Nesting

Image by Kenneth Spencer via Flickr

Image by Kenneth Spencer via Flickr

I do it every cycle whether its IVF or FET… Every. Single. Cycle.

In the final days leading up to our procedures I start cleaning and organizing. And when I am done, I clean and organize some more.

Pregnant women nest in order to prepare the home for baby. I suppose it also helps relieve anxiety about the impending birth, the pain, the joy, and changes it will bring to the household. I really wouldn’t know thanks to several weeks of prescribed bed rest when I was pregnant with Spork. But I know a lot about nesting before IVF. I even know why I do it, however having that knowledge doesn’t save me from practicing my own personal brand of crazy.

I nest before IVF in order to gain control over my environment as things begin to feel more and more out of control. I clean in an attempt to occupy my mind, however I try to convince myself and others that I do it to prepare the world around me for 12 days of light activity and waiting.

This time, I took it to a whole new level. My bags are packed, every single linen and piece of clothing in the house is washed and put away, the bills are paid, the drugs I will use this week are neatly organized into a pill box, those drugs that I no longer use are tidied up and stored for a possible later time that I pray never comes. I even boxed up Spork’s 24 month duds and broke out her hand-me-down 2T sizes, washing them and tucking them away (sigh).

This is what I do and I do it so very well.

My nesting began three weeks ago when I began meal planning so I could eliminate stress during the cycle by ensuring that I always had gluten free leftovers to carry with me throughout the state of Michigan as I traveled to and fro for work. Never mind that I never cook anyway and I would have been just fine leaving dinner up to Bill like I always do.

Tonight my nesting ends with an impeccably clean attic. That’s right, attic. I won’t even see my attic over the next 2 weeks while I wait to find out it we are going to have another baby, but I would know it was a flippin’ mess and that would be enough to make me crazy. Not only does this cleaning save me from being even more nuts than I will be during the two week wait,  it helps make me sane in the short term.

Cleaning the attic stops me from obsessing over questions like:

What if there are no eggs in my follicles?

What if we overstimulated and the eggs are immature?

What if Spork permanently damaged Bill’s little swimmers when she jumped on his lap a few days ago?

What if the eggs don’t fertilize?

What if I spill the only HCG within 3 hours of us tonight when I trigger?

The list goes on and on.

If you have followed my blog for more than 5 minutes you have already correctly diagnosed me as a control freak. I could try to fight it but after 38 years I know its pointless. All I can do is recognize it and try to be balanced by not letting my desire to relieve stress create more stress than it relieves. The meal planning failed that test, plus my cooking was pretty bad, which is why I stopped it last week. However it was sort of fun to watch Bill pretend to like my food so I may bring it back for some comic relief during the two week wait.

In fact, I think I will. After all, I can’t control whether or not my embryos attach and grow into healthy babies, but I can make a terrible batch of gluten free swedish meatballs to enjoy eat while we are waiting to find out the results.

Besides, other than a few bland meals, what’s the downside? My attic as well as my soul are better for this.

 

Do any of you do this as well or am I alone in my infertility induced obsessive compulsive behavior?

 

Ultrasound Number 4- Day 11 of Stimulation

IMG_7353

The lonesome trip to Grand Rapids last night was uneventful and I managed to stay away from Dr. Google. The scan was this morning was excellent. I still have a total of 8 follicles on the right and 3 on the left. There are a few smaller ones that might come along too. My estradiol level was 2710.

Deciding when to trigger is an art. My ovaries are kind of like an oven right now. If we wait too long the eggs may get burned (over-mature). If we trigger too early the eggs may be undercooked (immature). Neither an immature or over cooked egg would result in an embryo.

Follicle size and estradiol level help the doctor determine the best time possible to start the 38 to 42 hour time clock that ticks down to ovulation. We will schedule retrieval exactly 35 hours after trigger in order to get at the eggs when they are nice and loose and about to come out on their own.

