East Coast in past for my meds.  They supply everything that's needed: the meds, any mixing agents (some meds are in powder form), needles, swabs, and Sharps container.
8. Do the shots hurt?
1. The subcutaneous shots don't really hurt.  It's a bit like getting pinched.  The intramuscular shots are quite uncomfortable and can leave bruises.

It's time for IVF101! First up, terminology.

I said in a previous post that I would be answering some common questions about IVF.  First we'll start with terminology.

Intramuscular shot: A shot into a muscle, usually the butt.

Subcutaneous shot: A shot under the skin; for fertility meds, this usually means in the stomach.

hCG: human chorionic gonadotropin

Egg retrieval: A surgical procedure where the doctor uses an ultrasound guided needle to go through the wall of the uterus (going up through the vagina) to collect the follicles (eggs).
 
Embryo transfer: The transfer of a fertilized embryo into the uterus.

ICSI (intracytoplasmic sperm injection): A procedure where one sperm is injected directly into the egg.

Trigger shot: An intra-muscular shot of hCG to tell my body to release the follicles (eggs) that have been growing.  Retrieval takes place 36 hours after this shot.

Stimulation drugs: Drugs that tell my body to grow follicles (eggs).  In other words, to stimulate my ovaries.

Suppression drugs: Drugs that keep my body from ovulatin and from only growing one follicle (egg).  The goal is multiple follicles; I had 22 in my last cycle.  A good goal is 10 to 15.

I'll continue to add to this list as I find more terms that need definition.

Am I old or young?

I’m roughly 6 months from my 34^th birthday.  In the grand scheme of things this really isn’t all that old.  I’m too young for health conditions that traditionally affect the older set.  Things like heart disease, high blood pressure, strokes, type 2 diabetes, and certain cancers.

But when it comes to having children, the age issue becomes murky, especially for women.  Biologically, women are born with all the eggs they’ll ever have in their reproductive lifetime.  When the eggs run out, the show’s over and menopause starts.  Men on the other hand make sperm until they die.

For women it’s even more interesting.  Our eggs age and once you’re a certain age, you start to worry about things like egg quality (which isn’t stamped somewhere – there’s no set Use by Date); and terms like Advanced Maternal age start being thrown around.

My official diagnosis is Diminished Ovarian Reserve.  It was explained to me that this meant I was aging reproductively faster than the norm.  My egg quality, the Use by Date, was approaching faster than it should.  I still have questions of my own about this condition.  I’ve yet to get clarity on whether or not this means I’ll hit menopause earlier.

But it definitely means time is against me.  Since my last cycle I am now a little more than 3 years older.  Health wise I am 35 pounds lighter and relatively fit.  But will it be enough?  I hope so and for my sake (as well as my husband’s) I hope my Use by Date is still many years away.

Why start a blog now?

Our journey through fertility treatments and finally through IVF was kept very private for a variety of reasons.  I was young and maybe a little sad that someone in my age group had to go through this.  After all, I was only 27 when I did my first IVF cycle, and even younger when I started the process.   And perhaps I felt ashamed; there can be a stigma attached to fertility treatments – real or perceived.

The big reason?  We just didn’t want to answer a lot of questions.  Fertility treatments are painful enough as it is without everyone asking a ton of questions.  We were struggling with many of those questions ourselves and quite frankly didn’t have a lot of the answers.  Plus I didn’t want to deal with all those well-meaning people who would say things like:

“What if it’s twins, triplets, etc?”  (I was just trying to get pregnant with one; not worry about anything else.)

“Well Octomom just had 8!  Could that happen to you?”  (Thanks Octomom for giving fertility treatments a dirty name.)

“Why not adopt?”  (I have no problem with adoption at all; it is a very loving and generous thing to do, but it takes a very special kind of person to open their hearts and lives in that process and I knew I wasn’t that person.)

“If you just relax it’ll happen!” and many other varieties of “If you just….” followed by some other well-meaning advice.

“Are you pregnant yet?”

“Well so and so did ____ and they were able to get pregnant.  Why don’t you do that?”

And so on.  I just couldn’t deal with that.  I was dealing with my own stages of grief.  Really that’s what fertility treatments come down to for a lot of people.  I was angry, very angry.  Why me?  Why is it the teen mom and not me?  Why is it the crack head parent with three other children to support and not me?  So many why’s.  So many prayers for a baby.  Then it shifted to praying not for a baby, but praying for understanding.  I had to make peace with the fact that for some reason God needed me to go through this.

It was much easier to open up for our second cycle, but I still wasn’t comfortable with everyone in my life knowing I was doing this.  I just wanted to complete my family and move on with my life.

Now I get it.  This is why God needed me to go through this and why I needed to start a blog.  To help other people; to share my experiences in the hopes that it will make it easier for someone else that’s struggling; to provide understanding to those that never have or will never have to go through this.  And hopefully to help me find that missing piece...

Note to my readers: After my next blog post I will be answering common IVF questions!  Please post in the comments or send me a message of your questions and I will do my best to answer them.

Putting the cart before the horse

I'm a planner and an organizer.  Sometimes this means I get ahead of myself in planning things.

I'm already worrying about how we'll set up the bedrooms for the new baby.  There's no question that my house can hold another child.  Heck, my grandparents raised a large family here, much larger than my current family size or potential future family size. 

Do my boys double up and we keep our guest room?  It sounds kind of selfish really since the plan recently has been to turn that room into a library to house my book addiction.  Even more so because the boys are used to having their own space.  I even started thinking about how I would arrange the beds to maximize space for the two of them.

Or do they each get a room and we just shift them around?  Really this makes the most sense.  Everyone will have their own space.  The library dream goes on hold once again, which is hard to swallow because I finally got to see the dream start to take shape when Kurt's cousin designed this absolutely amazing space.  His design was everything I always wanted.

And back to the twins worry.  We've gotten lucky so far in that we've just had singleton pregnancies.  Sam's cycle I had 3 embryos put in, and with Zach's I had two put in.  We dodged that bullet twice.  Will we be able to dodge it again?  The bedroom issue gets even more complicated.

I'm also worrying about my car.  I just bought my car, brand new off the lot, in October 2010.  It's gorgeous, I love it, and it seems to have just the right amount of room for what we need to do.  If we are lucky enough to add another child, to find our missing piece, then things get tight, very tight.  This kind of thing frustrates my husband since we seem to keep car jumping.  The last 3 vehicles we've owned we've only owned for 2 years or less.  It's hard to get ahead on car payments when the vehicle keeps changing.

But the things that excite me about planning this time?  I'm thinking about the baby equipment we'll need.  A new crib is definitely in order.  I definitely got my money's worth out of my old one.  Plus a few other things that we would need.  And Lord help me if it's a girl!   I don't think my budget could handle all the things I would want to buy.

Is all this planning and thinking a positive thing?  Maybe.

Or maybe I'm just putting the cart in front of the horse....