A Caveat and Request

Since you've been reading this blog and following our family building journey, we've announced to you that we are pregnant. However, we are not ready to make a general announcement. It is way too early in the game and we haven't even seen a heart flutter or heard a heartbeat yet. So, please do not share this news with others, congratulate us on Facebook, or make it public in any other way. Thanks for your understanding.

Confirmed - It's Positive!

It worked on the first try! We're a little shocked after the number of tries it took for DS, and wanted to make sure it was really true. We had an ultrasound yesterday to confirm it. I'm officially 5w2d. I haven't actually calculated the due date yet but it will be in mid August, just 3 weeks after DSs due date.

Personally, I knew it was positive the day after bedrest. Call it intuition or whatever, but I just knew it, I had the same tugging and pulling sensation as last time. My HCG levels were high on Monday 12/6 and more than doubled by Wednesday 12/8. An ultrasound this week showed that my ovaries are still quite enlarged and there is fluid in my abdomen which was causing the pain I had all last week, although it has mostly subsided now.

I've started weaning off the steroids this past week and have one week left. I haven't slept past 4 am in 4 weeks and today got up at 3 am. I'm really hoping that it's the steroids causing the insomnia and that once I finally get off of them I'll be able to sleep again.

We're not out of the woods yet. Everyone knows that you normally don't tell people until 12 weeks because there is always a chance of miscarriage. We're still walking on eggshells a bit to make sure that everything works out. I'll continue all of my medications (except steroids) and will have weekly ultrasounds to check growth and make sure things are progressing.

In the meantime, we're excited to have a merry Christmas and get ready for our expanding family!

Needles and Bruises

Have I ever mentioned how much I hate shots? At least for stims, I use an empty syringe to draw up the mixed medication and the needle is super sharp and slides in like butter. Ganirelix (to prevent me from ovulating) was a pre-filled syringe and that is probably the worst needle. You get to your skin and the needle just stops and you have to literally jab it through. Lovenox (daily blood thinner) isn't quite as bad as Ganirelix but it also has a pretty dull needle that has to really be jabbed into the skin, which of course causes more pain than a sharp needle. Why do pre-filled syringes have such dull needles? I seriously have no idea.

Then we get to the bruising. Last time I was pg and did the blood thinner injections the full 39 wks and my belly was all black, blue, purple and green. This time a nurse told me that I can prevent bruising by not applying any pressure after the injection. I was so excited! I've been doing that every time. I have gauze to wipe up the blood but I don't apply any pressure. Yeah, doesn't work. The left side is lovely shades of blue, green and yellow showing healing and fresh bruises. The right side has some yellow healing bruises along with some bright purple ones. Considering it's a relatively small area of real estate that the injections can go into (about 2 inches on either side of the belly button), the space available becomes even more limited due to the bruising.

But alas, I'm just venting. I know the injections are necessary and I just hope that it's a positive outcome. I'll continue to grin and bear it...with a little side venting every now and then :)

When Will I Know?

That's the question some people are asking, so here's the answer. It's not quite as simple as a fertile person who pees on a stick and announces they are pg. The trigger shot that I did almost 2 weeks ago contains the hormone HCG that makes your body ovulate in 36 hours. The artificial HCG hormone slowly leaves your body over about 10 days and as of Friday it was down to 6.

Now I want my HCG levels to go up, and almost double every 48 hours. My official Beta (pg test) uses serum (blood) HCG levels to determine pg and is technically this next Sunday which is 14dp3dt (14 days past 3 day transfer). I'll get my HCG levels M/W/F this week when I go in for blood tests, so I'll know which way it's trending. I'm hoping for an HCG of > 200 on Sunday to show a strong Beta.

If it's positive, I keep going in for bloodwork twice a week to make sure the HCG is still doubling and that my estrogen and progesterone levels are in range, otherwise my medication needs to be adjusted. I would have an ultrasound to confirm how many embryos implanted. Then ultrasounds once a week to hear the heartbeat, then to make sure there is a fetal pole and a yolk sac. Around 8 weeks I would go to the OB for my first ultrasound there, and then I would officially graduate from the REs office around 10-12 weeks. Embryos through IVF have been through a lot with all of the synthetic FSH and LH that was used to create the egg, so it's a little more cautious to make sure the pg will stick.

If it's negative and HCG levels are low, I start weaning off steroids and stop the other hormones, blood thinners, etc., but still have to go back in for bloodwork to make sure the HCG goes back to zero.

So this is the week where the late afternoon phone calls from the doctor have my heart pumping as I wait to hear if we'll have a Merry Christmas or a melancholy one. I know of at least 4 pg friends and more that are trying. Whatever the outcome, please understand that I won't share it right away. If it's positive, there are still a number of steps that I need to get through to feel confident that it's a viable pg. If it's negative, I'm going to need some time to grieve and get the tears under control before I can face swollen bellies and baby talk again.

My Maybe Babies

When I first started this blog I added some comments from an infertility album I started a few years ago to grieve, say goodbye, and hold the pictures of the embryos that my DH and I created that didn't make it. We get pictures of these embryos on transfer day and we talk to them, look at them and start to love our possible future babies.

Here are the 3 "maybe babies" that are inside me right now. We love you and hope that at least one of you snuggle in, implant and fully develop over the next 9 months.

8 cell embryo with tiny fragmentation, the little bubbles near the top. The nurse said this one looks like a pretty flower and is probably a girl :)

8 cell graded as grainy

6 cell graded as grainy

Ultrasound during the transfer. The little white spot on the upper right with the arrow under it is where the embryos were placed in my uterus. You could actually see the tiny 3 dots swoosh out of the catheter.

Final Day of Bedrest

I realize that no one really cares what I do on bedrest, but I'm bored, so I'm going to talk about it anyway. Yesterday my DH worked from home and was able to fill my water, bring me lunch, etc. in between meetings. During the day I read the 300 page book "Breakfast at Tiffany's", I watched "Eat, Pray, Love" and I did a meditation which led into a 3 hour nap. Mixed in there was writing on this blog, sending a few emails and just staring into space.

Today my DH had to go into the office. He prepped a cooler for me with some snacks and drinks, and put a plate of food in the fridge ready for me to pop in the microwave. I've got "Charlie St. Cloud" loaded in the DVD player and a few other movies recorded on the DVR, along with a few magazines within arms reach.

The bedrest pains have set in. My lower back, sides and shoulders ache from lying on them for 42 hours so far. But as predicted, the hardest part is not being able to interact with my DS. Sure he comes running over every once in a while to give me a high five, and I did get him to sit on the couch with me while we read a book on Sunday, but he's just not really the kind of kid that sits still to snuggle. He's off and going. I'm very much looking forward to tomorrow where I can finally give him a proper snuggle hug.

Tonight I'll start to prop myself up with some pillows and let my body start adjusting again. From past experience, I've about passed out my first day off bedrest because my blood pressure gets so low. I've got a doc appt at 9 am tomorrow to check my blood and see how my estrogen and progesterone are doing, then a full day of work.

As for my little embryos, nothing to report there. I'm hoping they are getting all comfy and burrowing in, but it'll be a while before I know anything. There are all sorts of symptoms, or lack of, that you can read into during the 2WW, but I'm attempting to not obsess on it all and just see what happens.