After all this time I still find it hard to believe we have such a very short window to collect the goods before they would eject on their own and disappear into my body unfertilized and wasted. Pretty wild, huh?

Ultimately, we decided to “let it ride” and go one more day to make sure we get as many mature eggs as possible. While my estrogen level is in a great range for trigger, it is low enough that it gives us a little room to see if we can get some of those smaller follicles into the game.

So we will trigger tomorrow tonight for a retrieval on Thursday. Friday we will inject HCG into my uterus to prepare it to receive our embryos.

Saturday will be the big day!

This makes three cycles in a row that we stimulated for 11 days. Ironically, last time with Home Clinic we had 11 mature eggs.  At Celebrity Miracle Clinic we had 11 embryos.

Eleven seems to be our number. Let’s hope its lucky this time. Maybe I should go play craps or roulette or something.

6700205595_d406d73d66_z

Image by Ben Harrison via Flickr

On the balance, I feel really good physically even though I already look pregnant from all the bloating. I felt like absolute crap far sooner in all my previous cycles. With the exception of the cytotec induced night from hell, this has been my smoothest cycle ever.  My body seems to be handling the stress much better than in the past which I pray means higher odds of a fresh transfer sticking for us.

Gosh let’s hope so.

Mama needs a new pair of (baby) shoes!

 

Liebster Award- Danke Reinventing Kristen

Liebster Award– a peer nominated blogging award that began in Germany to encourage writers with less than 200 followers to “keep on keeping on.” In German, Liebster means favorite or beloved.

My fellow blogger Kristen was recently nominated for this award for the work that she does in telling her infertility story in her blog Reinventing Kristen. Kristen is also taking a writing class to help her further explore her passion for the written word. As a result she strings together some truly impressive and heart felt work. You should really check out her blog.

So you can imagine my reaction when I learned that she nominated me for this award.

Thank you Kristen. If I were German I would tell you that I am completely and utterly geehrt.

So here is how it works:

1. Link back to the blogger who gave you the award.

2. Answer the questions designated by the blogger who nominated you.

3. List 11 random facts about yourself.

4. Nominate 3-5 other bloggers with less than 200 followers.

5. Make up a set of questions for the nominated bloggers to answer.

 

Kristen’s Questions for Me:

What is the one thing in your life that you are most proud of achieving?

Without a doubt, my daughter. It took a surgery, couples counseling, four transfers, two fresh IVFs, and 11 embryos to have her. There were many moments that I doubted and came close to giving up but I am so thankful to have her. I am also proud of the kind of parent I am. Nobody’s perfect, but I know I am doing my best for her and will create a bright, strong, and healthy young woman.

What is your favourite flavour of ice cream?

Two scoops of strawberry on a waffle cone please! It can’t just be any old strawberry. I prefer the natural strawberry with the great big chunks of beautiful berries. If the ice cream itself is pink, I want no part of it. Sadly, its still 40 degrees here in Northern Michigan and my ice cream days are yet to come. I am not much of a sweet eater, so I typically only eat ice cream in the peak of the summer heat. Its more for nostalgia than craving.

What is your favourite movie?

I have to pick one? We don’t watch TV in this house (except ESPN and The Walking Dead) but we are total movie buffs. I had a huge crush on Carey Grant when I was younger and love Arsenic and Old Lace. Its a rare comedy for Grant and a super silly and funny flick. It also has a bit of a Halloween theme so if you haven’t seen it, think about renting it this October. As long as you can deal with black and white movies, you won’t be disappointed. Among more modern movies, I loved Eternal Sunshine of the Spotless Mind. Its rare that a plot surprises me, and this one did. Its one of only a handful of movies I have seen more than once since I got older and began to value my precious time.

What/who has been your greatest source of strength in life?

