Friday, January 30, 2009

New Octuplets a product of IUI or IVF!

If you haven't hear by now, it was announced just the other day that a woman in Califorina has recently given birth to octuplets... that's eight babies! Even more interesting is that they thought they were "only" pregnant with seven, and then during the delivery they discovered one more!! (how does that even happen!)

I know it should have occurred to the me the minute I heard the story that ART was somehow involved, but it didn't. It wasn't until I read the story on CNN this morning that I learned the mother underwent a embryo transfer (not sure if the entire procedure was IUI or IVF) and that they "all happened to take," according to the mother of the women who gave birth.

The real shocker is that, apparently, this family already had six children. So, let's see that's 6+8... 14 kids all together! Blessings come in many forms I guess. I just hope this family has a lot of help in the months and years to come. What a huge life change that would be.

I am very curious to find out what procedure she underwent - IUI or IVF. Kate Gosselin, from Jon & Kate Plus 8, had IUIs done both times. And, like Kate, this woman also didn't elect to do selective reduction. Given things like this are always a possiblity, albeit slim, it's still interesting to hear background stories of why a certain number of embroys were elected to be put back in and the feelings behind a couple's decision to carry all the babies to term or reduce. I will certainly be scoping out the rest of this story in the upcoming weeks!

In the meantime, I'll be saying one very large prayer for this sizeable family. Congrats!!

Thursday, January 29, 2009

In Vitro Maturation - Less riskly & expensive than IVF?

It's called In Vitro Maturation (IVM), but I had certainly never heard of it until just the other day. The CBS Early Show ran a story on this very topic; thanks to my Mom for bringing it to my attention. Apparently about 400 babies have been born thus far worldwide thanks to this treatment, but only one baby has resulted from In Vitro Maturation in the U.S. just last year.

What makes IVM so different from IVF
For one, they do not give you tons of injectable fertility meds to stimulate your ovaries in order to produce eggs. Instead, they only give you an HCG shot around days 3-5, retrieve the eggs and then they fully mature them in a dish filled with special media. From there the cycle mimics a traditional IVF cycle in that you take hormones to prepare your uterine lining and then the transfer is done.

Women Under 30-35 and with PCOS Good Candidates
In short, the article states IVM is safter for womem with polycistic-like ovaries (PCOS) and people who are sensitive to fertility drugs, and therefore at higher risk for ovarian hyper-stimulation syndrome. According to Dr. Tim Child, a fertility specialist at John Radcliffe Hospital, "Women who are 35 or less who have a good number of resting follicles in their ovaries, and there's about a 40-45 percent chance of pregnancy per IVM cycle." As a note, that makes it about half as effective as IVF (more like what you'd expect from an IUI cycle).

Cheaper & Less Risky?
In Vitro Maturation is touted as being "cheaper, easier on a woman's body and quicker". The RE that is currently treating the women who's pregnant here in the U.S. is Dr. Randy Morris with IVF 1 in the Chicago, IL area. His website says "The best candidates for IVM (in vitro maturation) are young women with large numbers of egg containing follicles or women who have attempted stimulated in-vitro fertilization and had production of a large number of eggs. Ideally, women under the age of 30 or 35 would be expected to have the greatest likelihood for having many eggs." He also mentions that overweight women would not be good candidates, because you can't see the small ovaries on an ultrasound, making it harder and more fisky to remove eggs.

For more information on how the procedure is done, visit Dr. Morris' website. Also, here is a recent article on the first women in the U.S. to have this procedure done by Dr. Morris.

What does this mean for us?
Well, given that we fit the profile to the T (at least at this point we seem to) and that Chicago isn't that far from home, we'd be silly not to call them and check into it. I can say that I feel really comfortable with Dr. Alhering currently and like the fact that IVF success rates are generally double that (80%) of IVM. However, if IVM is safer and considerably cheaper (like if it was the cost of an IUI), we might be able to afford to do several treatments for what it would cost us to do just one IVF. I have to admit I'm still a little weirded out that they are maturing your eggs for you... a extremely important part of the process, but then again, in ART there are a lot of things done outside the body and it still results in a perfectly healthy child.

