Stim cycle – Day 4

Sherman (our dog) has been having to wear a cone the last few nights because he has a cyst by his ear that he keeps breaking open.  It bleeds everywhere and then he rubs his head all over the floor and makes it worse. He’s cute…but not so smart.

On any given night, Sherman gets up at least 25 times.  He walks around, he gets a drink, he flops down on the ground like he weighs 500 lbs….and most nights we sleep through it.  However, strap a big cone around his head and it’s a whole different story.  He gets stuck trying to turn around between the bed and the wall…bang! bang! bang!  He goes to get a drink…bang!  He tries to fluff up his bed and face plants into the floor…bang! boom!  Annnnnd, he likes to us up at least once a night to go outside because he drinks too much water and can’t hold it through the night.  None of this lends for a particularly restful sleep.  Jerry has been an absolute saint….getting up with him, taking him out, readjusting his cone…all to let me get some much need rest.  But I still hear it and then I’m up.  So sleep the last two nights has been a little restless, for both of us.

I had a 7:30 appt this morning for an ultrasound and blood work, so when that alarm went off at 5:25…Jenny was cranky!  Fortunately, the office is 10 minutes from my house so I really have little to complain about.  They got me in & out in 20 minutes. That place is a well oiled machine!

So here are the updated results:

	E2	P4	LH	Follicles	Follicles	Follicles	Endometrial
				Right	Left	Total	Lining
Required	> 1000	< 2.0	< 5.0			5
Friday 4/26	72	0.8	5	8	1	9
Monday 4/29	189	0.1	2.1	6-7	2	9	4

The lining # she gave me was new, but apparently it’s right on track.  I’m doing pretty well for only being on the stims for 3 days.  Still, Dr. S wants to up my dosage of Follistim and see if we can raise my E2 levels a bit.

New protocol (today & tomorrow):

300 iu Menopur
375 IU Follistim
1 mg Dexamethasone

And you may wonder how I’m keeping track of all of this information???  In true Nerd-fashion, I have spreadsheets for my spreadsheets!  I actually think this part is fun :).

I forgot to ask the nurse about my exercise so I’m taking tonight off and then going to walk a few miles tomorrow.  I have a list of questions for Wednesday and that is one of them.  From what I’ve been reading, I am guessing the 9 mile hike I was planning on Stim Day 9 is probably a bad idea (sorry Dad).

Stim Cycle–Days 2 & 3

Current Protocol

300 IU Follisim
300 IU Menpur
1 mg Dexamethasone

I started Saturday and Sunday with a 4 mile walk.  Saturday was beautiful and Sunday was overcast.  It felt good to get some fresh air and really clear my head.  I hope I’m not overdoing it…the doctor said to listen to my body and my body is saying MOVE!  I’ll clear it all on Monday at my appt.  I’m being very careful to eat right (most of the time) and get lots of sleep so I’m hoping I’m doing everything I can from my end.

The shots are getting easier.  The only thing that’s a little unsettling is mixing the Menopur.  I just don’t want to screw up the dosage!  But the actual injections are really no big deal.

Physical symptoms – I really don’t have any yet.  I commented that I think I was starting to feel a little bloated and Jerry laughed and reminded me it’s only been 2 days.  But I’m still saying it!  I know my body pretty well by now.

Emotional symptoms – none!  I’m happy to report I feel great.  I’ll be the first to admit that I am pretty worried about this.  A hormonal Jenny is NO fun for anyone!!  Ask anyone that knows me…especially Jerry or my mother.  I can’t even stand to be around myself.  But I honestly haven’t had any sudden crying spells or screaming outburst so I would say we’re doing OK!

Stay tuned for tomorrow’s report when I have my first monitoring appt!  Can’t wait to see how this old body is reacting to all of this new stuff going on.

Stim Cycle – Day 1

 

The nurse I spoke with said it should really take it easy on the exercise.  Walking is fine, light weights (3-5 lbs) are fine, gentle yoga is fine….but no hip hop, zumba, kickboxing or bodypump.  I’m taking it as a good sign that the weather was perfect on Friday.  Jerry & I took advantage of the evening by taking a walk on Carson Street and stopping at dinner at the Doublewide Grill on the way home. It was a very relaxing Friday night…just what I needed. 

When we got home from dinner, we watched the Instructional CD which Walgreens had provided with our drugs.  It took us 45 minutes of going through the details of how to mix the Menopur & dose the Follistim but then we were ready to go. 

I did the actual preparation while Jerry re-read the steps back to me and supervised.  It probably should have been the other way around, as he’s practically a doctor, but I just jumped in and started tearing open stuff. He yelled at me a couple of times for not being as careful as I should be with sterilizing everything as i went. Then I yelled at him to stop yelling at me. He & I tend to get worked up pretty easily during stressful situations so this is going to be a nightly occurrence. We make up quickly so it’s all good.

