The What & How: Recapping our IVF Calendar Review

The first big step into the land of IVF - the Calendar Review. Yes, I believe this must make it even more official, than the last official thing I posted. :-) Even though the full payment hasn't been made, or we haven't started pumping the heavy meds into my system, this is the foundation for the weeks to come.

We were the first appointment of the day. I should stop here to make a mental note that even though we left the house at 7:45 for our 8:45 appt, we arrive unnervingly early - 8:15 to be exact. Full steam ahead we walked through the doors and were soon greeted by our coordinator, Peggy. After greeting us with a smile, she asked if we wanted any coffee (umm... no thanks, we're trying to get pregnant :D) and showed us to an empty office. Things were a bit disheveled there that day; they recently experienced a water leak on the 3rd floor of the building they occupy, so lots of men were scattered about putting new drywall in and getting the place back in order. We didn't mind, though she apologized repeatedly. Later she was sure to mention that none of the fancy equipment was harmed (whew!)

Going over the "playbook"
Once in the room, Peggy started by breaking down "the playbook", otherwise known as our IVF calendar. This thing comes complete with a rainbow of what to inject, when and how much, all squeezed tightly into a month's time frame - and this doesn't even cover the entire process. Apparently, we'll receive additional, super critical information during the first and second weeks in August via phone and e-mail. Lord help us if there is a power outage or major disaster. I'll be pumped full of meds with no one to release my precious eggs to.

That aside, the first set of instructions seems pretty straightforward. Peggy took the "you might not know much about IVF" approach (which I fully appreciated) and took the time to explain every step in great detail. It was nice to have us all on the same page going into each phase of the cycle. Along the way, I stopped to ask if they would allow us to replace the intramuscular injection of Progesterone in Oil (PIO) for vaginal suppositories. While the latter doesn't sound fun, it has to be better than super deep shots in the butt, right? No, they don't like to do that. If come two weeks after a BFP, they are just too much to handle, we can consider switching it up then, but the first approach will be to stick it out and take one for the team. At the end of the day, if that truely is what's best, then I suppose I'm up for it. Luckily those don't start until the day of the transfer and they are every three days only (+ suppositories), so it could be worse. She did mention the trick of using ice to numb if we needed to. I even asked about the numbing cream. She said that yes, we could use it.

At this point, she must have detected a little "internet forum" speak or something, because it was then that she gave me a small lecture on how it has been their experience that most patients only seem to get stressed out by them. In some ways, I needed to hear it, I really did. She had the unique ability to be "mother-like", when my Mom wasn't able to be present. The other part of me wanted to let her know that I really only make a practice of going to SIRM's forum or keeping my nose in good, reputable books like the one written by Dr. Sher, but I just couldn't get the words out in time. We were onto the next line of business. Which was...

Learning how to self/spouse-inject
This part made my stomach turn just a wee bit. As Peggy rightly pointed out most of these particular type of needles are made for those who don't work in the medical field. They are super thin and not very long; basically the same type that are used for insulin shots. At least that's the speech I was given... I think I bought it! :P I'm sure that after the first one or two, it won't be too big of a deal, but it's getting over that hump that's the hard part. We were able to use a test dummy - a wonderful invention of fake flesh on a portable pod that I could hold up to my stomach and pinch the "fat" of, similar to what we'll do for the real injections. I went first, pretending to look like a natural. She called Jay the "back-up". Right. How about he'll be the go-to guy on this one - at least at first. I'm not sure how I'll feel about shoving that thing into my body willingly. We both had a good laugh because when he did it, his needle almost stabbed my thumb that was holding up the dummy. She was like "you might want to stand to the side when you actually do it, and hold it a bit closer." When she told him to hold it like he was holding a dart, I think he thought that meant to "throw it" like he was throwing a dart too. Yeah, not so much. This, folks, should be quite interesting!

Ending our injectable conversations, she mentioned which ones will come pre-primed and which ones we'll have to mix and prime on our own. I just hope we don't get confused and inject the wrong dosage. Let's not think about that for now... The only other injection she didn't go over much was the PIO shot. She said they'll show us how to do an intramuscular (IM) when I have my first one on transfer day there in the office.

Things you never think you'd decide
After all the talk, it was time for some paperwork. Of course you can't do something this major without having to sign your life away. Some of the questions we were totally prepared for... How many eggs do you want to have fertilized. All. What do you want to do with any excess embryos. Freeze. What we didn't expect was - What do you want us to do with those extra embryos in the event both parties dies. Ok, so even though it was creepy, the answer was obvious. We'd want to do an anonymous donation. The one that was super weird was, what do you want to do if just one of you dies. That was so uncomfortable to think about. Peggy said that she has had to walk out of the room before because couples have started arguing back and forth trying to come to a resolution. Luckily we were able to talk it out and decide that really in any event like that that we'd want the other to have the power to decide to keep or to donate anonymously. I mean it makes sense that they would ask these questions, but talk about super creep factor. That is the farthest thing from your mind when you're at this point and it, for a split second, it was sorta like a little dark cloud surrounded by a sea of wonderful possibles. Blah. Out with the bad vibes, in with the good. Out with the bad, in with the good.

