A Journey to Conception

The Tweedles are great! Thanks for your support!

2009-09-17T09:16:00.006-05:00

Sorry for not updating lately... between being tired and busy the days have flown by. Last Thursday was our second ultrasound - the day we would hear our babies heartbeats - was a HUGE milestone in my mind. In looking back, as long of a road as infertility has been, today showed me that pregnancy presents itself with an entirely new set of concerns and worries. I feel blessed to be given even a chance to have those worries and struggles, just as I eventually became grateful for the very same trials we underwent as we were trying to conceive. Which brings me to my next thought...

I've decided it's time to retire this blog. It is devoted to a chapter which, while I'll certainly never forget, be ashamed of, or regret, is still merely the first of many chapters for myself and our family. This has been a wonderful outlet for me to journal the many months of struggle - all of the things I learned, experienced, felt - and also a way for me to hopefully help at least one other person who is going through a similar experience. I was pleasantly surprised by the outpouring of support I received as well... something I really didn't even expect going into this. You have all be so wonderful and your kind words and prayer have meant so much over these past months. Thank you for every bit of care, concern and excitement you've shown.

On that note, I also want to transition this blog to another out of respect. I know that many of you who subscribe, or will come across this in the future, are still on your own journey in TTC and I know how hard it can be to see a "pregnancy" update. There are some days when that wasn't a problem for me personally while we were TTC, but there were other days when I wanted to unsubscribe because it was just too much to handle. I think that so many of us can relate to this awkward time of when an IF friend gets her BFP. Tears of joy and sadness are sometimes almost equal. Please know that I understand that and, honestly, this time, while wonderful, has also been hard for that exact reason. Again, I can't say thank you enough for being there for me all these months.

If you would still like to get updates on how our babies are doing, we invite you to visit our new blog - subscribe or just drop in whenever you feel comfortable. We look forward to journaling about this next chapter of our lives and sharing it with all of our family and friends!

Holy cow. We're having twins!!!!!!!!!!!!!!!!!

2009-09-01T12:58:00.006-05:00

Shock and awe.
Complete and utter amazement.

Is this really happening?!?! Yes, I do believe it is. :-)
Two gestational sacs, two yolk sacs confirmed.
We go in next Thurs, Sept 10 for our second ultrasound and to see the Tweedle's heartbeats!!

GOD IS SO GOOD!!!

Anxiously awaiting our first US!

2009-08-30T22:14:00.001-05:00

Tuesday, Sept 1st, is "the" day!! I am both more excited that I can ever imagine being AND equally just as scared to lay eyes on that ultrasound screen.

Let's not elaborate on that last part though. I mean, really. At this point that does no one a bit of good. I'm staying positive and focused on the fact that a Tweedle, or two, have by now camped out very nicely, deep inside my lining and are leasing my uterus for the next 8+ months. I'm also very excited that the official countdown to holding baby(ies) has already begun!!

What we might see!
On Tuesday, I will be 5 days and 4 weeks along. I believe Dr. Ahlering will be performing an internal ultrasound, so that he can see as many teenie tiny details as possible. Let's face it. At this point, teenie tiny is pretty much all that would even exist. I was amazed that the book my mom just gave me on pregnancy said the baby would be about the size of a the letter "o" in the book, or that of a mustard seed, currently.

I am fascinated about what we might expect to see at this point, so I did a little googling (surprise, surprise :P) and found a smattering of things. As AmericanPregnancy.org states, "The gestational sac(s) is often the first thing that most transvaginal ultrasounds can detect at about 5 weeks. This is seen before a recognizable embryo can be seen. Within this week, at about week 5 ½ to the beginning of the 6th week, a yolk sac can be seen inside the gestational sac. The yolk sac will be the earliest source of nutrients for the developing fetus."

Details on each of these, and more, is outlined below - all taken from this site, which I found to be a wonderful resource! Usually I summarize my sources, but it was all so interesting! (to me anyway!)

Gestational Sac: The gestational sac is the earliest sonographic finding in pregnancy. The gestational sac appears as an echogenic (bright echoes) ring surrounding a sonolucent (clear) center. The gestational sac does not correspond to specific anatomic structures, but is an ultrasonic finding characteristic of early pregnancy. Ectopic pregnancies can also have a gestational sac identified with ultrasound, even though the pregnancy is not within the endometrial cavity. The gestational sac first appears at about 4 weeks gestational age, and grows at a rate of about 1 mm a day through the 9th week of pregnancy.

Twins?: Twins and other multiple gestations can usually be identified fairly early in pregnancy. They may be seen with two separate gestational sacs (diamniotic, dichorionic twins). They may be seen as two fetal poles occupying the same gestational sac (monochorionic twins). It is useful to identify twins early as the prognosis varies, depending on the chorionicity and amnionicity of the twins. A "vanishing twin" occurs in about 20% of twin pregnancies. In these cases, one of the twins fails to grow and thrive. Instead, its development arrests and it is reabsorbed, with no evidence at delivery of the twin pregnancy. It will prove useful to advise patients of this phenomenon who are found to have twins early in pregnancy.

Yolk Sac: As the pregnancy advances, the next structure to become visible to ultrasound is the yolk sac. This is a round, sonolucent structure with a bright rim. The yolk sac first appears during the fifth week of pregnancy and grows to be no larger than 6 mm. Yolk sacs larger than 6 mm are usually indicative of an abnormal pregnancy. Failure to identify (with transvaginal ultrasound) a yolk sac when the gestational sac has grown to 12 mm is also usually indicative of a failed pregnancy. Yolk sacs that are moving within the gestational sac ("floating"), contain echogenic material (rather than sonolucent), or are gross misshapen are ominous findings for the pregnancy.

Fetal Heart Beat: Using endovaginal scanning, fetal cardiac activity is often seen even before a fetal cell mass can be identified. The fetal cardiac muscle begins its' rhythmic contractions, and that rhythmic motion can be seen along the edge of the yolk sac. Initially, the fetal cardiac motion has a slower rate (60-90 BPM), but cardiac rate increases as the fetus develops further. Thus, for these early pregnancies, the actual cardiac rate is less important that its presence or absence. Sometimes, with normal pregnancies, the fetal heartbeat is not visible until a fetal pole of up to 4 mm in length is seen. Failure to identify fetal cardiac activity in a fetus whose overall length is greater than 4 mm is an ominous sign. It can sometimes be difficult identifying a fetal heartbeat from the background movement and maternal pulsations. You may find it useful in these cases to scan with one hand while taking the maternal pulse with the other. This makes it easier to identify sonographic movements that are dyssynchronous with the maternal pulse.

Fetal Pole: A mass of fetal cells, separate from the yolk sac, first becomes apparent on transvaginal ultrasound just after the 6th week of gestation. This mass of cells is known as the fetal pole. It is the fetus in its somite stage. Usually you can identify rhythmic fetal cardiac movement within the fetal pole, although it may need to grow several mm before this is apparent. The fetal pole grows at a rate of about 1 mm a day, starting at the 6th week of gestational age. Thus, a simple way to "date" an early pregnancy is to add the length of the fetus (in mm) to 6 weeks. Using this method, a fetal pole measuring 5 mm would have a gestational age of 6 weeks and 5 days.

Crown Rump Length: This term is borrowed from the early 20th century embryologists who found that preserved specimens of early miscarriages assumed a "sitting in the chair" posture in both formalin and alcohol. This posture made the measurement of head-to-toe length impossible. Instead, they subsituted the head-to-butt length (crown rump length) as a reproducible method of measuring the fetus. Early ultrasonographers used this term (CRL) because early fetuses also adopted the sitting in the chair posture in early pregnancy. Today, the crown rump length is a universally recognized term, very useful for measuring early pregnancies. The CRL is highly reproducible and is the single most accurate measure of gestational age. After 12 weeks, the accuracy of CRL in predicting gestational age diminishes and is replaced by measurement of the fetal biparietal diameter. In at least some respects, the term "crown rump length" is misleading, because during much of the first trimester, there is no fetal crown and no fetal rump to measure.

Symptoms few, but still present
I woke up Friday morning to a bit of spotting. This was the second occurrence of this, actually, but the first time it was so tiny it wasn't worth mentioning. This go-around, I wasn't super freaked out about it, but obviously a little concerned. It was just enough to tinge the Endometrin discharge that occurs, but nothing more, and it didn't continue throughout the day, nor did I experience any serious cramping. Although, I did wake up to some type of cramping in the middle of the night. It's not unusual for me to get up one to two times each night to pee (good thing I can easily fall back to sleep, right now anyway), but this night I woke up to a bit of either cramping or maybe what were slight uterine contractions. Either way, it was somewhat noticeable, but seemed to go away after I went the bathroom and lied back down. As for tonight, I have been having some mild pinching in my uterus again, which I'm taking as a way for the baby(ies) to let me know they're in there, growing away!

Looking forward to delivering some more good news soon! Please pray that our baby(ies) are cooking away and growing at a healthy rate for a very young 5 weeks, 4 days of age! Thanks again, everyone, for the many congrats and well wishes. We have loved each and every one of them and are still so very thankful for all of your kindness!

We're pregnant!!!

2009-08-20T17:44:00.004-05:00

Praise God for all of the wonderful things HE does!

He has big plans for this baby or babies!! The journey we've traveled to get to this point is so fresh and real, but I know there is a reason for it all. I am so very thankful he has heard our prayers and will keep praying for a healthy pregnancy. This is by no means over - we've only just begun another chapter. In fact, I suppose you could say we're not even out of the woods yet with infertility, but I just need to take some time to be thankful for how far we've come and to have faith that He will get us through this next stage safely.

Our 1st beta (5dp6dt) on Tuesday was 21 which was great. At this point, they said they look for it to be 5 or greater. Our second beta (7dp6dt) was today and it was 69!! They were looking for it to at least double, so we're right on track! Our due date, as of now, is April 30, 2010, right near my husband's birthday!

Being truthful, we actually knew we were pregnant yesterday. I know, I know. We weren't going to try and find out until our second beta. And, technically, we didn't. Instead, the information was blurted out without us asking. I had e-mailed the clinic yesterday afternoon asking them if we could call them to get the results today, instead of them call us. I don't think she really read my e-mail, so Jay had to call to get it straightened out. He no more than finished explaining that we wanted to find out "together" and that's why we wanted to call, and she said "your first beta was 21! you're without-a-doubt pregnant!" Yeah, crazy huh! I thought that she might have said something and asked him if she did. He called me on my lunch and said "yeah, she just blurted it out. want to know?"

Want to know? Umm... yeah! (boys and their silly questions!)

Anyway, that's when I lost it. Totally cryin like a baby.

Especially considering that earlier in the day I had been on my clinic's message board, watching the other ladies report their 1st beta and while I was SUPER happy they were getting positives already, I could only think that it made our chances just a wee bit less. I know that it was a dumb thing to think and that I shouldn't have allowed myself to go there, but I guess I couldn't help myself at the time. Needless to say, the fact that we ended up getting the news yesterday after all actually worked out nicely to ease my mind. And, this morning, I did a digital HPT that came out "pregnant"! That REALLY made me happy.

Other than the fact that I wish I could have been with Jay when we got the first bit of news, vs over the phone, I thought it was super cute that, after I got back to work, he had sent me an e-mail that said "my stomach's churning and my hands are shaking... still... hours later". :D I'll never forget the night before yesterday when when we're lying in bed and he says to me, as matter of fact as can be, "I'm ready to be a daddy". So precious! I'm sooo very thankful that is now going to be a reality!

Thank you, thank you for all the prayers. I know God heard each and every one of them. I would be beyond thankful if you continued to pray for a healthy pregnancy. Our first ultrasound will be Tuesday, Sept 1st at 11:30. We should be able to confirm one or two babies at that time, and we might even (if we're lucky) get to hear the heartbeat. Goodness, maybe it will REALLY set in then!

One more thing and them I promise I'm done... :) perhaps it's me making things up, but I swear I've noticed "symptoms", which as been really awesome that I can already connect with our baby(ies) in this way. Here are all of the things that have seemed "different" to me.

Sunday (3dp6dt): Subtle pinches in uterus - 1 x in the afternoon about a series of 6 about 2-3 seconds apart and then again in the evening while lying in bed.

Monday: WAY more hungry than normal. Ha, probably just me on this one, but great that I might already be able to "blame" it on the baby(ies). lol.

Tuesday (5dp6dt): First beta drawn at 8am. Result - 21! Pinches in uterus again when I woke up, this time a bit stronger and more obvious; by the evening, a slight bit of heaviness like AF, but very subtle.

Wednesday: By late afternoon into evening, heaviness like AF coming on - not as strong as a typical AF start, but still similar. Some minor AF-like cramping in the PM too.

Thursday (3dp6dt): Second beta drawn at 8am. Result - 69!!! I am officially 3 weeks and 6 days along (This site is great for figuring that out, by the way. You just enter in your ER date [mine was 8/7/09] and it tells you TONS of stuff). So far, this afternoon I've felt some of the heaviness again and more subtle cramping. Nothing severe, but noticeable.

I know I'm fortunate to have never miscarried (my heart goes out to all that have, I can't even imagine) and that I definitely am looking at these "symptoms" in such a different light. For now, I am going to continue to let myself enjoy each and every thing about this pregnancy and try to stay as positive as possible, for us and for our baby(ies), of course!

We're nearly half way there!

2009-08-16T20:48:00.002-05:00

I have a confession: I've been thinking about my little embabies today. A lot, actually.

How are they? What are the up to? Are they getting enough nutrients? Are they too hot? Too cold? Yes, I am totally "momming" these babies already!

Someone on my clinic's forum posted a little embryo development outline, which I now find super comforting to check every day and to stop and think about the fact that our babies could be doing that very thing. Have a look-see...

This is what happens in a 5 day transfer (dt), though I have a feeling this would still apply to our 6 day transfer, since the development rate is equal to a 5dt.

-1dpt ..embryo is growing and developing
0dpt... Embryo is now a blastocyst
1dpt....Blastocyst hatches out of shell on this day
2dpt...Blastocyst attaches to a site on the uterine lining
3dpt (today).. Implantation begins, as the blastocyst begins to bury in the lining
4dpt...Implantation process continues and morula buries deeper in the lining
5dpt... (1st beta) Morula is completely implanted in the lining and has placenta cells & fetal cells
6dpt...Placenta cells begin to secret HCG in the blood
7dpt...(2nd beta) More HCG is produced as fetus develops

Yes, today our Tweedles were busy implanting! Go babies go!! I was thrilled when I discovered this because this afternoon as I was sitting in the recliner, watching one of the cutest movies ever (Matilda) and trying to catch up on some design work, I swear I felt the most mild pinches in my uterus. About six or so of them within a couple seconds of each other. My heart is so content to connect this with implantation, so I'm not going to fight it!