So the deal with the Menopur is…you get these little 75 IU vials of powder and you have to mix them with a diluting solution. My dosage is 300 IUs so I was convinced I had to have 4 shots.  Panic!  But you actually just work through the solution until you have the full dosage in one syringe.  Just one shot…whew!

I got everything all mixed up and ready to shoot.  The injection is subcutaneous (under the skin) and the needle is really thin and about a half inch long.  It reminded me of a short acupuncture needle.  So I pinched up some skin on my stomach and gave the syringe to Jerry.  He looked at it, looked at me…“Maybe you should do it”.  I KNEW that was going to happen!  I really didn’t mind too much b/c I had to give myself injections when I had that stupid blood clot.  The needle is no big deal…the medicine just burns a little when you inject it. 

One down…one to go! 

 

The Follistim is a lot easier to work with.  You get a pen and a cartridge.  You just drop the cartridge into the pen and dial up your dosage.  Then pop on the needle and you’re good to go!  The second shot was easier to inject as I stood up this time and watched in a mirror.  I knew exactly where I was shooting them.

 

And you get this fancy little carrying case to take with you if you’re gonna be out during the injection time.  Ours is 6-9.  But I don’t know what I’d do about the Menopur, so I’m just going to make sure I’m home during that time. 

So first day…not bad. I think it’ll be easier once I have the process down. We’re just basically learning as we go!

Aaannnnd…we’re off!

I’ve been trying very hard to put this whole IVF extravaganza out of my mind for the last month.  We had 28 days to try to do things the old fashioned way…and while we gave it the old college try, no dice.  I knew we’d find out if we were successful sometime late this week & sure enough…she showed up first thing on Wednesday.  At least she’s punctual.

So that means, Wednesday afternoon, I called and ordered my big box of goodies (to the tune of $6,000!! That’s 2.5 times more than I had anticipated).  I also called my RE and scheduled my baseline blood work and ultrasound for Friday @ 7 am.

Then I came home to THIS on Thursday:

Seriously, all of that??  For meeeeee??  That’s a crapton of pharmaceuticals!  Good grief.  Once I laid all of the medicine out, I grabbed a pack of needles to check out what I was in for.

Not sure if the picture does it justice…but that is one BIG ASS NEEDLE!  The needley part is an inch and a half…and I got 2 GIANT bags of them.  These are for the Progesterone in oil (the other needles are much smaller).  And Jerry has to jam that thing into my butt everyday for how long?  Hopefully 12 weeks.  Now let me be clear, I will happily play the part of Jenny PinCushion for 12 months if that’s what it takes.  But I’ll be honest, it shook me up a bit.  And let’s not even talk about my husband…”we might have to hire a nurse to come over everyday and do these injections”.  I have a feeling I’m going to have to teach myself how to do it.  Whatever…it is what it is.  We can’t return the stuff so there is no turning back now.

So for those of you following along at home, the box contained:

Follistim & Menopur – “the stimulation medication”
These medications work to directly stimulate the ovaries to produce follicles.  Normally you only use one stim med, but I’m super lucky and get to use 2.  I get these injections for 8 to 15 days.

Ganirelix – “the holiding drug”
This prevents ovulation while continuing to stimulate my ovaries with the stim meds. This typically begins on day 5 of the stimulation cycle and is dependent upon my response to the stim meds.

Ovidrel – HCG or“Trigger Shot”
This will induce ovulation.  Once I’m cleared for retrieval, I get this shot and within 36 hours, they’ll take out my eggs.

Progesterone in Oil – “the one with the big ass needle”
This is used with the treatment cycle to support the endometrial lining.  I don’t start these shots until after the egg retrieval.

Dexamethasone & Medrol  – “steroids”
These may prevent the body from rejecting the transferred embryos.

Good times.

Bright and early on Friday, I had my blood draw and ultrasound. I zipped through my appointment in about 25 minutes, including wait time, and I always appreciate an efficient doctor’s office.

Here’s a key code for reference:

E2 (Estrogen) level – Estrogen stimulates the lining of the uterus, so that it grows and can sustain pregnancy.  It is also a measure of ovarian activity, as follicles produce estrogen.  The more follicles there are, the more estrogoen will be present.

P4 (progesterone) level – Hormone responsible for thickening the lining of the uterus to prepare it to accept implantation of a fertilized egg.

LH (lutenizing hormone) – necessary for the production of estrogen

Follicles – Fluid filled sacs in the ovary, which contain the eggs released at ovulation.