Touring babyland
After finishing awkward paperwork, we had the opportunity to take a little tour of the clinic. With it being a slow, out-of-the-ordinary Friday, we had a fun surprise of being able to meet the soon-to-be "man of the hour". No, sorry sweetie, I don't mean you. I mean one of the embryologists. He probably thought I was one odd duck when I said "thanks for everything in advance" or something Corny like that. Hey, he's talented and this was, quite possibly, our one chance to suck up. You would have done it too :-P AND, what's even cooler, is that we were able to peek our heads in the embryology lab. I'm not sure if he was referring to just himself or the lab too, but he said he'd been on the Discovery channel twice. Pretty high-tech stuff!

What I loved about the clinic is that it doesn't feel very "hospitally" at all. Warm, soothing colors on the wall. The space, overall, wasn't very big, which made it feel more approachable. The procedure room where they'll do the retrieval and transfer was right next to the lab and they have this little window they slide the important stuff through when it's go-time! The recovery areas were small, but seemed to contain all of the important stuff. Bed for relaxing, guest chair and a small TV for taking your mind off everything.

Everyone has a role
Our coordinator was really good about explaining what she does in all of this. She specifically said "Don't worry. That's what I'm here for. I'll do the worrying for you." Anytime I have a question or concern I am to call her directly during business hours, or the exchange line during after hours. She assured me someone will be there to answer any question. Then, when it comes time for retrieval, she'll be present in the room assisting Dr. Ahlering in immediately labeling the egg filled pipettes to the lab where they will inspect and count each egg that is retrieved. I believe she said that before we leave we should know about how many were retrieved and later that day she will call us to give us a fertilization report. Then, that next week will be filled with getting updates from her on how they are progressing -which ones make it through ICSI and mature into little embryos. For a 3-5 days we'll watch their progress to see which ones divide and continue to blossom, ideally hoping for 8-10 celled embryos by day 5 for a two blastocyst transfer. She's thinking we'll stim quickly and be ready for retrieval on Friday 8/7 and things we will make it to a day 5 transfer, which would put that on 8/11. Each of these we won't really know until the day or morning of. Those first two weeks will be filled with so, so much. I'm glad to know Peggy will be there every step of the way.

My OhMyGoshThisCouldREALLYHappenMoment
Oh, and how could I forget to mention. The "moment" I had while we went through our calendar. Following all of the meds, all of the procedures, there will be the wait. At this point in the conversation, Peggy started using words like "when we find out you are pregnant," I started to loose it. I don't generally allow my brain to get too far down that path. It just isn't safe. It was all too much when she started saying around the time when we'll be able to hear a heart beat(s) and find out if there is more than one sac - more than one baby!! At this point, I was looking around like a scared puppy dog for a box of Kleenex. Peggy could see it in my eyes and felt really bad that there wasn't anything to be found in the office we had borrowed (hers was being worked on). Moments like that are few and far between, but it was crazy to think that in less than two months from now we would not only find out if we were pregnant, but how many we were having. Totally crazy. I am so ready for this!!!!!!!!!!!!! Bring on the shots!

Ok, so on and on I've went and I've not gotten into the protocol or dates one bit. I'm going to pause and go get some sleep, but I'll be sure to write soon, complete with a pic of our very bright and color laden calendar. The first time I saw one of these I did second take. Lots of instructions, lots of meds and the biggest concern that came out of our appt. More of the really important stuff to come - promise!

Our IVF calendar review is tomorrow!

I feel nauseous. My nails, completely gone. Yeah, I think that pretty much sums it up.

The nausea is partially due to the stupid BCPs. Silly things are STILL making me sick to my stomach. The last week has been constant force feeding myself, as a good starchy bread is the only thing that makes feel better. I have a feeling I'm going to gain at least 10 lbs by the time this whole IVF thing is done. Probably more if we get pregnant. I have mixed feelings about this, but doesn't everyone?!

As for the nail comment, that would be nerves. I'm ashamed to say that yes, I bite and pick at my nails. It's not pretty and I'm not proud of it, but it's a stress reliever that I can't quite find a replacement for. About a month ago I decided I was going to kick the nasty habit so I ran out and bought a bottle of nail vitamins. I was good for about 2 weeks or so and constantly lathered my ugly nails in this $6 a bottle stuff and was, all things considered, quickly rewarded with a couple hard, healthy nails on each hand. Then, something must have happened. I think it was an afternoon when I started researching some dern IF stuff and got all worked up; before I knew it I had peeled away all my hard work. I was, am still, so very ashamed. Argh. Guess now is not the time to start trying to fix that. There are BIGGER things on the horizon. I do, however, need to calm myself down in moments like that because I'm sure my nerves looked on the inside the way my stupid nails do on the outside.

