You Can’t Change It (IVF Update)

I am a realist. It’s just who I am to my core. It doesn’t mean that I am negative, but that I like to know every possible way something could go, and what the odds are for each scenario. I also like to have a plan. And a plan B…and C…I do not like to be caught off guard.

There is a huge difference, at least in my head, of knowing what could happen, and actually experiencing it play out in your own life. There was a time, when we first started trying, that I knew there was a possibility there could be an issue, but even as I started to see my OB and my RE I didn’t actually think there would be a problem. Those first few months with the RE, having surgery, getting diagnosed with endometriosis, and experiencing 3 back-to-back failed IUI’s I felt pretty blindsided most of the time. Still with each obstacle or failure I went into the next thing believing that it could be successful. Even though the odds of getting pregnant from and IUI are small it does work for a lot of people, and I fully believed I could be one of them. When it didn’t work out I was disappointed, but not surprised.

When we started fertility treatments I thought we would do 6 IUI’s before moving onto IVF. After the first three failed we made the decision to try one more with injectables. Because the cost was so much higher for an IUI cycle with injectables it didn’t really make sense to try it more than once. I thought, at the time, if that cycle weren’t successful and our next step was IVF, that I would completely breakdown. It had been a long year, changing jobs, my grandpa passing away, and my dad getting sick. When we finally did the IUI, and it failed, I don’t even remember crying. I just felt kind of numb, and went on with life. As much as I wanted it, I couldn’t change the outcome, and the odds were not in our favor.

More than being upset about the cycle failing, I was concerned that I only produced ONE follicle using the more powerful drugs (Gonal F), which was the exact same response I had to taking Femara. During our consult for IVF a few weeks later the doctor assured me that this would not be a concern because I was on such a low dose. For someone my age they expected to get at least 15 eggs.

This is the part where I continue to remind myself that I cannot change the decisions I made, or the way things have played out. If only I had known, right?

We decided to take a year off from treatment. I wasn’t mentally ready to do IVF, and I wanted to be able to pay cash rather than finance the cost. We spent the year (especially me) focusing on improving our health. I lost weight. I purged our home of chemical products. I replaced many plastic products in the kitchen that could be leaching BPA. I changed every single product I put on my body. I started using oils instead of pills when possible. I started acupuncture. I cut a huge amount of sugar out of my diet, learned new REAL food recipes, and as IVF got closer cut out caffeine and alcohol completely. While all of these things are very positive changes and regardless of what happens I will continue to do them for probably the rest of my life, as far as my fertility is concerned, they did not make an impact.

A year later when I walked into the fertility clinic to start IVF, this time excited and ready, I was, again, blindsided by the AMH results and a much lower antral follicle count from the year prior. But I was told by basically everyone that I just needed to be positive. Everything would be fine. I asked the doctor about the result (because she never brought it up to me so I had to ask her about it) and she just told me that it was “kind of low” and she had adjusted my protocol to account for it. The only person that acknowledged that there could be an issue was my nurse, and I honestly really appreciated it. Everyone else, including my husband, just told me to “be positive”.

So I tried to push it out of my head, or at least to the back. I didn’t bring it up anymore because everyone make me feel like I was upset about nothing. I was tired of being told to be positive when I felt that I had a legitimate concern. I knew I couldn’t change what was going to happen, and of course I hope(d) for the best, but I just didn’t understand why no one wanted to admit that, given the information we now had, there could be an issue with the number and quality of the eggs they would be able to retrieve.

The first few days of stims were significantly more difficult for me than the last. I felt pretty crappy and exhausted and I started to feel really full/bloated. And then on Tuesday it all went away. At first I gave my acupuncture credit for feeling so good. My E2 level taken on Tuesday (CD7) was 950 which from what the nurse told me, and what I researched online seemed to be a good number for where I was in stims. Wednesday I started to feel worried because the full feeling I had previously had completely gone away. I actually felt totally normal. I just pushed it out of my mind because I knew if I said something I would be told again, to just “be positive”, and with all of the extra hormones pumping thru my body I might lose my shit.

