Our First Ultrasound- Day 4 of Stimulation

Here are the results of our first ultrasound for IVF cycle number 5.

This is how many follicles are visible on my ovaries.

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This is how many follicles are measuring at a size that should lead to a mature egg by the time we aspirate the follicles at retrieval.

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This is how many healthy eggs we need to make our baby.

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But will it be pink? Or will it be blue? Or BOTH???

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This is how I feel after only three full days of stimulation meds.

 

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This is how I will feel when we find that one Golden Egg.

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Image by JD Hanckock via Flickr

Theme Song for Day One of Stimulation Meds

 

Lady Gaga R Kelly

Do What You Want- Lady Gaga and R Kelly

This is my fifth IVF cycle and I am on higher dosages of more medications than ever before.  At the peak of my cycle I will be taking 4 shots a day plus a few oral medications.  Today I injected three different medications. But I am not complaining, I was super geeked to start today. I feel awesome, full of energy, and physically well. As usual, I have a really good feeling about this time.

This has to be it.

Its impressive how resilient the human mind can be, how we can hope without abandon no matter what we have been through. Its a miracle really.

I was listening to a TED talk this week and the speaker discussed that the average human being has an emotional status quo that he returns to after highs and lows. Even after tragedy, people generally find their emotional “normal” after three months.  Three months!

Too bad for those of us trying to conceive that the average menstrual cycle is only one month. Alas, we never get to fully heal before the next month rolls around and we are back in the game.

While we may never get back to normal, at least we can hope that before that three months is up we will be pregnant and our pain will become a distant memory. And it is that hope that has me full of joy and dreaming about what could be tonight.

Three shots? No problem.

You can do what you want with my body… as long as there is a chance I might have a baby in 9 months.

(Within reason, there is very little that I would allow nasty R. Kelly to do with my body).

 

 

Aspirations- How Our Cyst Was Removed and Our IVF Cycle Saved

I have been plagued with ovarian cysts since my earliest menstrual cycles. In order to stop their growth I was put on birth control pills at an age when I wasn’t even considering sexual activity (that would quickly change, but at the time I was pretty darn innocent).  In my teens and early twenties the cysts caused a pain so intense my legs would go numb.

To say my lifestyle was unhealthy at that age would be an understatement. It seems that when you drink a two liter of Mountain Dew a day it wreaks havoc on your body.  Its hard to believe that was ever me. Yes, gluten-free and organic me once ate fast food daily and downed caffeinated sugar water like it was going out of style.

Image by Louish Pixel via Flickr

Image by Louish Pixel via Flickr

My how we change as we age and face our own mortality.

As an adult my diet and lifestyle improved immensely and the cysts all but went away.

Despite my clean diet, the cysts have been back full force since starting IVF again last year. This is not at all unusual. Many women have cysts after cycling, so it makes sense that someone like me would do battle against the pesky little boogers after constantly flooding my body with all kinds of cyst creating hormones.

Cysts are the worst when it comes to preparing for an IVF cycle. One day you are cruising along, ordering meds, getting excited about an upcoming cycle and then you go to an ultrasound appointment and WHAMMO, the tech finds a cyst and everything comes to a screeching halt.

Image by thecrazyfilmgirl via Flickr

Image by thecrazyfilmgirl via Flickr

 

Many doctors sideline a patient when a cyst is discovered. Most cysts are functional cysts, fluid filled follicles that never released and egg and returned to resting state. They generally disappear on their own within 6 to 8 weeks. Since it is the safest route of elimination, doctors typically just wait it out.

There are several other types of cysts that are less likely to go away on their own. Many of those cysts should be removed surgically and biopsied to check for cancer.

Occasionally if a functional cyst is small and is not active, which can be determined by measuring estrogen production, a doctor will proceed with the IVF cycle and work around the cyst.

The cyst we discovered last week was not small, and since it had been hanging around since February despite the fact I was suppressed for much of the time, we decided to go in and eliminate the trouble maker. Suppression will normally allow for a cyst to go away and also keeps others from forming, so it was concerning that the cyst was still there and had grown slightly over the course of 8 weeks. The cyst needed to go.

There are two ways to remove a cyst. One is laparoscopic surgery which involves general anesthesia and at least a one cycle break for recovery time. The more common and less invasive approach, aspiration of the cyst, is the one we chose last week.

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I find it a little comical that our aspirations to have a baby sooner rather than later were saved by a literal aspiration of a cyst.

When the doctor surprised us and told us we would just go in and get rid of the cyst I was elated, but before I could even speak my mind kicked into gear and realized that this was going to be a lot like retrieval, but without anesthesia.

All I can say is OUCH. 

