3

Expect the Unexpected

This roller coaster ride feels like a real world version of Big Brother. Every week we get the phone call from Jackie, the IVF nurse (ie Julie.. for my fellow BB junkies..), it seems like a new twist. Since we first decided to go the IVF route in January, the plan has been to do IVF in May.

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On Thursday, Jackie called and asked “do you want to move your cycle up to April? We can start you on birth control tonight.” And I froze. I was speechless. I called Taylor before giving the yes, and then we were on our way.

But the plan… the plan was May. If you know me personally, you know that I am a type A, planning, regimented kind of person who gets thrown off if the plan changes, or something big happens. Even if the change is good. So while I have the “Yay! We get to move up IVF and try for a baby sooner!”, at the same time I’m thinking “Holy crap this was NOT what I was planning”.

So I had a little breakdown. It was almost a year ago exactly that we found out that we had a 1 in 200,000 chance of conceiving naturally, and all of those feelings resurfaced after our plan was set in motion.

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But… I feel better now. Today is day four of birth control, and I’m not going to lie, I’m not feeling great on it. It’s been a while since I was on the birth control pill, and I think it’s throwing me off emotionally. I know that as we’re about to start this (only 11 days until stims) I’m bound to feel a little emotional, but I feel SO down. Antisocial. it’s like there’s a huge weight sitting on top of me that I can’t quite get off. But it’s fine. I’m sure this will be the least of my hormonal issues we start the cycle. My boss, who I’ve been open with about everything, joked that I should put a whiteboard on my office door and indicate my mood with a smiley face or a frowning face to warn people what they’re walking into. Thanks, boss! Though it’s not a bad idea since my usual face makes it hard to tell what kind of mood I’m in….

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But why birth control? It does seem counterintuitive, doesn’t it? First, it may help to understand how the egg development process works. Don’t get intimidated by this picture.

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The natural egg production cycle

During natural conception, several eggs begin to grow in both ovaries at the beginning of a cycle. Each egg grows inside of a structure called a “follicle”. Even in my ultrasounds now, I have many of these “resting follicles”, which is a good thing for us doing egg retrieval! A follicle basically looks like a small blister, about 3 to 4 mm in size, nestled on the surface of the ovary, containing follicular fluid and a tiny cell the size of a small grain of sand, which is the “oocyte”, or egg. The egg is to the follicle as a seed is to a fruit.

As a result of natural hormones (the body stimulates the ovary with a hormone called follicle stimulating hormone (FSH)), only one follicle is selected for ovulation and the rest are reabsorbed by the ovaries. The selected follicle grows to be about 20 mm in diameter, or about the size of a large grape, before rupturing and releasing the ovum (the fully developed oocyte). The ovum is swept into the fallopian tube and has roughly 24 hours to be fertilized.

There are three main reasons that most IVF protocols start with birth control.

  1. It gives the ovaries a little time to rest before they are stimulated. Let’s stick with the grape comparison. In a normal cycle, you have one grape on one ovary. For egg retrieval, I could have 10-15 “grapes” on each ovary.
  2. It allows the doctor to control the timing. There is only one embryologist and one RE at our clinic, so this allows them to control each cycle so that there are no conflicts in scheduling, and each woman can have her retrieval at precisely the right time.
  3. Birth control is shown to help reduce ovarian cysts. A cyst is a naturally occurring fluid filled sac on the ovary. With a freaking grape farm growing on each ovary, there is no leftover room for cysts.

 

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Ovarian cyst

Last Friday we both had our pre-IVF blood work and signed consent forms. Next Thursday, I will have a sonohysterogram. Sonohysterography is a special kind of ultrasound exam. Fluid is put into the uterus through the cervix using a thin plastic tube, and sound waves are then used to create images of the lining of the uterus. The fluid helps show more detail than when ultrasound is used alone. This will allow doc to check for any abnormalities since we are planning on doing a fresh transfer (unfrozen embryos, 5 days after retrieval).

But just for a second, can we talk about hope? Even now… I know there is a good chance that this will work. BUT… I don’t want to be too hopeful. There’s still a decent chance that it won’t work. Even still…. I can’t help thinking what if it does.

If it does…. and I stay on the projected schedule (I probably won’t ..things always change), our retrieval/conception day would be April 3. That means that the due date would be on Christmas. I cannot imagine a better Christmas gift. It’s impossible to not have those thoughts. But we’ve had these thoughts before, these hopeful thoughts, and we have been crushed each time.

But still … We have hope.

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Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485
IVF Consult: $100
IVF Workup #1: $350
IVF Workup #2: $205

TOTAL: $3,276

 

 

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1

Plans and Probabilities

Today was the day, our IVF consult. We have been looking forward to this for a month. Until last night. Last night the reality finally hit me of what we were going for. This morning when we arrived at the clinic my stomach dropped as if I had fallen off of a cliff.

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I know what you’re thinking. It was only the consult… but it just felt different. We knew the procedure. We had an idea of the cost. But going in and talking about it, seeing things on paper, and scheduling feels completely different.