I suppose we'll be calling them in the next few weeks and I'll make sure to update and let everyone know our findings!

Sunday, January 25, 2009

"Be blessed, just as I have blessed them"

Talk about feeling empty. Tonight I sat in a room full of women who all either had a baby, or were pregnant with one... for the most part anyway. I knew this going into it, but told myself "It'll be fine. It'll be good for you. You need to be around friends."

I had already done the math ahead of time. There would be six other women, two of which were childless. I figured with me, it made three; a 3 to 4 ratio... not bad. I could handle that. It didn't take long for me to realize the odds had changed drastically - and not in my favor. One of the two I was counting on was now 16 weeks pregnant (found that out after I'd been there only 10 minutes) and another was pregnant with her second, quickly on her way to two being a mother of two, under the age of 2. That leaves myself and only one other girl without a baby, and that girl happens to still be in college and single. So really, it was just me in a class all of my own. Fabulous.

To make matters worse, the conversation for approximately four hours mainly consisted of exchanging baby stories, habits, wisdom or chatter of how the current pregnancy was going. And rightly so - I mean I would totally do that if I was in their shoes. But for someone like me, at only 45 minutes into it, I wasn't sure how I was going to manage to hold out the rest of the night. I love all these girls and am so happy for them, but it's diffucult at times to be an outsider and to have this tiny thought in the back of your mind that there's a small possibility what they're experiencing may never happen for us. Again, the most empty feeling ever.

As the night went on it did get easier. I decided to make friends with any baby that would respond to cooing, silly faces or a rattling toy. That part of the night was my favorite. It's so much fun to get on their level and interact with them - see what they're interested in and really watch their personalities come alive. I really can't wait for the day when I can just give one on one attention like that to my child. A child that I can kiss and cuddle and know that they are a part of my heart and who will love me unconditionally, just as I will love them.

I am trusting God knows these desires and has a plan for our life. I can't help but pray that our day comes soon! One image that He has burned in my mind, and I know it has to be for a reason, is of all of the sweet babies that are posted on the wall of our infertility clinic. As we walked past two large boards filled with photos I could almost hear Him saying,

"Be blessed, just as I have blessed them"

It made me smile inside. I'm so very thankful to have heard that and to know he is leading us through this, whatever might lie ahead of us. I needed to post this as a reminder to myself, that even during these low points, God has a plan.

Friday, January 16, 2009

Semen Analysis: What the results might mean...

We got our detailed diagnostic test results in the mail from SHER - very quickly I might add - 3 business days :) I love that clinic! I will say that there was one inconsistency in their notes regarding our situation. Dr. Ahlering referred twice to "pelvic discomfort" that I had "mentioned"... which I never did... maybe it was taken from the initial questionnaire I'd completed, maybe I mis-marked something? Who knows, because we never talked about that verbally. Anyway, not a big deal, but I do want to clear it up with them.

Semen Analysis Results
Our semen analysis didn't come back with complete flying colors afterall and it looks as though we might be dealing with slight male factor infertility. First, let's note what the job of sperm is. According to the Georgia Reproductive Specialists:

1) Sperm must be able to swim to the egg with a vigorous straight motion (motility, forward progression, revealed in the SA)
2) Sperm must be able to penetrate the egg to deliver your genes for fertilization (sperm penetration)

The only way you will know if it can penetrate an egg is to do a "sperm penetration assay (hamster test) or acrosin test". We haven't had this done, and at this point, I'm not sure if Dr. Ahlering would recommend that or not. The only reason we'd want to check this out is to see if we'd need to do assisted hatching with our IVF treatment to help encourage the egg to implant.

Also, his count was somewhat low (11.7 total concentration - they like to see 20 or above), however, according one site, "provided your sperm show adequate forward motility and good egg penetration, concentrations as low as 5 to 10 million can produce a pregnancy. It's interesting to note that only twenty-five years ago counts of 100 million sperm per ejaculate were the norm. With time, the effects of our toxic environment and/or lifestyle seem to be gradually degrading male sperm counts."