Besides that, I can't say I've felt any other "symptoms". However, as of today, all of the pain associated with ER is finally gone. Thank goodness! No more soreness when I urinate, walk around or sit. Still a little bloated in the tummy and I still have "love handles". :-) ER caused me to develop a very *nice* figure, very quickly that freaked me out a bit. Let's just say I pretty much looked about 3 months pregnant. I don't mind this at all if we get the news we're praying for on Thursday. Otherwise, me and ol' love handles are going to have to talk. ;-)

As today draws near a close, I feel fortunate to have had almost four days of little stress and to-dos post transfer. My parents and my mother-in-law came to visit on yesterday, which was sooo wonderful. Good to see them all, but also a lifesaver because it kept my mind off things. That can go SUCH a long way in times like these. My hope is that this next week back at work will be a good distration as well. Praying for no stress, but we all know how that goes when you take a few days off.

As always, thank you to everyone for your continued prayers. I find a great deal of comfort in knowing there are so many of you who genuinely care about and are praying for us and these little ones. Many of you, as my Mom reminded me yesterday, who I've never even had the privelage to meet. The fact that you all keep up with our journey to the extent you do is just amazing and extremely appreciated. We need as many cheerleaders as we can get!

Let's go Tweedles! Stick, stick, stick!

No frozen embabies :- (

2009-08-14T11:19:00.002-05:00

We just found out that out of the other 6 embryos that were grade 3 yesterday (which was day 6 of embryo development), NONE of them matured any farther and therefore could not be frozen.

That's right. We had a ridiculous number of eggs retrieved, thought nothing could touch us for a mere moment and now everything is riding on the two embryos that are inside me right now.

I know it only takes one to make a baby. I know that God can work miracles.

I pray that *that* miracle is had in this fresh cycle. My heart is trying to stay positive. I have to be positive. At the same time, I am openly admitting that, in the back of my mind, I wonder if these two little ones will make it, seeing as how all of their other siblings around them didn't. It just isn't a good sign to me that our grade 1, day 5 embie dropped off and all of those other grade 3s didn't perk up. Given our age, this just doesn't rest well with me.

Having said that, I am not going to try to think too hard about it over this next week. There will be plenty of time to over-analyze the "what-went-wrongs" if we find out this cycle didn't work.

Please, please continue to keep us in your prayers. We are far from out of the woods and our hearts are VERY much still wrapped up in this cycle. Wrapped up in the hope that we might be expecting 9 months from now, right around the day my husband was born.

I introduce to you: Our little tweedles!

2009-08-13T13:51:00.012-05:00

We made it!
Two embabies are nested all snuggly inside me
and I couldn't be more happy!!

We got the call this AM telling us we should be there at 10:30. Overall, it was super quick and simple. Undress from the waist down, climb onto the table, legs in stirrups, ultrasound on belly, speculum, catheter, babies in pipette... that's where it got really interesting! We were in awe as we watched Dr. Ahlering find the *perfect* spot in my endometrial lining (which he said looked great) and then a little "woosh!" on the ultrasound screen as he released each one into their new home. It was AMAZING!!

There was a bit of discomfort when he was digging into my lining so that he could burry them nice and deep, but It wasn't any more than a mild period cramp. Perfectly managable and worth it! What was probably the toughest was fighting off the tears as we watched everything unfold. I could feel them welling up, but I refused to get all worked up and not be able to see each and every move he was making on the screen. When we were finished, they moved me to a cot and wheeled me back into the recovery room to lie for 30 minutes, wheeled me out the car and that was that. Transfer was here and gone before we could blink an eye.

The SIRM ladies were so sweet today. Penny, the woman who called us yesterday with our news, called today regarding the transfer and asked how I was doing. You could honestly tell she felt concerned about the whole thing. Then, the woman who wheeled me out the the car gave me a big hug as she told me they were all sending us good thoughts going into next week. I have always felt so good about dealing with that office and, even though during the fertilization process I wish they would have been more forthcoming with info prior to it being requested, they have always been very sensitive, timely and respectful. I'm so happy we decided to go with them and am extremely thankful we have made it this far. Feeling very positive going into our beta countdown!

The final details on the blasts they transfered is that they were both grade 2 blasts - one was fully expanded and the other way in the pre-expansion stage. Of course, in my mind they are perfect in every way - see the top-most pic! Our little "tweedles" as Jay has us referring to them. I just think that's so cute! I've modified the previous names a little though. One is tweedle and the other tweedle dee. I just can't have my kids being referred to as "dum".

I just found some info on our little tweedles (ok ok, embryos) that I thought was very neat. According to this site, "Keeping the embryos in the laboratory for almost a week, allows us to observe them growing through the morula and blastocyst stages. The cells compact together to form a morula, and then begin to pump fluid to the center of the morula forming a cyst. As the cyst inflates with fluid, the cells of the embryo organize themselves into 2 distinct groups. The inner cells are the first cells of the fetus, and the outer cells will become the placenta. (neato!) The size of the embryo increases as more and more fluid is pumped into the cyst, and the blastocyst bursts out of its shell. (Our are expanding and will be getting ready to hatch out of their shell soon!) Once out of the shell, it is ready to implant in the uterus."

The other is a pic of them both nestled tightly in my uterus. This one is just too cool to me! The embies are the little white blobs (as indicated by the arrows) and the dotted line represents my endometrial lining. The lining one is a bit harder for me to wrap my head around, but as Jay said, it's the perspective that's throwing me off. Anyway, if the doc knows what he's seeing, then I belive it!

We are still waiting to hear about the fate of our other embryos. As of this AM, Dr. Ahlering spoke with the embryologist who said that our grade 1 blast did arrest and is no longer with us, exactly what they were thinking might happen because it was compacted, and the others (not sure how many at this point) are still growing . They want to watch them the rest of the day to see how much more they mature. Only then will we know how many, if any, we have to freeze. I am trying not to get my hopes to high, but of course it would be wonderful if we had at least two to freeze. Don't get me wrong though, I am thrilled about today's blasts. To make it to transfer is something I will never take for granted. So many things had to line up perfectly in order to even get to this point! As so many of you have pointed out (thank you so, so much by the way!), the grade of our blasts aren't a very good indicator of the possbilities. It's a human's guesstimation and that's about it. As far as we are concerned, I am pregnant until proven otherwise. That should be more than enough to get me at least half way to my beta ;)

Our first beta (HCG blood draw) is next Tuesday, 8/18; our second which will confirm pregnancy is Thursday, 8/20. At SIRM-St. Louis their practice is to not notify patients of the outcome of the first beta. The thought is that it's not really a perfect, or totally accurate, indicator of a BFP. However, the second is. It should, ideally, double from the first number. The paperwork said that we could inquire about the first number if we wanted to know, but I think we'll probably just wait.

We'll also wait on the HPT tests. I don't want to get my body all tied up in a knot if I can help it. And, really, the second beta is just one week from today. That's really not that long at all. Afterall, we've waited SOOO long to get to this point. In retrospect, this is a piece of cake!

As for me, it's total bedrest. I'm laid up on the couch, laptop and tv close by until mid-day tomorrow. Dr. A said that the minimal discomfort I'm feeling down low still from the ER is normal. My ovary still looks fairly enlarged, but there is no extra cause for OHSS alarm, especially since I'm not really having any other symptoms. It could get a bit worse if we get a BFP, but all is on track for now. I was very happy to hear that.

Now, let the dreams and big plans begin! Trying not to get too excited, of course, but how can you not let yourself be just a *little* bit happy!!

Looks like it will be a day 6 for us...

2009-08-12T14:18:00.005-05:00

Today was the day. I decided to work from home in anticipation they would call with a late morning or early afternoon ET time. Might I add, last night was no fun. Between waking up from the weirdest dreams and feeling jittery awaiting my own personal "Christmas morning", it was restless to say the least. Even still, the day had arrived and I anxiously paced the house with phone in hand.

When the phone rang, I was told our embies were considered "early blasts." Apparently the clinic felt as though we should wait and do a day 6 transfer, vs a day 5 so that they could mature a bit more. What frustrated me was they had no additional details. No idea on the current count or quality. Nothing. I was nervous and a little upset, so Jay said he would call for more info.

I think what came next was so hard for me to handle because on Monday's day 3 fertilization report, we were told "they are still alive and are all grades 1 or 2". Even though, at the time, I didn't believe that wholeheartedly, it was what I hung onto. Maybe there really would still be TONS of them come day 5. We had even started conversations of how that could actually, in a weird way, complicate things because how would they choose what ones were the best or how would we feel to have that many frozen and possibly never be able to transfer them all. That's not something we probably have to be concerned about at this point.

As of this morning, we now have 9 embryos remaining.

1 - grade 1
1 - grade 2
8 - grade 3

I don't think I've cried that much in a long time. It was just shocking to me - the idea that that many had dropped off and the majority were of a lesser quality than 1s & 2s. I was worried that if we waited until day 6, we'd be gambling more than we were gaining. To me, at the time, we already had two that were obvious front-runners and that we should just do a 5-day of the 1 & 2 grades. I was afraid I would be mortified to find out we waited until day 6 and didn't have anything promising to transfer. I would rather have them not make it in me, then to die in the lab at this point in the game. I know that sounds somewhat weird and twisted, but there is a certain degree of connection that I just really need to feel like this cycle was a positive one, even if it doesn't result in a BFP.

Ok, so with those feelings in mind, we agreed it would be nice to know what the advantage would be to waiting one more day. Would we really be gaining more than we'd be risking loosing?

When he called back, they put him on hold and spoke with one of the embryologists. What he said was our grade 1 is currently what they refer to as "compacted" blastocyst. They actually think there is a chance it won't make it because of that, even though it's currently the best quality. As for all of the 3s, they are "expanded" and what they are looking for them to do is to improve over the next day and become 2, or better. I've been reassured by another fellow IVFer (thank you again!) that that very thing can happen. I also know it's possible for day 6 embies to become viable pregnancies. My friend with twins (lol. yes, I keep mentioning her), just transferred two grade 2s (I believe it was) on day 6 and both took beautifully. These women are my inspiration and my hope. Thank you girls!

After all of the drama this morning, I do feel better now that we know the facts. As the day progresses, I am becoming a bit more at ease. I know in my heart everything is out of our hands and that God is in control. We just have to have faith that everything will work out and we'll be at a good place for tomorrow's transfer. Ultimately, it would be fantastic to have additional blasts to freeze, but at this point, my biggest concern is to complete this cycle.

Best get caught up on all the work I've neglected so far today. I'm going to attempt to distract myself tonight as well. The wait really is almost the worst part.

Thanks everyone for continuing to follow our progress and for all your thoughts and prayers as we go into tomorrow's transfer. I'll update as soon as I hear more!

Our Embryos: Alive, Healthy & Set for Day 5 Transfer!

2009-08-10T22:03:00.009-05:00

We got our 3-day fertilization report this morning. Honestly, we didn't learn too much new I suppose. They reiterated that we will be doing a 5-day transfer on Wednesday. When I asked for more details about how our "sports team" was doing, she actually said she didn't count them because there were so many! :P Part of me laughed a little, and the other part of me wished she had just because. I mean, yeah, so there are 29 and, yes, that's double what most couples have, but any soon-to-be mommy is curious as to how her children are doing, even if there are a gazillion of them. I followed up by saying, "I anticipated that some of them would begin to drop off by day 3... is that the case, or are there still about 29?" To which she said, "Yes, I think there are about 29 still." Honestly, I don't think she knew, but I didn't see any point in pushing it.

She did say that all of them were either a grade 1 or 2, so that's good. While I was beyond happy to hear that, I am realistically taking that with a grain of salt, only because if she didn't even count them, how would she really know if "all" of them were a 1 or 2. What I'm guessing happened was they put (hopefully at least) several under the microscope, saw that type of quality and that satisfied them for now. The fact that there are still tons alive and a handful that are of really good quality was probably enough tell us we will wait until day 5. I can handle that - that's fair. Of course, in the back of my mind, I sit here and wonder exactly how they really are doing. I know in my heart I'll never get to see all of their tiny faces, but still, a mother will always paint this perfect picture in her mind.

For those curious about the various grades and or stages of embryo development in IVF, I found these links to be helpful:

The First Days of Fertilization & Embryo Grades - http://www.sharedjourney.com/articles/Time.html
Blastocysts - http://www.ivf.com/blastocyst.html
Embryo Development - http://www.ivf.net/ivf/embryo_development-o2591.html

Tonight we did our second PIO shot. This time it was the left upper cheek/hip. I numbed that thing with cold packs (yes, it takes multiple, alternating packs to do the trick) for an hour before hand. At this point, we're not taking any chances. The good thing is that, again, I'm happy to report it didn't really hurt at all. Amazing! I know that one of these days that might be different, but we have Sharpie markered plus signs on each cheek which will stay there until we end our PIO injections. I told you we're not taking any chances, didn't I :) I will say, that today, the first cheek didn't hurt any longer (never did too awful much anyway), but today I did notice a funny little nerve sensation shoot down my butt when I touched another area of my body. I can only hope we're not doing permanent damage here people!

Again, all in the name of baby... or should I say "babies". I've been keeping up with the July St. Louis SIRM cycle and from what I can tell, in just the ladies who actually post to that site (maybe represents half, if that), FOUR women are pregnant with twins! One being my friend Jenny that I mentioned being pregnant a few posts ago. Still so very happy for her!

Ah, and on that, I will go to bed, having some sort of retrieval/transfer/pregnancy dream I'm sure. It's been consuming my nights lately! I think it has taken over Jay's too. Last night we both woke up around 1am.... I get up to go the bathroom and come back to bed to be informed that we will be referring to the two embryos that get transferred on Wednesday as "Tweedle-dee and Tweedle-dum". I really don't even remember his rationale to tell you the truth. I was too busy chuckling! My response "I don't know how I feel about referring to one of them as "dum", dear." lol. But, whatever. I'll let him name the embryos and then I'll get to have the final say on the real names :D And last, but not least, he, for the first time, throws out two girls names and wanted to know if I liked them or not. "Baby, it's 1am in the morning. You're going to have to write them down and we'll talk about them when the time comes." I can't say I was a huge fan of the names, personally, but I ADORED that his mind was running circles about that stuff at 1am. So cute! He's gonna be a great daddy!!