Thursday I went in for monitoring. I felt a little anxious. I had a hard time sleeping the night before but I was still in a light happy mood. I was sincerely praying for 10 follicles. I thought that seven or eight might be more realistic given my antral follicle count was 10. As soon as she started the ultrasound and went to the right side I started to feel panic. Three follicles. There was another that was about ¼ the size of the three, and one that was so smalls he couldn’t measure it. And then the left side. Two follicles. And another that was too small to measure. So five follicles. The doc also confirmed that they were all mature and that I would trigger that night which was a complete surprise to everyone.

I was honestly shocked. I got dressed and they moved me to another room to wait for the nurse. It took her a while to get everything in order because my retrieval wasn’t expected until next week. I sat there, letting the information sink in. Five. Just Five. I text my husband, and my good friend D who has also done IVF. The nurse and I went over instructions and final medications that needed to be taken, but she had to wait to schedule the exact time until later in the morning. She gave me a hug and told me she would call me later. I called my husband to give him more information about what had transpired, to let him know he would need to find time to clean out the pipes as soon as possible (awkward because it was on a business trip in meetings all day), and to plan what we would do with my stepson on Friday night/Saturday morning since he could not come with us. Our conversation was brief.

I headed into the office and in the 30 minute car ride I could feel the tears welling up. I wasn’t crying because I lost hope or because I thought this was the end. It most definitely is not the end. But after being told so many times to ignore all of the not-so-great things that have happened the past few months in the name of positivity, I needed to acknowledge that this was not good news.

I promise you I totally understand that it only takes one. I am praying that we have one. I know that is 100% possible and I have not given up on that. Two feels like a dream come true.

Tomorrow morning we will go in and see what happens. I know I can’t change it. I can’t control it. I have prayed for it and I have done everything I could do.

For now…To be continued……

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Stims Day Five

Hello from day 5 of stims (day 7 of microdose Lupron). I thought I would just give a little update on how things are going 5 days in….

Currently I take 4 shots per day, every 12 hours. In the morning I take Lupron, injected into my thigh, and Gonal-F, injected into my stomach. The Gonal-F injection is a breeze. The pre-filled pens are super easy-peasy to use and the injection doesn’t hurt. The only thing I really notice is that now that I’ve been doing it for a few days, along with Menopur that also goes in my stomach, the needle hurts a little more going in. I think that’s because my tummy is beginning to feel like a pin cushion.

The Lupron hurts like hell. The needle is fine, but the actual medicine being injected is awful. Thankfully after about 5 or 10 minutes it goes away.

At night I take the Lupron again, in the opposite leg, and also Menopur. Menopur must be mixed which isn’t super complicated, but I seem to have issues getting it to draw into the syringe every time. I have tried both the mixing needle and the Q caps. For what it’s worth I prefer the needle to mix. The injection itself hurts, and it is more difficult to inject than the Gonal-F. The pain does go away in a few minutes thankfully.

As far as side effects go…..mornings are the worst. I feel great when I wake up, and then about 10 am I start to feel really groggy. This started the first day I took the Gonal-F. It’s hard for me to focus and I often get a headache as well. I have also had some odd pain in my jaw around this time and right before I go to bed. A few times I have experienced some dizziness, which has only happened when I was being active (going on a walk or doing housework). I am pretty sure this is from the Lupron because the first time it happened I hadn’t started stims yet. I feel bloated and unfortunately this has led to some gas as well. I have also had a few hot flashes.

I spent my weekend away at the Oregon Coast where I was able to relax a lot and take naps. Being at work today has been difficult but doable. I am a little nervous about how I will be able to handle things as the week goes on, but I am just taking things one day at a time.

Tomorrow is my first lab to check my estrogen and Thursday I go in for an ultrasound to monitor progress. Prayers are appreciated!