Kruger morphology, where they look at the shape and make-up of the sperm for abnormalities, results were 16% (they like to see 15% or moe), and comments noted were "Overall, good. Valcuoles and some head abnormalities". When doing research online, I came across a statement from a women who said, "If you have a Kruger between 10% and 15% your chances of conceiving with IUI are very very slim. If your Kruger is between 5% and 9% you will likely NOT have success with IUI, you should be directed to IVF and with Kruger below 5% you should be directed to IVF with ICSI. These are not hard and fast numbers. ICSI increases your chances with IVF so if you are doing IVF and you have Kruger morphology below normal, I would seriously consider ICSI." Another site, this time from the Georgia Reproductive Specialists, states "normal sperm function is predicted when more than 15% are normal".

The good thing is that motility(the percentage of sperm moving and the progression of the motile) was 77 (they like to at least see 50) and rapid cell count was 40 (normal is 25).

Honestly, we're still learning the ins and outs of male infertility factors. For now I'm trying to think positive about this; afterall, the doctor didn't seem to stress any male factor during our follow-up conversation, or on their internal notes they mailed to us, there was only a slight mention of the low count. For now, we're taking some initial steps to try and improve his sperm production... things like a multi-vitamin (especially focusing on zinc and vitamin A) and changing to boxers. In the coming weeks we are planning to ask Dr. Ahlering more about the male factor infertility we're dealing with, all the while keeping in mind that sperm takes approximately ninety days to form and mature. Whatever we do, if anything, in regards to this sperm issue, we need to make sure we're thinking proactively in time for the IVF cycle we eventually do. Live: Dr's Thoughts on Semen Analysis
In doing some research on reading semen analysis results, I came across another Live online radio show titled "Treating Male Factor Infertility", hosted by Kim Hahn, with the special guest being none other than my RE, Dr. Peter Ahlering of SIRM/SHER of St. Louis, from 12/04/08. To listen to this archived show, click here. As always, I like to take notes of what I find to be most helpful from the show and have summarized them below. As a disclaimer, these are in my own words and are in no way meant to represent verbadum the thoughts of either party mentioned above.

Who needs a semen analysis and what tests to run
If a couple has been trying for more than six months, don't just blame it on a female factor. Males who should be particuraly concerned are those exposed to chemicals over long periods of times (i.e. farmers), however, that certainly doesn't exclude all others, it just puts those type of individuals at a higher risk. All couples who have been trying and aren't seeing a positive pregnancy test should have a full semen analysis to insure you're not overlooking a possible male factor. Remember, it's not enough to just check count and motility. Typically, someone will call their OB or general practicitioner for a semen analysis. They then getting results from a lab that is suboptiomal because it's coming from a lesser quality lab and often is run through a generic, compter-generated screening process, rather than a human interpretation. DNA fragmentation is almost never suggested by most doctors, simply because they aren't educated enough. One sample looks for four things - count, motility, high resoultion morphology and DNA fragmentation. Currently, these four things tell us the most we'll know about sperm. SIRM's internal lab looks that the sample themselves, immediately. The DNA fragmentation will need to be sent away to a specialized lab (only three in the country).

A year can make a big difference
Age still plays a part in male factor - a year can make a big difference sometimes. One year you can have 500,000 or a million, which is great, but they may come back a year later and they have none. Dr. Ahlering says he suggests people consider Sperm Crown Preservation in many cases for anyone who is dealing with male infertility, for that exact reason. You never know what will happen. Low count, motility, etc. - you never know what you'll deal with in the future. Dr. Ahlering recommends men see a Reproductive Endocrinologist, not a urologist, if you're dealing with more severe male infertility cases, because they're not interested in knowing the cutting edge technology of male infertility. You will find some urologists who specialize in this, but that's not the majority.