PS. Thanks everyone for your sweet comments and continued thoughts and prayers! I'll never tire of them!

Our Fertilization Report - God is so Good!!

2009-08-08T20:24:00.003-05:00

Out of the 43 (apparently it was 43, not 42) that were retrieved...

31 were mature
29 fertilized

We have 29 embabies right now. When I put it that way, it blows my mind to no end. I think that everyone at the clinic was surprised too. I was called by two different ladies, one of which led by saying "I have amazing news for you". Yes, amazing indeed. At this point, I cannot explain it, or even understand it. I just have to give all the credit to God, for the hand he's had on us during this process. He knows how much this means to us and I know he is at work in our lives. That, I have no doubt about. Even still, God, I'm sorry if I underestimated you at any point, but 29?!? :)

Of course I called and shared the news with my Mom, to which she said that my Grandma, the women who we always comment has a "hotline to heaven" was apparently praying that we would get 25. This coming from someone who hasn't a clue about the average number to even pray for. Out of all numbers, she picked that one. lol. So cute and ambitious. I am going to die if the final count at day 5 is 25. That would be beyond amazing. I asked that my Mom relay to her that people are impressed to get numbers in the high teens, or low twenties. Maybe that's a detail I should have shared before she started praying. :D

While on the phone, my Mom told my Dad the news by starting off saying I AM a "Fertile Myrtle" after all, to which my Dad says that he actually had a Grandma that was named Myrtle who had twelve kids. Go figure. I can't say we're shooting for 12, but surely having a Fertile Myrtle in the fam has to be a good omen, if nothing else.

Whew. Talk about some kinda Saturday. I should add that, today, I've actually been feeling worse than yesterday. Yesterday, the pain was mostly right where my ovary must be (pretty low and two the left). Any pain was nearly relieved by going pee, which was nice. Last night, I woke up about every 40 minutes starting at 2:30 to go relieve myself. Who thought there was that much in me. The only thing that stinks about going to the ladies room is that each time I go, it hurts. A cross between when I had my abdominal surgery all those years ago and what it feels like to pee during a UTI. So that's fun.

At this point, I'm trying to take the pain in strides. It's still bearable, but a bit worrisome, admittedly, because now the tenderness has risen all the way up slightly above my belly button. My abdomen feels VERY bloated (uncomfortably so) and hurts when you push on it anywhere in that area. I've also found myself walking slightly bent and on my tip toes from time to time to help relieve the pain. And SLOWLY! For goodness sake, heaven forbid I make a quick move and - BAM! Tons of pain.

At this point, all of this is leading me to be decently concerned about OHSS. I wasn't alerted of this at the clinic, but I have read about and heard about it from friends. While I wasn't totally oblivious about this possibility going into it, I guess I expected them to tell me "be on the lookout". But they haven't. Not sure if that means they honestly weren't concerned, or if they just neglected to mention it. I never did find out what my final E2 number was on Wednesday; as of Mon & Tues, they weren't dangerously high. Some other women I'm cycling with right now had numbers in the 6,000/7,000 range. Mine was low 3,000. So, from what I know, that's good. However, the fact that they aspirated that MANY follicles is something that ups the chances of OHSS, I do believe. This link did a good job of explaining the reason why... I'm assuming it's correct.

As a result, I'm having pains and now I'm unsure of when I should really start becoming super concerned. It seems like if my ribs are extended, I start throwing up, I gain weight fast, or stop urinating what I'm putting in, I should begin to get really concerned. I don't feel like I'm totally there, but am probably showing some signs of something mild. For peace of mind, we called the after-hours line at SIRM this evening and were told it sounds like what I'm experiencing is fairly expected, but that yes, we should keep an eye on it. She said that after ER, the now empty follicles actually fill back up with blood which causes some of the pain and bloating the day after and that signs of severe OHSS don't typically show up until close to a week after ER. I've also read that for those who get a BFP, their OHSS can be exacerbated.

Needless to say, I'm not looking forward to trying to sleep tonight. The idea of laying down that much and getting up over and over just isn't appealing. As for coping, this site suggests (like many others) lots of fluids and gentle exercise like walking to keep the blood flowing and kidneys working. I've also been keeping a heating pad on my tummy, which I suppose isn't harmful. It does a pretty good job of soothing it somewhat. Lately, I've found that it actually feels better to sit upright, rather than lie down for a long length of time. With all those things in mind, we're just taking hour by hour, hoping it gets a bit better by later tomorrow in time for work on Monday. Of course, in the back of my mind, I'm really wanting to make sure it's better by transfer, most likely on Wednesday or Thursday. It would be sad if it had to be canceled because of it, so please pray that we can avoid that.

What lies ahead...
Our next fertilization report comes on Monday. That's typically the day they make the call to do a 3-day transfer, or wait it out until day 5. When I talked to our coordinator today, she said that with our high embryo count, she knows confidently we'll be waiting until day 5. In the back of my mind, though she didn't say this, I almost wonder if they'll also be considering a day 6. In either case, that would put transfer on either Wednesday or Thursday of this next week. Wow. Of this week! Still seems so surreal!

Prayers are being heard!
Thanks again to everyone who is following our progress. Your comments and support means so much. Your prayers are unbelievable! Looking forward to sharing SUPER good news with you over the next couple weeks ;-)

One PIO shot down, many more to go!

2009-08-08T20:15:00.003-05:00

Last night was our first evil, dreaded progesterone in oil shot. I had really started to build up a lot of anxiety about this part of the cycle. I thought for a second I had mustered up the confidence to do it, but last minute, that backfired. As we were coming up with our game plan, I started to feel light-headed and nauseous.

In the end, I felt better knowing we'd done lots of reading online for various tips. I knew that we were prepping as much as we could and that we just had to go for it. Our approach is outlined below. I must give the disclaimer that I am not a nurse, nor claim to be one. If you are reading this and administering PIO, please consult your clinic and/or pharmacy for full, proper instructions.

Pick a time in the PM, that's not too close to bedtime. You'll see why below.

Numb area with an icepack before hand to ease the stick. I used those smaller freeze packs you put in lunches. Just stuck it under my pants (yes, I'll be sure to wash it before our next picnic) and walked around, replacing it with a new one every 20 minutes or so for about an hour. Looking back, that was probably a little excessive, but I my thought was I'd rather err on the safe side the first time around.

Identify the correct area on the cheek/hip to inject. A proper injection site, from what I've read and been told by our nurse, is extremely important. The upper 1/4 quadrant of the toosh, to be exact. We were specifically told it shouldn't really be "in the butt" at all. If you go too low, you're at risk for hitting your sciatic nerve, which can cause semi-permanent nerve damage and I'm sure hurt like a mutha. To find the right spot, we drew a horizontal line at my crack over one cheek, and then split that cheek vertically down the center, which allowed us to identify the upper 1/4 quad.

Take all of the weight off the muscle you're injecting into. I recommend lying face down. The more tense, the more it will hurt and the harder it will be for the PIO to disperse into the area. We did a trial to see what would work best. I tried standing and bending over slightly with one leg lose. I thought, at first, I would like that more because it would give me some sense of control, vs. lying face down. But, when I lied down on the couch, Jay was able to pinch a larger area of muscle and it really did seem to be considerably more relaxed. At this point I cried and literally cried out to God "Please, please help me!" I thought I was going to be able to hold it together, but right as he was doing it, I got so scared. :) Even still, we pushed on!

Pinch a good chunk of skin and insert with a swift, dark like motion. Stick it in only as far as you think you need, simply to ease some of the pain... For us, since my butt is on the smaller side, we probably don't need to put it in all the way (a whopping 1 1/2 inches!) in order to hit muscle. Obviously, this wouldn't work for everyone. They tell you to test, anyway, to make sure you're in muscle, so our thought was we'll be able to know for sure by doing the test. The test I'm speaking of is, after you stick it in, you're supposed to pull back every so slightly on the trigger. If there is resistance, and no blood coming back through into the syringe, you know you've hit muscle. If there IS blood, you're supposed to pull it out, replace the needle and re-stick. Otherwise, you will be injecting PIO into an artery. Not good. What wasn't too bad though, was the injection itself. After working myself up to tears, once the needle was in, I was like "it's ok, it's ok, it doesn't hurt" just so he knew he wasn't hurting me. Half of this, I feel like, was him being able to actually give the injection to me. I, for one, am not sure that I could have done it. I am so proud of him!! After all of that worrying, it really wasn't a big deal for either of us.

After sticking, hold still while the med is being administered. What a concept, huh. :) After he stuck me, which I barely felt most likely because of the icing technique, I could still feel the presence of the needle, but it didn't hurt at all. This is good, seeing as how it takes a bit of time to inject all of the PIO into the muscle due to the thickness of the solution. We are using the Watson brand PIO in sesame oil (got ours from IVP Care), which I've read others have had a better experience with. Who knows how much truth there is to that.

It is over!! Now celebrate. I told Jay "this was our Mt. Everest!" Some people jump out of planes or take life-endangering hikes to the highest points of the earth - we give/get PIO shots. :)

Massage, heat, walk around, massage heat and repeat! Ok, so maybe we didn't do all of that AND repeat, but you get the idea. The part, I'm told, of getting it not to hurt as bad the next day, is to do all of these things as much as you can. That's why you should chose a time in the evening that allows for all of this, vs doing it right before bed. Our time is 8ish.

Today, the area is sore, but it's not super bad to walk on; it mostly hurts if something pushes into it. My hope is that between alternating cheeks and our injection being only every three days (can't believe I just said "only" to that. lol), that it will heal the next time we get to the same spot. Only time will tell! I am going to declare that I hope we have to stay on them because that means we'll be pregnant! I think we do them through the first trimester. Yikes!

Egg Retrieval Day: 15+? Try 43!!

2009-08-07T15:20:00.005-05:00

No, that's not a typo, and no I'm not dyslexic.

They got 43 eggs!

I am totally blown away by that. Is there such thing as too many?!? (Being half serious about that.) This ovary is like the little engine that could. :)

I am super curious to see what tomorrow's mature count and fertilization report brings. Right now I can't even wrap my head around it. What if we have fertilization in the upper 20s even? Could we realistically expect to have embryos in the high teens? That would be insane. A blessing, but totally unbelievable!

As far as the procedure itself, it wasn't bad at all. We arrived right on time and I was immediately taken back to get dressed (gotta love those one-size-fits all gowns), the IV was started, then they gave us our new calendar and instructions for after the procedure (what to do, not to do, etc) and showed us how to do the PIO IM shots.

Then, when they were ready for me, they had me walk back to the procedure room, undo the back of my gown and put my legs in the holders (always a good time). At that time they administered the anesthesia through the existing IV... it wasn't but a couple minutes and the everything got blurry and after that I don't really remember anything until I was back in the recovery area. Actually, now that I think about it, I never even saw Dr. Ahlering. Funny stuff! I think the entire ER itself took maybe 20 minutes or so. I did remember feeling a slight bit of pain during the procedure, but it was bearable and I just went back to sleep. After that we spent about another 20 minutes in the recovery area before they wheeled me out to the car. That was it. Pretty darn simple.

Can I just say how much I love my husband. He's been so stinkin sweet to me! He stopped to get me a drink on the way home, dropped by the chocolate store to get some fresh hand-dipped chocolate strawberries, blueberries and rasberries :) (totally his idea!) and lunch from the Bread Co. And, about 10 minutes ago, two vases of fresh flowers arrived at the house. Yeah, he's a keeper ;-)

Side effect to speak of... An hour or so after the procedure (at home), after eating a little bread and drinking some water, I started feeling nauseous and threw up. Twice. That was fun. I'm also bleeding a decent amount, which they said could happen, and a bit of cramping/soreness. I've found that if I lie down it's much better, so I'll be couching it the rest of the day.

That is, until the dreaded PIO shots. Wish us luck with those. Pray even, because I am quite anxious about the whole thing. If all else fails, it'll be "no pain, no gain" that I'll be cheering over and over. :)

I'm triggered and ready for Friday!!!

2009-08-05T19:35:00.003-05:00

It's is so totally official now! Yay!!

Today's US was phenomenal. Dr. Alhering was smiling from the minute we started. He immediately saw lots of follicles and started measuring the big ones.

16
18
16
22
18
and so on...

At this point, he actually says that he's not going to even bother calling them all out. He already sees exactly what he likes. There are many others that, he said, are also within range and will hold eggs as well, which is great, but there are plenty of big ones too which is what they like to confirm.

He reiterated that my estradiol numbers do in fact look great (exactly what you said Fran!) - they are high, but not too high, and they aren't continuing to go sky high, so that's what they like to see. How nice, because I had to go in to get blood work AGAIN this morning and it sucked. They stuck me in the same vein they did yesterday (said it actually looked better than the arm they did the day before) and gosh darn it if it didn't hurt. I was dreading slightly what they might do tomorrow. Ah, not to worry. It was minor to begin with and now it's not even a concern!

As he was wrapping up with the US, he said, we'll definitely be doing a Friday ER and we can definitely expect to get 15+ eggs at retrieval!!! It just doesn't get better than that!! I couldn't stop smiling the entire time he doing the US. And then, after leaving the office, total permagrin the rest of the afternoon. I screamed in the car. I, of course, called Jay and then my Mom. I am so very thankful and blessed by every milestone we overcome in this. God is so good!

Looking back, today was pretty surreal. Still is. It's so funny how you envision something working out in your head and then, when the time comes, it just feels a lot different than how you imagined. I know that's not a new concept, but it definitely describes my day and many of the steps in our IVF leading to this point.

Before I left the office, I was given a set of instructions for tonight. Trigger and start the ZPack basically. And, I was also given instructions for ER - what not to do, what to do. I wasn't told exactly when those two things would happen though. That, they said, they would call me about later in the afternoon.

Then, just as planned, we got the call:

Peggy said: "You have come about as close as you can to winning the lottery!"