So, what am I so nervous about?
Yesterday marked just three weeks until we start our protocol - that's right, actual injections. On Tuesday I spoke with my IVF coordinator, Peggy. Our calendar review is set for tomorrow at 8:30 am. She was nice enough to send me a preliminary calendar, which I'm using to look up any meds I'm unfamiliar with. Tonight, Jay and I will sit down and make our list of questions and then pray we have the ability to remember everything that is explained to us tomorrow. In this appt we should get a high level look at how the cycle works, as well as little details about when we'll take what meds and such. Should be fun?!

Peparing to destress my life
I really do feel like my stress levels will be a huge part of how our cycle turns out. It's one detail that I want to pay attention to now, and not regret that I had later. Yesterday, I finally purchased the yoga dvd I posted about awhile back. With shipping it was about $22 or so and hopefully worth every penny. My plan, as of now, is to set up a TV in the soon-to-be baby's room (like the positive vibes there ;) so that I can leave the yoga gear (mat, relaxing candles, relaxing eye patches and other papering goodies) out all the time. The goal is to do yoga every morning and evening, and maybe even during lunch if I'm having a stressful day, every day.

This is just one aspect of destressing I hope to start soon. Another would be starting accupuncture in the next week or so. Last night at my local infertility group meeting, we had a wonderful accupuncturist come and speak. She was ultra informative, easy to talk to and I think treatment will be something that can I can only benefit from during this time. Still on the hunt for some good ways to destress during the day at my desk job...

It might be boring, but still, it's progress!

Now, let me put you to sleep with the details... I finished my last Provera pill (10 of 10) on Sunday. In the past when I've taken this to induce a cycle, I only take 5 and then 2 or 3 days following AF will arrive. I expected the wait to be the same in this case, but it wasn't at all; instead it showed up the middle of the next day. Surprise! As instructed, I contacted my clinic to let them know it was CD1. They called in a BCP prescription (for Aviane to be exact, which contains ethinyl estradiol

and levonorgestrel, two forms of the female hormones estrogen and progesterone) and I was told to start my first pill no later than CD5. I have read before about CD3 being a common day women begin the regime, so I decided I would too and popped it late last night.

Everyone always talks about how funny it is that you're TTC and you are on BCP. :-) To me, if it seems weird or crazy, it pretty much fits right in with IF. hahaa! Actually, what I hate about the BCP, which I completely forgot about until right when I opened the pack, is that I feel nauseous from the stupid things. Years and years ago when I was on the pill, I dealt with this constantly. It would always take a good 4 days or so for my body to get used to the low-dose hormones. Even if I take them with food or at night, my stomach will hurt pretty much the entire next day. Ultimately, this is why I stopped taking them and switched to the Nuva Ring. Anyway, is it annoying - yes. Will it be worth it - yes indeed! This is mild to what these next couple months will throw at me, I'm sure, so I best get used to it now. *grin*

Why do most people take BCP during an IVF cycle?
Most of the time, and I fit right into this personally and because I'm cycling at SIRM, women with unpredictable cycles are put on the BCP to sync their body with the rest of the women who are cycling that same month. I believe that sometimes even women with regular cycles will be put on this because they want the ability to do ER & ET around the same days for scheduling purposes. Also, in women who are known to be classified as "high responders" (where they will recruit lots and lots of eggs), the pill is thought to lessen the risk of dangerous OHSS. Since I am PCOS, I fit into this category as well.

A little clarification from my last IVF update...
I spoke with Mary again. Based on her previous note, she cleared up for me that the ER will fall on 8/5 or after (not 8/3). Beginning around 8/3, I'll be in their office sometimes daily for monitoring to see how the follicles are doing. I’ll then have approximately a 2-day break between the HCG and ER and then a 3-6 day break between ER and ET. So, knowing this, I am able to get a better idea that the first two weeks in August will be when I'll be taking quite a bit of time off work for appts, procedures and bed rest.

Things you never thought you'd tell your boss :P
I am fortunate enough to work for a wonderful company. We're a fairly small group (just 13 of us) and the owner/my boss is a young guy himself. I have always been able to be extremely open about family priorities, career goals, etc. and everything as always been very well received. I'm happy to report our upcoming IVF is no exception. I filled him in on the general idea of how things will work, which tells the story of when I'll need to be out of the office and sometimes the very short notice of when I'll need time off (take those two weeks in Aug for example). He was fine with everything and was more interested to say things like "Are you ready for this?" and "I'll be crossing my fingers for you." With IVF, I feel like we have to put our best foot forward and the last thing I need to do is stress about about my job too. It's such a relief to know that isn't a concern - I consider it a blessing from God!

What's next?
I'm waiting to get a call from my IVF cycle coordinator, Peggy, who will then set up our IVF calendar review. I was told on Monday she would be contacting me within a week or so and to mention it to them if I hadn't heard anything. So, I wait. If nothing by, say Tuesday of next week, I call. I think that's fair, don't you ;-)

Oh and - let the countdown to shots begin!
It was also confirmed that down-regulation (also known as ovarian supression) with Lupron will begin on or around July 15 (like I posted way back when). That's now less than a month away - hooray!