My Dad. We lost him to cancer when I was only 19 but he had already made quite the impression by then. He was a great man, very kind and generous with his time and energy. He loved his kids and was crazy about my Mom. Dad was the perfect example for a young woman and I credit him for leading me to my second greatest source of strength, my husband. Though they never met, it was the image of my father as the picture of the perfect husband that led me to settle for nothing less than Bill Winslow. Bill has be strong for us when we needed it most, and even when I hardly deserved it. Like I was, Spork is lucky to have such a great man for a father to set the “mate” bar high for her.

If you had to pick your favourite motivational one-liner, what would it be?

“Whether you think you can or you can’t, you are right.”

If you had one tip for someone about to go through IVF, what would it be?

I have millions! The main one is not to forget to nurture your relationship and enjoy life while you are devoting most of your energy to making a baby. To be a whole parent, and maybe even to be successful in IVF, you have to remained balanced and also have compassion for yourself and your spouse. Infertility puts more strain on a marriage that most people would think. You still need to take vacations, have date night, and have sex for fun. Otherwise your life and maybe even your love could slip away while you are waiting for baby.

What was it about your partner, that first time that you met them, that attracted you?

His deep, sexy voice over the phone. We met in person, but when I really took notice it was when he called me for that first date. It still makes me giddy like a schoolgirl if I stop and think about it (like I just did).

Are you a dog person or a cat person?

Neither and both. I hated cats until I had the coolest cat in the world forced on me when I married Bill. I hated him, but like many cats he could sense that and set out on a mission to make me fall in love with him. lt worked. He actually slept sort of wrapped around the top of my head at night. Sometimes I would wake up and he would be laying beside me with his front leg stretched across my chest like he was holding me.I loved that cat. We lost him at 7 years old to the tainted cat food debacle that happened a few years back.

We have a dog named Don Diego. He is a dog I desperately wanted but really haven’t had much to do with since he was trained and stopped being an adorable puppy. I am one of those people who like the idea of animals but am terrible at caring for them. To be honest, I was a little afraid this would be true with Spork. Thankfully her cuteness has not worn off yet.

I despise Don Diego’s slobber and hair and regularly swear I will never have another dog. I am sure I will though.

Dammit.

Eleven Random Facts About Me

1). In high school I won the State Championship for Spanish Oral Proficiency in two different years. Today I can barely ask a Mexican waiter where the bathroom is. I would have no problem asking how to find the library, but strangely I have never needed directions to a library in a Spanish speaking country.

2) I ran the Columbus marathon in 2009.Bill ran the race with me and we crossed the finish line holding hands. I still consider myself a marathon runner even though it has been 5 years and I have only run one race. I will absolutely get back to running distance after I am done battling infertility.

3) On a whim, I got a tattoo of a band of daisies on my ankle when I was 19. I have hated it ever since. It is faded from three laser treatments and I will complete the removal when I am done making babies.

4) I want to go to law school when I retire. Or maybe when my kids are grown. Heck, at my age they may be one and the same.

5) I love creative writing and enjoy a great book, but have lost my interest in fiction. A few years ago I decided that since life is stranger than fiction it made more sense to read non-fiction. I read a great deal about behavioral economics and psychology. Why people and groups of people do what they do fascinates me. I also love statistics and the art of prediction.

6) I am about to begin reading the Bible again from cover to cover. The last few years I have found myself yearning to have a stronger relationship with God but have had a difficult time really “feeling it.” Over the next year I am going to re-read the Bible and see what comes of it.

7) Just about everything I want to do except having a baby has to wait until after we are done with infertility and it makes me nutso. Items on the post baby list include getting ripped at Crossfit, lasik eye surgery, laser hair removal, eating gluten, and of course more marathons.

8) I am the oldest, meanest, most emotional, and most self centered of 4 kids. But we are super tight and my siblings love me anyway. My youngest sister lives just down the road and we spend an unusual amount of time together.

9) I hate flying. This of course began after September 11th. I have even had to go so far as taking valium for flights. Another reason I am glad to be at a closer clinic for treatment now.