Current Rx Cocktail

Now that the stimulation injections are complete and my embryos are back in my oven where they should be, my drug mix has changed slightly. Here's the current daily cocktail:

When I wake up:

> Synthroid - for being hypothyroid. Keeping my thyroid under control is crucial for getting pregnant and preventing miscarriage as I have increased odds of miscarriage.

> Progesterone - while I used to do injections in the booty at night, this time around I use a cream instead.

At breakfast:

> Prenatal vitamin

> Calcium supplement

> Prednisone - steroid to help suppress my immune system to allow implantation

> Selenium - can help decrease the chance of miscarriage due to thyroid issues. Not totally proven, but won't hurt.

> DHA - omega 3 fatty acid (fish oil) to help with early fetal development

> Folgard - I have MTHFR which is a genetic mutation (homozygous, or two copies, of the A6777 mutation) meaning I don't absorb folic acid and can have blood clots. This drug is mega doses of folic acid, B6 and B12 to help me absorb the folic acid which is critical for early fetal growth to help prevent neural tube defects.

> Baby Aspirin - again for MTHFR, this helps to prevent blood clots which can mean not enough blood gets to my uterus to help the baby grow.

> Pineapple core - yes, that's correct. I actually cut up fresh pineapples, save the core and munch on it throughout the day. It's a natural form of bromelain that can help with implantation. You can buy it as a vitamin supplement, but the correct dose is difficult to determine. Eating fresh pineapple core is actually better. Over the last 10 ART procedures that I've had, I've eaten enough pineapple core to last me a lifetime. But once again, I'm crunching through it.

In the evening:

> Lovenox - blood thinner that I inject in my stomach to help prevent blood clots (again related to MTHFR). This does cause massive bruising on my stomach and burns when injected. While not at all fun and a little controversial as to its benefits, it worked last time and I took it the entire pg, so I'll do it again.

> Folgard - second dose of the day

> Prednisone - second dose of the day

What's coming up:

I'll be going in for blood tests every other day to check my hormone levels. I will most likely need to take Estrogen supplements. So at some point I'll start wearing an estrogen patch that will be changed every 2-3 days, along with taking oral estrogen 3 times a day.

Back to bedrest for now...

(a post on the actual transfer is listed below)

Transfer Time

I went in for transfer on Sunday, after dropping DS off at a friends house at 7:45 am. We talked to the doc about the quality of the embryos. Of the 4, two were 8 cell, one was 6 cell and the last one was only 3 cells. One 8 cell has a little fragmentation, the other 8 and 6 were listed as "grainy", whatever that means. The doc, DH and I all agreed to transfer the two 8 cells and the 6 cell. They aren't perfect, but they still look pretty good. Once I'm off bedrest, I'll post their pictures. The 3 cell one will be allowed to grow until day 6 to see if it will be a blastocyst and ready to freeze, but I doubt it.

I was feeling quite comfortable with my valium and watched as our 3 little embryos were inserted right back into me. You can actually see them as a white spot on the ultrasound as the 3 little dots swooshed out of the catheter and at least one of them will hopefully burrow in.

I also asked the doc about the whole 3 vs. 5 day transfer issue. He said the nurses do the schedule and standard protocol is a 5 day transfer if there are 4 embryos. But as soon as he saw that it was me, he also told the nurse I need a 3 day transfer. At least we were all on the same page on that one. Naturally speaking, days 3-5 is where the embryo travels down the fallopian tube sloughing off some of it's outer shell (hatching) so that it's ready to implant in the lining of the uterus. Day 5 transfers more closely resemble nature, but that's only if the embryo will survive in the petri dish. While my embryos are back inside me and already in my uterus, implantation (if it happens) still wouldn't occur until probably tomorrow. One of the procedures performed on the embryos prior to being transferred back is called Assisted Hatching where they slightly scratch the surface of the embryo to allow it to hatch on it's own, since it doesn't have the benefit of traveling down my fallopian tube like it would naturally.

Transfer day counts as day 1 of bedrest. 1 day down, 2 more to go.

Fert Report

Got the call, 4 out of the 5 eggs fertilized. This is good. They wanted to do a day 5 transfer initially, but I said no. I've always done a day 3 transfer and no embryo has ever lived to day 5 in the culture. Doc called back and agreed to day 3. I'm really thinking there was some miscommunication and my RE didn't really think that with my history trying to make a day 5 with only 4 embryo's was a good idea. That's a little crazy actually.

Anyway, transfer is Sunday at 10:30 am. Then 3 days of bedrest for me. We'll have to wait to find out the quality of the embryos to decide how many to put back and we don't know that information until we're in the room ready to go.

Retrieval Results

The day started off ominously when we got in my Acadia at 6am and the car wouldn't start. Of all the steps in an IVF cycle, the timing of the trigger shot and the retrieval are the most crucial. After about 10 minutes working with my car, we ended up having to take DHs Subaru WRX STI, which is entirely uncomfortable with swollen ovaries, and we got there in a record 31 minutes going 85 mph to make sure we weren't late.

We walked into the building with the doctors and had a little chat in the elevator. I met the RE doing my retrieval and told him I only have 3, maybe 4, eggs and he needed to get them. He said not to worry, he's pretty greedy and he'll get everything he can. After doing paperwork we chatted with the RE for another 30 minutes just hanging out. We joked with the embryologist and told him to pick out a girly looking swimmer this time. Just to be clear, it was a joke. While it is possible to do full gender selection, we are not doing that. We did a lot of chatting with the docs before the procedure, it's a very different feel on a holiday when the staff is limited and just there for a few retrievals and transfers vs. other planned surgeries and a full days work.

A mystery was solved during my chat with the anesthesiologist. I'd mentioned before that the hysteroscopy surgeries were really kicking my butt and I was sleeping for 3-4 hours afterwards. Apparently that's because with those I have IV anesthesia along with gas (general anesthesia) and it takes a while for all the gas to work out of your system. For the retrieval, it's just IV anesthesia (sometimes called "twilight") and moves through your body faster. I felt pretty good after the surgery, napped for just an hour and was fully able to cook Thanksgiving dinner for DHs family.

But I'm getting ahead of myself. The retrieval. As I was moving into the OR and saying bye to my DH, I said "We're hoping for 3, 4, or maybe more." My first question in recovery of course was how many eggs. Oh yeah, we got 5! Now, we don't actually know if all the eggs are mature, if they will fertilize or survive the culture for the next 3 days, but for now we've got smiles on our faces with 5 eggs, which is more than we had expected.

I should be getting a call later this afternoon with the fertilization report. Come on, embies, fertilize, grow and come on back to me!

Insurance Companies and IF Etiquette

This one is purely a vent.

Insurance Companies

I pre-registered at the hospital and then got the call that insurance has denied this retrieval and it will cost $2,800 out of pocket. First off, you don't spend $3,800 on Rx and then not do the retrieval, so I'm pretty stuck. I called insurance and they said I already had 4 oocyte (egg) retrievals, which is not true, only 3. Apparently one of the claims in 2008 went through twice and everything has to go to the medical review board. In the meantime, I have to shell out the $2,800 upfront to have the retrieval done. Small glimmer of hope is that since the retrieval will be on a holiday, I have to go the surgery center rather than the usual hospital. Since the surgery center is partially owned by my doc and they know the situation, there's a chance I won't have to pay upfront and can wait for this to all get sorted out. We'll see.

