2

What Goes Up….

I know that many of you are awaiting to hear the results of our first round of fertility treatments, expecting to hear that positive news. Believe me, Taylor and I were even more excited. But at the same time we were anxious and terrified. The excitement that our potential dream of expanding our family would come true has been there before.

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Well, the reality of infertility hit us hard this week when we got that negative. It’s hard to describe how it feels –
Failure
Empty
A heaviness that sits between your heart and your throat
Resentment at the hope that you allowed yourself to have

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Sometimes a picture is worth 1000 words

But. This is reality. Just because you are starting fertility treatments doesn’t mean that there is going to be magic, and it’s certainly not easy. We thought trying for 16 cycles on our own was hard – and yes, it is. But this. This is when the hard part starts.

We are incredibly thankful for all of our family, friends, and new friends on this journey with us, and all of your support. I am personally thankful for my husband. Who is the strongest and most compassionate, supportive person that I know. The person who knows what to do to help me when it simply hurts.

image1.JPGBarley doesn’t cuddle often, but he seems to know when I need it

So what next? Well, we wanted to roll into another month of IUI. However, because of holiday office closures we will likely not be allowed to do another round this cycle. I don’t know if I can emotionally handle doing another round of IUI, especially after waiting a month of doing nothing, when I know the chances are so low. This is all a numbers game, and the numbers with IUI are against us. We may end up just taking the month off and then going straight into IVF, but that’s to be determined, and we will have to discuss our concerns with Dr. Dunaway.

Right now this is hard and feels impossible. But it will be okay, and we will bounce back. We have been doing this for so many cycles that although it doesn’t get easier, we know the stages of grief well by now.

I do not wish this one anyone. But one in seven couples WILL faces infertility. To my friends who are going through this journey as well, and those who are going through it silently, you are braver than you think and stronger than you believe. And to those friends who have not had to fight this battle – please be mindful of what you say to others and the questions you ask regarding reproduction and fertility. You never know what they could be going through and what scars they hide in their hearts. They will tell you, good news or bad, when they are ready.

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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.

iui-picture

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