10) I used to smoke cigarettes and miss them. I choose not to smoke solely for health reasons. If I learned the world was going to end tomorrow, I would go out and by a carton right now and would drink expensive red wine and smoke my brains out until the end came. That is, if I didn’t have a daughter and husband who would be put off by it.

11) My first kiss is now a proud gay man. I just learned this a couple of years ago. It was a relief to know that I wasn’t really rejected after all. Phew…

Now for my nominees:

1) In Vertigo Fertizo-we both began blogging at about the same time. She is honest, creative, and downright hilarious at times. But she is still very serious and while I am sad that her first IVF didn’t work out, I have enjoyed following her journey.

2) Honestly Infertile– she is doing what I initially set out to do, poking fun at infertility. However I just couldn’t always remain light and funny as she describes it on her “about” page. Sometimes her humor can be a little gross, but delightfully so. There are many gross things about infertility.

3) A Few Pieces Missing from Normalcy- An Infertile Man’s Perspective. I can’t tell how many followers he has or if he has received the award, but he should if he hasn’t. His posts are super honest and sometimes a little dark (as any honest infertility post would be).

Questions for my nominees

1) Do you have to be dragged out on the dance floor or are you the one doing the dragging?

 

2) What is one product you have to splurge to buy the name brand and why?

 

3) Who is your secret celebrity crush and why?

 

4) What is the most obnoxious fertility related experience you have had? It could be something that happened or something moronic that someone has said to you.

 

5) What extracurricular activities did you participate in when you were in school?

 

6) What is your favorite season and why?

 

7) The secret to a great marriage is…

 

8) Why did you start your blog?

Ultrasound Number 3- Day 9 of Stimulation

 IMG_7367

Over many years and cycles I have developed a series of informal rules for IVF in order to protect me from me. These are simply things that I do or do not do in order to remain emotionally sound and balanced as I navigate this challenging process. Last night I not only broke one of my rules, I completely anhialated it. And it was one of the most sacred rules I attempt to follow.

I cruised into Grand Rapids early enough to find a delicious organic and gluten-free friendly restaurant and had an amazing meal. After my sweet potato and quinoa burger I was anxious to get back to the hotel and take advantage of some “Mommy time.” I had big plans to blog my little heart out.

But I didn’t write a word. Not one single word.

Why?

As soon as  I opened my Macbook I lost all self control and proceeded to spend the entire evening with my old friend Dr. Google. I was frantically seeking reassurance the cramping and bleeding from Thursday night wasn’t going to delay our transfer.

As is always the case, all I found was more reason to worry.  Since it was late Friday night and I was all alone, I had no doctor to calm my fears. There was no husband to tell me to shut the computer, calm down, and go to bed. I was up past midnight, which is kind of tough for an old lady with a 6:30 AM injection and a 7:30 AM ultrasound.

And to think when I checked into the hotel I was worried the busloads of teenage girls in town for a big volleyball tournament would keep me up late.

I bet I outlasted them all.

No matter what the situation, spending too much time with Dr. Google is never a good thing. I am the first underscore the importance of educating yourself and being your own advocate in all things fertility related. It is critical to research and question your clinic’s plans, but only within reason. There is a distinct difference in learning about a process and relentlessly searching the internet in an attempt to find answers.

What I found last night was unsettling. There was a dearth of information of using cytotec prior to embryo transfer, but the data available about cervical dilation prior to embryo transfer made it very clear that the procedure should occur a month to three months in advance of the procedure. Pregnancy outcomes when a cervix is dilated too close to transfer drop to almost nil. One study had a 0% pregnancy rate for cervical dilation at embryo retrieval. Another study had a 2.5% pregnancy rate for cervical dilation two days prior to transfer.

Our transfer should happen sometime next week, a measly 5 to 7 days from taking the cytotec.

Cue major freak out and sleepless night.

Needless to say I was anxious to see the doctor today. In fact I practically accosted him when he entered the exam room. I don’t think I even said hello prior to telling him about the bleeding and hysterically citing all the studies that stole my shut eye.