Why your average lab often isn't good enough
When looking at count in a semen analysis, 20 million isn't the "cut-off" entirely. Sometimes you can have higher and it not result in a pregnancy. Sometimes it's lower and it still yields a pregnancy. One problem in using a lab where results are read by a reference laboratory, rather than using an infertility clinic's lab, machines can mistakenly read things that aren't sperm as sperm (white blood cells, debris) and it can over estimate the count. Also, the machine doesn't look at the entire picture. The cut-offs they give are generalities and people can, therefore, have a false assurance. With a clinic's lab you are getting personally assessed results for a more accurate set of results.

Which results are most important
DNA fragmentation has been available commercially about 6-7 years. If you rank influence on infertility potential - this is #1. To review...

In terms of importance:

#1 DNA fragmentation
#2 Morphology
#3 Motility
#4 Count

Qualitative results are most important. If there are abnormalities in this, non-IVF treatments have a very low probability of success, regardless of count and motility. What is the effect of this on pregnancy? When there is DNA fragmentation present, the probability of achieving pregnancy is lower and the probability of having a miscarriage is higher (most often earlier miscarriages). Usually implants, but never reaches the ultrasound stage of pregnancy.

For the record, morphology is the shape, size, and other microscopic qualities that can be evaluated. The majority have defects, and multiple defects, and ones can't be capable of fertilizing or creating a baby. But with ICSI they would select the ones with the highest quality.

UPDATE: Our DNA fragmentation test came back with flying colors, so nothing to worry about there. Thankfully!

Saturday, January 10, 2009

We've decided to move straight to IVF!!

Isn't that exciting!!

I have given a lot more thought to whether or not I should do laparoscopy. Initially, I was leaning more towards having it done, since it's covered by insurance, with the goal of going in and confirming scarring and fixing a hydrosalpinx (if it existed) to increase IVF results. However, after doing some more research, it appears that disconnecting a tube from an ovary (which is what they'd probably do if I did have a hydro) could harm the blood flow to the ovary (2nd reference site here) and ultimately cause it not to work as well. Seeing as how the that is my only ovary and only chance of having our own blood children, and that with the scarring that exists the doctor said it probably won't function normal anyway, I really don't feel like taking any more chances, especially since the sonohystogram didn't detect a hydrosalpinx. One site I found reported on a study done in 1999 stated "salpingectomy prior to IVF can be recommended to women with ultrasound visible hydrosalpinges, but a general recommendation to all women with hydrosalpinx is not justified".

Ultimately, if it really needed to be done I believe Dr. Ahlering would have suggested it, however, I am the one who continues to ask him questions about it, when all along (after he detected the presence of scar tissue via fluid ultrasound) he has recommended skipping the lap and moving straight to IVF. His position is if we really want to try for IUI, which he thinks we may have success with simply because we're young, the lap would be worth doing, but that he believes IVF is the real way to go in this scenario, given my pelvic issues from the past surgery.Right now our goal is to come up with a way to pay for IVF, as it is more than likely the only real way we'll be able to conceive.

We talked to the financial coordinator at SHER on Monday. We learned that this is going to be quite a bit more expensive than we had originally been told though. I don't think that Dr. Ahlering was trying to mislead us or anything, I just think he was referring to the relative base price for package services for IVF. In reality, once you add in the not-so-optional "options", each cycle could be an anywhere from $5,000 to probably around $10,000 on top of the already high package prices. If it sounds complicated already, your absolutely right. To respect the clinic, I won't post their prices here, but if you come across this and are looking for a general idea, you're welcome to contact me and I can provide you a bit more insight. Keep in mind, their consultation is totally and completely free, so really the best thing to do is contact SHER Institute of Reproductive Medicine directly to set up an appointment.