Your trigger will be at exactly 6:45 pm tonight (Wednesday)
Egg Retrieval will be at 8:45 am on Friday

This evening, after work, what did I do? Ran home, decided to go out for a celebratory all-you-can-eat Chinese dinner with my husband, drove super fast back to my office to pick up our latest set of instructions, drove back, threw the car into park and at precisely 6:45pm on the dot received my final tummy shot of Ovidrel (HCG). For a split second, I was like "it did say 6:45, right?!?" I just hate how cruel the mind can be. What a awful, awful trick.

And There you have it. I'm all triggered up and waiting for the big day!! Please pray that these eggies stay where they belong, ripen fully and beautifully right at picking time and that our ER goes smoothly and recovery is a breeze.

Whew! Good thing there's not a limit on the amount of things you can pray about. :)

Tomorrow is another big day!

2009-08-04T21:14:00.004-05:00

Our newest set of instructions came in today around noon.

Tonight
Stim again - this time Follistim 50 IU

Tomorrow
Lupron in the AM
Oral Meds
Another E2 blood draw before 8 am
US appt at 1 pm

At this rate, I’d say that we’ll, more than likely, have a Saturday egg retrieval (ER), since they’re still having me stim tonight, but maybe that’s too much to assume. Either way, it makes no difference to me. Any day is a good day for ER!!

I did ask how my E2 numbers came out and was told they look good: "we just want to bump up the follicles a bit more". She gave the numbers to me - 3,230 and 3,124 - but I’m not sure which one she said was Monday and which was today (sheesh). I am reading online and it sounds like it’s plausible the lower number is today and that it’s ok that it’s lower because they are controlling it by the level of stims they’re giving me (stims went down slightly and so didn’t the E2, is the idea). If the E2 goes down on its own though at this stage, it sounds like that’s not a good thing, but I don’t think that’s what’s happening here. Here is the reference I used to come to this conclusion. Surprisingly, there's not a whole lot of info on estradiol numbers as it relates to IVF circulating out on the net. What I got from SIRM regarding my estradiol was, when I asked her if the numbers are on track, and she said, yes, the numbers look good. So there you have it. I'm not really going to think to hard about it and just trust they know what they're doing. My, my how I am changing. :)

In other related news, it officially hurts to walk too fast. I knew that day would come soon. And I have been visiting the ladies room WAY more than I'd care to, but darn it if all that extra pressure just adds to the discomfort, so in I go, and back again I return about 30-40 minutes later. You'd think I would have stopped or lowered my liquid intake by now, but I've heard that extra fluid is good for growing follicles. Maybe it's an old infertile wives tale, but it seems like it would make good sense, so I've been downing as much as I can.

Ok, and yes, I know this is TMI, but gosh darn it, who cares. This is my blog! You know how they say you're supposed to get EWCM during your most fertile phase (i.e. right around ovulation). Well my silly little body must think I am getting ready to have the ovulation of a lifetime (which I guess is actually correct!) because ever since Saturday, I have had more EWCM than I've ever had in any cycle in my life. Hahaa! I'm going to chalk that up as a good thing. That maybe these hormones aren't too drastically different from what my own body would produce, if it was, say "normal". :)

Ok, I've had a good laugh, at my own expense, and my belly is poking out like I'm about 3 months along (from what I've heard anyway), so I'm going to think about retiring early for the night. You know... a little extra beauty sleep for these super fantastic eggs that are cooking, just waiting to break out and join their other half in a few short days.

Will update again tomorrow, and this time, will hopefully have a date/time for trigger & ER!

Who needs two of 'em anyways? :-D

2009-08-03T21:47:00.002-05:00

First and foremost, thanks everyone for your sweet comments and for all the support and prayers. We wouldn't be making it through this without them!

Before I get on to the great news about our US today, I'll mention that our second, and looks to be last, Luveris (LH) injection last night went MUCH better than the first night. Thank goodness. By the end of yesterday, I was definitely feeling quite tender and bloated. I weighed myself right before bed and I had gained about 4 lbs! Luckily when I did it again this morning, most of that must have been water weight, because I was back down to only about 1lb from where I had been. Whew! Don't need any early signs of OHSS!

So... onto the good stuff: Our CD 9 US Results!
Can I just say that I'm oh so proud of my single, solitary ovary (and what remains of my right). The tender little thing is definitely doing double duty. Thank you ovary! In a nutshell, Dr. A thinks we should expect to get in the upper teens for retrieval count. Yay, Yay, YAY!!

In he walked with a nurse - I just knew that meant business! He cut right to the chase and started measuring all the ones worth measuring (mentioning there were still a decent amount of smaller ones that we wouldn't count). I'll be real honest, I started counting up in my head each one as he called out "12 mm", "14", "16"... but I lost track right when it mattered the most. I knew I should have pulled out the pen and paper. I did, however, play back the voice recorder I took along and I'm pretty sure the below is fairly accurate.

So, as of CD 9, here is our count, according to measurement:
12mm - 8
13mm - 8
14mm - 5
15mm - 1
16mm - 2
18mm - 1

He summed up the scan by stating most are currently in the 12-14 range, with a couple outliers and that we won't need much additional stim; tonight he had me do 75 IU, with the idea of keeping them going and nudging the size up a bit. As of my appt this afternoon, they still hadn't received my estradiol level from the lab. He said they will look closely at that when they get the results and want me to go for another E2 draw tomorrow AM.

As for my uterine lining, it is measuring at 12, which he said looks very nice. This site states, "There is some ongoing debate as to "how thin is too thin", as well as to "how thick is too thick". In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so might possibly reduce chances for a successful pregnancy. During IVF treatment, the uterine lining starts at about 3mm thick at the end of the menstrual period. After the estrogen levels rise sufficiently, the lining of the uterus then thickens by about 1mm each day during IVF."

I have another scan for Wednesday at 1pm to assess where things are at. For some reason he felt compelled enough to say that he has a feeling ER will be Saturday, vs Friday, and that they'll have "no problem getting upper teens on ER day". Yippee!!! Go ovary go!!

I am supposed to hear back from their office by tomorrow afternoon regarding how my estradiol numbers are looking (from today and then again tomorrow). In going back and rereading a passage from the book "The A.R.T of Making Babies", by Dr. Geoffrey Sher, it appears as though "a woman who is optimally stimulate will, in our opinion, usually demonstrate a continuing rise or at least maintain a sustained level of blood estradiol while receiving gonadotrophins. This would confirm that the follicles and eggs are continuing to develop optimally. It has been demonstrated that a large drop in the blood estradiol level after gonadotrophins are discontinued is often associated with poor-quality eggs." With that said, I guess we won't really know the latter (because I'm not off the stims yet), but we should be looking for the numbers to be high or slowly climbing still. At least that is how it sounds.

FWIW, his book also states, "The optimum time for ER is about 34-36 hours after the final gonadotrophins injection is administered. (aka trigger shot). The average number of eggs retrieved varies from program to program. We average between 8 and 15 eggs per retrieval attempt, and can usually successfully fertilize about 70-80% of the mature eggs retrieved." He goes on to say "while the level of hormones and the US findings roughly correlate with the chances of retrieving a large number of eggs, this doesn't always hold true. Sometimes the follicles don't want to give up the eggs, or scar tissue may prevent us from reaching the ovary. And just because we retrieve an egg doesn't mean it will fertilize or that a fertilized egg will produce a "good-quality embryo". If we get a lot of eggs, that's great. I always emphasize that we have had many pregnancies result from the transfer of just one embryo." It'd been awhile since I read that and I feel like now it's a good overview for what's to come.

Ok, back to my E2 levels... depending on how those look, it could change when my trigger shot is or if we do another night of stims, which he didn't really mention today, but I suppose isn't out of the realm of possibilities. When I was making my appt for Wednesday afternoon, I was thinking to myself, "but what if I end up triggering before my 1pm Wed appt?" I asked the woman at the desk that and she said that if I wasn't given specific instruction today, that it wasn't a concern (timing of the two I guess). So, we'll see what happens!

Sorry this post is all over the place. I am so freakin excited that my mind is just racing!! Thanks again to everyone who is following our progress - for your prayers, words of encouragement and good vibes! I'm not too proud to say, keep them coming :D

Still stimming, eagerly awaiting our next scan!

2009-08-02T16:07:00.001-05:00

Hooray for the weekend! And for the fact that Friday marked exactly one week, or right around there, until egg retrieval. Time has F-L-O-W-N by!

We had our second US scan on Friday
And thank goodness! It was hard to tell at first what Dr. Ahlering was thinking... we were all looking at the monitor, seeing lots of follicles, but his reaction just wasn't what I thought it would be. That's because I think he expected to see something other than what was there. This time around, he measured some of them, with the biggest coming in around 11 or 12 mm. He said that, come next week, we'll be looking for them to be anywhere from 16-20 mm in size. He did point out others that were there, but weren't as far along in size yet. In total, he said I had around 12+ follicles, but I didn't really get the impression that he counted one by one.

He said that, overall, there really isn't much to say at this point. Monday is when we'll have our next scan and, at that time, is when he'll be counting, measuring and deciding where I'm at in terms of meds and such. Before he left the room he also said my uterine lining is looking good and that he was going to take a peek at my calendar and check to see if anything needs to be adjusted.

With that under our belt, I went back into the waiting room and Jay went to "produce" (hahaa! I love it when our coordinator calls it that) his back-up sample. As I was waiting, a friend who's doing her cycle in September came in the office. Such a small world! We chatted for awhile and then before long, out came Peggy with a new calendar in hand.

Dr. A decided to change our stim dosage again!
We're back up to practically where we were when we first started. Friday was supposed to be the first day of our stims going down in dosage, but he kept us at 225 every day except the last day. That day we go down to 150 IU. I guess that while things looked good, they didn't look as good as he thought they could. Jay's theory is that he wants to try and get the other follicles that aren't quite as mature yet to catch up. I've heard follicles do mature at different rates, so this definitely seems logical, but I'm sure there is more to know than that, so this is one area I definitely want to do some more reading on over the weekend.

In the end, I'm glad we went yesterday. I would hate to have just waited until Monday to possibly find out that the one ovary wasn't producing as much as we hoped... though I think that 12+ for one ovary is pretty good. The thing is, at SIRM, they don't typically see patients until the Monday before ER, during stimming. We were seen only because we asked specifically, due to concerns we have since I have only one ovary. The good thing is that when we expressed a concern in our calendar review, there was no hesitation whatsoever to add in the extra appointment. Thankfully we asked! It definitely made me feel better going into the weekend knowing what is going on down there.

Thursday night we did our first injection of LH - Luveris
Boy did that suck. The needle was the same as the micro-fine you use for Lupron, but the medication itself stung and had a slight burning sensation the entire time he was injecting it. I, being the one pinching my skin, had a really hard time cooperating. When something stings like a bee you want to react and pull away from it, not stand there and take it. I accidentally moved a little just as we were finishing and looked down to see my skin had instantly swollen a semi-hard bulge appeard. It took about 15 minutes for the lump to go away, even with a hot washcloth over top.

Since we elected to do that first, we had to follow it up with a separate Follistim. The last time we did this, the 225 IU seemed to pool up under my the surface of my skin for awhile. It didn't hurt, but it was sorta freaky! Last night it wasn't near as noticeable and the injection itself went pretty smooth, thankfully. Tonight we'll do another vial of Luveris, perhaps our last (let's hope!). This morning it occurred to me that we're running out of spots to give injections, or at least it feels like it anyway. I do not, however, have any desire to explore giving them in my thigh or the back of my arm, so we'll just have to make do!

Tomorrow is CD 9: That means another E2 check and US
I am really anxious to see what this ovary has been up to. On Thursday I noticed some light twinges, on Friday during the US I could tell things were definitely more tender and yesterday it was pretty obvious that I have started gaining a little extra fluff in my tummy. Today I'm markedly more sore when I sit or put pressure on my stomach. "Just how big are those things getting?!" is all I can think. So we wait with lots of anticipation. Depending on what Dr. Ahlering sees determines if I'll stay on stims longer, when my next appointment will be and even when he thinks I might do the trigger shot prior to ER. Speaking of trigger shot, I just realized last night that I'm not sure if that injection has been ordered yet or not, or what injection I'll even be doing to trigger. All it states on my current calendar is "HCG shot" and there are several different types. So, that will for sure be asked tomorrow.

This has been a wonderful weekend full of things-not-planned: lazy days of board games, movies, afternoon naps and snuggling with the three loves of my life (my pups and my husband, of course). It has been VERY stress-free and a much needed way to begin a new week full of lots of things yet to be determined. And, of course, there have been tons of things on my mind. Each night before I drift of to sleep I've seemed to grasp onto some scenario surrounding IVF or pregnancy and imagine us in the middle of it all. Your mind races when there is so much that lies ahead! Things like the excitement of getting our final beta in just a few short weeks and those darn PIO intramuscular shots that I have been sorely dreading, both of which deserve their own post. More to come!

And the verdict is in...

2009-07-28T21:40:00.002-05:00

Regarding the nasty cortisone issue: Our cycle is still a go!! The plan is that my husband is will go in this Friday, a week before retrieval, and produce a specimen, which they'll freeze, as a back-up to the second specimen he'll give on retrieval day.

How did we arrive at that conclusion?
Well, I posted a question to the SIRM forums (totally love that place), and four other RE's gave me their take. The opinions really are pretty varied, which is crazy in an of itself, but it just goes to show you that one good doctor and another good doctor can still have a different take on things. Makes me really value second opinions all that much more. Anyway, their replies were:

The injection of steroids will have no short term ill effects. Don't worry!
Good luck! Geoff Sher

His count is low to start with and any steriod treatment can negatively affect or change hormone release and related events such as sperm and testosterone production. He can collect once to see what the parameters are and then decide whether to move forward or not. Good luck.
Aykut Bayrak, MD

Unlikely to negatively affect sperm, so I wouldnt worry.
Drew Tortoriello, MD

Dear Cathy,
This would be a great question for you to direct to your RE. In most situations, this sort of a treatment should have no impact upon your cycle. If there is a concern however your center should be able to freeze a back up sperm specimen or two now for you to use in your upcoming cycle. That might give you an additional peace-of-mind which can be important in minimizing your stress hormone level.
Best thoughts, ~Robert; Robert Greene, MD

I called my clinic this AM and ended up leaving an embarrassingly long voicemail with Peggy, our IVF coordinator. She called several hours later and I was so totally impressed. It was clear that she had listened to my entire message, even the part where I mentioned I posed this question to the doctors at other SIRM clinics and had received mixed replies. She said that she went and spoke directly with one of their andrologists on staff to get her take.