Basically, the decision for us comes down to probabilities. With IUI, our probabilities after seeing our counts after the sperm wash were just too low for us to justify the cost, when that money could be going towards IVF where we have a great possibility. Dr. Dunaway thinks that with my age and my eggs, that our probability of success with transferring two embryos would be as high as 90%. So that’s what we will go with.

The soonest that our clinic can get us in is for the May cycle. That is much later than we were anticipating, but we are comfortable with Dr. Dunaway and trust his judgement. Now we start the process of evaluating the financial portion and what exactly we want to do. I’ll be doing another post soon explaining the IVF process.

So how am I feeling?

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Yep. That about sums it up. It will get better, it’s just an overwhelming amount of information. Are we ready? Yes and no. Personally I’m ready to have it over with. Honestly, thinking about all of the stresses that we have right now it’s probably best that we wait until May. Soon we will have our heads wrapped around all of this and we will be ready to move forward. Thank you all for your love and support. It’s impossible to go on this journey alone.

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Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485
IVF Consult: $100

TOTAL: $2,721

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IUI #1

First of all, I’m a week late, but I hope that you all had a very happy Thanksgiving! The last week and a half was certainly a whirlwind of excitement, nervousness, anticipation, and most fun of all.. hormones!

Clomid and Novarel

Oh man y’all, Clomid was a BLAST.

90Because everyone enjoys a BBT reference

I was an emotional wreck. Seriously. I think I cried a dozen times, for literally no reason, and I’m not a person who cries very often. The headache was intense. Tylenol would help, but it never quite went away. And as time went by, my abdomen became so uncomfortable. I did work out twice, and upon seeing the results of the Clomid I really should not have been working out because of how many follicles developed, and will be restricted should we do this again next month.

I took the Clomid from CD4-CD8, and I went to the Fertility Institute on CD12. The ultrasound tech was very surprised, because I had responded incredibly to the medication! I had four follicles greater than 19mm in diameter, and four others that were close. To give a comparison, typically a follicle is 18mm at ovulation – and that’s just one! Sure did explain my discomfort. The nurse gave me instructions on the injection and some potential scenarios depending on what Dr. Dunaway wanted to do.

captureOvarian follicles

Earlier in the week I ordered my hCG trigger shot, Novarel. It came from a mail in pharmacy recommended by the FI. Originally I was going to use an in-network pharmacy because it would be covered by insurance (GASP!) but then I found out that they would cover nothing until I met my $4,000 deductible (that will reset for the new year). Using insurance towards my deductible would have been $450, out of pocket with that pharmacy $350, and to go with out of pocket with the original pharmacy would be $125. No brainer there.

 baby-novarel-triggerThe package came with a syringe, a needle for mixing, a needle for administering, one liquid solution vial, and one powder vial

The office called me back in the afternoon and instructed me to do the injection at 8pm, and we would go in for IUI in the morning. Easy enough, right? Well… I had visitors in from work. And they wanted to see New Orleans. I gave myself the trigger shot in the dirty bathroom of a bar on Bourbon Street. Though I would bet that I’m not the first person to ever shoot up in that bathroom. The injection itself wasn’t too bad, but I think we have an instinct to NOT stab ourselves. It was almost painless, and I only ended up with a little discomfort at the injection site for the next two days.

During the ultrasound, in addition to measuring your follicle size, they measure the thickness of the uterine lining. My lining was 4.5mm, and they typically look for at least 7mm. Lining thinning is common with these medications, so I was put on an estrogen pill. Now this pill. It’s just a little blue pill. But can we make it easy and take it orally? No? Of course not. This is a vaginal pill. Did I mention that it’s blue? Well, we will call this the Smurf Effect. It probably would have been nice to have warning on that one. So word to the wise – if you are reading this and have to use these in the future – panty liners will be your friend.

IUI #1

CD13! Insemination day! Sounds romantic. The entire process was really fairly easy. We got there around 0800, and Taylor gave his specimen. They tell you to come back in about two hours, so we decided to go over to the Mall of Louisiana and walk around. Nothing was open, so we just walked around and enjoyed some coffee. The time went by surprisingly quickly, and before we knew it we were back at the office. While we were gone, the lab tech had “washed” the sperm. This is done using a centrifuge. It removes any debris, slow sperm, and certain proteins in the semen. Cervical fluid removes destroys these proteins, and if it were to be inserted into the uterus as is it would have caused me a large amount of cramping. Our final sperm count after washing was 25 million. With 1% morphology, that means we had about 250,000 sperm capable of penetrating the egg. This was the A team!

I undressed from the waist down with the classy blanket covering my legs and Dr. Dunaway came in and said “I’m feeling lucky today!” (let’s hope so, doc). The chair leaned me back – ALL the way. It felt very strange, as your legs are much more elevated than a typical exam. He inserted the speculum, and since my cervix decided to not play hide and seek, the catheter went into my uterus with no problem. I only had mild cramping. Doc even let Taylor do the plunger, so that if this works we can say that he was involved in the conception!   This was particularly “fun” for Taylor, since he has never been to a gynecologist appointment and seen what we women have to go through once a year for pap smears. They had me lay there for about 15 minutes, and then we were good to go.

download.jpgThe IUI procedure

What Next?