My policy also states that I am allowed 4 oocyte retrievals, then with a live birth up to 2 more. When I asked about this, stating that since I had a live birth even if your records say I had 4 already, I should still be allowed 2 more regardless. Then they started analyzing the actual policy and stated that it's 4 total so this would be my last one covered by insurance. That is clearly not how the policy is written. If this IVF fails, I'm going to need to file an appeal with insurance before we move forward with the next one. The other part is that they asked if I ever submitted paperwork of a live birth. Hmm, didn't you pay for a c-section, newborn screenings and my DS is on the policy? Apparently my RE has to submit stating that the live birth is a direct result of the oocyte retrieval (and I didn't have a surprise pg). Did I mention that as a part of IVF it really helps if you remain stress free, yeah right.

IF Etiquette

I'm a member of RESOLVE the national infertility association and active on their chat boards. One discussion that I recall from the first time I went through infertility treatment was etiquette in the waiting room. Meaning, if you happen to have a child, don't bring them to the waiting room of an IF clinic. That's just rubbing salt into the wound. The first time around, it rarely happened and when it did I just tried to ignore the child. It was too painful. We all understand that going to the OB/GYN for the annual exam will be traumatic. Swollen bellies just staring at you, excited talk about ultrasounds and fetal growth, babies crying, kids all over the place. That's to be expected and you steel your nerves and forge ahead. But at an IF clinic, that's your safe place. The one place that you shouldn't have to look at another child while you mentally spiral downwards in the "what if" game should you never get pregnant.

This time around, I don't think I've ever been in the waiting room without another child there. How did times change this much in 2 years? Why are there so many kids in the waiting room? From the previous discussion, I understand that SAHMs might need to bring their kids since they have no alternative care. But today, a mother, child and grandma show up. And the grandma is talking loud playing with the child. If you look around the room, most eyes are averted and looking at the floor, very actively trying not to look at the reminder of what they might never have.

For me, I will try my hardest to never take my DS to the clinic or the hospital. I just cannot do that to my fellow IF women in pain and anguish. It can take a huge physical and mental toll to be in a situation like that and not feel increased anxiety and stress.

Retrieval on Thanksgiving....

Monitoring Update

Well, on Monday I went back in and those follies just did not grow enough over the weekend. Left had 15 and 19, while the right had a 17 and two at 11. My E2 was 709. We discussed ER being on Thursday (Thanksgiving) rather than Wednesday as planned. Got the call later that after reviewing my labs, I needed to do one more day of stims and Ganirelix.

Today I went back in and they are looking better. Left has an 18 and 20. Right has a 20, and a 14 mm that might grow enough to be mature. We're looking at 3, possibly 4 eggs. Sometimes they find more in retrieval that don't show up on u/s, but it would only be 1 more. Sigh. Such is my body that I just don't respond or produce much. I'm still waiting for the final call, but I'm expecting to do my HCG trigger shot tonight.

In the past, the IM shots had to be done in the butt. We did that for the trigger shots and progesterone during the 2WW and then the whole first trimester. Progesterone is a thick oil requiring a 25 gauge needle, rather than a 27 or 32 gauge sub-q injection. But my clinic has changed protocols and they no longer do any shots in the butt. My poor DH has done roughly 115 shots in my booty, staring at my ass like a meat map to find the best spot that doesn't already have a knot in it. However there was a mix up with the drugs so my HCG trigger shot is an IM shot rather than a sub-q. DH will just have this last chance to jab a needle in my booty.

Thanksgiving

Did I mention that we're hosting Thanksgiving for DH's out of town family that is staying with us? Kind of throws a kink in the plans. I've been doing a little bit of cooking each night. When I thought retrieval was Wed, I made a lasagna that we could just toss in the oven for dinner that night while I sleep off the anesthesia. Now it's going to be Thursday, so I'm going to need to prepare the stuffing, green bean casserole, potatoes, bread, etc. as much as possible ahead of time. IF stuff never really sticks to the schedule. Which also means I've had to rearrange care of DS a few times as well. Luckily with this new timing, DHs family will watch him for retrieval and I've got an awesome friend who even while hosting lots of her own family/friends agreed to watch him for the Sunday transfer.

Still waiting for the official call to give the go-ahead. Tonight would be one shot in the butt and start antibiotics. Tomorrow will be blissfully injection free!

Monitoring Update - On Track

I had another ultrasound and bloodwork on Friday. Everything is on track and looking good. The left side has 2 follies at 13 and 14. The right side has a 12, 9, 7 and 6 mm follies. It looks like I might be able to get about 4 eggs if the 12, 13, 14, and 9 are all mature at the same time. Based on the follicle size I started the Ganirelix injections last night as well. This will prevent my LH surge from happening which triggers your body to start ovulating the eggs. We want to keep them growing.

Estrogen came in at 565 and is rising appropriately now after the kick start of increasing my meds. FedEx shipment of the new drugs arrived right on time and I have exactly enough medication to take me through Monday night if I have to take full doses of the Menopur, Bravelle and Ganirelix. Anything additional needs to be ordered Monday for delivery Tuesday for evening injections.

Based on all of this I'm estimating egg retrieval to be on Wednesday with embryo transfer on Saturday. Which means bedrest would be Saturday, Sunday and Monday. Considering I'm hosting Thanksgiving with DHs family this will be interesting. I'll attempt to prep the ingredients and get as much ready to go as possible since I'll be out of commission on Wednesday and still in pain on Thursday for Thanksgiving.

I was talking to the nurse and making my usual assumptions about the cycle and at one point she turned to me and said, "Lisa, you just know too much." That statement is so true. For TTC#1 I did 13 medicated cycles (4 clomid, 6 IUI, 3 IVF) and you gain a lot of knowledge in that amount of time.

As for my body, I'm in the usual amount of pain. I'm pretty much uncomfortable most of the time due to the pressure of my enlarged ovaries. They are typically the size of a grape and during this time swell up to the size of a golf ball (and I have just a few follicles, it's worse for people who really respond well). The prednisone steroids are causing chest pains and general flutterings of pain in random places.

However the prednisone is also causing me to lose weight. I've lost 5 lbs in a week. The side effects are that you gain weight on prednisone, so I'm a little concerned about how effectively it's working. The first time I took it, I also lost weight and that cycle ended up being converted from IVF to IUI due to a large cyst. The second time I took it (my BFP cycle) I gained 5 lbs in a week. As usual, I'm googling for any indication of this being good or bad, although I assume bad. I'm taking prednisone to suppress my own immune system and help allow implantation to occur by not rejecting the embryo. While I officially only have anti-thyroid antibodies (ATA) and my other immune issue markers (ANA, APA, NKA, etc.) are negative, after 12 cycles my RE and I decided I might as well try immunosuppression and it worked. So yes, this all just goes to the point that I know too much. It's tough to sit back, relax, and let it all happen when I have so much data to compare everything too on previous cycles.

But for the rest of this weekend at least, I'm going to try to chill and let those follies grow. By Monday, I should hopefully get the news that I'm ready for my trigger shot and looking for a retrieval on Wednesday. Come on follies, grow!

The Cost of Drugs

For my initial set of drugs, I ordered them from IVFMeds in Europe and it's ridiculous how much cheaper they are there than in the US. 1 vial ranges from $30-$40 and I was planning on using 5 vials a day. In the US, 1 vial is $90. While I still spent $2,335 on the initial order, I actually saved about $3,400 by ordering overseas.