The andrologist said that while, yes, this type of steroid can possibly affect hormones like testosterone, if it was going to have an impact, it likely wouldn't show itself in this upcoming cycle because the sperm that will be produced have already been recruited several weeks before now. If we were to see an effect, it would be a couple months from now, if it does happen. She said that knowing my husband has had a somewhat lower count before, if it would make us feel more comfortable, we could do two specimens - one this week, frozen and ready to go as a back-up if the specimen he produces in two weeks at retrieval isn't sufficient in quantity. I'm sure this will cost us a bit more money, but, for peace of mind sake, we've decided to go forward with this plan.

I know I won't be happy with myself if I don't put this behind me as we continue to move forward. Luckily, we had the chance to sit down tonight and talk about what happened yesterday. Ok, it was more me just getting stuff off of my chest, but he was great. He listened and really let me just say what I needed to say. There are many times in a marriage when I feel that you just have to talk about the "moral of the story" when a given issue arises. It was less that this happened specifically, and more that I just want him to think more first before making such a huge decision. A decision that will impact both of us. I never want to put myself in a position where I would be apt to blame him for something, nor do I want him to ever be in a position where he feels a huge sense of guilt for something that happens.

After 8.5 years of marriage, I put good communication at the tip top of my list on the things that have kept our relationship so strong. I am always thankful each and every time we're able to reconnect on issues and move foward, growing from the past.

Hooray for Follistim
Today marked the start of 6 evenings of Follistim. I'm not too keen on trying out the top of my thigh or my sholder as an injection site, so all around the belly button we go! I did notice the Follistim was a bit more "stingy" than the Lupron. Most likely because there's just more of it that goes into my skin. All in all, still very bearable. Now it's time to see what this ovary can do! I'll go in this Friday to have my second US. This appt was something that wasn't supposed to be a part of the original protocol, but we wanted to be checked on extra time during stims since I have PCOS and the one ovary. Really rather not take too many extra chances if we can help it. Hopefully this will give us some extra peace of mind going into the weekend, which will be nice. I can't wait to see how everything looks!

Please God, don't let this impact our cycle

2009-07-27T20:51:00.003-05:00

I couldn't help it. My heart sank tonight.
I was furious and then I cried. It wasn't pretty.

Going into the evening, I was still on a high after learning a good friend who is doing IVF in July with my same doctor got her second beta back. She is pregnant!! And from the looks of it, it just might be twins! So, Congrats Jenny!! So unbelievably excited for you.

With all of the energy and good vibes the air, I was spinning with excitement. I get home, eager to bask in the joy of an overall pretty darn good Monday (work included), and start chatting away with my husband, trying to find out what happened at his doctor appt this afternoon. I knew he was going to go. I was glad. He is an avid tennis player who always seems to have something physical keeping him from something he loves so much. I want him to get feeling up to par. Believe me, I do.

He had mentioned via text message that he got a "big shot" today. I was both confused, because I thought that he was just getting looked at, and sad that I couldn't be there for him. After all, I get the injection thing. I am empathy.

It wasn't until he said cortisone shot that I connected all the dots. Waaaahhhh? Huuuuhhh? They gave you that just two weeks before our retrieval?!?! This didn't just happen. Please tell me that we can rewind the clocks and take it back!

And, of course, I have to stop and thank Lupron again. Lupron: You're the best. You turn me into one of those super crazy "stereotypical" ladies. You know, totally over-reacting and just swearing you could rip off your husband's head and feed it to the birds. Yeah, this is so not me. But it was this afternoon.

What's done is done. Now it's a matter of figuring out how much it impacts our cycle. I want to hear it straight. Tell me plain and simple - will this stupid cortisone shot jeopardize the success of our IVF cycle? Because if the chance is good, I'd rather postpone it. We start stims tomorrow. Why go through all of that and spend the money if it will be in vain.

Believe me, I'm trying really hard to keep a level head about this. Really I am. And I know that my husband is both upset that I got so upset and would, I'm sure, love to take it back. Ok, well, at least I think he would. He hasn't come out and said it, but I feel better just believing that, even though it would be good to hear. In all fairness, he said he asked his doctor before he was given the shot. He said he mentioned IVF twice. I guess my big hang up is that I would never put that much trust in someone who doesn't specialize in infertility. I would have preferred he call our clinic first. Bare minimum.

But, again. What's done is done. I know it wasn't done intentionally, and I know I'm probably making it out to be more than it is. I also feel like a bad wife for not being more supportive of the fact that he just got a pretty painful shot in his wrist. Instead, I'm more focused on how it affects our IVF.

For tonight, I'm going to pray and believe that we'll get good news tomorrow when we call our IVF coordinator to get her take. Pray that this link, or this link, my husband dug up are signs that confirm it will do no harm, or maybe even a little good. We will if we have to, but in truth, my heart is too much in this cycle to turn back now.

Provided we're still on track, I've been meaning to post this for a while. This is the first part of our IVF calendar... new one to come next week as we approach egg retrieval.

(click to enlarge, if you wish.)

Gearing up for Operation Human Pincushion!

2009-07-27T08:21:00.001-05:00

Ok so last week, week number two of our IVF cycle, was just flat out exhausting. Not so much because of the meds or any one thing about IVF specifically... it was more that it was extremely stressful. Stress which I want to keep at a minimum more than ever right now.

As with the rest of the U.S. economy in the past year, profits are down significantly for the company I work for. Since there are only about 12 of us here, there's not a lot of room for variance. We were told last Friday that things had to change immediately just so that we all have a chance at keeping our jobs. The biggest change that affects me is that my boss will now not be doing any creative design work from this point forward. In the past, we're nearly shared the workload. As you can imagine, this could, and most likely will, affect me in a big way. And here is where the stress comes in.

On Tuesday, I saw my first official side effect of being on Lupron. It seems that it makes a stressful situation about 80x worse than it normally is. I could feel my blood pressure rising and was *this* close to saying "WHATEVER!"and just walking out of a meeting - total out of body experience. Luckily, we broke for lunch which gave me the chance to run home, get a bite to eat and do some yoga and deep breathing. I honestly don't think I would have been able to make it through the afternoon (with a job anyway :P) otherwise.

My plan with work is to just try taking things day by day and not to get consumed by the long, long list of projects on my to-do list. I cannot let this work stuff affect our success. I will not!

Now for the fun stuff!
Tuesday, I woke up early and made my way to have my E2 blood drawn before 8am, as instructed. Then, Thursday, AF showed up, as anticipated, and I was due for my baseline ultrasound scan at 11 am. Both turned out wonderful! My E2 was nice and low, meaning no functional cysts present. Apparently, if one of these were to exist, all of the FSH/stim drugs that we will be injecting next week would have went directly to that functional cyst, instead of to devleoping healthy follicles. Didn't know that and found it very intersting, even though, thankfully, it doesn't apply to me.

Onto good news number two: The scan revealed, as Dr. Ahlering put it "Lots and lots and lots and lots of follicles" on my ovary. By his expression, I think he saw more than he thought he would because he said he was going to primitively step down the dosage of Follistim that begins next week. Instead of it being 225 IU for each of the 6 days, it will now start out at 225 IU for 3 days, then go down to 150 for two days, and only 75 on the final day. If he kept me at where I was at, we'd end up risking severe hyperstimulation, which we don't want.

He also commented that it looked like my left ovary and what remains of my right ovary appeared to be on top of one another (further confirming things are all jacked up in there!), but didn't seem concerned about it - just made the observation. I asked him if it still looked as though the left ovary was glued to my uterus and he said for sure. You could see the follicle filled ovary and the curvature of my uterus right up next to each other and it didn't budge a bit when he poked it with the ultrasound wand. I asked if it would be a concern once I did get pregnant and he said no - that sort of thing isn't super uncommon.

All in all, I left that office feeling so darn good!
When he walked in, he greeted me with a warm smile and a tone of calm. The first thing out of his mouth other than "hello, good to see you" was "are we ready to get you a big round belly?" That just put a huge smile on my face. Totally unexpected, but you could tell it was a tone of excitement that mirrored why I was there that day. And then, a simple thing that I've had no other doctor do before during an exam... After the scan was complete - me still lying on my back totally exposed (we all know how fun that is) - he extended his hand as a gesture to help me sit back up and regain my dignity. Usually, I'm left feeling like "ok, we're done, but you're still down there talking to me and this is awkward". :) Simple things like that go such a long way for me!

Follistim, here we come!
Going into this next week, I'll continue doing the Lupron injection in the AM, keep taking dexamethasone & my prenatal, and then on Tuesday, we'll add the Follistim injection in the evening. I'll be well on my way to becoming a human pincushion! :)

One down... lots more to go!

2009-07-15T21:40:00.005-05:00

I'm happy to report today went pretty well, even after all of the months of curiosity and anticipation. We got up a tad late, but got moving right away. I wanted to eat a little something before pumping my body full of meds, so that was the first line of business.

The night before we reviewed the video that came with our meds, going over the how-to's one last time. We actually found it to be a pretty beneficial way to refresh all that we had been told in our review. When it came time, we did just as we were instructed. Found a flat surface, disinfected it, laid out all the supplies and then Jay got down to business. I was really proud of how well he remembered everything.

At this point, I was searching for ways to stall. Yes, I'll admit it. The syringe was primed and ready to go and I was being a baby. "But wait..." "Hold on one more second..." I literally did this for somewhere around eight minutes. It was sad :P

First I said... don't count it. Don't even mention that you're going to do it. I don't want to know. Then after about 6 minutes into stalling, I decide that I DID want him to count to three. Hey, I'm a woman. I can change my mind, right? I even pushed him to the point that he said "you want a baby right?" and I do believe he hummed some sort of familiar high school pep cheer at one point. :-D

Finally - I give the go. Of course I looked away. There is no way I'm ready to see that at this point. Maybe never. The actual "stick" itself wasn't bad at all. It felt different than any other needle I've ever been stuck with. A tiny pinch and then I could slightly feel it slide in. Little creepy, yes, but better than it hurting the entire time. The part I felt the most was when, after he stuck me, he moved the needle around a bit (not meaning to). Again, that wasn't even that big of a deal, but it made it more obvious that something was in there. Yes, I prefer to be oblivious, thank you very much!

Whew! Finally that first stick was over. I'm sure it will be that much easier tomorrow for our next go around. What remained was a blotchy red spot and a little bit of itching around the site for about 10 minutes or so.

(yes, that's my beautiful scar below my belly button,
post ovary and tube removal many years ago)

After the stick came the pills. As my Mom and Dad can attest, I am and have always been horrible at taking pills. I may have pushed someone to the point of frustration that they threw a coffee cup through the wall. Maybe. ;-)

I have gotten better through the years but even to this day, sometimes even the thought of swallowing a pill literally gives me the chills. Isn't that just stupid! It is what it is I guess. Maybe after all of this I'll finally be over it. In the meantime, I have to find a way to deal with it. So, I bring you the Reduced Fat Oreo and Pill Combo. A surefire way to make taking pills enjoyable. It's my plan A for this part of the cycle. So far, it's working beautifully.

No side effects to report yet, though I think time will really be the determining factor here. Please body, be good to me! Do what you need to do to get us a baby and nothing more (I wonder if it can hear me :-P).

On that note, I'm tired (probably the reason for the extra dose of sarcasm and the multitude of smiley faces) so off to bed I go. Thanks to everyone for the nice thoughts and comments today. All are very much appreciated!!

Forever grateful

2009-07-14T21:38:00.002-05:00

As of last Wednesday we were paid in full with our clinic. As I shared with another blogger friend, I am at peace with that. Thankful even. God has taken us so far in our lives together. He has provided a way for us to be able to afford even the chance to have a baby. For that we will be forever grateful.

On Friday, received an e-mail from Dr. Ahlering regarding the stim of choice. While he didn't get into detail about why he originally chose Bravelle, he did say "I whole heartedly believe that you can use (Follistim) the donated meds. No doubt." Since this is the stim we felt made the most sense for us anyway (compared to Bravelle), I feel good about this reassurance. Perhaps if this cycle doesn't work and he feels that the stim was the culprit, we might get into details then. For now, I feel good about this cycle. Just hearing him give his approval put us at ease. It is so nice to feel as though you are in wonderful hands. Not everyone get to that place, nor does that place reside 20 minutes from their home. We are grateful!

As hinted to above (because I don't think I've posted on this yet), we were graciously gifted meds - our stims mostly and also some PIO. Again, we are forever grateful for this woman; someone who has since made peace with not being able to have children and is moving on. Still not sure how one goes about doing that.

While we're counting all the ways we feel forever grateful, I cannot forget my parents. They who, even during uneasy times with my dad being unemployed, somehow were still able to lend a helping hand. I tell you - I hope and pray that one day we will be able to help our children out in all the ways they have helped us. As my Mom put it: this is our grandchild too. For all the ways that they have helped us through this - financially, spiritually, emotionally - we will be forever grateful.

And yet another blessing. The total for what meds remained that I needed to purchase came out to $230. We had budgeted for around $4,000 or so. Yes, I am so very grateful!

Tonight, as I reflect on where we've been.... All of the long months we've waited for this very day, I realize I have made it. I have been through so much and know that I can and will handle what tomorrow holds. Yes, I am anxious. Yes, even a little bit queasy at the thought of that needle, albeit small. Even still, I know God will bring me through it. And for that I am already grateful beyond words.

Tomorrow is OUR day!!! Finally!

To everyone who has helped us get to this point, and I do mean everyone... all of the above and of course my close friends, fellow IF bloggers and my wonderful local support group who all let me vent and share my stress... thank you will never quite do it. Hopefully soon we'll have a sweet baby to share as your reward ;-)

Attempting to destress, and what do I get? Stress!

2009-07-11T11:52:00.000-05:00

I've been thinking of exploring acupuncture for quite some time. If we're putting this much effort and money into our cycle already, and if it has a chance of improving our odds, I wanted to give it a shot. With our IVF cycle nearly upon us, I decided NOW is definitely the time.

A couple of weeks ago, Christine Kleinschmidt of the WellBody Acupuncture Clinic in Maplewood, MO. came to speak to the local St. Louis area infertility group I attend. Christine was awesome and came highly recommended by ladies all around the St. Louis area, many who have gone through infertility treatments - some who've also cycled under Dr. Ahlering's care too!

