Protocols, Outlines, and Stress

In a few hours I am going to hop on a plane for part two of my holiday vacation, which is a very good thing because I just need the distraction.

My appointment yesterday went well. But it was just a lot. A whole lot.

My nurse was very nice and I can tell she really cares about her patients. She took her time going though things and stopped often to ask if I had questions. She made me feel comfortable and she was very approachable which I am sure will be very valuable through all of this.

First we discussed the consent forms we need to sign. She took her time going through each one and what it meant.

We also went over my outline, which is basically a tentative schedule of events over the next two months. If felt like a check list. You have to check the box to move forward. Basically step one: Start Period and call the nurse. Oh and send in a hefty check to the clinic. At that time they will schedule my hysteroscopy, another appointment with the nurse for injection training, and I will start BC on day 3 and she will let me know how many days to take it.

After the hysteroscopy is complete if it goes well and I am cleared to proceed she will order my medication.

When my next cycle starts I will call her again and be scheduled for a baseline ultrasound appointment. I will meet with her again and get the ok to start meds.

Starting on Day 7 of my cycle I will be in the clinic every day doing ultrasounds and bloodwork. Meds will be adjusted based on the results each day. Hopefully around Day 13 my retrieval will be scheduled.

Transfer will be on day 3 or day 5. She said that patients with 5 embryos or less usually are scheduled for day 3, which based on my follicle count I will likely fall into the day 3 transfer category.

Next we went over my protocol (Lupron Microdose). Because of my low AMH my protocol was adjusted to have more stimulation and less suppression. In patients with a low AMH the largest concern is poor response to stimulation, therefore the amount of suppression is decreased. I will be taking significantly less Lupron and for a shorter period of time that what was previously planned because they do not want the Lupron to over suppress my ovaries so they don’t respond to the stims.

My nurse and I had a good conversation about my AMH and what it means. Previously I had emailed Dr. S about the results and she referred to them as “a little low”, however the nurse reaffirmed my feelings that they are actually VERY LOW. She said that she personally would highly recommend we move forward with IVF as soon as possible due to my AMH. Obviously you can’t go back in time, but I wished I had had this test a year or two ago. First I would like to know if there had been a significant decline over the past two years or if my AMH has always been low. With my decrease in follicle count from 2014 to 2015 from 16 to 10 I would be interested to know if the two numbers both have dropped that significantly. If this number has always been low would it have changed how we moved forward? I would imagine we would not have waited the year to move forward with IVF and just found a way to make it work. She stressed that quality is much more important than quantity, which I appreciate, but most of what I have researched shows that a low AMH drastically increases the risk of the cycle to be cancelled due to non-response. This is the largest concern sitting in the back of my mind at the moment. Interestingly the doctor and the nurse did not use the words Diminished Ovarian Reserve but I feel like the writing is on the wall. One study I read said that my AMH is typically found in someone over 41 and I am 33.

Because I know that many people are very interested in the cost of all of this I will be completely transparent to what we will be paying.

Cycle Fees to the clinic: $9,850 (includes all blood work, ultrasounds, egg retrieval, transfer, embryology, two betas

ICSI: $1800

Cryopreservation of embryos: $800 (if required and includes one year of storage)

Estimated medication cost based on Freedom Fertility’s website: $5,300.

I believe there is also a fee for the hysteroscopy however I do not know what that is yet. I also do not know what my pre-cycle bloodwork cost is yet.

So far known cost is: $16,950 (not including unknown cost stated above, acupuncture on transfer, and cryopreservation).

I will also be transparent in sharing that to date we have spent $12,135 on our fertility journey which includes office visits, ultrasounds, 4 IUIs, medication, supplements, acupuncture, an HSG, blood work, semen analysis, and my laparoscopy/hysteroscopy to remove my cyst (partially covered by insurance).

So now I wait for AF to arrive sometime next week. Hopefully a few days in Portland with my family will be a good distraction. I hope everyone has a wonderful New Year and may 2016 bring babes for all of my TTC sisters!

Looking Back/Ahead and IVF Updates

EEK can you believe it’s going to be 2016 in a few days? This year seriously flew by. 2015 was filled with a lot of great things for me, including a very special trip to Italy with my mom and grandma. I am forever grateful for the unexpected opportunity to join them on that trip, although I wish it was under different circumstances.

We already have some exciting things planned for 2016 including IVF, but I will get to that in a minute. I have a girl’s weekend planned in Oregon in March and we will be traveling to Kansas to celebrate my grandma’s 90^th birthday on Memorial Day weekend. We also may take a quick weekend trip to Vegas in January with some friends. We aren’t planning anything past May yet until we know if IVF was successful. We will also be celebrating our 5 year wedding anniversary in August which seems really unbelievable!