Now that I'm on a higher dose (8 vials/day), I need to get refills and can't wait for the overseas delivery time so I have to order in the US. I ran out of Rx insurance coverage in 2007 when I hit my $10,000 lifetime limit, so everything is out of pocket. The US pharmacy I normally use was at $90/vial. My doc's office said they use a different one now and it is actually a bit cheaper. I had to pay a $10 membership fee to get the the reduced rates (whatever) but it was $68/vial of Bravelle and $54.90/vial of Menopur. It's still another $1,236.50 to pay for 14 more vials, but overall I saved another $1,400. I like to focus on the savings and not the money I'm actually paying. I won't calculate the savings I would have had getting it all from Europe.

Bottom line is that these drugs cost a whole lot of money and so far I'm only talking about a few of the injectables. Not even the pills, patches and creams. Dang US pharmaceutical industry overcharging as much as they can on all the drugs!

Reality Check

Ultrasound this morning showed that the follies have grown so that's good news. Left side has 2 around 10 mm and the right has 1 at 10 mm and then a few smaller ones on both. It's good that there are 3 around the same size, so if they grow at the same speed it's easier to know when to do the trigger shot vs. having them all at different sizes.

Bloodwork just came in and my E2 level has moved up to 226, which is better and gives a glimmer of hope. Each mature egg should have an E2 level of about 150 - 200. I'm on day 6 of stims and my BFP cycle at this point I was at 628 and had 5 mature eggs. It will be less eggs this time, which I somewhat expected. While there are a number of follicles, it seems likely that they won't all have eggs in them.

Here's the reality check - somehow over the last two years of being pg and having DS I had blissfully been lost in the world that I had worked so hard to achieve. Now I'm sucked back into the reality that a 2nd pg might not be possible. My main symptom of infertility is my AMH level which is beyond low, meaning Diminished Ovarian Reserve. I have a tiny amount of eggs left and the ones I do have aren't that good. My body has to work well beyond what an average person has to do just to produce one egg. Which means I also am a poor responder to stims, even the artificial Rx can't make my body produce eggs. Generally people doing IVF get 15-20 eggs at a retrieval, I've had 1, 4, and 5 respectively.

The outlook does not look good. DOR, FSH = 15, E2 not rising. The reality is I'm probably at the very end of whatever reproductive life I have left. The initial thought was possibly cancel this cycle and try again for a better one. But I don't think there will be a better one. This is it. I'm 2 years older, my eggs are crap, and my body once again does not respond. All I need is that one magical egg to push to the top and make it through the rigors of being sucked out of my body by a needle, dumped in a petri dish, have a sperm manually injected into it, and then grow in a culture for 3 days until it's put in a catheter and shot back up into me. Is that really asking too much?

I hit the doc again on Friday, come on follies, grow!

Uh-oh, Low Estrogen

I had another ultrasound and bloodwork done on Monday. Things were looking good from the ultrasound. 5 follicles on the right, which is about normal. Even 3 on the left, which is really good considering the left side normally doesn't produce anything. But even a few follicles doesn't mean they'll all end up being mature so we're looking at still around 3-5 possible eggs.

Then I got the phone call. My estrogen (E2) level is really low. For baseline at the beginning of the cycle it should be below 60. Mine was in the 20's which is good. For CD6 which was Monday, it should have been over 200, but it was only at 68. This is bad. It means my body is not responding to the meds. This is a new problem for me, I've never had to worry about my E2 levels before. Just goes to show that even having a protocol that worked one time, doesn't mean it will work again. My hormones are different, I'm 2 years older, and my body has changed.

They increased my dose. I'm now doing the maximum amount of drugs at 300 IU Bravelle and 300 IU Menopur. My bloodwork on Wednesday will be the indicator of if this is working or not. If my E2 doesn't increase to an appropriate level, we'll probably need to cancel this cycle and start doing more testing, try a different protocol, etc.

As a reference, each injection at the prior dose is about $300. At the increased dose it's around $500. So I shove $500 a day into my stomach (not counting all the other oral Rx I take). You would think that losing the money and cancelling the cycle would hurt, but I am so numb to the amount of money it takes to make a baby. We just paid $600 to have the infectious disease bloodwork done for both DH and me in the even that we ever have an embryo that survives to be frozen, which we won't but have to pay it anyway.

What really hurts is the thought of not being able to have another baby, or to spend a few more years trying while not being able to focus in the moment on everything DS is doing. DH and I had a pep talk last night, I meditated this morning, and I'm sending super estrogen thoughts to my ovaries right now. Come on follies, grow!

And so it begins...again

IVF #4 for TTC #2 has finally begun after months of preparation. Had my baseline ultrasound and bloodwork today and everything looked good. I started stims this evening. DH did his infectious disease bloodwork and I'll do mine at the next visit.

Here's the stats:

Antral follicles - 5 on the left, 4 on the right

FSH = 9 (lower than my previous 15 in 2008, but higher than the 6 that I had in July)

E2 and P4 are all within normal limits

A look at the meds needed to make a baby. If only getting drunk and doing it in the backseat of a car would really work, it would be much easier.

It took a little bit to steel my nerve again for the injections. It's been about 16 months since I did the last shot, which was Heparin as a blood thinner. It took a bit longer to mix up the 5 vials of powder, but it's all coming back to me now. To think I used to do this in bar bathrooms, cars, and friends houses all the time. Luckily the injections are at night and since I'm generally home to put my DS to bed, it should be a bit tamer this time around.

I did 225 IU of Bravelle and 150 IU of Menopur, plus 5 mg of Prednisone steriods twice today. I assume I'll be packing on the pounds again due to the steroids, but I know it's all worth it in the end. I'm using the power of my birthday wish to hope that this one works for us and we get pg with another LO on this cycle!

3rd Hystersoscopy - Check!

Just had another hysteroscopy on Thursday and the news was good - only minimal scar tissue grew back. The surgeon was able to remove all of it. I'm back on estrogen for a week to help keep the uterine walls from sticking together. The other piece of good news is that even if this first IVF fails, he doesn't think the tissue will grow back that quickly and I won't need to have a hysteroscopy before each and every cycle - whew!

I've got all my drugs in the house. I've got an appointment for my baseline bloodwork and ultrasound next Friday. I seriously never thought that I would be excited to see a needle again, but after 5 months of "preparing" to start trying for #2, the prospect of actually moving forward is very encouraging. If all goes well at my baseline, I'll be ready to stick a needle in my tummy next weekend!

Reason #54 Why I Want the First Try to Work

I have no illusions that our first IVF for TTC #2 will actually work. But I have yet another reason why I really want it to. My company just got bought out and some details of the changes were just released. Our health benefits will stay the same for 2011 as will the STD/LTD plan for maternity leave. But starting in 2012 we'll merge to the new company's benefits and rumor has it they are worse. Currently I'm one of the lucky ones that has fertility insurance, but that's likely to go away.

I really hope that IVF in November will work which would allow for my whole pregnancy and delivery, along with my maternity leave to all be covered under the current benefit program.

I still have to get through the next hurdle which is good results for the next hysteroscopy on 10/28, but after that I can only hope that the next IVF goes off without a hitch.