The doctor inserted a long ultrasound probe that had a small tube like structure on it that contained a needle (Ouch). He injected the area with lidocaine (Ouch) and then pierced the vaginal wall (Ouch) in order to reach the ovary. Once there he inserted a needle (Ouch) and drew all the fluid out of the cyst while we watched in awe. Why awe?

It was such an amazing feeling to annihilate my fertility nemesis. Every time I go in for a baseline ultrasound I am overcome with fear that a large dark spot, the tell tale phantom shadow of a cyst,  will be there to rain on my fertility treatment parade. Those giant dark spots have haunted me for years as I waited and wondered if one would be there when the critical time to start arrives.

After living in fear of dreaded cysts, watching one shrink out of existence right before my eyes made me feel a little like David must have felt when he nailed Goliath between the eyes.

The procedure did have some after effects. I had light bleeding for four days in addition to moderate cramping for the first two days. I was assured by my clinic this was all normal. Also, Bill had an unusually good vantage point and is still regrouping despite his attempts at distracting himself during the procedure.

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The good news is this should have no effect on the outcome of our cycle.

Studies on cysts and how their removal impacts IVF cycles are few and far between, but every study I could find indicates there are no known issues due to the removal of cysts immediately prior to beginning an IVF cycle. Live birth rates for cycles following aspirations of cysts are the same as the national average.

I have cycled with cysts in the past and know it affected the number of eggs produced, so I am at peace with our decision to take the aggressive approach, even if it did hurt a bit.

 

 

 

Our Baby In A Box Has Arrived!

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Our Baby was safely delivered on Friday April 11th at 2:30 PM. The new arrival weighs 8 lbs and 6 ounces, is 24 inches long, 18 inches deep, and 18 inches wide. Baby and Fed Ex delivery truck driver are both doing well.  The adoptive parents, however, are recovering from minor strokes after reviewing the bill.

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3 vials human growth hormone                 $916

3 tabs valium                                                 $1

4 tabs methylprednisolone                            $7

1 tab promethazine                                       $1

2 vials progesterone in oil                             $55

4 tabs azithromycin                                      $4

7 kits Cetrotide                                             $662

6 450iu kits of Gonal-f (fsh)                          $2664

1 vial of lupron                                              $99

1 vial HCG                                                    $86

10 vials Menopur (fsh)                                 $730

 

Total                                                            $5224 out of pocket

 

Chance at giving Spork a sibling                 PRICELESS

Who Says You Can’t Come Home Again?

Image:David Simmer II via Flickr

Image:David Simmer II via Flickr

We had our Homecoming at New/Old clinic yesterday. Bill and I are both thrilled with the plan we have developed and also the stark difference in bedside manner and genuine caring we received from every individual we interacted with, especially our doctor.

I must confess that it was only six short months ago that I was angry with this clinic. I never stopped loving our doctor or nurses, but our last cycle was tough. We had a difficult transfer, lost 4 embryos total in the freeze/thaw process, and ultimately had a miscarriage. It was time for us to try something different and we did, even though I had a nagging feeling that I shouldn’t leave a team of nurses and doctors who understood me, my body and my history so well.

Over the years I have gone back and forth on the importance of beside manner. Does it matter? Do I care whether my doctor is nice to me, or for that matter even takes a moment to speak to me, as long as he gets the job done?

As it turns out, yes. It does matter to me. I want a doctor who listens to me, who has obvious passion for our joint objective, and who appreciates the power he has to eliminate stress in one aspect of this intense process.

I have that in New/Old clinic and it was clear yesterday.

First, rather than spending only 4 minutes with my doctor, we spent more like 40. Surprisingly, he put his ego completely aside and reviewed with me every aspect of my cycle with Celebrity Miracle Clinic. We discussed what we liked and didn’t like and adjusted our plan accordingly. There were a few things he said “no” to putting in the plan, but when he did he justified it with studies and science.

One example of this is intramuscular injectable progesterone. He agreed to let me do less painful suppositories, but only after I am pregnant. Studies show an ever so slight but still meaningful increase in pregnancy rates with injectable progesterone because suppositories can cause cramping and the implantation threatening uterine contractions that come a long with it.

We were most pleased with how much we accomplished yesterday and how flexible the clinic was in making it happen. Our appointment was only for a consultation, but when I told our doctor that I had a cyst since February that hadn’t budged despite being suppressed the whole time, he immediately squeezed us in for an ultrasound. When we saw that the little booger was too big to ignore, we weighed the options and decided to drain it in a painful but quick procedure. They made this happen even though is wasn’t “in the schedule” and it was late enough in the day we would likely be keeping the entire office there well past closing time.

