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.

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.

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.

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.

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.

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

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.