Waiting until November

Based on my last consult, we realized that since the lab closes for 2-3 weeks each year in December, we can only get in one IVF. Rushing to get it done before we go to Jamaica and either getting a BFN, having a low Beta, or stressing about it wasn't going to do any good. So I'll remain on BCP, have my next hysteroscopy on 10/28, go on vacation and plan to start stims as soon as we get back.

The last day for stims based on the lab closing is 11/29. We should have 8 days of wiggle room in there to make sure we get done. Since I'm always a day 3 transfer, I probably have even 2 more days of wiggle room that they allow for day 5 transfers. What this means is I might be on bedrest during Thanksgiving and we're hosting some of DH's family. Oh well.

Now I need to get moving on working through all the additional drugs I need to order. The Bravelle, Menopur and Antagon are in the house. But I need Lovenox, Prednisone, HCG, Estrogen, antibiotics, valium, and the list goes on and on. I need to pull out my old notes on which pharmacy's had the best rates and get that ready to have all my Rx's called in. Be prepared for some additional venting on how I hate Rx companies over the next few weeks.

While we are definitely not pleased with the waiting game, it has been out of our control based on all the hysteroscopies. Even without the planned vacation, at this point we would only be able to do one IVF this year (I always need a month off after treatment due to ovarian cysts). Mentally, this helps us to feel better about where we are, as we were both frustrated with the fact that we've been trying to get started since May, always planning around this vacation, and the timing has hit this vacation right on the head.

Another Diagnosis

Had a consult with my RE yesterday. He said I have Asherman's Syndrome. It's when a trauma to the uterus (my c-section) results in the formation of scar tissue. There are varying degrees of severity and that is what we still don't know. Will it keep growing back? Is it gone? Will it get worse?

Here's the revised plan. Stay on my current estrogen and progesterone therapy for the full 21 days to let my uterus heal from the last surgery. Go in for ultrasound on day 1, then start birth control (BCP) on day 5. Have another hysteroscopy so they can check to see if the scar tissue has grown back. If it's clear, I heal for a few days while on BCP, then go off, get a day 1 and start IVF. If only minor scar tissue removal needs to be done, I heal for a while on BCP then same thing and start IVF. If it's major regrowth of scar tissue, they remove it and we re-assess.

Any way you look at it, it's all a whole lot of delays. I was really planning on getting at least 2 IVFs in this year (possibly even 3) until all this happened. I've already hit my out of pocket maximum on insurance so I was hoping to get 2 IVFs for minimal money (although the Rx costs are still the biggest hit). Now, I'll be lucky if we get to do 1 this year. Based on all these hysteroscopies/healing/waiting by the time I'm ready to start it will hit my family all-inclusive trip to Jamaica. I already declared that there is no way in hell I will be in any type of a 2 week wait during that trip. I'm either not drinking because I'm happy and pregnant. Or drinking it up because I'm sad.

To put it quite simply, IF sucks.

4 lbs - Seriously?

On Thursday I was happily still just below my pre-pg weight. As of Friday post surgery, I had gained 4lbs and my clothes felt tight. I'm hoping some of it is the IV fluids still in my body, and not just the fact that I started high doses of estrogen again.

I'm expecting the usual weight gain from steriods and injections, but that's not until I'm actually starting my IVF cycle. This pre-cycle weight gain is annoying. Ah, welcome back to the world of fertility treatments...this blows.

I'm also still feeling extremely weak and get tired very easily. Sounds like time to lie on the couch and watch a movie.

Bye-bye Scar Tissue

I had another hysteroscopy yesterday, this time to cut out the scar tissue blocking the left side of my uterus. The doc said they had a plan to go after the scar tissue and cut out as much as they could, but they were not planning to be overly aggressive or heroic with removing all of it. I asked why. He said from the pictures, it didn't look promising to get it all and they didn't want to perforate my uterus. Good call. He said they would be doing ultrasound guidance to help determine where to cut and possibly it would be better than they expected.

They explained more about the balloon that they were going to put in to hold the sides of my uterus open while I heal. Apparently it would have a piece that hangs out of me and I would need to tape it to my leg or tuck it in my undies. Lovely. I also learned that the "few days to heal" is actually 21 days of estrogen therapy with progesterone added in the last 7 days. While I was hoping to start stims for IVF in a week, it's going to be another 3 week delay. I was quite disappointed at yet another setback, but realize that getting my uterus in the best possible shape is the most important thing.

And then they dropped the next bomb. I will most likely need to go back at the end of this 3 week period to have another hysteroscopy to get any additional scar tissue that grew back while I was healing. I had asked how quickly it grows back and the most crucial time is 2-3 weeks after it was removed. TTC#1 took 4 surgeries to get pg, and 2 surgeries for delivery. TTC#2 is starting off with 3 surgeries before I've even had my first retrieval.

Did all the pre-op paperwork, pee in a cup, vitals, and IV. I always say right away that I need lidocaine in my hand before they start digging for a vein for the IV, which always brings the anesthiologist right in. She started flicking my veins until they were tingling and said she could do it without lidocaine and wouldn't dig. I hesitantly said ok, and she got in right away. Score 1 for the anesthiologist. Off to the operating room. Got situated on the table, strapped down my arms, chatted with the scrub nurse and anesthiologist. Got some good oxygen and relaxy drugs. I never get enough time with the relaxy drugs before they put me to sleep, I mean at least let me enjoy the high for awhile, right?

Wake up in recovery. I immediately ask the nurse if I have a balloon in me. Nope. They tried putting the balloon in and apparently my body rejected it and it wouldn't stay in. So I'm just on the hormone therapy which is working on building a thick lining in my uterus. I also realized that I must have majorly chomped my lip because it is all puffy and hurts. My DH comes back to see me and then the doc comes in. It went better than expected and they got a good chunk of the scar tissue out. I think he said more, but I'll have to ask DH again, I'm still a bit fuzzy on the rest, but know I need to setup another consult with the RE to determine next steps based on the surgery results.

On the personal front, I'm not bouncing back from this one. I came home and slept for 2 1/2 hours, was exhausted from doing DSs evening routine, then went to bed at 9:30pm. Got up for work this morning and realized that I still have a ways to go for recovery. My blood pressue must be really low because I am extremely weak. It was an effort to carry DS this morning and while I've been working, I think I need a nap. I incorrectly think that just because there isn't an external scar that needs to heal and I'm not in pain (uncomfortable a bit, but no real pain) that I'm fine. I'm not. My body still needs time to rest. I need to remember that for the next surgery in a few weeks. Luckily the weekend will be here and I can chill for a few days.

Not the news I wanted to hear...more surgery

We aren't moving forward very quickly. I just had a consult with the RE today to review my hysteroscopy and MRI results. Apparently if you think of my uterine cavity as a triangle, 1/3 of it is blocked off. He assumes it's with scar tissue, which is bad. Scar tissue doesn't have any blood supply and it's blocking an entire wall of my uterus. This poses a number of problems.

1) I have bad eggs, I'm making the numbers up but it means only about 1 in 50 of my eggs is any good.
2) I don't stim well (I don't respond to the drugs). Typically, people doing IVF will have anywhere between 5 - 15 eggs retrieved which can then be fertilized into embryos. On my 3 previous IVFs, I had 1 egg, 3 eggs and 4 eggs that fertilized, although most were crappy eggs.
3) If there is no blood supply, there is nowhere for the embryo to implant. With my limited chances from #1 and #2 above, I don't want to decrease it by another 50% if the embryo decides to implant on the scar tissue side instead of the clean side.