To prepare me I was given a high powered antibiotic and 800 mg of ibuprofen. Because both could upset my stomach I was given crackers and juice. When I told the nurse I was gluten-free, she was clearly ready to check with the entire staff to see if there was anything they had in their personal stashes that I could eat. I told her that I thought it was a good excuse to break the diet and that it had been months since I had Cheez-its so not to worry.

When she left the room my husband turned to me and said “She is going to go ask everyone here if they have anything you can eat. The other clinic would have sent us to their kiosk down the corridor from their big beautiful waterfall and wouldn’t have given a damn.”

While I am not sure that is true, the point is we feel like this clinic really cares about us. Our doctor cracks us up because after decades in the business he still is obviously super geeked about advances in ART technologies. He doesn’t talk down to us and also recognizes the value of our opinion. But most of all, we are so impressed that the clinic recognized how far away we were from home and did what was necessary to remove the cyst rather than having us come back, or worse, waiting another month or two to see if the cyst went away on its own.

That just couldn’t have happened at Celebrity Miracle Clinic because access to the doctor is too limited and the clinic is too big to be that nimble.

So as you can tell we are pleased with our decision. While it may have taken more green to prove it, the grass is not always greener on the other side. And even more importantly, we are excited about our plan and even a bit surprised by some of the changes we made. Here it is in short form. As we progress through it I will pick it apart and explain the “why” behind some of what we are doing in more detail.

1) Stop birth control on April 16th and start maximum dosage of stimulation meds on April 18th. I love that we aren’t wasting any time and that we are beginning with the highest dosage to enlist as many of my resting follicles as possible. I will take 150iu of Menopur in the morning and 300iu of Gonal-F at night to stimulate growth of the egg yielding follicles in my ovaries.

2) Begin taking Omnitrope, a name brand of growth hormone, when I begin stimulation medications. I will inject 24iu a day during the entire time I am stimming. Studies show that this can improve egg quality in older women. It is theorized that because naturally produced growth hormone decreases as you age its decline may cause quality issues. Sample sizes are small for these studies but results are promising.

3) Use Cytotec to soften the cervix due to my difficult anatomy 7-10 days prior to transfer. The doctor also scheduled the transfer at a time that he was sure to be the one to do it since he knows our history with difficult transfer. We will also check my bladder level prior to going back for the procedure since it has been a problem for us in the past.

4) Inject HCG into the uterus the day prior to transfer to increase implantation rate. Studies have shown that growth factor injected into the uterus prior to transfer increases implantation rates.

5) Use time lapse photography to take snapshots every 8 seconds of the first two days the embryos are developing to rule out embryos that are not developing properly and are likely aneuploid (abnormal number of chromosomes). While this is not as accurate as genetic testing, it works to accomplish the same outcome while not damaging the embryos.

6) Assess on day two of embryo growth whether we freeze all the embryos or proceed with a fresh transfer on day three. This was a surprise. I thought we had ruled out a fresh transfer but both my doctor and my husband want to proceed with a fresh transfer if we have a number of good embryos. We will prepare my body for a fresh transfer and make a game time decision. I am as nervous about this as I am excited because it means I may be pregnant the first part of May, the same month I conceived Spork.

I feel like with this plan we are doing as much as we can to give this cycle the best chance of success possible.

We spent the entire afternoon building this plan and removing the cyst which could have been a taxing and exhausting experience.  But it wasn’t. If anything it was invigorating. We accomplished so much in one afternoon, removing all obstacles and setting up our plan of attack. It wasn’t taxing at all because we weren’t in some sterile, cold, and beautiful mecca of fertility where our doctor was kept safely behind a curtain.

We were home.

 

 

Begin at the Beginning

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When I began my last post about infertility and insurance I had no idea I was going to go down that path.  The post was supposed to be about something completely different, but then I found myself following a new train of thought that has now led to a whole series of posts I have planned. That’s what I love about blogging and what makes it so cathartic, it helps you uncover and work through feelings and thoughts you didn’t even know you had.

The insurance post began by highlighting one of the few positive outcomes of our last failed cycle. With more than a little sarcasm I began with a discussion of our tax savings due to our hellacious IVF spend in 2013. It was intended to simply be a preface that led to a broader discussion about another benefit of our last failed cycle, one that I am less sarcastic about than giving a doctor tens of thousands of bucks just to save a bit on what we give Uncle Sam.

The other benefit I am eluding to is that now we can begin at the beginning.

When we started this blog, we were already in the middle, waiting to do a frozen embryo transfer back in January.  We were in the last leg of a long journey with one of the best clinics in the country. We had already completed the most intense and challenging part of IVF. So much had already happened that we did not have the opportunity to share and explain.  Now we have that opportunity.

I always planned to go back to the beginning and describe the stimulation process, retrieval, and how we prepared for and experienced both regardless of whether or not the last transfer stuck. One of my hopes for this site is to build a repository of information based on real life experiences so that those in search of information can find it here anytime. While I could do this based on memory, there is nothing quite like documenting experiences as they occur in real time.