Turns out, the doctor knew all about the studies. In fact he knew a lot about them that I didn’t know, like the essential fact that the cervical dilation referenced in the studies is a stretching of the cervix that happens under anesthesia and creates trauma that needs to heal prior to a successful transfer.  The cytotec that we used has a very short half life and did not actually dilate my cervix, it only softened it.

Most importantly, the ultrasound showed a uterus with the correct triple pattern measuring at 10mm. This is absolutely perfect for this stage of IVF. We could even see on the ultrasound that the bleeding I experienced had come from the cervix and that we could expect a little more over the next few days as it clears up.

Everything was perfectly normal and exactly as it should be.

I was worrying over nothing, as I seem to do when my estrogen begins to approach 2000. I always get a little bit crazy at this stage of stimulation. While being so close to retrieval is exciting, its a lot to manage when your body is processing all the hormones as well as physical distortion and discomfort from enlarged ovaries full of follicles.

Speaking of follicles, would you believe they are the exact same size as two days ago? The meds are still working, its just that my clinic measures differently than the local hospital that monitors me closer to home. According to the doctor its not uncommon to have a 2mm difference with a different machine and user which is why they have me travel the three plus hours for monitoring as we get close to time for retrieval. My largest follicle is still 17.5mm which means we have a little more time than I thought.

I have another ultrasound at the clinic Monday morning to confirm, but it looks like we are back to the original plan of triggering Monday night, retrieving the eggs on Wednesday, and transferring on Friday.

So today was another inspiring distress eliminating appointment, especially since the left ovary seems to be producing a few more follicles large enough to give us eggs.  I am not sure how many good follicles we have though, because in all the excitement and desire to resolve my cervical dilation fears I completely forgot to ask about the number of follicles and my estradiol level.

But its okay.  I don’t need to know all the details. Really, I don’t. Last night was a reminder that sometimes its good to put a little faith in your doctor and take a break from questions and data.  Besides, after tonight I am only one lonely night in a hotel room away from getting a final pre-retrieval count Monday morning.

Between now and then, I am saying farewell to Dr. Google.

 

 

Ouch…

Just when things when things were cruising along and we were feeling super confident about this cycle… WHAM. A problem comes and hits us right between the eyes. This is not uncommon with IVF. For me at least it always seems I have one or two roadblocks along the way to transfer.

Nobody said it would be easy.

Last night through a new curveball at us, one that I am hoping doesn’t cancel our transfer. Our eggs should be fine, but I am concerned we may have to freeze all the embryos and wait until next month to bring them back home where they belong. I hope I am getting way ahead of myself and that my early morning scan tomorrow proves otherwise.

What happened?

For those of you keeping close tabs on our journey, you know that I often have difficult embryo transfers. The transfer is the most delicate part of the process, when our precious would-be babies are most at risk. Having a smooth transfer is a key indicator of success and it is the “art” behind the science of what the Reproductive Endocrinologist does. I have a tough cervix due to past surgeries and my uterus is also extremely retroverted. If the follicular ultrasound is like the Triple Lindy for sonographers, my transfer is like an Inward 4 1/2 somersault from the 10 meter platform for the RE (this is the most difficult olympic dive according to Google, for those of you who are unfamiliar).

Image by Victor Valore via Flickr

Image by Victor Valore via Flickr

To help navigate my disagreeable anatomy, I take cytotec prior to transfer to help soften the cervix and make everything a little more hospitable. This allows the catheter which will transport the embryos to gain easier access to the sweet spot. Its rarely done, but my situation is pretty rare.

We used cytotec for the first time at Celebrity Miracle Clinic and it did indeed help smooth the process. So when I returned to Home Clinic we added it to the plan. However my RE wanted to move the cytotec closer to transfer to obtain the max benefit from the softening. At Celebrity Miracle Clinic I took the cytotec almost a month prior to transfer, and not while taking stimulation medications. This meant that there was very little going on in my abdomen at the time and all I experienced was some persistent and moderate cramping.