All in all, this does not bode well. What to do? Apparently I need to have another HSG test (massive x-ray/ultrasound where they shoot dye up your hoo-ha) to see if there is any opening in my fallopian tube and to determine how massive the scar tissue is. Essentially, the RE is trying to figure out where/how he'll be able to cut the scar tissue out. Once that is decided...

I need to have another hysteroscopy, the same surgery I had three weeks ago. But this time, they'll be cutting the scar tissue out. My RE assured me that since scar tissue doesn't have any blood supply, I shouldn't have any issues with bleeding beyond a normal hysteroscopy. However, in order to prevent additional scar tissue from forming while my body recovers from surgery, they will insert a balloon into my uterus to keep the sides from touching each other. I'll keep it in for 3 days, then have it taken out at a normal office visit. It doesn't sound like any of this will be very pleasant.

Right after the surgery, I'll be put on massive doses of estrogen and progesterone for the next week or so. With the massive hormones and balloon shoved up me, don't be surprised if I complain of bloating. I don't quite recall the reason for all the estrogen and progesterone, but after that I should get another AF and be ready to start the IVF cycle.

On another venting side note about Rx issues, I had noted that my Bravelle finally shipped - yay! But that was a week ago and it has not arrived. It's coming via USPS Express International and requires a signature. I even paid the extra $89 for Speed Shipping which normally has it arrive in 3-4 days. I called about it last Friday, they said it was in the US. Tracking finally saw it in NY on Saturday. Sunday night it left Houston and was supposed to arrive today. I worked from home today in order to sign for it, but alas, it is still not here. I'm going to have to work from home again tomorrow to get the package, because going to the post office and waiting 30-45 minutes in line is probably worse, since they are only open during my work hours, or the time I have with my DS.

A regular theme throughout TTC#1 was...can I just catch a break? I'm starting to feel that way all over again. Why, oh why, doesn't *anything* just work smoothly?

MRI Results

I called for results. The nurse read the radiologist report and said that everything looks good and I'm fine. I asked, then how do you explain that the doctor doing my hysteroscopy couldn't see the end of my right fallopian tube and thought my uterus looks small? The nurse said she would talk to the RE.

The call back said that Doc G. reminded the nurse of the issues with my c-section and that the blood pooling in my uterus could cause scar tissue preventing implantation. Doc G. is going to look through all the radiology films himself rather than taking the radiologist report. This is good that he's taking it seriously and will be confirming everything before we start. The bad news is it could take well over a week. The waiting game continues.

On a positive note, I just had my TSH checked and it's holding steady at 1.76. And the UK got their delivery of Bravelle and my drugs have shipped. According to the tracking number they aren't in the US yet but I should have them in a few days.

Once we get the go ahead, there are still many more drugs I'll need to order (steroids, estrogen, progesterone, antibiotics, valium, blood thinners, etc..), but the heavy hitting expensive ones will all be in hand.

MRI - check!

In my quest for baby #2, I've now completed my diagnostic hysteroscopy and an MRI (with and without contrast). The last time I had an exam with contrast (dye) was a HSG (hysterosaligram or something like that) and I shoved my legs in stirrups and they shot it in. That's what I was expecting again today. But nope - yet another IV had to be started into my tiny, barely there veins. Luckily they did the IV in the crook of my arm rather than in my hand, since my hand is still bruised from last week's IV.

An MRI is LOUD! I had earplugs and headphones on and it still sounded like an alternating machine gun and fire alarm going off. The exam itself wasn't too bad. Although I'm not sure I could have mentally handled being in the machine any further. I was just able to roll my eyes back and see the ceiling which helped me to stave off any feelings of claustrophobia. The radiologist wouldn't tell me anything. Hopefully I'll get some type of results on Monday.

In the meantime, the UK is still short on Bravelle, but think they will have shipment on Monday to send out. The cost savings from ordering in the UK vs the US is still worth waiting a few extra days. I already have to wait for the MRI results so maybe the timing will work out.

Fingers crossed that the MRI results don't show scar tissue requiring the laporascopy (another surgery where they would scrape the inside of my uterus - what fun).

Hysteroscopy today

Well, I had my hysteroscopy today and it wasn't the result I was looking for. Sounds like the right fallopian tube is clear. The left fallopian tube is either blocked, or embedded in so much scar tissue that the doc couldn't see the end of it. It might also be the reason why the doc said my uterus looked smaller than he would expect, too much scar tissue. So now I need to have an MRI to help figure out what's going on. Good news of course is that since we know we're doing IVF, my fallopian tubes aren't really needed anyway. Although this also pretty much rules out any "surprise pregnancies". Bad news, too much scar tissue, nowhere for a baby to grow. More to come.

I am wiped out. Normally I do pretty well after surgery and anesthesia (I had 6 surgeries to have DS, so I know what I'm talking about). I always get the post-anesthesia chills and I go to the hospital with a sweater and a blanket to use in the car. Today I got home, finally ate food for the first time at 1pm, then proceeded to sleep for 3 hours and I still feel groggy. I wonder if it's my old age....

Updates from my previous post. My prolactin level looks great. It's supposed to be between 3-30 and mine is at 4. I ordered the most expensive drugs from the UK and my Ganirelix and Menopur have arrived. However there is a shortage of Bravelle and they are waiting to get another shipment. I'm going to have to play the time game to either hunt some down in the US, or keep taking birth control until it arrives. Considering I now have to have an MRI and see what those results are, the Bravelle might get here in time.

Any my favorite, I've already gained 2 lbs after being on birth control for 2 weeks. Lovely.

Familiar Routine

I realized I had some spotting the other day and nothing much else has happened. Hmm, wonder if that was yet again another "blink and you'll miss it" period. I called the doc this morning to say I think I'm on day 3 so I went in for testing. Most of the staff has changed, but it was comforting to go back to the same nurse that told me I was pregnant about 22 months ago.

The ususal chat with reception, bloodwork (with a better nurse than the normal one who unfortunately still works there but was on vacation this week) and then an ultrasound (u/s). My antral follicle count looks promising with about 10 on the right and 3 on the left - if only the left side of my body would kick it into gear. E2, P4, FSH and LH all look good. I'm still waiting on the prolactin level since they don't check that one in the office. But other than that, we're moving ahead. I picked up my BCP today and I'll start it tomorrow. I should be scheduling the hysteroscopy in the next week or two. Hopefully nothing shows up during that surgery requiring additional recovery time or medication.

We talked through the list of drugs they use for IVF. Many of the protocols have changed but the doc and I agreed to do exactly what we did last time. I got my Rx and have started looking at costs from the various IVF drug pharmacies. I think going to Europe is still cheaper, so I need to figure out dosages and put in an order so it can get shipped out. For just one drug for 12 days, I'm already at $1,080. I still have many more drugs to add to that list. I forget the staggering price of medication.

Here's hoping the prolactin level comes back low and my hysteroscopy doesn't turn up anything bad. Oh, and for scheduling surgery, timing would have it fall right on my DSs bday. Considering my horrible delivery and near death experience (botched c-section with 7 blood transfusions and 3 days in ICU), if I were superstitous I would probably avoid scheduling another surgery on the same day.