Sure I would rather be pregnant right now, but since that didn’t happen I will just have to settle for the blog being slightly more interesting and helpful for other infertiles.

The beginning, the whole IVF process from start to finish, officially kicks off tomorrow when we have our consultation with New/Old clinic.  This is kind of a big deal because we live in a rural area and our clinic is over three hours away which means a whole day off work to fit in an hour long discussion. As a result of the distance we have our monitoring done locally so this is one of only a handful of times we will be there in person and can look our Miracle Man in the eye to ask him the tough stuff.

I have my usual list of twenty questions ready for Miracle Man and saved in my phone. By tomorrow night we will have our official plan and will have taken an important step toward a sibling for Spork. Friday our “Baby in a Box” will be delivered to our door.  As is always the case at this stage, our sadness has all but lifted and we are growing hopeful, anxious, and excited about this next step.

Stay tuned, wish us luck, and enjoy.

 

P.S. I still don’t have a name that feels right for “New/Old Clinic” so for now that is it. If one strikes me that fits I will let you know.

Infertility, Insurance, and Insanity- Part One

Once and a great while there is an upside to our failure to conceive. For instance, we learned Friday that we saved over $11,000 on our 2013 taxes due to our outrageous out-of-pocket medical expenses. Of course we would rather have a baby and the money even if it means we had to pay more in taxes, but you have to celebrate the small wins in life.

Our tax benefit was so great because we pay 100% out of pocket for our procedures. Our medical insurance does not include fertility treatments and we live in a state that does not mandate coverage. We racked up a ridiculously high deduction because we completed two fresh cycles and one frozen cycle last year over the course of multiple extended out-of-state trips. Our deduction that was ironically greater than the deduction for an additional dependent would have been.

Yay us.

Just think, if the government required fertility treatments to be covered by insurance they would have $11,000 more dollars to spend.  In addition, more people would have babies which would also increase the tax base. More money would be spent on treatments, competition would increase, costs would come down, and insurance premiums would barely budge due to the relatively small number of claims compared to more common treatments like Type 2 diabetes or smoking induced illnesses.

Image: Andrew Magill via Flickr

Image: Andrew Magill via Flickr

So why not cover fertility treatments?

According to some, there are a number of reasons why infertility should not be covered. Over the course of a few posts I plan to tackle them all.

Insurance Coverage Fallacy Number 1- Infertility Treatment is Elective and Should Not Be Covered

I mention diabetes and smoking induced illnesses because one common argument against covering fertility treatments is that most of the 90% of people who have never faced infertility view treatment to have your own genetic child as “elective.”

For most people, the powerful desire to conceive, carry, and give birth to a child is no more elective than eating too much junk or smoking is to those addicted to bad food or cigarettes. Before you get all worked up, yes,  I know there are type two diabetics who eat healthy, make good choices, and exercise only to still be plagued with the illness thanks to bad genes. I will likely be one of them someday given my family history coupled with the fact that I developed gestational diabetes when pregnant with Spork.

I also know there are many people who never  smoked a day in their life who battle serious respiratory illnesses. My father passed away at 41 from throat and lung cancer and never touched a cancer stick.

So I think I am pretty safe drawing these correlations.

Now that I have addressed the exceptions, let’s honestly talk about everyone else.  Smokers choose to inhale toxins proven to cause serious health issues, yet treatment for emphysema and lung cancers are covered by insurance. Many diabetics choose to eat crap despite knowing the potential costs and risks. These choices and treating the outcomes are expensive but are fully covered by insurance.

Yet infertility is not covered by most company plans and only 15 states mandate some sort of coverage.

Unlike diabetes or smoking related illnesses, infertility is not typically caused by choices couples make in life. Most commonly, infertility is caused by circumstances outside of the couple’s control. Dealing with this hardship causes enormous emotional pain, not to mention a massive financial burden that puts a significant strain on a couple. Modern companies who care about the well-being of employees choose to offer insurance coverage in order to provide for a productive and focused workforce. Unfortunately that situation is all too rare.

The fact that fertility treatments are not covered is a sad situation which is at least in part due to how quiet sufferers are about treatments, its causes, and its many emotional, financial and physical burdens. If infertility affected more people and we were more open about it, it would be impossible for a politician or employer to fail to support coverage and remain in business.  Alas it affects only about 8% of us, and of that number there are many who do not want to pursue aggressive options like IVF.

Which leads me to the next common argument against covering fertility treatments which I will attack in Part 2.

Insurance Coverage Fallacy Number 2- If Fertility Treatments Were Covered People Wouldn’t Adopt