Up! left me feeling down :-(

For anyone who hasn't seen the recent Pixar film "Up!", you may want to refrain from reading this. I don't plan to give the entire plot line away, but I will probably go a little farther than most care to know, if you still have plans to see it. Just know that if you are dealing with infertility issues, this movie WILL hit home. I had heard about there being "something" in the movie, but wasn't prepared to the degree I needed to be. Honestly, I don't know if I could have prepared myself.

Ok. Nough said. Stop reading if you don't want to know details :)

Now, down to business. First, I should say that I am madly in love with Pixar films - Finding Nemo, Toy Story I & II, Monster's Inc., The Incredibles, WallE.... I'm sure there are more than I'm leaving out. Point is, I am dedicated. If you took a look at our small library of DVDs at home, you'd swear an 8 year old lived in our home. I get lost in some of those movies, I really and truly do.

I never saw it coming
When I saw Up! advertised a year or so ago, I was sold. They never did reveal much of the story line in commercials. The plot I gathered based on previews was that a crotchety old man ties balloons to his house, floats up in the air with a boy on his porch and then they go on a jungle adventure together"... yes - this is what I thought I was going to see. A treasured story about the old and the young at heart relating to each other and teaching one another life's important lessons. Sounds like something Pixar would do, right?

Instead they spend what has to be about 20-30 minutes at the beginning of the movie getting you invested in the characters as children, follow them through to a very loving, happy marriage into a time when they begin planning and getting excited for a baby to a point when... drum roll please... the wife is in tears sitting on a table in the infertility or OBGYN clinic. When they go back home, they take down all of the baby things and paint over the walls in the baby room. It's over for them. A dream is gone. They are infertile.

Seriously. This is what I paid $11.50 to see in 3D no less. Needless to say, I am curled up in my seat crying my eyes out at a kids movie. How fantastic is that.

From this point on, I was hoping things would get better. After all, it is a kids movie.
I guess at this point all the writers could thing of was to give the couple in the story a "new" dream. Which, whatever, that's fine. I mean some people do chose a life without children after learning they're infertile. Fair enough. Personally, I really would have loved to see them incorporate adoption into this story. Seemed like a wonderful opportunity to address a topic that is otherwise fairly untouched in children's movies. As an added bonus, some of us, including myself, would have been inspired and shown once again that there really IS more than one path to a child.

Sigh. Sadly, that is not the direction the movie took. Instead, the couple decided to set their sights on saving up one day moving to their dream hideaway -- Paradise Falls. For a moment, they're happy again. They have a poster of this wonderful place with their house sitting high atop the majestic peak. Every day they walk past a piggy bank, saving up for the day that their dream becomes reality. But, one thing after another breaks and they continue to dip into their savings, slowly watching their dream fade away. Then - his wife dies.

Yes, she dies!

Of course, my heart is breaking in two by now. To have never experienced sharing the love of a child together. The love of his life dying, leaving him all alone with dreams and hopes never achieved. At this point, I nearly walked out of the movie. Again, though, I'm thinking "It's a freakin kids movie - there HAS to be a silver lining." There is ALWAYS a sliver lining, that's why I LOVE these films in the first place.

Reality is good, but come on!
This is the point where I pause and say how much I fully appreciate when there is a touch of reality, even in the rated G. For most, where else would they learn about harsh realities of life. (Not that I think it's right, but for a lot of kids this is probably the first place they come into contact with things like this.) For instance, I am in love with Finding Nemo for this exact reason. They do a wonderful job of taking the audience full circle - with the death of Nemo's mother to his lost adventure at sea and the bond that's created with his dad. Oh and who could forget Nemo's "little fin" - a perfect way to say we all have our "handicaps" in life, but it's what you make of it and how you choose to treat others with those disabilities. I'm sure I'm telling you stuff you already know. Forgive me, I'm on a roll!

Point being, I can't help but feel they took this way too far. Yes, if you stick it out, you will see that there is a silver lining to all of the doom and gloom but, from my theater seat, I couldn't see past all of the tears to really connect with that. I'm being honest when I say that when it finally got to scenes where they were making jokes, I really and truly didn't feel like smiling.

The mass of humanity will never understand
As some "genius" so eloquently put it on rottentomatoes.com, "Practically perfect in every way, this is Pixar's most uplifting adventure yet!" Are you freakin kidding me! I guess he thought it was a devilishly clever play on words. I can just hear him explaining to his friends now "Get it, get it - "Up" "U-P-lifting adventure" - OMG that is soooo great!" Gold star, genius. Just beautiful. The problem is, that seems to be the general consensus so far. This movie has gone over so well with the general public because most of them are fertile. They don't know what it's like to experience the thought that they may never have kids of their own one day and what it means to live with that hanging in the balance.

I guess that's what I hated about this movie. It stirred up this concept that I try so hard to forget and brought it to life. Even worse, it ripped apart the love this couple shared for each other - the one thing that keeps me going through this. That totally, totally sucked. I can't say that I see myself buying this one. It would just be too hard to swallow a second time, even if we DO get pregnant in August. I'll save myself the $25 and put it towards IVF for baby #2!

Patience... I know it's around here somewhere.

Still speculating... still wondering. What will my exact IVF protocol be? If you can't tell, I'm getting a little antsy!