I'm Dreading the Return of IF Stress

The countdown is here. AF should be coming soon which means I'll need to call the RE, start bloodwork and BCP. Call pharmacys to check the going rate of all my drugs (although I'm pretty sure I'll order from Europe again), track every day of my cycle and have my hysteroscopy. No magical cure happened to my body after being pregnant. I'm not one of those people who gets a surprise BFP. I'm one of those people that goes through massive amounts of fertility drugs to get 2 eggs and have nothing to freeze.

I'm currently about 5lbs below my pre-prego weight. I'm betting I'll gain a few lbs while on BCP. Then when I start up steriods I'll balloon up another 5lbs, and that's not even including when I start the other hormones (stim-fat, as we like to call it).

Although I'm dreading it, mentally I'm ready to start again. I just want to get this over with and be done building our family. I'm trying to prepare myself that it's not going to happen in the first IVF and will probably take a few rounds just like last time, but I know I'll be absolutely devastated with a BFN.

And We're Off...Like a Herd of Turtles

Well, DS took it upon himself to wean at 9.5 months so we're actually ahead of the plan that was laid out before. Called the RE yesterday and I need to wait through 1 more cycle, then the next one I'll do BCP and get Day 3 labs done to check FSH, E2, P4 and Prolactin to determine if I'm getting close to ready. If so, we'll do the hysteroscopy. If my cycles are at all regular, that means the hysterscopy would be in mid-July and IVF starting mid-August.

Initially DH and I had said we would try naturally for a few months before jumping into IVF again, but with this plan we'll only really try for 2 months before doing IVF - and honestly we're both fine with that since we have no realistic hopes that natural would work anyway.

On the Rx front, I had vented before about not being able to get Folgard from my Rx company. Just an update that it did take 1 month, yes a whole month, but I finally have my Folgard and started taking it this week. Crazy, inept, infuriating, $*#Y$, #@($*, .....

My Rx Company Makes Me Cry

Yes, that's correct. I very strongly despise my Prescription Drug company, which we'll call OffMark. They constantly say they can't find the Rx that has been called in, or that they won't allow a drug, yet they offer no alternative. If they would just say, you can't have this one, but you could have that one which is the exact same thing as long as your doctor approves, my life would be easier.

Just the thought of calling OffMark and working with them on Rx makes me so angry I want to cry (and I often do). The timing of these medications is so critical that getting the runaround from OffMark completely raises my blood pressure and makes me very upset.

After my RE meeting, all I want is a simple Rx prenatal with mega folic acid. I took it in the past and OffMark provided it with no problem. I wonder how many phone calls it will take this time to get my vitamin - ugh.

We Have a Plan - well, maybe...

Saw the RE yesterday, we'll call him Doc G. I did not realize how long it would take to get started again. After I completely wean from nursing, he said it takes 2-3 months for my prolactin levels to get back to normal to even try. It will also take about 2 months to wean, so we're looking at about 5 months if I started weaning today.

Because of my near death experience during my C-section, the blood pooling in my uterus could have formed scar tissue which would cause problems. I'll need to have another hysteroscopy (surgery) done before we can even attempt to move forward with IVF. Not what I wanted to hear.

Doc G did confirm that we'll use the same protocol as last time, we won't vary anything even if we're not sure if it's needed, like the steroids for a month and blood thinners the whole time.

On a positive note, it did feel a little bit like a reunion seeing my old doc and 2 of the staff members that are still there. I guess it's been about 18 months since I was there last.

The plan...
- Wean for 2 months
- BCP for 1 month
- BCP for month 2 with hysteroscopy
- Check prolactin levels and day 3 bloodwork
- Possibly begin IVF at least 5 months from now

Made the first step

I just booked an appointment with my RE. I've been debating the timing of all of this and trying to find out when I should stop nursing to try to get my cycles back. But I guess the first step is talking to the RE and probably having all of my bloodwork done again. What fun.

I guess we're really going to get started on the roller coaster again...

Incompetent Medical Staff

I remember back to a time when I was naive and thought that doctors and nurses knew everything. I trusted what they said and unless it was something huge, never thought about getting a second opinion or researching something over and over again online. Sadly, I know better now and I've learned that the hard way.

As I've been thinking about when we're going to try again, I'm running through all the items that I have control of about my body, which are pretty few. Two years into my infertility journey I learned that I was hypothyroid and needed to be on thyroid medication. Having an underactive thyroid negatively impacts fertility, you may think, why wasn't this checked up front? The OB checked it but it fell "in range". The RE didn't check because he assumed the OB did. I went to an endocrinologist on my own to have a full panel run and found out that while I was "in range", for fertility it's best to have your TSH <2. Mine wasn't. I got all that fixed and we had our DS.

My Rx dosage changed during pregnancy as it normally does and I wan't to make sure everything was back on track. Enter my company's health clinic. I gave blood, they called with the results and said I was slightly elevated and they wanted me to take an extra pill on Saturdays. Since I don't implicitly trust doctors anymore and keep my own records of everything, I ask, what is slightly elevated? 4.79! Are you kidding me? I told them I needed it to be under 2 and they needed to increase my dose. But apparently they aren't authorized to do that. Whatever. My PCP increases my dose and I go back to my company's health clinic (because it's free) to have my blood tested 4 weeks later. They attempt to get blood out of both arms and can't get any. They tell me to come back another day after I've had a lot of water. Um, I just drank 34 oz of water, had a protein shake and oatmeal, I can't be any more prepared to give a blood sample.

I do have tiny veins and always require a butterfly needle. Some people can't get blood out of one arm, but I've never had it where they can't get it out of both. I am tired of incompetence and of being a pin cushion. So today I'm headed to an actual medical lab where I'll have to pay to have a blood sample taken in order to work with my PCP to get my dose adjusted to have a TSH <2. I'm so glad I thought about starting this process now before I waste any money doing an IVF just to find out my TSH is out of whack.

On that same note, I've been headed to the chiropractor a lot lately to make sure my lower back is inline. When I did acupuncture on and off for a year during my last 2 IUIs and my first 2 IVFs, he thought that I had "sticky blood" and needed more flow to my reproductive organs. Testing revealed that I do have a MTHFR genetic mutation causing blood clots and I took injectible blood thinners my entire pg. Again, this wasn't found until about 2 years into TTC. It was only found because I insisted on having what my RE called a miscarriage panel run on me. They didn't want to do it because I hadn't ever had a miscarriage. So let's think about that. Never having a miscarriage means I've never been pg. If I've never been pg, then nothing has ever implanted. Think I might have an implantation issue? Alas the MTHFR which means I don't absorb folic acid and don't get enough blood to my uterus to allow an embryo to implant and grow. During my pg I went to the chiropractor every 3 weeks to make sure my back was properly adjusted to allow as much blood as possible to flow where it needed to go.

I am tired of incompetent medical staff that don't go above and beyond to find the issue. But this time around I am much wiser, much more educated, and I really do not take no for an answer. When the health clinic said they couldn't increase my dose, my brain immediately started scanning my list of doctors to see which one I could talk into writing an Rx for me. My life, my body, my money, I need to get what I want.

