Jenny & Jerry

Stim Cycle – Day 7

Jerry gave me my first shot last night!  We’ve moved onto the thigh b/c my stomach is not happy with all of the poking that’s been going on.  My pants hit right at the injection site and it’s getting uncomfortable.

He was so apprehensive (it was kind of cute) and I just told him to pretend it was a dart.  “Just don’t go slow”.  His aim and tempo were perfect…but once it was in, he just looked at me, like “now what?”.  “You need to push the plunger, honey”.  Oh yeah…I have high hopes for him when it’s time to break out the big guns.

Blood work & Ultrasound were scheduled for 7:30 am…I got there at 7:10.  They try to discourage patients from coming in early (big sign behind the desk…You will be seen in the order of your appointment, not in the order you arrive.) and I get it.  I just never know what the parking situation is going to be like so I prefer to be early.  

Here are today’s 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
Wednesday 5/1 436   2.1        
Thursday 5/2 614 0.3   9 2 11  

They have started to size my follicles by mm.  Right now I have:

Right side:  16, 13, 12, 12, 12, 11 and 3 follicles which are less 10  (i.e. 3 < 10)

Left side:  2 <10

They want to see the follicle size > 15 so we’re moving right along.  I have at least 6 that should make the cut so fingers crossed this will get us to retrieval.

New protocol:

Follistim 375 iu
Menopur 300 iu
Dexamethasone 1 mg
New drug Ganirelix  – This is the holding drug which will prevent me from ovulating.  It’s in a prefilled syringe so I don’t have to worry about the dosage.  I’m to take it (via injection) as soon as I get home from work tonight and then every morning at the same time.  Looks like the alarm will be set for 5:30 am all weekend too (sorry Jerry!).

Next appt…bright and early at 6:45 for blood work (no ultrasound) tomorrow morning.

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Stim Cycle – Days 5 & 6

Protocol for days 5 & 6

375 iu Follistim
300 iu Menopur
1 mg Dexamethasone

Day 5 – Today was uneventful.  I didn’t have a monitoring appointment in the morning so I got to sleep in a little (5:30 is sleeping in for me…yipee!).

I had a bit of trouble with the Follistim dosage.  During our injection orientation, I remember the nurse saying there would always be additional medicine in the cartridge to allow for human error. The cartridges I have are 900 iu and I had two 300 iu injections and one 375 iu injection from that one cartridges.  It looked like there was still some medicine in the vial so I thought it would stop when it ran out.  So while the needle was in, I was trying to get the rest of the medicine out and the plunger just depressed the entire way.  The stupid thing was already empty.  So I jabbed myself for nothing which is really annoying.  After reloading the pen, I dialed up the correct dose but ended up pinching my skin higher on my stomach than usual.  The liquid really burned going in and it was the first time these shots brought tears to my eyes.  Lesson learned…aim for closer to hipbones.  You can barely feel it.  Problem is…that skin is all bruised and sore so now I’m moving on to my thighs.

Honestly, these injections have really been no big deal.  It’s scary looking at the needle but they really don’t hurt that much.

Day 6 – I had a 6:30 appt for a blood draw only.  They wanted to check my E2 & LH levels (If you’re at all interested in understanding these tests, I think this article outlines them very well).

The results were good:

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
Wednesday 5/1 436 2.1

They want to see doubling of the E2 level every 48 hours, as that is a sign of
continued follicle development.  So we’re good there.  A surge in LH would indicate the start of ovulation, which we don’t want, so it’s good that number stayed the same.

I finally remembered to ask the nurse my questions:

*Exercise – 2-3 miles of walking is fine.  Just try not to get overheated.  9 mile hike is officially off.
*Drinking one 8oz cup of coffee is fine.  Try not to go over that.  I haven’t had any so will probably just continue to drink decaf (yuck!).  I’m basically just acting like I’m already pregnant right now…no caffeine, alcohol, artificial sweeteners, high mercury fish or hair dye.  Good thing I did my roots a week ago 🙂
*Estimated day of retrieval – average is cycle day 10-12.  We will know 2 days before the actual date, which is important to planning for work and um, other stuff.

My instructions were to continue with the current dosage.

Soooooooo…I go back tomorrow for another blood test and ultrasound.  Things are moving right along….Eeeek!

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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.

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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).

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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.

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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.

Picture 005

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! 

Picture 007 

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.

 Picture 006

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!

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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:

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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.

Picture 001

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.

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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.

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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!

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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!

 

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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.

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