Well guess what? When taken close to transfer with a lush lining and ovaries the size of oranges, it really flipping hurts and also causes bleeding. And why wouldn’t it? That is what the Cytotec is designed to do.The drug is used to induce labor and miscarriage. With additional pressure in the abdomen from oversized ovaries and a perfect lining it only makes sense that there would be some pain and even bleeding.

I have never experienced full on labor, Spork was a c-section baby taken at 37 weeks due to a compromised placenta, but I feel like I got a glimpse of it last night. It was so bad that we called to neighbors, my Inlaws, at 1 AM to see if they had Tylenol.  Acetaminophen is the only pain medication approved during IVF and we had picked a heck of a time to run out. When Bill’s parents came up empty, he had to leave the house to track some down. There was no way I was sleeping without some help with the intense pain.

I am still crampy today but much better, but there is still some bleeding. The question is, is the bleeding from my lining? Will my lining still be thick enough and retain the right patterns for transfer? We have to wait and see for the ultrasound tomorrow.

I am so hopeful the little bit of bleeding is an irritated cervix and the lining is still intact.

Fingers crossed that we are still a go for transfer.

I simply cannot wait until tomorrow.

Ultrasound 2- Day 7 of Stimulation

IMG_7264

Today’s scan was good overall. We still have 16 follicles. The same number are measuring in the range we want but the left/right ovary mix changed.

With today’s scan I would have expected the results to be about the same, or maybe even a greater number of follicles. While the numbers overall stayed the same, 7 on the left and 9 on the right, only two were measuring where they should be on the left.  However all 9 are now looking good on the right.

So we remain at 11.

Image by Curtis Perry vis Flickr

Image by Curtis Perry vis Flickr

My left ovary has often been a source of trouble, and my right has historically produced more. However I have never seen the left respond this poorly.

It makes me wonder, did my unhealthy ovary cause the cyst we aspirated or did the aspiration of the cyst cause the unhealthy ovary?

Nearly all the follicles on the right ovary were measuring around 17mm.  My estradiol level was 913. Ovulation is typically triggered when four or more follicles are larger than 18mm and estradiol is over 2000. Follicles typically grow about 1-2mm per day during this stage of stimulation. Choosing the exact right time is paramount. Waiting too late or going too early could create problems with egg quality which decreases fertilization rates and embryo quality.

What does all this gobbled gook mean? It means we are closer than I would have thought.

It means we could be pregnant by Wednesday.  

Wow. It seems like things are moving lightening fast since we had our failed cycle with Celebrity Miracle Clinic.

Tomorrow night I will make the 3 hour drive down to the clinic for a 7:30 AM ultrasound with the doctor. I should know by midday Saturday when we will trigger.

Bill is staying home with Spork and meeting with clients so I will be flying solo on this quick overnight trip to the clinic. Spending the night alone in a roadside hotel isn’t exactly the way I had planned to spend my Friday night, but I can’t complain. Its worth the trip down to be seen by the doctor so we can all feel good about when to make the decision to trigger. I could choose to continue to monitor locally, but the doctor prefers to see what is going on for himself at this stage.

That’s great and I am all for it, but do you think he will wear green underwear for me?

You may recall that my local sonographer is also a great friend and we threw a baby shower her a few weeks ago. Well, she had her baby on Tuesday and would you believe that her backup person broke out the fertility green lingerie just for little ole me? The ladies decided to switch from fertility orange to fertility green to see if it would bring a change of luck.

I too decided to change things up a bit and switched to orange toes this week.  I actually planned to do away with the superstitions altogether since they haven’t been working for me. However when I arrived at the salon I discovered five new shades of orange. One of the fiery selections was called “My Paprika is Hotter than Yours.”

Paprika

How can you NOT wear that nail polish?