The benefits
I really loved they way she presented herself - very knowledgeable and in tune with IVF and seemed compassionate and understanding of what we are all going through. She gave a nice overview of possible benefits such as a more regulated endocrine system (read: less stress!), hormones in sync and ready to produce better quality eggs, helping the eggies that will be recruited mature at the same time for retrieval day and better blood flow to important reproductive organs throughout and after transfer. Given that I have PCOS and scarring issues the first and last are particularly important. I recently did a guest post on a friend's blog detailing more about the wealth of knowledge Christine had to share. Check it out when you get the chance.

Why I chose the middle road... my excuse anyway
Given her obvious level of expertise, I was all but convinced I would be making an appointment with her that next week. Well, the next week came and I started breaking it down. It would take 40 minutes for me to drive to her office, and she doesn't have true evening hours, so I would have to work through my lunch two days a week so that I could swing cutting out of work early. Then, with the possibility of driving back home 40 minutes in rush hour traffic, I decided maybe I should seriously pursue another option closer to home.

So, I paid yet another visit to Google and searched high and low for someone who specialized in acupuncture for fertility. In the end, all I could locate was one doctor who does both chiropractics and acupuncture. A bit hesitant I continued on through her website to a paragraph that read the doctor has "completed extensive post-graduate study in acupuncture emphasizing areas of study such as female issues". Perfect, I think. A lot better than I've managed to find elsewhere and she is only 15 minutes from both work and home. That alone, I thought, had to count for something. So, I gave the office a call and they scheduled a 15 minute consult for the next day.

I came out of the initial consult feeling pretty good
Even though I waited a good 30 minutes to see the doctor for a 15 minute appointment, I thought maybe it was because they had "worked me in" or something, so I kept an open mind. In the review, I had the chance to ask a few questions and she asked a few of me; enough that told me she has worked with other women who've dealt with infertility before and that she was aware ART treatments are fairly complex in nature. So far so good. She sends me out the door with a survey to complete which would help her tell which areas my Qi is weak - essentially it was the questionnaire from the infamous book, The Infertility Cure, we have all read or heard of in the IF community. It was clear she has read it too, which is good, and I would imagine that a lot the ways she treats her patients are mirrored from this book. On the whole, I suppose there's nothing wrong with that.

There's a first time for everything - My first official session
On this appointment, I was supposed to have a physical, discuss current hormone levels, etc. Given that this was the Friday before the holiday, they must have way over-booked themselves. I waited another 30 minutes for the doctor on this day. I also didn't have my physical like I was supposed to have. We did manage to squeeze in a five minute conversation about the questionnaire that I completed and, from that, she began to locate areas that she felt may need work on. I walked away with a smattering of concepts like "I suffer from blood stasis, or blood stagnation, and also dampness" and that "my liver and ovaries are weak".

After the quick review, she took me out into their multi-purpose room to do the session, but all the tables were full. I was so thankful for this because she then took me around into another more private room where the lights were dim and the curtain was pulled. There, I was told to lie on my back and raise my right arm in the air and make a fist. For the next minute she proceeded to push against that arm (and I was told to resist) while she took her other hand and pressed on what she called "points" along my upper and middle chest, and down alongside my rib cage and around to my sides. Each time she would get to a new spot, she would call out a different organ or key Qi area. At the end she mentioned something about my liver and ovaries being the weakest. Between this and the review, she felt she had enough info to start the sticking. As she was talking to me she started poking them in all sorts of places - just above my wrists on the top of my arm, on the flip side, in the web of my thumb and pointer finger and then a couple places on my legs - just above my knee on my inner thigh and one point below my knee and towards the ankle.

Then, without much warning, she whipped out the electrodes and started hook them up to most of the needles saying that it amplifies the affect. I was, admittedly, a bit freaked about this at first. She turned it on and said I should start to feel a slight pulse in some of the points. And then we waited. And waited. And still nothing. I was really beginning to wonder just how high she was turning that thing up so that I would feel it. And then, oh boy, did I feel it. It wasn't just a pulse, it was a pinch and in one area in particular, it was a pretty strong pinch (my inner thigh)... you know the type of loving pinch only a little brother can give that causes you to let out a nice loud scream. Only I that machine looked nothing like my brother and I didn't think it would be fitting if I screamed for my mommy. Just when I gave the "OK" I can feel it, without any time to ask if it should even be that strong or an explanation of what to expect, she set the timer for 15 minutes, drew the curtain and walked away.

But waaaaiiiit!!! I can't take this for that long!! I honestly wanted to reach my scrawny fingers down there and yang out those two needles as quick as I could. Instead, I found some inner place that I didn't know existed and managed to see through the 15 minutes. I will say that about 5 minutes into it, my once reddish palms now matched the rest of my skin color (she had said blood was pooling in that area) and seemed to be the same temp as the rest of my body. At about the 10 minute mark, the tear-jerking pinch in my inner thigh wasn't so unbearable and had managed to even it's pulse with the rest of my nodes. Thank goodness! Cause, really, 15 minutes is a L-O-N-G time when you're sitting there starring at the ceiling :-)

High hopes for the second appointment...
With one session under the belt on Friday, I figured why not. Let's do it again on Monday like the doctor requests. Attempting to get it all in under an hour's time so I can be back at work, I head out. Arrive at my appointment 5 minutes early, am handed "my folder" and told to proceed back into the lovely muti-purpose room where I was asked by a male nurse/assistant of sorts which area I was having done. I said, I really didn't know and that I was told the Dr and I would be coming up with a treatment plan today. He then shows me to a table and tells me to make myself comfortable while he let's the Dr know I'm waiting.

Fast forward the clock to 40 minutes later, a different doctor shows up at my bedside and tells me she'll be doing my session today. I know she was just being polite, but I kindly explained that I was in for infertility and wanted to speak to the doctor so that we could develop a customized treatment plan before doing my session today. I then also told her that I probably didn't have time any longer for a session but was still hoping I could talk with the doctor to get that taken care of.

A minute later my doctor comes over. I told her the same - that I didn't have time for a session but wanted to make sure we were coming up with a treatment plan that will coincide with my upcoming IVF cycle. The response was ok I suppose. She attempted to tell me more than she already had, but I didn't feel like I learned all that much new, to which she ended by saying the only true critical times would be around what she called "harvest" and "implantation". Gag. Ok, I'll cut her some slack. I mean at least she grasps the overall concept, but would have made me feel better if she had the lingo down. She also throws in a caveat that "and you won't know exactly when those will even be, so it might not even matter"... almost as if she might not be able to work me in during those critical times, so don't concentrate solely on them. And, to top it all off, she let's me know she will be out of the country for a few weeks, some of which will fall during my cycle.

Well, if nothing else did it, that certainly did. Why would I want to go there if the person I found and was half beginning to trust just up and disappears for a good portion of my cycle. I didn't want to come to the woman who just got her acupuncture license a couple years ago, I wanted to come to you! I really did leave more stressed than when I went in, I'm afraid.

I tell you all of that... why?
Because, like most of my posts, this is a way for me to vent. To journal all of life's random happenings, down to the last boring detail if I so choose. I also do it because I'm sure at some point someone else will read this who has never been to have acupuncture done and has no idea of what to expect, or anything to compare their experience to. I fall into that last category even as I write this. The only knowledge I have beside this, as far as what is "ideal," would be from listening to the guest speaker I mentioned earlier. The same woman who I really am now wishing I would have gone to in the first place. Last week I was trying to figure out how I could make it work so that I could go to her. While I've not ruled it out all together, it is looking more like it may be too stressful to try and coordinate.

I do eventually want to do a session with her though - if nothing else to experience *ahem* what a real infertility acupuncture session is like. In the meantime, perhaps a massage or two is in order... you know, for destressing and all ;-)

Will it be Bravelle or Follistim?

2009-07-07T21:30:00.003-05:00

Anyone who has gone through, contemplated or will soon go through IVF knows just how important your protocol is. While is not the entire determining factor of success, it is a HUGE part of it.

A protocol should be specifically designed with the woman's infertility factors in mind: any and all conditions or family conditions, past surgeries, current blood work, ultrasounds, any past incidents of miscarriages, and probably many other things I'm forgetting. Point being, your protocol shouldn't be out-of-the-box. Everyone's body is different and in order for you to get to the outcome you desire (yes, a BFP!), your protocol should be one that is custom-fit for your issues in mind. Even then, there is no exact science, but it's a great place to start.

Count my issues, and blessings, one by one
Luckily, I have age on my side. My ovarian count, or FSH level, appears to be good and my AFC is good (15+). What I'm working with is the fact that I have only one ovary (appears to be slightly damaged due to surgical scarring) which means they may get less eggs and I have PCOS. At this point, it might be good that I have PCOS to some extent because it likely means I'll still produce a good number of follicles and eggs during IVF. The problem is, however, those eggs may be of lesser quality than your average woman.

Along with most other PCOS women, my FSH to LH ratio is out of whack
Normal values should be a 1:1 ratio, where as PCO women have an LH that is more like 2 to even 3 times as high as their FSH. Mine is 4.5 times as high!! This means that my body is ultra sensitive to LH. If there is too much, this can cause an over-production of androgens (male hormones), which can have a negative impact on the quaility of the eggs the retrieve. Poor quality eggs can sometimes lead to a lesser potential that they will fertilize well and turn into healthy embryos for transfer. No healthy embroys, means no BFP.

So, how does this relate back to my IVF protocol?
Well, I am - for certain - going to be on the Long Lupron Protocol. Lurpon is designed to suppress your pitutiary so that your body doesn't make it's own LH or FSH. The idea behind this protocol is that between BCP clearing up most cysts and by taking the Lupron for an etended period of time, my body's hormones and natural androgen production should be at a minimum. Once the ovaries are quiet, then they'll add in the drugs stimulate the ovary(ies) to do it's thing and from there the idea is that we'll recruite between atleast 8-15 healthy eggs, or more if we're super lucky. Yes, the time before stimming is critical for someone with PCOS, but stimming itself is JUST as important.

This brings me to the concern that came about in our calendar review.
As we were handed out calendar, we saw a familiar, but unexpected stim with our name on it - Bravelle. We had read about this drug in many places, including Dr. Sher's book (wow, I still haven't reviewed this...) and SIRM's Dr. visited forums, but couldn't for the life of us think about what the difference between this drug and Gonal F or Follistim were. We knew for certain that the latter two were 100% FSH because, in truth, that's what we expected we'd see on our calendar.

Instead, it was six days of Bravelle (3 vials each day to be exact). To be sure I understood before we went any further, I asked our coordinator what the difference between that and Follistim was. She started by explaining that everyone is given specific protocols and that our doctor wouldn't put us on something if he didn't think it was "the" way to go. Ok - I buy that. Afterall, we think Dr. A is swell and he has wonderful success rates. No need to be convinced on that one - it's one of the main reasons we chose him. Ok, so after being assured our protocol is custom and carefully selected, my husband mentions that we were just surprised to see it on our calendar and that we happen to have been gifted Follistim. Now... give me a little "eeeeerrrrr" breaks sound effect and spin your little car around into a 360. "Oh, you have Follistim. Well if you have Follistim, then we'll use that for sure."
Wait just a sec. A minute ago Bravelle was "the" stim for us that had been specifically selected from a host of drugs. We both say to her in unison, "If Bravelle is what Dr. Ahlering things will be best for us, then we, by all means, want to use that instead. Even if it means having to buy different drugs. We're ok with that." To which she assures us it's no problem to substitute an equal amount of Follistim for the units of Bravelle we were supposed to be on. Again, I ask - what is the main difference between Follistim and Bravelle (half of me wished I'd brought our book with us, but I can only imagine how that would have come off), to which she replied something like "they're the exact same thing". I really wasn't up for arguing and I was putting my trust in the fact that she does this nearly every day. So, we continue on.

Back at work that afternoon, I decided to do one last inquiry on the matter and low and behold, it is what I suspected. While Follistim and Gonal F are the same thing (FSH only), Bravelle is FSH + 2% LH. With my body's natural sensitivity to LH, my instant reaction is to think that an FSH only stim would be the way to go for me. Additional research also seems to support this. However, even so, I want to keep an open mind. Afterall, I DO trust my doctor. He really does seem to put his all into each and every cycle. Knowing we're all human, I don't expect my coordinator to remember every little fact there is surrounding IVF. So even that I'm willing to keep an open mind about. I do think, though, that the doctor should always give the final OK, even in situations where it seems safe to switch something up.

In an effort to stay on the same page with our coordinator, I sent her an e-mail asking that we better understand the "whys" behind the protocol that was selected for us. I also brought up our concern about having too much LH given my circumstance. In the end, we are really just seeking peace of mind. To know that we're going into this cycle with a game plan that feels, within our depths, like "the" protocol is sooo extremely important.

Our doctor's been on vacation this past week, so we hope to hear back sometime this week about what lies ahead for our stim. In the meantime, we start Lurpon next Wednesday!

From a high level, here's what our IVF protcol looks like, currently:

Continue BCP. When I come to the sugar pills, I'll skip those and start a new pack.
On 7/15, begin daily prescription prenatal vitamin, Dexamethasone in the AM (a low dose steroid that enhances the implantation process by positively impacting the immune receptivity of the embryo; I was told this can cause insomnia. Let's hope not... I think I'll be needing all the sleep I can get during this time) and start the first of our daily Lupron injections in the AM (Lupron is designed to suppress the pituitary which produces your body's own key hormones - FSH & LH).
I should get a period around 7/22-7/24.
7/23 I go in for a baseline ultrasound to check out my ovary
Still on Lupron, on 7/28 I'll add in my injectable stim of FSH in the PM- actual stim type still TBD. Hmm... TBD? Yep. I'll expand on this in a sec.
Still on Lupron and stim, on 7/31 add in a 3rd injection of LH (Menopur).
Skip a day of Menopur and on 8/2 add in another dose of Menopur (LH).
On 8/3, I'll go in for an US and E2 check. This is, what they consider to be CD9 and it marks the last day for Lupron. It's also the last of the true concrete part of this calendar.

I will scan my updated calendar, once we here back regarding our stim. It really is crazy to see it all mapped out in one solitary calendar.