I have a lot of hope for 2016 and I am excited to see what the year brings. In 2015 I really focused on my health and my body. It was easier at some points of the year and harder at others but overall I maintained about a 10 lb weight loss from where I started and I learned a lot about what is the best way to fuel my body. I definitely know how to set myself up for success for feeling my best and I learned a ton of great new recipes!

In 2016 my focus is going to be my attitude and my presence. Basically I am going to focus on complaining less and counting my blessings more. A very large challenge for sure. I also want to be present in the moment. Less distractions, more interactions.

IVF UPDATE

I have my nurse coordinator meeting tomorrow afternoon. She did actually call me today to ask about some paperwork so I felt great about that since it’s the first time I have actually talked to her. She posted a timeline to my patient portal today, and I am looking forward to hearing more tomorrow. I am cycle day 20 today, which means my period could arrive in the next 5-10 days. In times like these my irregular cycles make me crazy.

In preparation for all of this I have added more supplements to my regiment. Due to my low AMH I added DHEA 3x per day because I have serious egg quality concerns. I also added L-Arginine, Vitamin E, and Maca. I was already taking COQ10 3x per day, Omega fish oil, Vitamin D (2x per day), Acai, Primrose Oil, Prenatal + a folate tab, probiotics, and B12. I think that’s all. I also plan to start taking melatonin.

I am on a strict 2 glass of wine per day (or less) restriction until my BCP cycle starts and then it will be no alcohol. I have also had a very limited amount of caffeine the past few weeks and I will have zero starting with my BCP cycle. After our holiday travel (we get back on January 3^rd) I will go strict Whole30 eating and start juicing every day. The only exception to this will be if we go to Vegas for the weekend, where I will still have no alcohol or caffeine but will probably ease up for two days on the eating.

This week I will be starting double treatments at Acupuncture adding back treatments which can improve follicle count.

Despite the several feet of snow in Oregon over Christmas I actually walked several miles each day (thanks to my dog who needed to be taken out). Being back at work today has been a total bummer because I feel like I’m chained to a desk for all daylight hours. I really would like to keep up the walking routine but with the cold weather and darkness after 5 it’s going to be a real challenge. Basically there are 4 months a year I really wish we had a treadmill. On that note does anyone have a fertility Yoga DVD they recommend?

Well hopefully I will have more to update tomorrow after my appointments. I hope you all had a great Christmas!

Near Miss

Every time you make a plan it falls apart and comes together a million times. That is infertility.

It’s just human nature to plan. Having a plan offers a sense of security. Even after you watch every plan you make crumble into a million pieces…..you move on to the next plan.

Getting back into treatments with my RE is exactly as expected. Hectic. Stressful. Unpredictable.

After my initial appointment with the doctor two weeks ago I tried my best to take DEEP BREATHS and have faith that the clinic would come through for me. After about a week and a half of waiting for them to call I emailed the doctor. Also on that day they posted my lab results which included my AMH.   It was low. According to what I found online it was the lowest possible result to be considered “low” as opposed to “very low”. Obviously this was really upsetting and I wanted to hear what the RE thought.

I should also mention that last week was horrible. I was sick with a fever, cough, and sore throat from Sunday-Tuesday. I had literally just gotten back on my feet on Wednesday and got called into appear for Jury Duty. I spent two days being questioned as a potential juror and thankfully was excused from the case at the end of Thursday. Friday morning I was hoping to get a few hours in the office before going to the dentist to have 5 cavities filled, and when I got in my car to leave I found it had been broken into. So instead I spent the morning calling the police and waiting for a locksmith to come rekey my house (the thief took a house key).

It was almost laughable how horrible the week went, but in the end everything that happened as more of a near miss than a total disaster. Getting sick is terrible but I am THANKFUL that I did not get called into jury duty while I had a 101 fever and that I bounced back quickly.

Getting called into Jury duty sucks but had I actually been picked to be on the jury for the case I would have had to miss my planned holiday vacation and even possibly postpone IVF because the trial was expected to last weeks. I am THANKFUL I was excused after 2 days.

Getting my car broken into sucks, but the person didn’t damage anything and they didn’t steal anything that couldn’t be replaced. They also didn’t use the key they stole to get into the house while we were sleeping. While I feel violated, I am THANKFUL because it could have been much worse.

Also if I had been called to serve in the jury, or if I had been required to stay another day I would have had to cancel my dentist appointment. I hate going to the dentist, but it was important that I get the work done before the end of the year to use my insurance benefit. I am THANKFUL to have it behind me.