He’s Got This

Today I was cleared to start my IVF meds.  It doesn’t even feel like it is real.  The last month of BCP (take 2) went incredibly fast. Even the last few days of waiting for AF didn’t feel like waiting.  I had so much going on that this morning I finally noticed that AF hadn’t arrived yet…..and then about 30 minutes later there she was.

I went to work as normal and called my nurse at 8:30.  She was called me back around 10:15 and I went into the office for a baseline at 11:45.  Last month I had all sorts of butterflies and anxiety but today I have been completely calm.   When Dr. S. confirmed I had no cysts I felt happy, but I sort of expected to feel instant anxiety about starting the meds but I really felt calm.  Talking with my nurse to go over my appointments afterwards I even mentioned to her how at peace I felt and that it was really surprising.

I felt so upset last month when things didn’t work out but I can honestly say it was for the best.  In the past 21 days I have had a lot of fun, and I have been able to completely relax.  I know I am just starting the hard part and there is no telling how I will feel in a few days but right now I am just happy to say that I am good and I feel ready.  I have totally relinquished control to God.  He’s got this.

For those that are interested in the technical stuff….tomorrow I will start my microdose Lupron (2x per day).  Thursday, in addition to the Lupron, I will be taking Gonal-F (AM) and Menopur (PM).  I will go in for my first labs to test my estrogen on Tuesday March 8th, and my first monitoring ultrasound on March 10th!

****Here are a few pics from my Friday at Lake Tahoe.  It was one of those perfectly still mornings and the lake was like glass.  We just sat and took it all in for a few hours.   I am so grateful to have had that moment to reflect and relax.

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Game On- CD1

Game on baby.  Let’s do this.

Today is CD 1 of my very long awaited IVF cycle. The 21 days of birth control went really quickly. The 3 since stopping the pill and waiting for AF to arrive….eternity. She actually made her entrance last night while I was making dinner. I might have squealed like a little girl and immediately Snapchatted the news to two of my besties (Don’t worry…it was just a selfie making a funny face). Obviously at exactly 8:30 when my clinic switches on their business hours phone system I dialed my nurse to share the news with her as well. Unfortunately she wasn’t standing by the phone awaiting my call so I had to leave a message and I headed to acupuncture.

Usually acupuncture really chills me out. Last week I actually feel asleep. This week I just laid there wondering if I was missing the call from my nurse. I mean I did relax some, but not to the usual level of Zen magic I get from my sessions. Of course the nurse did call ten minutes into my appointment but honestly that’s a good thing because I would have been disappointed if I didn’t have a message from her. When I called back, it turns out this time she was waiting for my call. She actually answered and then put me on hold to finish a phone call. I am scheduled to come in this afternoon at 4 for my baseline.

On a separate note, my medication arrived last Friday. Opening that HUGE box of meds was actually really overwhelming and gave me some anxiety. I mean how is it possible that all of it goes into my body in such a short period of time? For the time being the entire top shelf of my fridge is reserved for fertility meds. Honestly it does keep me from wanting to open the refrigerator very often to have them just staring at me.

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I am also feeling super blessed to have some really wonderful people in my life who have been checking up on me, sending me cards, an adult “swearword” coloring book, and this beautiful necklace from Desirae. My heart is so full knowing these people are thinking of me.

 

While it’s so exciting to be moving forward it’s also overwhelming and stressful. I am so thankful for your prayers and positive thoughts! XOXO

Back in the Stirrups

Normally I don’t talk to myself, but if you saw me this morning you would be convinced I was a lunatic. The talking to myself was necessary….because I was trying to talk myself down from the impending panic attack I was feeling knocking at the door to my sanity.

So my morning went like this….

I left my house and headed straight for the pharmacy. My original thought was, Great my appointment isn’t until 9:15 at the clinic which leaves me ample time to get my prescription for Letrozole and Estrace first (so I could get my butt to work as fast as possible after the appointment). Well as it turns out, my pharmacy opens at 9. SHIT. This isn’t the biggest deal, but I just knew they wouldn’t have it ready by the time I got there and so I would have to wait….which just adds stress on to the whole “missing work” thing.