Here’s to hoping it works…

IVF 101- The Players

This blog exists mostly as a way for me to fuel my never-ending obsession with getting pregnant. But its not the only reason. I blog to help other couples dealing with infertility. I blog to educate those who are not going through this journey to give them a little glimpse into this world so they can help those imprisoned in it .

For most of you, a post describing the basics stages of IVF will be all too familiar and remedial. If that is true for you, stop for a moment and think about it. Do you remember that almost-impossible-to-recall time when you didn’t know everything about IVF? When you had to ask what IVF stood for? This article is for those who still retain that blissful ignorance and for those that love and want to understand them.

So for those who don’t know, IVF stands for In Vitro Fertlization, which is Latin for fertilization that takes place in vitro or outside of the body. You would think that since the the first test tube baby was born fairly recently in 1978, we could just drop the fancy Latin and call it HMC for “Hail Mary Conception ” or  LDE “Last Ditch Effort.” After all, it is the final option couples explore when trying to conceive, usually after trying everything else. But like everything with IVF, its too intricate for a simple and descriptive name.  IVF is complicated on every measurable level beginning with the number of people involved in the process.

Your Baby Dream Team- The Players

Reproductive Endocrinologist– Your main dude or dudette. He creates your treatment plan, makes adjustments to your medication, and will perform your retrieval and transfer. In some smaller clinics you interact with your RE frequently and he is actively involved in regular discussions with you. In larger clinics you never see your RE and even need to schedule time with him to ask questions. Some clinics actually have the audacity to charge for consultation time with the RE if it is outside of the regular communication plan. I have been billed only twice for consultations at two different clinics. In both cases I called and had it waived. Always remember you are the patient, which means you are paying the bills and have a right to your information and feedback from your doctor. Most RE’s are terrific, but if that is not what you experience use your voice. It also helps if you try to pack as much into your planned communication with your doctor and come prepared. Many clinics have multiple REs so the person you consult with may not be the one who performs your procedures depending on timing.

Embryologist– Your embryo’s main dude or dudette. She manages the lab and takes care of the eggs once your RE retrieves them. She and her team are the lucky ones who get to create the life by joining your eggs and sperm, and then monitor them as they grow into embryos. She also manages the storage process in the event you need to freeze your would-be-babies for later.  In most clinics you rarely interact directly with the Embryologist. Sometimes she will call you with fertilization or embryo quality results, but in many offices the nurses or RE handle that. She will be present at transfer to assist the RE in getting your embryos from point A to point B. Like REs, many clinics have multiple embryologists.

Master and Creator

Nurses– Your translators and best friends. They speak fluent Reproductive Endocrinoligist and will be the people you interact with most often. They order your meds, take your frantic calls, tell you when to take what and will even show you how. Because they regularly deal with desperate women who are hopped up on hormones, they may very well be the most patient and wonderful people on the planet. Some clinics assign you one nurse who helps you manage your plan, while some take more of a triage approach where you work with whoever is available. There are advantages and disadvantages to both. If you are using donor eggs, there will usually be special nurses to work with you and your donor to coordinate communication and timing.

Sonographers (ultrasound techs)- Your examiners. These people will regularly violate you with a large wand to determine if your lining is thick enough and has the right number of layers (three!) for transfer. They also monitor the size of your ovaries and the number and size of your egg containing follicles through the course of your IVF cycle. Once you start taking medications to stimulate the ovaries you will see the sonographer every two to three days. When you are close to retrieval your appointments may be daily. They will also monitor your pregnancy until you graduate to a plain old obstetrician at about 10 to 12 weeks. In some clinics, nurses are trained techs and also perform this function. Its worth noting that for a sonographer, a trans-vaginal follicular ultrasound is the most complicated test that they do. It’s like Rodney Dangerfield’s Triple Lindy for sonographers. Your tech will be trying to count and concentrate which usually means their eyes are squinted and their mouths are open. This is normal and does not mean anything is wrong. Let them do their thing and then ask them questions when they are done. Its hard work and I have only met a few that can carry on a conversation while performing a follicular scan.