Well…. now we wait. This has got to be the longest two week wait (TWW) of my life.

Since the IUI, I’ve had pretty bad cramping for two days,especially when I would walk for longer than a few minutes. This could have been from the IUI, or the fact that I was ovulating and had so many eggs, or from the medication. And my damn headache has still not gone away.

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I will test on December 14th, which is 14 days post ovulation (or 14dpo as we say in the TTC.. trying to conceive.. world). I cannot take a test early because pregnancy tests look for hCG, known as the pregnancy hormone. Well, since I injected myself with hCG, if I test early I could risk getting a false positive and I’m not sure that I could emotionally handle that. I will take the estrogen pills until either I am ten weeks pregnant, or until I get a negative test. If I get a positive hpt (home pregnancy test) on the 14th, then I will go into the office that day for a blood test to confirm.

If this doesn’t work we have already decided that we will try one more round of IUI immediately following this cycle, and after that we will have to go to IVF.

Happy TWW everyone, and baby dust to all of my TTC friends!

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Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485

TOTAL: $2,621

2

Step Two: Bring in the Experts

Step One: Admit you have a problem

According to the World Health Organization, infertility is defined as “the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. The male partner can be evaluated for infertility or subfertility using a variety of clinical interventions, and also from a laboratory evaluation of semen.” (Semen manual, 5th Edition).

who-laboratory-manual-for-the-examination-of-human-semen-and-spermcervical-mucus-interaction-1-728Yes… there is a semen manual…

Step one: CHECK. On to Step Two, because we can drive ourselves crazy with Dr. Google (according to google we’re infertile or dying of cancer). We decided to see Dr. Heber Dunaway, who has an absolutely incredible resume in the field of reproductive medicine, and the clinic as a whole has positive success rates.

Today we had our first appointment at the Fertility Institute. It wasn’t exactly what we were expecting, but overall it was a positive experience. You walk into the clinic and sit in the waiting room with all of these other people. You can’t help but wonder, “so what’s your issue?”, “how many times have you been here?”, or my favorite thought “do you get to give a ‘sample’ today?”.

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When you go into any fertility appointment, the focus will be on the female, regardless of your diagnosis. Apparently women are more complicated, go figure? We had twelve pages of new patient paperwork, nine of which were solely dedicated to female questions. I get that – but what many people don’t realize is that male factors count for HALF of all infertility challenges.

But honestly, I’m not sure why you fill out the paperwork at all, because they ask you the exact same questions in person. For a consultation, you don’t go to the examination room, you go sit in the doctor’s actual office. You know, the kind you see people sitting in when they’re talking about serious medical decisions. Those chairs have got to be $400 a piece (so that explains why fertility treatments are so expensive).

Our first 15 to 20 minutes was with the nurse, who was wonderful. Very kind, and empathetic. Next came in doc. I’ve got to say, any nervousness that I had previously experienced, was gone when he came in and told us that he had no doubt we would be pregnant one way or another. He looked at Taylor’s numbers and he was happy with 2/3.

There are three main factors that are analyzed for male fertility: count, motility, and morphology. Count is the concentration of sperm in a sample, generally given in sperm/mL. Motility is given in a percentage, and is a percentage of the sperm that move forward normally. Morphology is the shape of the sperm, also given in the percentage of the sample that are normal.

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So for us count is fantastic, motility is fantastic, but definitely not shooting off fireworks to celebrate morphology. Taylor likes to describe it as there is a ton of people packed into a small bar, but when they leave they are too drunk to know where to go (I love this man’s sense of humor).

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Our most recent SA results

Doc said it was interesting, because if morphology is low then typically all three factors will be low. So this is a very positive sign for us. Our next step forward is to try at least two rounds of IUI (Intrauterine Insemination). Luckily for me I do not require any more testing, for now. Positives for IUI: MUCH less expensive than IVF, it will cost us about $1,300 per round instead of $20,000 per round, less invasive, less risky. So, why not?

I will call the office on CD1 (cycle day 1) to schedule a baseline transvaginal ultrasound and confirm I do not have any ovarian cysts cooking for CD3. I will then begin taking a low doses of Clomid, which stimulates an increase in the amount of hormones that support the growth and release of a mature egg, i.e. it will likely make me produce more than one egg. We will have periodic ultrasounds to check follicle growth (where the eggs mature) until about CD12-CD14, and when the eggs are cooked JUST RIGHT I’ll get a trigger shot of hCG (Human chorionic gonadotropin) to make me ovulate… yes, this is the shot in the butt. Can’t wait. We will come back the next day. While I am being poked and prodded and having doctors use a speculum to make my vagina into a real life archeological dig site, Taylor gets to give another sample (are we starting to see a trend?).  Doc will inject the swimmers directly into my uterus to give them the best chance possible.

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Sounds simple enough, right? It is reassuring having a plan to move forward. Which is further than we were when we woke up this morning.

One day at a time.

 

Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
TOTAL: $1,121