As for what's not on the calendar yet... the rest is still very much up in the air. Generally speaking, the first week in August I will likely be in my RE's office for a daily ultrasound and perhaps blood work. Our coordinator thinks that I'll respond nicely to the stims (I guess since I'm PCO?) and that I'll probably do the HCG trigger shot during the mid morning on 8/5, which would put my retrieval sometime Friday. The trigger time and retrieval procedure will be precisely timed and I might not have too much advance notice as to when we'll trigger. If, I do in fact, have that sort of timing on retrieval, and they get a good number of eggs and then embryos to fertilize, she is guessing I'd do a 5 day transfer of two embbies on Wed 8/12. Even still, all of the stuff just mentioned is a total guess at this point.

Ah, the suspense! And we're not even in the thick of things yet.

The What & How: Recapping our IVF Calendar Review

2009-06-29T23:46:00.004-05:00

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!

2009-06-25T15:54:00.003-05:00

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!

2009-06-18T21:44:00.008-05:00

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 :-(

2009-06-15T22:07:00.008-05:00

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.

2009-06-11T16:50:00.001-05:00

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 ;)

2009-06-07T10:58:00.013-05:00

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.

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?)
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.
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?)
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.
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.
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.)
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.
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.
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.)
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 :-)

2009-06-04T17:54:00.005-05:00

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

2009-06-04T12:57:00.009-05:00

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

2009-06-02T09:15:00.031-05:00

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!

2009-06-01T16:53:00.017-05:00

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.

Almost... but not quite official

2009-05-27T23:40:00.009-05:00

I know, I know. Make that week number two of not being a good blogger. I confess. My apologies! I've been preoccupied I suppose. Between either feeling unmotivated or busy with sudden projects, I've just not dedicated any time to this. But I'm back! And it's time to get down to business.

This is the week, as I last mentioned, that we wanted to put our deposit down for our August IVF. Seeing as how tomorrow is Thursday, I'm not sure if that will be happening. First it was that we didn't have our final fancy spreadsheet made (not to worry, it's about 95% done now). Then it was that we needed to check with CapitalOne (who we were going to get our infertility loan through), to see if we should expect a similar rate and approval amount to insure something hasn't massively changed. As of tonight (thanks to a few wonderful IF girls in my local infertility group), I learned that CapitalOne is no longer lending these types of loans due to the state of the economy. How wonderful is that. Like we need one more thing. I was bummed, but was assured that you can used a home equity line of credit for these types of things too (also thanks for that tip!... these girls are good!).

Our new line of attack - Pursue a line of credit
When I mentioned it to Jay, he nicely reminded me (my memory is horrible) that he already brought this up as an option before, but I was very adamant about not wanting to use our home as collateral on anything. Right. It's all coming back to me now. Yes, ideally, I'd still like to avoid this (it just seems so risky I guess), but if that's our only option at this point, then I suppose we need to consider it. The more he explained it to me, the more I suppose it's not as bad as what I imagined it to be. The rate is better than what we would have been getting with the CapitalOne option and we don't have to take it all out at once, but instead just take out only what we will actually need as we go along.

Another reason we're behind schedule is that Jay has been super busy this week at work with a new project that is wrapping up on Monday. He's been doing a little when he has time, but it's not been much. So, when I got home from my IF meeting, I wrote up a doc with local banks and credit unions and their HELOC rates/terms. Yes, I will be bugging the heck out of him tomorrow to make sure he checks into at least a few of them... bugging IS a wifely "right", right? :)

Ok, so after doing ALL of that (a lot of stuff to figure out in a matter of a couple hours), I checked back in with the docs I received several months back from our clinic. Specifically, I was looking to see when the IVF August cycle date was and when their "off" month during the summer way. Up until now, for some reason, I was thinking their off month was the cycle before ours - but, it's not. That was the May cycle. Which hopefully means August won't be *quite* as full already as I thought it might be. Which is nice, however their doc clearly states "We encourage you to put down a deposit two months in advance to the cycle you wish to participate in. A list of our cycles is outlined below. Final payment dates are also included." And just like that too :) I'm guessing that if it's important enough to emphasize, we ought to take it seriously. Then I read, "A refundable deposit of $2,000.00 is required to secure your cycle of treatment with SIRM and the deposit is applied towards the total fees. " which to me is nice because it tells me that we might be ok to go ahead and put our deposit down now (without having figured out all of our stuff precisely), because it is in fact refundable. Again, nice!

Now, onto IVF calendar stuff...
The August IVF cycle at SIRM St. Louis begins on August 17, 2009, which I'm guessing means I would start my first injection of Lupron that day. We will have to have our final payment in full submitted on July 22, so as long as we get everything ironed out well before that date, we should be good to go. I really don't know why I hadn't marked this day until now... I guess it never dawned on me that THAT would be my date and exactly what that meant. It's so nice to be able to mark something more specific on my calendar!

Maybe I should make one of those silly paper chains or something to count down... or would that actually be bad to focus on it that way? I'm going to give this one some more thought. I'd like it to be a preparatory/celebratory thing. Something fun - like looking forward to vacation. After all, it will cost about 3-4 times as much as our jaunt to Turks & Caicos last year did. Yikes!! Hopefully we'll have the best souvenir EVER to show for it.

My UnMother's Day Surprise!

2009-05-19T08:50:00.004-05:00

Lots of catching up to do! For me, a week of not writing seems like an eternity. I don't generally do posts with a spattering of thoughts, but here goes.

Mother's Day Weekend
Overall, we had a really nice weekend. The weather was beautiful so Jay and I decided to take advantage of living so close to lots of stores and restaurants. We stepped out our back door and walked about three minutes to get a bite to eat and then went to several stores before heading home. We were having a good time poking fun at ourselves because we must have looked like a couple hippies carrying our canvas grocery bags to and from each store. Who cares - we had fun!

On Sunday, we took our moms some New Guinea Impatiens and an adorable little potted plant hanger (we bought one for ourselves and love it so much we thought our moms would too!). After that, we spent some time at my grandparent's farm; ate lunch, talked and rode down to the creek. I thought I might have the chance to talk to my Grandma about our infertility stuff for the first time, and maybe tell my Aunt (I'm still not sure if she knows), but the opportunity didn't present itself.

Even though it wasn't "my" Mother's Day (hence the "UnMother connotation from Alice and Wonderland's UnBirthday), my mom surprised me with a note that I know truly was from the heart. I can't begin to explain how much this meant to me! With the note was a stuffed frog; a little guy I'm calling my infertility mascot! We had a good laugh because while he's cute, he seems to have a skin condition that won't allow his hair to grow. I said "he's the kind of cute only a mother could love" :P I have a feeling he will become my good luck charm as we approach and endure our IVF cycle.

*Almost* Only Two Months until IVF!
Speaking of our cycle, It just occurred to me the other day that May isn't too far from being over. Next weekend is Memorial Day and then June is pretty much here. You might remember from several posts ago that I had a lot of "to-dos" for myself and for us. How's that all going... well, I've not started working out like I want to - so that's still in the works. I'm almost positive I'm signing up for an aerobics dance class at the community college two days a week starting in June. I know, it's so 80s of me, :P but I have more fun when I'm doing those type of things.

The eating healthier thing... we have been trying to avoid trans fats for a super long time now, so that doesn't count. So, what have we done? Little things honestly. We've made more of an effort to try and buy whole grain wheat bread and then not eat a lot of it. Ah yes, and fruit and veggies. I've definitely made a better effort to replace some of my cookies and chocolate for some tasty grapefruit, Fuji apples, sweet red grapes or a handful of strawberries (with no added sugar, thank you very much!). I've also been eating more carrots than normal. You know, simple smarter eating choices. Trying to buy organic if given the option, but not going out of my way at this point.

The house projects are slowly getting done. The house is due to be painted in the next month or so, our VUE got new front tires last week, we purchased a new computer (had to give my old trusty Mac the boot) and I'm beginning to finally burn DVDs of old home movies and photos from as far back as 2005. Once that's all done (so like maybe later this fall or winter, or perhaps once I am pregnant and have been given bed rest... sad that I am looking forward to that possibility, though I know I would eat my words!) I still have to work on scrap booking literally EVERYTHING from the last 8 year's we've been married. I'm beginning to question if that's even possible at this point. Yikes!

Oh, and as for our daily routine (sleeping in late and getting home late), well that's improved slightly. We did really good the first week and not as good the second. You know how it goes. I'd like to make a go of doing even better this week... we'll see.

I go from feeling really inspired and ready to get stuff done, to feeling blah. Sometimes I get overwhelmed by "what if" I continue to prepare my life for something that might not happen for us. In the end, I know that we'll be better off in these areas of our life, even if we don't have a successful IVF cycle, so I keep pushing myself through it.

Who said committing was easy?
We're still not technically locked in for the August IVF cycle. Our goal was to have this done by the first of June, so in reality we're not behind yet. I am, however, getting quite antsy! My in-house financial whiz (yes, my sweet husband) is putting the finishing touches on our new fancy financial spreadsheet which will help us feel 100% comfortable with committing to forking over the dough for the 2-cycle IVF package. As of now, we have already spent countless hours looking over the numbers, but I must admit I pushed for us to take one final look at everything so that I could sleep easier at night going into it. Aside from buying a home, this feels like one of the biggest investments we will ever make. Yes, in my eyes, this really is an investment, regardless of the outcome.

She's back... and, again, I couldn't be happier!

2009-05-10T22:19:00.013-05:00

The world really does know way too much about my life. :) The thought of sharing what seems like really private information to you all, when I stop and think about it, is pretty funny. All in the name of infertility and trying to, not only figure out my body, hopefully help another woman who might be reading this, better understand her body, too.

In the arena of TMI
I'm here to announce that I have somehow managed to start another cycle on my own. Yes, another. Twice in a row!! AND, this time, instead of my cycle being 90-something days long, was only 43. Quick, somebody give AF a gold metal, because I think she deserves it :P

In my little pre-IVF world, this is GREAT news! Not because I think this means we'll now get pregnant on our own (because we still have tube scarring and sperm count issues), but because it does open the door a bit wider to the *possibility* of a miracle happening one day, provided this trend continues (crossing fingers and toes on this one!). Otherwise, it would have been close to impossible, aside from any miracle that God might assist in ;)

This is also good because, honestly, I just feel better! My body actually feels more in sync with itself, which I'm sure has something to do with the fact that my hormone fluctuations are more "normalized" (going up and down as they should in a "normal" woman's cycle).

I assume most people who stumble on this blog already know how to chart their cycle (because more than likely you too are having issues getting pregnant), but I also appreciate the fact that there are "newbies" who are just getting started on this whole roller coaster like I once was.

For those who are new to this...
Or, didn't know that you could track symptoms and know more about what's happening with your body - well you can! By simply being more in-tune with your body and keeping an eye out for fertility signs you can tell WAY more than you ever thought you could. I won't go into too much detail on here about the ins and outs of what to look for, because honestly, FertilityFriend.com does a fantastic job of covering everything you ever wanted to know about how your monthly cycle works.

If you'd like to learn more, I'd recommend checking out their site. In particular, they have both an online e-mail course you can sign up for (where they will e-mail you daily lessons for a few weeks - I did this first and it was fantastic!) or they've also put together an online handbook which takes you through the process in one fell swoop.

Below is my chart for this past cycle... see more TMI ;)
What's neat about it is that you can get really close to figuring out when you most likely ovulated. Last cycle I was SURE I ovulated... this cycle I'm pretty sure, but I didn't have the typical O pains like I did before. I DID, however, have lots of other tell-tell signs, as you'll see highlighted in the O window I've plotted below.

In the end though, this is just as much for me as it is for a newbie. A girl can't possibly recall everything! And, I find that if I don't write it down, I will never truly be in tune with my body, let alone notice what happens from one cycle to another. As you can see from my chart, I've long sense stopped obsessing about taking my temp daily (was never a good indicator anyway, since I have PCOS) and have found that this is the perfect happy-medium!

My first baby dream

2009-05-05T21:01:00.007-05:00

Last night was bittersweet. My head was somewhere high above my bed, deep in a dream where I was a mommy - with a baby - with my husband. We were a complete family. I remember being happy. Very happy.

I think what brought on this dream was a comment my husband made right before we fell asleep. He mentioned he told some people at work about a show I watched a few weeks ago on TLC, called "I Didn't Know I Was Pregnant". Yes, that was the name, and premise, of the show. Please tell me I wasn't the only one fascinated with how this could even happen. Crazy!

Anyway, that was also the premise for my dream. I vaguely remember that we were eagerly anticipating our IVF cycle, and then, BOOM! Much like that silly TV show, the next thing I knew, I was carrying a baby (a boy, from what I can remember) in my arms. And, while I realized it was weird, I was still thinking "I can't wait to see the look on my Mom's face when I tell her I just had a baby!" :P So funny! Before she came over, we were giving the baby a bath and got him all diapered up and then he pooed. Jay was like "What's this all about! We just put a new diaper on you!" and I couldn't stop laughing and handed him another diaper. I distinctly remember wrapping him in a blanket and cuddling him, and yes, even the sensation of a warm, baby-fresh scent (is this normal for a dream?!)

Then my mom came over and I surprised her with the baby and she totally lost it and started crying, but didn't really ask how the baby came about. All she wanted to do was hold him! Which I thought, after I woke up, was very funny. The other strange thing about the dream... because every dream has to be just a tiny bit weird... was that our house wasn't "our house" (the one we live in now), it instead was on a peninsula jetting out into the ocean. When I looked out the large bay window, I saw water closing in all around our home and starting to creep up over the roadway leading to the mainland. I started to get all anxious and anxiety set in, but Mom assured me we could still make it into town. Weird again.

I both hate and love these type of dreams... the ones that cause you to oversleep because you can't help but want to finish and, at the same time, they torture you because they are something you'd really rather your brain and heart not think about. Cruel joke? Maybe, but that's ok. Like I said it was quite bittersweet and something that, ultimately, I'm glad I had. As long as I don't get tortured with them on a regular basis, I don't mind. ;)

There's more than one path to a child...

2009-05-01T10:48:00.018-05:00

I've wanted to share this link for awhile now.
It's a reminder to myself, while in the midst of infertility,
there are many paths to having a child and a family.

http://twosheldons.blogspot.com/2009/04/something-more.html

I am fascinated with this couple's experience for several reasons. I have said before that I believe God and His plans for our life are far greater than I will ever know or understand. I say this because I know deep in my heart this is true. This couple's story is yet another testimony of His will, though this time, infertility is directly addressed. I know that this will not be God's "will" for everyone, certainly, but it was at this time for this particular couple.