So today, finally back at work, it was time to go full court press to get my nurse meeting set up at the clinic. I reached out to my doctor again via email, and called the main line.

I was able to find out by the phone call that I had been assigned a nurse, however she was on vacation all week. They let me leave a message with her back up nurse, who did call me back and got me scheduled with my nurse next week. She also said I did not need to meet with the financial coordinator since we are paying out of pocket. The doctor also emailed me back and gave me her thoughts on the AMH test result and told me she wrote up my cycle plan for the nurse, so hopefully we will go over it next week at my appointment.

I feel relieved. I am really THANKFUL that I can go into the holiday feeling like things are back on track because I will likely be ready to start BC right after the holidays.

While I have felt a little like the universe has been picking on me the past few weeks I am really THANKFUL because life is always going to have little bumps and being an adult means you have to deal with them as they come, but in the end nothing has derailed me from my plan.

Back to the RE

First thank you so much to those who commented on my last post about my tummy troubles. I thought I was finally past whatever it was that was upsetting my stomach so much, but apparently not. After making it through Saturday and most of Sunday without getting sick (including 3 meals out) I thought I was in the clear. Nope. After dinner last night I barely made it home without getting sick. Whatever the issue is, it seems to be completely around eating. It’s really the worst.

This is the first Monday in a while that I actually looked forward too. Mostly because I am not working today and of course the anticipation of my first appointment back at the RE in over a year…

Our appointment was first thing this morning. I was expecting to just have an office visit that would basically be a repeat of our IVF consult from last year. I was very surprised when they wanted to do an ultrasound first. I should also note that we met with Dr. S, who is not our regular doctor. Dr. M was not available until the end of the month and that just wasn’t going to work. I had heard good things about Dr. S so I decided to schedule with her because she had more availability.

The ultrasound was quick and she just checked for cysts (none!) and did antral follicle count. Last October I think my count was 15 or 16 and today it was only 10. I was not happy with that news.

The office visit part of the appointment was exactly as I expected. She basically did an overview of the process, which we had already heard before. She discussed success rates and risks. We let her know that we did not want to do the embryo biopsy. She ordered a lab panel for me and told me the financial and nurse coordinator would be in touch. I let her know we were hoping to start birth control in January and she felt that was reasonable. I am really trying not get my heart set on anything as far as dates go because I know how much can change.

After the appointment I headed straight to the lab to get my bloodwork. Since I was scared to eat beforehand thanks to my unpredictable stomach I had was good to get them taken care of now. I also had to write my primary care doc to get a TSH for my thyroid which I can hopefully get done later this week. The wildcard will be getting my appointment set up with the nurse coordinator and financial coordinator with the holiday thrown in to my month window before my January cycle starts. Deep breaths….

I am hoping to get to the eye doctor today and I have a dentist appointment this afternoon. Honestly I need to get a lot done today and it’s already noon!

ON A SEPARATE NOTE….A LITTLE RANT

If things go as planned and there are nothing crazy happens with my cycle I would be on BC from about January 8^th-28^th. The weekend of the 23^rd my husband has an annual guy’s trip to Vegas with some of his childhood friends. This year, however, some of the wives have said they want to come and have a girl’s weekend. Clearly a girl’s weekend in Vegas doesn’t sound all that great to me since I won’t be drinking at all. While we were waiting for our appointment this morning my husband tells me that one of his friends had written him about the Vegas trip last night and my husband told him that I probably would not be coming. His friend told him that the only reason that his wife wanted to go was to see me. I don’t actually know his wife very well and we haven’t spent much time together but I told my husband I would write her and let her know the situation. When I got home I wrote her a Facebook message letting her know I would love to come see her however I wouldn’t drinking and would want to keep it low-key. Through the magic of Facebook I saw that she read the message right away but she did not respond.

About an hour later I wrote my husband a text to let him know that I had written her. His response, “I heard.”

Already I’m pretty annoyed that somehow he already knew that I had written her, especially since she hadn’t responded to me. So I asked him how he knew I had written her.

“My sister told me.”

WHAT!?!?! Why is his sister a part of all of this now? I know that his sister and the woman I wrote are friends, but as far as I know his sister wasn’t invited on the trip so why is she involved?!?!

So basically I feel like I am being talked about behind my back about something that is clearly very personal. Apparently I should have just not gone on the trip with no explanation. Seriously is this 5^th grade?  It’s really upsetting.

I really want to be open about what we are going through with our infertility, however situations like these are what make it so difficult. It does not feel good to think people are gossiping about your infertility. L