	E2	P4	LH	Follicles	Follicles	Follicles
				Right	Left	Total
Required for retrieval	> 1000	< 2.0	< 5.0			5
Friday 4/26	72	0.8	5	8	1	9

Damn lazy left ovary! I’m officially Miranda Hobbs! And her story ended well 🙂

And here is our schedule for the first 3 days:

		Stim	DHEA	Follistim	Menopur	Dexamethasone
		Day	25 mg
26-Apr	Fri	1	3x per day	300 IU	300 IU	1 mg
27-Apr	Sat	2	3x per day	300 IU	300 IU	1 mg
28-Apr	Sun	3	3x per day	300 IU	300 IU	1 mg

So Jerry & I are going to spend our weekend shooting up!  Let’s get this party started.

We have a date!

I am doing a horrible job documenting this process! Here’s what’s been going on:

Jerry and I met with Dr. S to go over our protocol on 3/11. I also needed to have a physical and cervical cultures plus some more bloodwork (CBC, type & screen, HIV, RPR, Hep B&C). I found out my mammogram came back clear (Yay!) and Dr. S reviewed the whole process with us. As I had my Rubella vaccination on 3/6, we can’t proceed with the first cycle @ 3/27 as I had hoped. You need to wait 30 days after the vaccination to get pregnant. So, that means we’ll be getting the party started @ 4/21! We went over all of the medications (yikes…I’m petrified of this part!) and were given the pharmacy information for a place in Pittsburgh. My insurance doesn’t cover any of the meds so it really doesn’t matter where we order them.

We scheduled the nurse talk for 3/29. This is when we sign all of the consent forms and go into massive debt. Shit’s getting real!

I want to thank everyone who has left comments and introduced themselves. This process can get very lonely…I don’t know anyone going through this in real life. I feel like my friends are getting really sick of the “why me” tears and the constant updates. I hate that I have to go through this but it’s really comforting to not have to go it alone.

The plan

Well after 5 days, I finally heard back from the IVF-C.  I was not a happy camper and may or may not have called her a few ugly names behind her back…I’m not a big fan of waiting around.  My patience is pretty much non-existent.  But she had some family stuff going on & I know how that goes so I forgave her.  Plus, she’s super nice.

Anyway, I thought we were way ahead of the game but no…I still need my History & Physical, Cervical Cultures and mammogram; plus bloodwork for HIV, HTLV RPR,  Hep B&C, cyctic fibrosis.  Jerry is getting all of his bloodwork and stuff done today so she set me up to have everything done in one fail swoop on 3/11.

Blood work @ 10:30
H&P & cultures @ 11
Physician’s consult @ 11:30
Lunch with my Mom @ 12:30 J
(mammogram is scheduled for 3/6)

Bam!  Then we’ll order the meds, schedule our nurse talk (aka..pay up!) and we’ll be on our way.  Oh, and get this…Jerry found out that his insurance covers IVF treatments up to $10,000!!  That would be awesome if I were on his insurance.  But I’m not.  Whomp, whomp…

So we decided that we’re going to buy the 1+1 ARC package (one fresh & one frozen transfer) for around $10,000.  If that doesn’t work, we’ll buy another 1+1 package.  The 2+2 package is @ $17,500…and as we don’t get anything back if it works the first time, Jerry prefers to take a $2,500 bet over a $7,500 one.  And if that doesn’t work, we’ll wait to do the final cycle at the beginning of 2014 after I’m on his insurance (both of our plan years end 12/31).  I love having a plan!

Orientation

It was rather uneventful.  I’m not sure exactly what I was expecting, but it was really just basic information about the process.  No specifics, which I guess makes sense b/c every case is different.  Jerry found it very informative.  As I’ve been doing a lot of my own research (Dr. Google is such a blessing &  a curse!), I really didn’t learn anything new.

There was a social worker present and we received information about the support groups and counseling which is available to us.  We also got a lot of financial info, and by a lot I mean, they made it real clear that you have to have your payment in full before any treatment starts.  I was a little surprised that there wasn’t a rep from ARC there.

The following day, I got to work.  I called the IVF Coordinator (IVF-C) and left a message explaining we wanted to get the ball rolling ASAP.  I called ARC and got quotes on each treatment package.  I called my OB/Gyn and requested copies of my most recent Pap test.  I called and scheduled Jerry’s follow up analysis and blood work.  We’re lucky that we have a lot of the pretesting out of the way.  This could all be happening within the next month!  Yikes!

 

Money, honey

Let’s talk about money.  IVF is EXPENSIVE!  To the tune of $10,000 per cycle + the cost of meds.  Jerry and I have both maxed out our Health Spending Accounts for 2013.  That’s $2,500 each.

We are pursuing ARC (Advance Reproductive Care) to offset the cost of treatment.  ARC makes the IVF process kind of like buying a car.  There are different “packages” you can purchase and you can finance all or part of the treatment.

