IVF | Laughter Through Tears

Nesting

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

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.

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!

Ultrasound Number 3- Day 9 of Stimulation

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

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

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

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.”

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.

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 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

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.

Theme Song for Day One of Stimulation Meds

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

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

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.

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.

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!

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.

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

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.