Now comes the hard part where we decide how we're going to pull off affording this. We have to take in to account that the possibility of having multiples is fairly high and would be silly if we didn't factor that in. If we had anything more than a singleton I would want to stay home full-time with them. Even if we have one I'd like to work only part-time. Right now we're looking at how much we'd save by refinancing our current home (which we've only been in a little over one year) given the low rates right now and if we could get rid of one of our vehicles and just buy a junker as our second car. Truthfully, I feel like that won't get our expenses down low enough to where we could live soly off one income, but it's worth checking into. The other option is to try and sell our home in the spring. While I love our home - love the location, neighborhood and charm - I am not opposed to moving again if it means having the family and life I want for my family. I refuse to let a material thing stand in the way of our happiness. Our house is too much house to clean anyway :)

And all of that pretty much just scratches the surface on the work that needs to be done. We still need to become more IVF savvy, talk with Captial One Financing, think of what needs to be updated around the house before we could put it on the market... if I only had more hours in the day. Well, like my mom reminded me last night on the phone - we don't have to have all the answers tomorrow. Very, very true.

Tuesday, January 6, 2009

Diagnostic test follow-up with RE

You're never going to believe this - our follow-up appointment was TODAY, not tomorrow! Man, I really, really think I'm losing it.

I did a similar thing yesterday - went to the dentist and asked for the wrong doctor! One of my fake teeth, yes I unfortunately have three of them, fell out again - fun, fun. Another expense not covered by insurance. (Sorry, just had to whine about that!) Anyway, in my defense, it was the doctor I had seen up until the last appointment when I found out he wasn't in-network anymore, but still. Total brain fart!

I did end up calling him back, however, my husband wasn't able to be there. Basically he said all our tests came back looking good - though he didn't have any specific things to say about that. I think he was away from his desk on his cell and didn't have the numbers in front of him. I'm going to call tomorrow to get a copy of everything.

He pretty much said the same thing as before - we appear to have a substantial pelvic issue, based on the sonohystogram ultrasound, where scarring looks to be an issue. We can certainly try IUI, though he doesn't think we'd have much success. He recommends bypassing the IUI and going with IVF. I asked him about the tubal condition called hydrosalpinx (where it fills with fluid and can spill back into your uterus). He confirmed what I had read - that severe cases can be picked up via ultrasound and that he didn't pick up anything on my sonohystogram. He said it's not a super common occurance and he's not particularly concerned about it affecting IVF results if it's not severe. In his words "In 10 cases with tube damage, 2 will be blocked, and 1 of those 2 will be hydrosalpinx."

I asked him if it was worth considering doing the laparoscopy, since he's 99% sure it will be covered by our insurance, to try and correct any scarring so that we can pursue IUI. He said that we could try that, but again, he doesn't see much success in treating adhesion issues. They used to do this a lot years ago, but in retrospect it just didn't prove to be that successful unless it's super minor damage (which isn't very common) so they don't recommend it any longer. The scarring could be so far gone that the organ never works quite right again. Also, new scarring can occur from the surgery. He's not against going in and looking to confirm scarring and treat a hydrosalpinx, if it exists, if that's what we choose to do. All in all though, he just doesn't see much point in that when we'd probably not have a lot of success with in it and would end up doing IVF anyway.

He's going to have a financial coordinator call us so we can set some time up to learn more about our financing options. In the meantime, we need to chat amongst ourselves and think about if we want to have the laparascopy done, if we want a second opinion, or if we're going to go
straight to IVF without any additional information.

And, in the meantime, I'm going to try and find my brain. I must have left it somewhere in Chicago.

Hydrosalpinx and it's affect on IVF success

With our infertility testing follow-up tomorrow, I am beginning to form a list of questions to ask Dr. Ahlering.

One concern, in particular, is this issue of pelvic adhesion from my past ovarian and tube surgery. In doing some research, I came across the information below regarding a condition called "hydrosalpinx" that appears could affect the results of IVF. I haven't been told I have this condition, but I do want to bring it up to my doctor and try to either rule this out, or find out how we will deal with this issue.

What is Hydrosalpinx?
A blocked fallopian tube that is filled with fluid, usually a result of previous pelvic infection such as pelvic inflammatory disease, but also can be caused by adhesion formation from surgery, endometriosis, and cancer of the tube, ovary or other surrounding organs.