Reflecting Back to Last Year

It was around this time last year that I had learned my first IVF had failed and I was reeling with loss, disappointment and sadness. I had thought that taking the leap from IUI to IVF would be a cure-all and would bring us success. I was not prepared for this type of failure. I can recall every feeling of the days between egg retrieval and embryo transfer vividly.

I shelled out thousands of dollars for all the drugs, followed the protocols but there were only two follicles that showed on ultrasound. Just two. Well, two is better than the one I would normally produce...at least that's what I told myself in order to hold it together. In recovery after the egg retrival, I asked how many eggs were retrieved. My DH looked at me and said, one. One. All of that for one measly egg that I could have produced on my own. I started crying right there in recovery with my DH and the nurse trying to comfort me. The RE who did the procedure (not my normal RE) saw me crying and I apologized to her and thanked her for getting the one. Most people doing IVF have anywhere between 6-20 eggs retrieved. I had one.

That one little egg had to make it through so much over the next few days. It had to fertilize. Which it did with ICSI (inject sperm directly into egg). It had to live for 3 days and divide and grow. It couldn't arrest, it couldn't fragment, it had to thrive in the culture it was growing in. I remember going through the motions at work in a trance, chained to my cell phone. A friend at work knew what was going on but everytime she stopped by my desk I burst into tears. I couldn't even talk to her. Was I going to have a transfer date set, or was the one embryo that all our hopes and dreams were pinned to going to die. I felt like a jury was deciding my fate, I couldn't eat or sleep, couldn't work, it was awful.

Transfer date was set, and it was an absolutely perfect looking 8 cell embryo. We fell in love instantly. This was our DNA, this was our child. We sang songs to it over the next 2 weeks, we talked to it, we had dreams of our child. Then we got the BFN. I was devastated. If after 4 clomids and 5 IUIs this didn't work, what would? Would anything?

It wasn't until after the 2nd IVF failed and I was heading towards depression that I finally created a little infertility album to commemorate and grieve each lost embryo, each lost possibility of our child. Here are the first two pages of that album.

Infertility Album

Through years of unsuccessfully trying to have a baby, we’ve realized just how precious each chance is at making a new life. Our journey has been long, filled with researching medical articles, doctor appointments, counting the calendar, medications, injections, hope, continual disappointment…and it’s not over yet.

The journey started with six months of trying naturally before four cycles of Clomid, 5 IUIs, and now onto IVF. IVF provides a unique look, and a physical snapshot, of each tiny 6-8 cell embryo that is placed back into my body. A special piece of our combined DNA that had the odds against it from the start, was given a chance at life, but unfortunately didn’t make it. Holding each picture of the beginning of our child, allows some form of attachment to begin even during the torturous two week wait to find out if the pregnancy test is positive. The picture that you think will be the amazing first page of your child’s baby album, but never is. A loss through IVF is felt so much more painfully and completely than a natural or IUI cycle.

This album provides a chance to grieve, let go, and say good-bye to each child that will never be. We love you.

IVF Cycle #1

Started on January 21, 2008
Egg Retrieval on February 3, 2008
Embryo Transfer on February 6, 2008
Negative Pregnancy test on February 22, 2008

Only one egg was retrieved and fertilized with ICSI. Our combined DNA grew into a perfect 8 cell embryo that was transferred back to me. We had so much hope that having finally moved onto IVF, we would get the positive test result we were looking for. Unfortunately, that did not happen. During the two week wait, this was the song we sang to you:

Come on little embryo. Doodee, doodee, doo-dee-do.
Go ahead implant yourself. Doodee, doodee, doo-dee-do.
Come on little embryo. Doodee, doodee, doo-dee-do.
We’ll take good care of you. Doodee, doodee, doo-dee-do.

Good-bye, we love you.

Drugs, Drugs and more Drugs

The first time you get the "big box" of drugs, you're excited that you're moving onto the next step and full of hope, but at the same time you're freaked out because you don't understand anything that's going to happen next and the needles and medications are completely overwhelming. I remember sitting down on the floor and going through the box to see if I even understood what everything was and to try to match it up with my cycle calendar.

Here's the contents of my first "big box":

I've swapped out many of the drugs in this picture for various other fun varieties. But they all end the same, a lovely needle jabbed into soft flesh to inject a liquid that burns and possibly bruises. At the beginning I had to do each injection at home and it would take me about 30 minutes. By the end, I was injecting in the car, at bars, friends houses, you name it.

After switching up the cocktail a few times, here's a rundown of what actually ended up working for me after ordering most of my drugs from Europe through http://www.ivfmeds.com/ at about 1/2 the cost:

* Bravelle 225 IU CD 3-12

* Menopur 150 IU CD 3-12

* Prednisone 5mg 2x day CD 3-beta

* Ganirelix CD 9-11

* Folgard (mega dose Folic Acid, B6, B12) due to MTHFR

* Baby aspirin from CD1 (stop just for ER)

* Lovenox 40mg starting at ET through entire pg (switching to Heparin 1ml 2xday at the end) due to MTHFR

* Progesterone 1cc ET - 12 weeks

* Estrace (oral estrogen) ET - 12 weeks

* Vivelle (estrogen patch) ET - 12 weeks

If only this were the magic potion that would work exactly the same next time around, but alas, we all know that life is just not that perfect....

Where to begin?

Hmm, how can you sum up 2.5 years of hell? While I did have success with my DS, that doesn't change the emotional, physical and financial toll that infertility has taken...and will take again.

I hadn't quite figured out how to do this first post, but I think it will just be a vent of the things I hate about IF. For the fertiles who might be reading this, IF stands for infertilty. I've added a little dictionary of terms on the side in case anyone gets lost in the lingo.

Things I hate about IF:
* Getting my blood drawn every other day by an incompentent med. tech.
* Not being able to plan vacations in advance because you never know if you'll have a doc appt that day, be on bedrest, or in surgery
* Progesterone injections that cause big ol' knots in the booty - oh, and that my DH looks at my butt like a meat map from a steak restaurant finding the best place for an injection
* Swollen ovaries that make you bend over and walk funny
* Lying to friends about why you can't drink, or worse telling them why and then having them ask if it worked this time
* People who think they know what they are talking about and say that since I had one LO, my IF must be cured. Ignorant.
* Baby showers
* Insurance companies - don't even get me started, just thinking about Caremark can honestly make me cry. How complicated is it to fill my order correctly? As if I don't have enough to stress about - oh wait, I'm supposed to reduce my stress to get pregnant, yeah right
* Stim fat. That's where all the hormones being injected cause your body to get fat, mainly around the belly. Because there's nothing worse than shelling out thousands of dollars for just a mere chance at getting pregnant, getting a negative test, and then not being able to button your jeans. To quote another friends blog: "Insult, mean injury"
* The cost of it all. A friend complained about a $200 hospital copay for her kid. Really? Each injection into my tummy is $300 and I do that 4 times a day. Don't talk to me about money.
* Cysts are my enemy. For some reason my body hates all the hormones and I get a huge ol' cyst causing me to sit out every other cycle.
* Working while dealing with IF. It's this secret you keep and it's hard to explain why you show up late every other day, take 3 days off but can't predict when those 3 days will be, or start crying at your desk.
* Phone calls from the REs office. Could I be any more anxious every time the cell phone rings knowing it's my life and happiness they hold in my hands?

There are so many more things I hate about IF, but I would never leave my computer if I tried to list them all out.