Option A              One cycle            1+1         1 fresh and 1 frozen embryo transfer     $9,000+

Option B              Two cycles          2+2         2 fresh and 2 frozen embryo transfers   $17,000+

Option C              Three cycles       3 +3        3 fresh and 3 frozen embryo transfers   $22,000+

Obviously it makes more sense to pick Option C.  That gives you the best shot at having a baby in the most cost effective way.

But here are some fun things to consider:

1.  If you get pregnant on the first attempt, oh well…they keep the balance
2. Who knows if there will be any viable embryos to freeze?  We may only get one perfect little bugger to transfer, so that would eliminate the benefit of getting the additional frozen embryo transfers
3. ICSI costs an additional $1,500 per cycle…YAY!
4. There is an additional $2,000 – 4,000 in pharmacy costs (aka drugs, shots, hormones, etc) per cycle.

So we have a lot to think about in terms of which option we want to pursue.  I can’t help but be a little angry that most people don’t have to spend 1/2 of their kid’s college fund on just having the kid.  But it’s the hand I was dealt so suck it up and stop being bitter, right?  Riiiiiggghhht.

Wanting a family

If you would have asked me 5 years ago if I thought I would ever have kids, the answer would have been a resounding NO!  I don’t want to get married.  I don’t want to have kids.  End of story.

Until I met Jerry and all of that changed.  I knew I wanted to marry him within a few months of dating and suddenly the prospect of having a family of my own didn’t seem so bad.  So now, I want kids.  Or a kid.  I think Jerry & I would be great parents.

But I’m not one of those women who has always ached for a baby.  I don’t have that “thing” that’s all consuming and makes a woman desperate for her own child.   But I don’t realize how much I wanted a baby until I couldn’t have one.

That being said…I think deciding later in life that you want a child makes you more accepting if it doesn’t happen.  I know we have a small window.  I know there is a pretty big chance we won’t be parents.  I’m at the point now where I’m ok either way.  Took me a little while to get here, but I know it’s out of my hands and there is only so much I can do.  I want to exhaust all of our options and have no regrets.  If we don’t have kids, I want to know we did everything to have a family…it just wasn’t meant to be. We will have an amazing life regardless.

IVF is the last stop.  I kind of feel like we’re going to the casino, plopping $30,000 on the table and letting it ride.  There is a good chance we’ll walk away from this with nothing.  But there is that small hope that it will work.  And if it does, it will be worth all of the heartache and $$ that we’ve invested in this process.

Hope for the best…plan for the worst.  That’s all we can do.

Bit of History

I was 38 when I married Jerry in 2011.  He was 36.  First marriage for both of us…I guess we took our sweet time to find our perfect someone.

We knew we wanted to have kids and started trying on our honeymoon.  Perfect timing, right?  According to my ultra scientific iphone app, I was supposed to be ovulating during that week and I honestly thought I’d come home from Aruba and we’d be having a baby.

Well it didn’t work out that way but within 6 months, I found out I was pregnant.  We had just made an appointment with my OB/GYN to start fertility testing and were thrilled that we wouldn’t need it.  I miscarried around 7 weeks.  Put it up there as one of the suckiest things I’ve had to deal with in my 38 years.  I’m not going to dwell on that now but suffice it to say, I should have put myself in therapy stat…it was a really dark few (many) months.

After my D&C, we were cleared to start trying again in June.  Flash forward to November, 2012.  Still not pregnant, getting more and more frustrated that we weren’t doing anything about it (other than using an OPK and trying to time sex appropriately…very romantic).  I was very concerned about my Advance Maternal Age (aka old ass eggs) and felt like time was ticking away.  My OB/GYN (Dr. L) suggested we start with a few cycles on Clomid for me and some testing for Jerry.

We found out that Jerry has a low sperm count, including poor motility and morphology.  So Dr. L suggested we contact a reproductive endocrinologist.  I went off Clomid and we scheduled an appointment with the best of the best in our city.

Enter Dr. S.  We met with him on 12/07/2012 and went through an extensive consultation.  I left feeling very hopeful that we were formulating a plan and getting things moving in the right direction.  I was given scripts for a billion blood tests and a whole host of other tests for my lady parts.

Everything checked out fine for me.  My tubes aren’t blocked. My uterus is “perfect”.  My ovaries are working, albeit one side is over producing and one side is under producing…I say it all evens out.  There is a whole lot of technical stuff that we discussed and I wish I would have taken my magic pen with me so I could have recorded the information.  But I didn’t.

The recommended course of action for us is IVF with ICSI.  Basically, with Jerry’s low sperm count, it makes more sense to pull out my eggs and inject them with one perfect sperm that will hopefully do the trick.  That is where we are now.  We have an orientation to learn about the process on 2/20.

Let the games begin…