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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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