I took a few deep breaths, and drove to the Starbucks next door. Might as well have a nice latte while I still can right? I got my coffee and proceeded to call Freedom Pharmacy to set up my Ovidrel and Gonal-F delivery. The good news….they actually had the prescription this time. The bad news….because of the holiday weekend they cannot deliver on Tuesday (the day I need to start the Gonal-F). My choices are tomorrow or Saturday, but my husband and I will both be gone starting tomorrow. And my office closes at 1 on Fridays in August so I can’t even have it delivered there! And in rolls the anxiety. I told her I would figure something out and call her back and I started to drive to the clinic literally out loud trying to get myself to calm down. When I arrived in the parking lot I was able to get a hold of a friend who lives a few minutes a way that is actually going to be in town for the weekend. I am having everything delivered to her and hopefully she gets it all in the fridge.

I entered the clinic feeling slightly better but still on edge just wondering what else might not go as planned. As I mentioned I met with the financial coordinator last week. At that time she told me the cost of my cycle, and that it would be due when I arrived for my baseline ultrasound (today), and that I could pay by credit card, check, cashiers check, or debit card. Pretty much anything except cash. Well then today the receptionist gave me a hard time about paying by check because of some random technicality in the system. I forgot to check how much my debit card allows in transactions per day before I left, and I was literally beginning to lose it when she finally figured out that I could pay by check. Such unnecessary stress!

Thankfully the actual appointment went well. It was with my preferred doctor at the clinic, Dr. M, and I was clear of cysts. Even the whole ultrasound while on my period thing wasn’t as bad as I thought it would be. I had a quick meeting with the nurse coordinator and then off I went back to the pharmacy.

As expected they did not have my meds ready. And I needed to pick up my thyroid meds as well which I knew I would have to ask them to do for me since they can’t seem to figure out how to keep them on auto refill since I take two different dosages. There were seriously like 8 people working behind the pharmacy counter and it was complete chaos. After finally talking to the pharmacist he tells me that one of my thyroid meds only has enough left on the prescription for ½ of what I need for a month. What?!?! How is that even possible? I was able to convince him to give me those pills so I could get through the weekend, while he got the refill from my doctor. It still took 30 minutes to get out of there.

By the time I got back to work I was a wreck stress-wise. I was thankful that my boss was not in the office when I got back. I got right to work and accomplished everything on my priority list quickly. Of course not long after I got back I got a message from my doctor that they will only refill my thyroid meds for 1 month because I need a blood test! I literally just saw her when she made me come in in May for a “Med check” appointment and she didn’t say anything about needing one soon. Actually I asked her to give me a lab sheet for Lab Corp in case I wanted to get one voluntarily. It was stupid enough that I had to go in for an appointment with her so she could “see how I was doing taking my thyroid medication that I have taken my entire life”…..and how this! I mean what a waste of time and money!

Keeping my eye on the prize, I am super grateful that all of this worked out and I know I need to seriously work on keeping a little calmer when I get curve balls. Honestly if my boss hadn’t made me feel so uncomfortable about missing work for doctor visits, I think I would have handled all of this better. I am so thankful I had no cysts and can go forward with this cycle, and that thank goodness my next ultrasound appointment is on a Saturday. My beta day will be Sept 23 or 24th which could be the perfect belated birthday present.

The Next Level- Prep for IUI #4

Today was my appointment with the financial coordinator and nurse coordinator at my RE’s office.  It was a lot of information to soak up in an hour, but I left feeling more like a legit infertility patient.  I mean it’s not necessarily that I didn’t feel legit before, but my first three IUI cycles felt different.  For one, it felt reactionary and shocking.  I had no idea what to expect.  It was kind of like being in the kindergarten of infertility treatments.  You are qualified to be there, but they just easy you in with the “easy” stuff.  Apparently when you start injectables  you have graduated to another level, and shit gets real.  