Hydrosalpinx's affect on IVF success
According to, if a woman going through IVF has a hydrosalpinx visible by ultrasound, then the average expected IVF success rate is lower as compared that expected in a similar patient without a hydrosalpinx. If there is are bilateral hydrosalpinges (hydros on each side - the plural of hydrosalpinx is hydrosalpinges) visible on ultrasound, studies have shown that the expected IVF success rate is even lower than with a hydro on one side.

What to Do states that careful ultrasound examination should be able to detect a significant hydrosalpinx. Studies have shown that if surgery is performed to remove the fallopian tube (or tubes), the expected IVF success rate is then normalized. Another approach that is effective is disconnecting the tube from the uterus and leaving it in the body. This is often done in cases with severe scarring where it is difficult to completely remove the tube. Some IVF doctors insist that women with hydros have laparoscopic surgery to remove or disconnect them from the uterus prior to performing in vitro fertilization.

Other fertility specialists will counsel the patients about the potential risks and benefits of having the surgery before the IVF: Surgery first, then IVF - Higher potential for IVF success, but need to have surgery, with some pain, some risk of a surgical complication, time off work, and delay until IVF. OR, Go straight to IVF, no surgery - Lower potential for IVF success, but avoid surgery, no delay for IVF, etc.

Tubal damage could lead to higher risk of ectopic pregnancy
Wikipedia states (though I'm not sure where they got their info from), that, historically, people with tubal infertility due to hydrosalpinx underwent tubal corrective surgery to open up the distally occluded end of the tubes (salpingostomy) and remove adhesions (adhesiolysis). Unfortunately, pregnancy rates tended to be low as the infection process often had permanently damaged the tubes, and in many cases hydrosalpinges and adhesions formed again. Also, ectcopic pregnancy is a typical complication.

Monday, January 5, 2009

2009: A year of faith and happiness

It's time to take a deep breathe - '08 is now complete and I am mustering up the strength and faith to face 2009 head on.

In celebration of my Dad returning from a tour in Iraq, me and my husband, my Mom, Dad and brother all went to Chicago for a short vacation. It was the first time I had been on a train since I was a little girl, and the first time I really had the chance to explore the city somewhat in depth. All in all it was fun to spend time with the family, do touristy things and have a chance to girl-talk with my Mom - everyone needs a good dose of that from time to time.

The unfortunate part of the trip was that hormones must have been getting the best of me. I was a real bear, let me tell you. I was frustrated over the littlest of things and have never wanted to curse or throw something through a window more than on that little vacation! By the last day I was really trying to be more aware of what would set me off and just retreat to my "happy place", hoping the moment would pass.

Ok, so maybe hormones weren't the only thing to blame. Some of my other issues I will let rest, as it's just not worth bringing up. I will say that I think things from the past few months have really just come down on me harder than ever before. While we seem to be getting closer to a path, or infertility diagnosis, I now feel the weight of life bearing down on my shoulders. How are we going to pay for this? Are we selling our house - if so, what needs to be done first? How am I going to make it through repeated self-injected shots? I could go on and on.

For some strange reason I felt this overwhelming sense of failure surrounding a lot of things in my life. Now don't get me wrong - I know I am quite blessed and have accomplished a good deal in my still seemlingly short life. In fact, I struggle with allowing myself to vent like this because I know so many people have far worse things to deal with. I feel so selfish sometimes. What is certain is that I can't continue to stress and overplan. Infertility is teaching me to take each moment as it comes. Some days this is easier than others though - this past weekend it wasn't easy. I felt a strong urge to invision, plan and make certain my life is going in the direction I so badly want it to go in.

I say all of this to admit that I need to resolve to have faith that everything is like it is for a reason and that God is in control of every situation. I need to believe and let go - allow myself to take one day at a time and learn to take care of my mental, as well as physical self.

I guess you could say that's my resolution for this year - to simply let go and be happy. I think I'll begin that by enjoying my 8 year anniversary with my husband tonight... a little birdie tells me he's planning a relaxing evening at home. A welcomed, much needed treat!

Happy Anniversary

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