My goal by the end of this weekend is to continue educating myself enough so that I'll be able to understand if the protocol I'm given seems right for me. No, I am not a doctor, nor will I claim to be once I'm thru researching. We are, however, investing a lot in this cycle: physically, emotionally and financially. I see no reason why I shouldn't be proactive with this as I am with buying a home or switching jobs. This is just as important, and arguably MORE important, than either of those. Our family tree is at stake here!

Why is the IVF protocol so important?
As Dr. Geoffrey Sher's states in his book on IVF, titled The A.R.T of Making Babies, "In order for any organism to attain an optimal state of maturation (ripening) it must first undergo full growth and development. A fruit plucked from a tree before having developed fully or a poorly developed fruit might still ripen (mature) on the shelf and might even appear as enticing as one that had previously undergone proper development, but it will lack the same quality. The same principles apply to the development and maturation of human eggs."

I love, love, love this analogy. Comparing the ripening of fruit to a woman's eggs just makes so much sense to me. This is exactly why I am taking the time and energy to try and make sure the protocol I'll be given is the right one for me - especially since I have PCOS. The protocol, or meds, they put me on will directly contribute to how my eggs will develop which is a HUGE part of whether or not we will be successful (not the entire variable, but a big one none the less). Don't misunderstand me, please. I do fully trust my doctor. He is a brilliant and very kind man. I am sure that he and his staff will do whatever they possibly can to insure we have successful cycle. Even still, I know I will rest easier knowing that I fully understand his decision and that I've researched enough to have full and complete faith that what we go forward with really does make the most sense for us.

Attempting to avert regrets

What if we don't have a successful cycle?

In truth, this is hugely possible, so I think the "what ifs" make a lot of sense here. If that happens, we'll naturally wonder what might have gone wrong. I'm sure we'll have a follow-up appointment with the doctor in order to review and develop a game plan for #2. If at that point in time something in our conversation comes up that I questioned internally prior to and during that cycle, but didn't say anything about, I won't be able to forgive myself. We are investing way too much in this cycle to not do our homework and feel good about things going into, during and after. However, if I DO research and ask questions about anything I am curious about or feel uncomfortable with and get those things resolved, and we still don't have a successful cycle (which I know is very possible), I will feel good that everyone involved did what they felt was right.

I'm only half way through this book, but I cannot say enough great things about it. (I promise to do a book review on it soon! It's too good to keep secret!)

____________________________________________________________________________________


The day following down payment, I e-mailed Mary, the clinical coordinator at SIRM. I was told to call her on day 1 of bleeding, but since I'm an irregular cycler, I needed further instruction. My first impression was FANTASTIC! She was quick to respond with a very detailed and personable e-mail. She asked what day I'm currently on (at the time it was CD 30) and then a day later, she responded to let me know she phoned in a script for Provera. Today is day 7 of 10 pills total. My husband's response to Provera, "So I guess that means we're officially starting our IVF protocol"... yeah, I guess you COULD say that!!

How our IVF cycle will work from a high level
Then, because I couldn't stand not knowing and all the girls on the SIRM forum recommended it, I e-mailed her again to ask how the process works from a high level (since we're new, I have no clue other than what I've heard). She said (paraphrased): You will find out your protocol at your calendar review and will be getting a prescription for all meds then as well. The cycle begins on 8/3 so that week and the following week, you will be in our office sometimes daily (especially the first week) for ultrasounds. The egg retrieval (ER) will fall over the first weekend, then embryo transfer (ET) will fall 3, 5, or 6 days after the ER. Peggy will be your IVF coordinator and should be contacting you soon to set up the calendar review appt. You will go over everything at the review. Between now and then, it looks like all your pre-cycle testing is complete with the exception of your husbands blood work. Be sure to contact me on day 1 of your next period so that you can start the BCP. From that point on, all will fall into place. You'll be seen for the calendar review and again on 8/3 for the first of your monitoring ultrasounds. As mentioned earlier, you will be in the office frequently from that point on 10-14 days. You'll find out if you're pregnant about a week or so after your ET.

Sooo... now I am informed, but still have a lot of questions. Based on this, that makes it seem as though I will NOT begin as early as I last thought. Clearly, this just re-enforces the fact that I have a lot of research to do. We (yes me AND my husband) have been reading Dr. Sher's book every night this week! At my request, of course ;) I feel like we have a small window of time in which we both need to learn a lot and be on the same page with our information. So, after a little push, he agreed to do so. I am so thankful for this because he is MUCH sharper than I am and it is so nice to have a second brain processing all of this info. My hope is that we'll have enough questions formed by early next week so that I can dig a little deeper to see what is next for us.

Wake up and smell the coffee... Decaf, please ;)

Today began by checking my blogroll to catch up on what everyone had been up to the past couple days. AF just arrived for my friend Fran and she outlined what was ahead of her over these next few weeks for her IVF protocol. Fran and I will practically be cycle buddies (though she's a week or so ahead of me), which is neat. (By the way, Fran: I tried commenting to your latest post, but had no luck... the darn comment button just doesn't appear to be functioning. Anyway, just wanted to say "Hooray for starting!")