First, I never had to see a financial coordinator for my Letrozole only cycles.  I just paid for each appointment when I came in that day, and no one ever really told me the overall cost for appointments or medication.  This time things are different.  Even when she came to the waiting room to get me she took me to a completely different part of the office I didn’t know existed.  For a mixed cycle (or straight injectable cycle), you pay for everything at your baseline ultrasound.  That includes all ultrasounds, two back-to-back IUIs, a Beta at their lab (they always sent me to an outside lab before), estridol testing, and possibly other things I am now forgetting.  She also gave me an estimate on my medication cost.  All in all, this cycle will likely cost about $600 more than my Letrozole cycles, which is honestly a big relief.  She also gave me an estimate on the straight up injectable cycle, which was about double the cost of a mixed cycle (5k-ish). Honestly I do not see us ever doing that, but rather going to IVF.  The other interesting thing was that she went over the positive beta scenario with me, as it relates to billing.  Up to this point, no one at the clinic had ever mentioned to me what would happen if I actually got pregnant.  I learned that they basically do monitoring for you until 8 weeks, and she went over what would be billed to my insurance in that case.  I also had to fill out a form that stated I understood all my treatment was out-of-pocket (until positive beta), which I had never had to do before.  

Next I headed into the nurse coordinator’s office.  She went over what seemed like a mountain of paper work with me.  She first informed me that apparently I need a PAP.  Mine expired like 30 days ago…..and my OBGYN takes like 3-4 months to get into for a PAP.  I sort of started to freak out, but apparently they do them in the RE office, so I am scheduled for next Wednesday.  Also if the schedule doesn’t work out for the IUI for my next cycle, I will need blood work, because I have a few tests that expire this month.  She then went over the cycle schedule and what medication I would be taking on what day.  She is also calling in my Ovidrel and Gonal-F now.  She then went over some handouts she went sending me home with about fertility stress management, counseling, resources, ect.  I sort of laughed at this only because I was a little surprised they wouldn’t have given it to me A YEAR AGO WHEN I BECAME A PATIENT.  Again, apparently when you start shooting yourself up that’s when they start taking you seriously.  The next set of handouts had to do with do’s and don’ts that will start the first day I take fertility meds through when I get a positive beta (again, this was not discussed for oral cycles).  Finally she started to grill me on my prenatals and supplements.  She even sent me home with a big bunch of prescription prenatals to try (because most over the counter ones make me nauseous).  

Then we got to the hard part……the demo on giving yourself shots.  I mean it seemed easy enough to inject into a red cube, but when I am shooting a needle into my stomach I think I will feel differently.  Maybe it won’t be a big deal by the time I get to trigger, but right now Ovidrel scares me the most.  For my oral cycles the clinic has always done that one for me, and its possible they will again at my CD 11 appointment but she said i may have to do it myself.  I really wish I had a best friend in the nursing field.  

I also talked to the nurse coordinator about trying to work scheduled appointments in the early morning or later afternoon, since I work so far away.  Basically she said they would do what they could but I should really hope that some of the appointments fall on a weekend.  The only way that will really happen is if my cycle is 27/28 days or 32/33/34 days.  At this point I am really pulling for the 32-34 range…….not that I have any control :-).  

Despite the overload of info I am really trying to keep the most positive attitude possible, and not focus on the “this is it or its IVF” thing.  We will see how that goes when I start filling my body with hormones.  I am super relieved that this cycle is *only* going to cost around 2k.   I really expected it to be a lot more.  it’s funny how 2k feels like nothing when you have already spent thousands more than that on something.  If it brings me a baby, obviously money well spent.  If not…….well lets not think about that.  It’s honestly kind of weird to be back to blogging about all of this again after so many months of just waiting.  I already remember how doing treatment plans literally takes over your whole life.  I do feel more prepared this time mentally and emotionally.  I am just really praying that everything goes smoothly with no unforeseen stress, and of course for that positive beta…..finally.