Third Parties– Your saviors. In the event that you need to use someone else’s “stuff” to get knocked up you may find yourself working with a surrogate, gestational carrier, egg donor, or sperm donor. Even people that use gestational carriers and surrogates get confused on the difference. A surrogate is a saint of a woman who will give you both her eggs and her body.  A gestational carrier is a saint of a woman who will give you only her body, you have to provide the eggs.

Pharmacy– Your dealer. Fertility drugs are not your average, every day, run-of-the-mill medications. You cannot find most of what you will need at your local Rite Aid or Walgreens. Instead you will need to use a specialty pharmacy. There are several national chains and larger cities will also have local options. Without insurance, the medications can run up to as much as $6000 per cycle for women who need a lot of juice to get their reproductive system to react. Prices vary a great deal and its worth the time and annoyance to call around and get quotes on the more expensive medications. For instance, I found that one pharmacy offered the HCG trigger shot for $88 while another charged $250. Shop around and ask about rebate programs if you self-pay.

Phlebotomist– Your own personal vampire. If you are undergoing IVF you are probably no stranger to the phlebotomist but you are about to potentially add her to your Christmas list given how much time you will spend with her. In some clinics, nurses also draw labs. Some clinics have you visit a third party lab for blood draws. Wherever you go, you will likely have blood work done every time you have an ultrasound or diagnostic appointment. Just accept the fact that you will look like a heroin addict by the time you get knocked up. And take it from me, don’t volunteer to allow someone in training use your veins for practice. They can learn on happy pregnant people who don’t have to do this every other day.  Trust me on this one, you are not being mean. Just say no.

Image by Thirteen of Clubs vis Flickr

Image by Thirteen of Clubs via Flickr

Counselor– Your lifeline. Most clinics have someone on staff available to you and your partner for free. Many clinics even host support groups for patients. I strongly encourage you to take advantage of this if it is available to you. Even for the strongest of us, IVF is emotional torture and the process is especially hard on relationships. These people have tools that can help you cope that may or may not increase your odds of success, but even if they don’t directly help you conceive, I guarantee they will increase the odds of your relationship surviving IVF. Don’t wait until you feel like you need it. Start dealing with your volatile emotions now.

Billing– Your necessary evil. These people will work with your insurance if you have coverage to make sure as much is covered as possible. They are also Gestapo like in their ability to put fear into you if you are not up to date on your payments prior to your procedures. Nothing can throw a wrench into your baby making plans like having a treatment threatened to be cancelled until you pony up some cash. Stay up to date on your payments, but more importantly spend time with them in the beginning to ensure you understand all your options and the full costs. Many clinics offer special packages for those who qualify and one of my biggest regrets is not exploring options when I was young enough to take advantage of them.

That is your dream team.  Hopefully it helps you understand why your clinic might make you feel a little bit like a football that is being thrown back and forth. Sometimes it seems like there is very little forward motion, but don’t let that deceive you. All of these people are on your side and are working hard to take some yards against infertility and arrive at your joint goal of having a healthy baby. IVF is complicated. Because of this you need a number of people who specialize in small parts of it to help you along the way. It may feel clunky and disconnected at times as a result, but its part of the process.

Image by Mark McGee via Flickr

Image by Mark McGee via Flickr

Ultimately though, you are the most important member of your dream team. Its important for you to understand the process, learn about IVF, and question your team when appropriate. While all these people are working for you, nobody cares about your success the way that you do.  And mistakes do happen. I have run out of medications on the weekend, not knowing the clinic expected me to know I needed more meds when my dosages were increased. I have experienced nurses failing to order meds and even certain procedures. I even had a pharmacy send a refrigerated medication using regular ground transportation and it was ruined by the time it arrived. Stuff happens and you have to be vigilant to avoid letting it throw off your cycle.

You are your own best advocate in a complicated process, which we discuss in more detail in IVF 102- The Process.