After reading her post, my progression of thoughts went like this:
Fran knows what's ahead of her, which is awesome!
I wish I knew.
... I know.
I'll see what Dr. Google has to say.
Then, with limited knowledge of what type of protocol I'll be on,
I type: "how does a typical lupron ivf cycle work?"
To which I stumble on a site and find this:
Gulp. If this DOES represent what my protocol will look like, then I'm starting even SOONER than I thought with injectables (Lupron could begin around July 2nd!!). The only thing I've been told so far about my protocol was what Dr. Ahering said in our last appointment with him back mid April. He said at first glance he imagines he'll put me on a "classic" Lupron protocol, or L3C (as it's referred to at SIRM). What you see above is considered a "classic" Lupron protocol, according to that particular clinic; I would assume my clinic's would be nearly identical.

Without confirmation from my clinic, here is what COULD lie ahead for me. These conclusions are based on the above chart/clinc info noted below and a sample calendar from another clinic. My thoughts are in blue.

1. Menstruation starts. (Should be around June 16 for me.) Baseline labs such as FSH can be drawn on day 3. (Around June 18 for me?)
   
2. Birth control pill (Begins on CD 3?) is used to suppress the pituitary and to resolve any residual ovarian cyst from previous cycles. The pill also allows flexibility in IVF scheduling. Women who start menses at different times can have their cycles synchronized by the pill in order to start IVF treatment as a group.
3. Lupron, an injectable medication, is started near the end of the pill cycle to further suppress the pituitary. (This could be around July 2 for me!?) The pill is eventually discontinued while Lupron is continued into the next phase to maintain pituitary suppression. Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. (Based on this sample calendar, from yet another clinic, it sounds like I might just continue Lupron up until the time everyone else starts their stims, so July 15... I guess there's no harm in "over" suppressing my ovary, especially since I have PCOS?)
   
4. Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. The injectable medications used to stimulate the ovaries (Bravelle, Follistim, Gonal-f, Repronex - I believe I'll be doing Follistim or Gonal-f) are actually LH and FSH, the same hormones normally produced by the pituitary. Close monitoring of the ovaries with blood works and sonograms is essential during this period to ensure optimal egg development and avoid complications.
5. Human Chorionic Gonadotropin (HCG) injection is given when the follicles reach mature sizes. HCG induces the eggs to undergo the final maturation. It also causes the eggs to be detached from the wall of the follicles to facilitate their removal.
6. Egg retrieval is performed about 36 hours after the HCG injection. The procedure takes 20 minutes and is conducted under IV anesthesia. A long needle is introduced into the pelvic space through the vagina under ultrasound guidance. After their aspiration, the eggs are inseminated or injected with the sperm in the same day. (ER for my cycle will be on or around August 3.)
   
7. Embryo culture typically takes 5 days after the day of retrieval, the same duration an embryo takes to travel from the tube into the uterus under natural condition.
8. Embryo transfer usually takes place on the fifth day of culture (otherwise known as the blastocyst stage). Two best blastocysts are transferred into the uterus using a soft catheter. The procedure is similar to an IUI and requires no anesthesia. The remaining embryos, if there are any, can be frozen for future use.
9. Endometrial support with progesterone and estrogen supplements is important to prepare the uterine lining for implantation. Progesterone is started on the day after the retrieval. Progesterone transforms the endometrium into a rich environment to prepare for embryo implantation. Progesterone is usually administered in oil (PIO) form by deep muscular injection into the buttocks. (Our patients use progesterone vaginally instead of by injections. Our decision to use vaginal progesterone is based on numerous scientific researches that showed the superiority of the vaginal route over the intramuscular or oral route in endometrial maturation. I think my clinic normally recommends PIO, but I'm going to ask about suppositories or Endometrin inserts instead.) (Estrogen is added back to maintain hormonal balance within the endometrium. The estrogen level usually drops after egg retrieval since many estrogen producing cells are also removed along with the eggs. Estrogen can be used as a patch or as tablets. (I don't know if my clinic gives Estrogen supplements like this.)
10. Pregnancy test can be performed 12 days after embryo transfer (Not sure if this is the typical number of days my clinic likes to test on). Once the test is positive, progesterone and estrogen are continued until the 11th week. A vaginal sonogram is performed at the 7th week to confirm the pregnancy.

In short, that's a lot of "what if's," but it definitely tells me that I need to get thoughts in order and begin to ask questions to my clinic. I am a prefer-to-know type of girl so I know I'll feel better once everything is confirmed. I also want to find out what supplements/vitamins we can be taking in order to help my husband's sperm and my egg quality, due to PCOS. Need to start that regime ASAP I'd imagine. Lots to do and learn!

Also, it's time to cut out caffeine and alcohol. Not that I was ever a big consumer of either, but I ought to eliminate this just to be safe. This weekend was full of enjoying a little of both. My mom came over on Friday to visit (we had a wonderful time!) and we bought some Teavana tea - very expensive, but it was so unique it will be a nice little treat from time to time. I bring it up for those who are undergoing, or about to undergo IF treatments. Their Tarocco Ruby Orange Herbal Tea/Apple Lemon Pomegranate Rooibos Tea combo is completely caffeine-free and is absolutely AMAZING! It tastes exactly like super yummy fruit juice and is fairly thick, for an iced tea. If you're looking for something different and IF friendly, I'd highly recommend it.

All in all, it was a great weekend. Lots of time spent with family and friends, which I always love. I even got to celebrate our upcoming IVF with my husband on Saturday and then with my good friends Sunday. What more could you ask for!! Going into a new week, please pray that we get good news back about our loan situation. This is the last big nail biter in terms of something that would be able to hold us up from starting. We applied last week and should know early this week if we'll be able to get the financing we need to pay for our upcoming cycle. We've gotten ourselves excited enough already that it would definitely be tough to let go of our hope now.

Welcome Lost and Founders :-)

How neat! Today I, and a couple other IF bloggers I know, were highlighted in today's post on the Lost and Found Connections infertility blog. This blog is such a cool idea! A very dedicated individual(s) read through various blogs and gather up noteworthy IF posts to share. It's a great way to meet new bloggers and learn about interesting things that might be happening in their journey, encouraging support for one another. If you've never checked it out, I would highly recommend it!

Welcome to anyone who has made it here by way of the "Connections Abound" posting. I hope you find my journey helpful with something you might be going through. If you read a post you connect with or find useful, please comment and let me know!

Other bloggers that I "follow" who were also featured are:

http://nottheuglyduckling.blogspot.com/ - Meghan is celebrating the fact that her RE is now listening to her loud and clear (you go girl!). She is seeking advice on next steps for tests and such that she could have done to get her diagnosis once and for all.

http://twosheldons.blogspot.com/ - This is the couple I blogged about previously who went from doing IF treatments to adopting with the flick of a switch. After much trepidation about whether or not the birth mother would sign the final paperwork, they are now enjoying being at home with their new little girl! God is good!!

Basking in the glow of the possibility

As my mom correctly put it, this is one of the few times I've been "super excited!". The fact that IVF will finally be our first real chance to get pregnant, who wouldn't be excited.

There have been other times, certainly, when I've been super excited - like the day I graduated college (so glad to be done!), the day that I married my husband 8.5 years ago, buying our first and now second house, landing a job, adding a new furry creature to the family... all of the somewhat standard things to be excited about I suppose. Heck I was even "super excited" when we *first* started trying over a year ago. ;)

This is different
This time, all of this excitement and anticipation comes laced with not being in control of the situation. Usually, when I'm pumped about something, I would take the bull by it's horns and see it through to fruition. Time I can't do that. I don't know all of what lies ahead and no matter how much researching I do, ultimately, much of it... probably about 90% of it anyway, is totally out of my control. So, along with being "super excited" also comes TONS of other emotions.

I'm sure you'll see or read about plenty of those over the next couple months (you can't say I didn't warn you :). IF is one ginormous roller coaster full of highs and lows. Right now, THIS is a high point. Probably the highest in our journey so far. I feel thankful for those who celebrate the good times with us and, equally, those who help us through the tough times. I think my mom was so surprised to see me "super excited" because as a child I was horrible about expressing even the slight hint of enjoyment (as was my brother... maybe it's just in the jeans?!) This had to have been beyond annoying as a parent. I have no clue why I did this; I can only hope everyone who ever did a nice thing for me truly knows how much I appreciated it.

Never the less, I think I've gotten better about showing my emotions as an adult. I'm sure my husband can attest to this; he'd probably wish I showed less emotion a good deal of the time. :) Notice I said better, not perfect. Sometimes I try not to get too worked up as a way of protecting myself. I learned this very quickly during our first home buying experience. We had our sights set on a house; the same house that went on the market and was sold in a single day (yes, that's when the US economy was thriving!)

I wanted so badly to not have problems getting pregnant because this was one area where I wanted to be 100% excited and happy for this part of my life - no worries, no over thinking it - just blissful, unexpected ignorance! It's something I've waited and prepared for for so long. Even though I now know things will be more difficult, I want so badly to STILL be able to be excited and giddy about it.

Down payment day was full of giddiness.
For a moment you'd have thought I found out I was pregnant right then and there!

Eight Things: Random stuff you might not know

The tag bug bit me (yes, Clare I'm calling you a bug :-) ... hope you don't mind!), so here goes. Lots of totally random stuff about me. I'm defying one of the rules though and not tagging anyone back, so if you're reading this and you'd like to play along, please do! Always a fun way of learning more about other fellow bloggers.

Ok, so the rules of 8 are:
1. Mention person who tagged you: Clare - The Pitter-Patter
2. Complete your list of 8s
3. Tag 8 people (again, not doing it!)

8 THINGS I AM LOOKING FORWARD TO
*Starting small group at my church in two weeks and meeting new people
*Getting a fresh coat of paint on our house this summer
*Our next trip to Silky's for frozen custard... yum (especially in October for their pumpkin spice)
*When my husband finally gets vacation days so we can take more trips together
*Having a little extra time away from work to concentrate on our family once the baby arrives
*Seeing our embroys on screen for the first time during our upcoming IVF cycle!
*Watching my husband's expression as he holds our baby for the first time
*Not have to constantly think about this IF stuff

8 THINGS I DID YESTERDAY
*Got ready for work. Went to work... nothing out of the ordinary
*Enjoyed lunch at home with my kids (fondly referred to as my puh puhs)
*Made "the" IVF call
*Bought a bottle of my favorite wine, and didn't get carded :D (though my 30 yr old husband does!)
*Worked outside, tidying up the landscaping
*Sat in the grass beside two wild bunnies grazing for food; the CUTEST yardwork I've ever done!
*Shamelessly played Guitar Hero on the Wii w/ my husband
*Watched a little Jon & Kate Plus 8 (so sad for that family! please pray for them)

8 THINGS I WISH I COULD DO
*Take a short retreat to the beach... lake or oceanside, just to get away from it all for a sec
*Buy a new, comfortable couch for relaxing in the family room
*Replace the dated & worn parkay flooring in the upstairs with something more warm & inviting
*Spend less time at work and more time working on our house and "us"
*Invest in a professional camera and polish my skills

Now for all the really important stuff.... ;)
*Buy baby stuff and be an insider in the "mommy club"
*Get pregnant, stay pregnant & give birth to our healthy baby!
*Spend the day feeling more wanted and fulfilled after hearing someone call me "mommy"


8 SHOWS I WATCH
*Lost
*24
*Heros
*The Ellen Show
*Jon & Kate Plus 8
*A Baby Story
*House Hunters
*Planet Earth

8 FAVORITE FRUITS
*Strawberries
*Fuji or Gala Apples
*Bananas
*Fresh Cut Pineapple
*Sweet Red Grapes
*Grapefruit
*In-Season Peaches
*Mango

8 PLACES I'D LIKE TO TRAVEL
*New Zealand
*Brazil
*Hawaii
*The Northeast US Region
*France
*Perú
*South Africa
*Antarctica

8 PLACES I'VE LIVED
*Very small, farm town in Illinois
*An army base in Herlong, California - another small town
*Spent most of my childhood in another small farm town in Illinois
*A nearby small college town in Illinois; both in the dorm and family housing
*A bigger town beside the second small town, with my mother-in-law
*Same bigger town beside second small town, but this time our first tiny apartment
*Move to Missouri, upgrade the apartment
*Move about 15 min away to a house in Missouri; 2 years later we move into our current home

You see... there's this list and WE'RE on it!

My heart was racing. Palms sweaty. Me, my phone and a small notebook stepped away from my desk this afternoon and snuck off to an empty suite where I would make "the" phone call. The call that makes it officially, official.

When the time came, I was happy and fully prepared to relay my CC # to my clinic; today was "down payment day." Refundable if something happens and we need to back out; otherwise it will be applied to the lump sum. Even that I've learned to accept. By now I've come to the realization that no company health insurance will be there for us in our time of need. It's up to us to turn over hard earned cash accumulated over the last year and will be up to us to pay off the remainder owed during the next several months. It's worth it because THIS - August IVF at SIRM St. Louis - is OUR chance. Our long awaited shot at having OUR baby. I was pumped and ready!

What I was not prepared for was what came next.
I was told final payment would be due July 8. I doubted that in and of itself will be a problem, but it did make me curious. The clinic cycle calendar I was given in early January of this year said final payment would be due July 22 - approximately one week prior to starting meds. My next natural thought was... so, is the August cycle date still August 17th (like my previous post stated)?

To which she said "No. No it's not. The new, correct date is now August 3rd." However, even that date isn't when I'll start meds. That date is for the actual retrieval.

Come again. Retrieval on August 3? Yep. "And you'll start meds around July 15th." :-|

Basically what you're telling me is the entire August IVF process is ONE MONTH SOONER than I'd originally expected?! It was then that my blood pressure sky rocketed, a wave of heat came over me and then cold sweats. THIS IS IT! It's really happening! And SOON!

To celebrate I first did what must have looked like the stupidest happy dance ever (good thing I was in a room by myself :P) and then I told a few close friends and relatives. I don't think the high left me for several hours. I'm not sure I've ever felt this type of combined excited and totally scared in my life!!


That's all fine and great, but what's next?
I was told to call Mary on Day 1 of my next cycle. Since I'm a very irregular cycler, I asked what if I didn't start my cycle by a certain date and she said I should e-mail her to find out what to do in that situation. So, that e-mail will go out tonight.

On a related note, Dr. Ahlering just so happened to e-mail me yesterday to see if everything had been addressed properly during our last meeting, which I think means he had an old e-mail of mine in his inbox and noticed he hadn't seen me come up on any of the recent IVF cycles. I'm just glad he saw my name and thought of our situation, especially for being as busy as he is. I did let him know I will be coming his way soon! I feel so fortunate to be able to cycle under his care!

For tonight, I will rest better knowing that somewhere there is a list with OUR name on it, and that list is titled "August IVF". For the time being, that alone makes me beyond happy.