What's the other reason I'm so fascinated?
I'm blown away by this couple's awesome ability to turn things over to God and to be ready and open to adoption at the drop of a hat. If you read her post, you'll see that it was practically day and night for them - one minute she was learning the fate of their last IUI cycle (which started out as an IVF cycle) and the next she was learning they were being matched with a family who's baby is due THIS June! Wow, just wow!

While I'm not super savvy on the topic of adoption, I think most who've adopted will agree that this sort of smooth, quick turn-around isn't typically the case. Most couples spend months and months, if not years, going through the adoption process. Again, not speaking from experience here, only from what I've heard. I think that the fact that this happened for them in the manner that it did only furthers the story of how amazing, and meant to be, this all really is.

Adoption is something that we've always been open to. I can remember conversations from early in our marriage where we said we'd love to be able to adopt at some point. The opportunity to give a child in need a life full of care and love would be one of the greatest gifts we could give. At the time, we were thinking that if we were to do this, it would be after we had at least one biological child, and certainly years into our marriage when our family was well established and we had the money to afford to do so.

Well, now the cards have changed.
For one, Now we're having to fork out the dough no matter what. Some people might think, why not go ahead and adopt now, rather than go the whole IVF route? The thought has certainly crossed my mind, believe me. You should know the answer to that question isn't as simple as it sounds.

For one, I don't feel that's the route God is leading us in at this point in time. Have we (have I specifically) prayed enough about this... honestly, we probably haven't. The reason for this I suppose is the overwhelming drive we're feeling to pursue IVF. Yes, at this point, I do feel God wants us be where we are right now, with the doctor we're with... yes, I even think he wanted it to take a year for us to get here.

To add to that, my heart truly isn't in adoption right now. It's like you imagined what helping to create a tiny life would be like and it's really really hard to stop wanting that. I want to know what it's like to experience carrying a baby inside me, feeling it kicking and squirming and to see it be born with funny little traits that one of us has. This is human nature right?

My mind is also not in adoption at this moment. My mind is 100% into IVF. From a technical standpoint, now is a better time clinically for us to try and my mind knows that; while we're still young and have a higher chance of pregnancy. And not to mention all of the time it takes to read up on what goes into IVF and things you can do to try and increase the odds at success is enough for one little brain to handle. To add adoption to the mix on all levels, especially this one, would be too much to handle. Information overload!

The big question is...
Will there ever come a time when we come to a fork in the road and switch paths from IVF to adoption? That's something yet to be decided. When will that be? How will we know it's "time"? That I don't know. This entire journey to conception for us has been a ridiculously large learning process - learning to let go, to listen, trust and have faith and, of course, the dreaded wait. My hope is that when we "know", we'll just know!

IVF Book Review : "The Complete Guide to IVF"

2009-04-30T10:46:00.001-05:00

Just a little over a week ago, the packages started arriving. Exciting!! I spent a few days digging around on Amazon.com, trying to find the "best" IVF books out there.

My IVF book criteria:
- They needed to be somewhat recently published (this was really hard to find actually!)
- Go into at least a bit of detail on specifics surrounding what an IVF cycle is like
- I was also looking for at least one of them to include a story (or stories) about people who underwent IVF - preferably a first-hand account.

I ended up purchasing three books, one of which I've already finished and reviewed below. Stay tuned for more... this next book I just started is proving to be the best yet!!
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The Complete Guide to IVF:
An Inside View of Fertility Clinics and Treatment

Straight from the book description: The most recent studies show that 40,000 cycles of IVF are carried out in the UK each year - and approximately a million are carried out worldwide. It is estimated that at least 200,000 IVF babies are born annually - and this figure is constantly rising. With assisted conception increasing year on year, 'The Complete Guide to IVF' offers an invaluable and insightful approach to the process. Packed with first-hand accounts of patients who have been through it, and Kate Brian's own experience of IVF, this book will de-mystify the treatment and give a 'behind-the-scenes' account of what really happens. Addressing the entire experience, right from the initial clinic visit through to the assisted conception cycle, 'The Complete Guide to IVF' provides an accessible, down-to-earth and reassuring account of using IVF to conceive.

Published year: 2009
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My rating: (3 out of 5)

Who would benefit from this book? Anyone who is in the very beginning stages of understanding what IVF is all about and wants an easy-to-read overview; this could include not only patients, but also friends or relatives alike.

What I liked about this book: I purchased this book for two main reasons - it was one of the most recently published books on IVF that I could find AND because it seemed to contain (based on the description) the first-person perspective that I was looking for. Did it fulfill those wishes? Yes, it certainly did. It was an easy read that touched briefly on many main areas of IVF, starting with the beginning stages of suppression and egg stimulation, going all the way through retrieval and transfer and what to expect along the way. Throughout the book, in each section, the author would include comments or experiences she had with that particular topic, as well as include a very brief quote from another infertility patient, which was a nice touch. It also had a chapter dedicated to male infertility, covering not only causes but also how to emotionally deal with infertility and be a support system for a partner.

What I didn't like: While I am glad I bought it, I don't know that I'll use it as a reference tool all that much. I think the problem was that it was so surface level it didn't leave me with many thoughts of, right - what an interesting point, or wow - I didn't know that! Sure there was stuff that I didn't know, simply because I'm in the very beginning stages of really trying to learn the ins and outs of IVF, but I wish it would have had a bit more to it.

That being said, it does make for a very good "first" read. I'm glad I did end up reading it first, because otherwise, I'm afraid I may have felt like it wasn't telling me anything new.

Another potential downfall, though completely no fault of the author or this book, if you're from the U.S. you should know that this was written by someone who underwent and interviewed residents of the UK for this book. Why do I mention it? Well some of the info might not be quite as catered to what U.S. clinics are like; however, I didn't get the feeling that there wouldn't be too many differences, so it still seemed very applicable.

It's NIAW - National Infertility Awareness Week!

2009-04-29T11:06:00.004-05:00

Holy cow, they've moved our week! Yes, our week. The one week out of the year where we can stand united and make one gianormous announcement so that everyone will know just how many women, men and families are affected by this. RESOLVE reports the grand total is somewhere around 7.3 million Americans - not counting the other gazillion in the rest of the world.

Why is it important to spread the word?
Personally, in the future my hope is that other women will be more aware and proactive with reproductive health, supported and understood more by their friends and family and, here in the U.S., that legislators take notice and eventually pass a federally-mandated infertility insurance coverage option law.

This week used to occur in the fall every year, but it seems as though this was a conscious decision made to also help support women who are struggling with trying to become a mother, right around Mother's Day - a difficult holiday where we fertile-challenged women are reminded of another year with no baby. It's also a great way for everyone to keep in mind that while it's certainly a time to be thankful for our moms, it's also a time to reflect on how much it really means to be a mom and that not everyone is so fortunate. Something this precious shouldn't be taken for granted - ever.

Thanks to Melissa Ford's post at Blogher, author of the very popular infertility and pregnancy loss blog, Stirrup Queens and Sperm Palace Jesters, for talking about the NIAW move and bringing it to our attention!

FREE TeleSeminars through May 2
One last thing worth noting, and I wish I would have caught this sooner since there are only a few days left to take advantage of it, but RESOLVE is offering FREE TeleSeminars on various infertility topics through the remainder of NIAW (May 2). Check out their list of topics to see if anything interests you!

Oh to be a woman!

2009-04-28T11:14:00.007-05:00

Before I share my "poor me" pity party I had yesterday, let's have a little laugh. This has to be one of my favorite videos. It's on a related subject of a bad case of the darn rampant, womanly hormones. (Yes, Mom, this is the video I was telling you about!)

God help me when I actually start on IVF meds, I just might be one of those ladies!!

As for yesterday, ah, yes... onto the pity party. Yesterday I had a small case of the blues. You know... popping a tear at the little things. It was silly really. Every now and again you sit back and look at the big picture and wonder what you're life will look like in a few years... just hoping and crossing every finger that it will include us with baby in tow. Anyways, it was one of those days. Every time I turned around there was something that moved me.

Like the story of a young couple who tried and tried to get pregnant and finally - after doing IVF - they got pregnant, only to loose their baby after it was born very prematurely because the mother developed severe, life-threatening preeclampsia. They watched him fight and fight for life for several weeks, only to have him pass away in their arms. Wow. What a life-altering experience. One that I can't even, and am completely and totally scared to, imagine. My heart aches for them.

Or the fact that my good friend Meghan's first IUI was looking like it wasn't going to pan out for her. They deserve this, darn it!

And then I check FertilityFriend to see where I am in my current cycle and think "ok, so I'm on CD 35... I had fertile-like signs around day..." - wait, who am I kidding. It's silly for me to even think that I'd have a chance at anything, but my heart always tells me that God can work miracles. So the glimmer of hope remains, as silly as it is with as crazy as my body is.

Did I mention my husband turned 31 on Sunday. That made me sad yesterday too. Not because I'm married to a guy in his 30s, but because "that" 31-year-old guy, who happens to be MY husband, isn't a father yet. I want us to be young parents, if I haven't mentioned that before.

And, last but not least, this darn song that I keep hearing on the radio. I've heard it enough now, and sang it enough while shuffling around the house, that I felt the need to share a few lines. There is a reason that I heard this song while coming into work yesterday AND going home (my drive time each way is all of 3 minutes). It was a nice way to end a day and helps me to stay focused on what's ahead.

There is hope for me yet
Because God won't forget
All the plans he's made for me
I have to wait and see
He's not finished with me yet

Still wondering why I'm here
Still wrestling with my fear
But oh, He's up to something
And the farther on I go
I've seen enough to know
That I'm, not here for nothing

He's up to something

Infertility Book Review : "Expecing Miracles"

2009-04-22T12:19:00.016-05:00

You can never be too informed when it comes to infertility. I've found, and I'm sure many other IF women would agree, that the more you know, the better you feel about the situation. Infertility takes away so much power from your life, that for me, I've felt a great sense of control in just knowing what lies ahead. Or, often it's just been to confirm that I feel like I'm in good hands with a given doctor.

I've read a few books already on trying to conceive and infertility, and will be reading more in the future regarding IVF specifically, so stay tuned! I wanted to share these resources on my blog, in the hopes that it might help someone else out there in bloggerspace. :-)

One of the first general infertility books I read was titled "Expecting Miracles" by Christo Zouves, MD, a gift from my parents (probably more from my Mom - thanks Mom!) for Christmas.
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Expecting Miracles

Straight from the book description: Expecting Miracles provides a moving, in-depth look at the options, the decisions, the unexpected twists, turns, and disappointments that these couples experience as they work with Dr. Zouves. As he shares his own story and those of the patients, egg donors, and surrogates he has known, Dr. Zouves gives readers a rare view of the human side of reproductive medicine and all that goes into helping infertile couples realize their dreams of parenthood.

Published year: 1999
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My rating: (4 out of 5)

Who would benefit from this book? Anyone currently pursuing ART treatments, whether that is IUI, IVF... heck maybe even people using clomid. It's a good first look into the issues couples deal with when trying to conceive after some time who are unsuccessful and seek the help of a reproductive endocrinologist (RE) to determine why they can't get pregnant.

What I liked about this book: I loved the perspective this book is written from: An infertility doctor's experiences with couples and their own story and journey through infertility treatments. Each chapter is dedicated to one specific couple - he provides you with a set-up for what they're dealing with and then you follow them through treatment, learning about what things they choose to do, and then learn about the result of their cycle. It's cool because you get a really good perspective on various issues people deal with and how they personal dealt with them. It is definitely one of those books that you don't want to put down - at least not while your in the middle of a chapter learning about the "fate" of their family.

What I didn't like: I gave it 4 out of 5 only because the data in the book is somewhat out-of-date now (which makes it difficult to say "hey I should try that" or "guess I'll have that to look forward to"). There were many times when I said to myself, I don't think this is how they'd approach that nowadays. As long as you read it for the purpose of getting an insiders perspective on how they handled their situations, and not necessarily a way to direct your treatment, you'll be good to go. Don't get me wrong, there were a lot of things that you can take away from this even from a treatment perspective.

Overall, I think I learned most that many times, even when you think there's no hope left, there may be additional things to try or a better doctor in your future.

More than worth a few bucks on Amazon. Enjoy!

"Thank You" Infertility!

2009-04-21T15:35:00.009-05:00

Yahooo... it's our 1 year infertility anniversary! :P
Hey, you have to have a good attitude about it, right?

Really though, the cause for celebration should actually be that during our anniversary month we were able to make a decision that will get us one step closer to getting pregnant. I'll tip my glass to that. I'd REALLY celebrate if we won the lottery and it covered the cost of our treatment ;)

I can't believe it just dawned on me that this month marks exactly one year since we started TTC. I was looking back at old basal body temp charts and on April 21 of last year I recorded my first temp ever. Little did I know at that time we would be where we are today.

And, I must be in a spring-cleaning mood... today I was going through my e-mail inbox I found old e-mails I had sent myself, one with the subject "Pregnant belly dancing classes" and one titled "Make your own baby food"... those two were from the fall and winter of 07/08. :-) I had a good chuckle.

Looking back, do I wish I could redo this past year? In some ways, yes. I'm not going to lie. It's been a pretty strange year, full of ups and downs. There are times when I can honestly say I've felt depressed and alone. The latter part of that year, though, while it's still been trying, it has felt more like an uphill climb. Like it's been difficult, but that we've been moving in a positive direction and growing stronger.

Of course I would have loved it if we would have gotten pregnant on our first cycle, heck even the first six cycles, but we are where we are for a reason. That I am sure of. The world is so much bigger than my tiny little mind can fathom and God's will and purpose is wider than my little eyes can see. For a quasi control-freak, it's a constant struggle for me to be ok with that I must admit. I know it's true, but I pray constantly to be ok with it.

One thing's for sure - I have learned ALOT in the past year. Things I may not have grasped quite so quickly, if at all. Now, it's time for the "thank you's"... all the things that infertility has taught me this year.

* Patience is a learned trait. Boy has this given me a run for my money. "Are we there yet"... tehehee.

* Be your own health advocate. Don't walk into a Dr's appt thinking they know everything - that simply just not realistic and most often not true. They tend to know quite a bit, but not everyone is perfect.

* A friend in the darkest of hours is a friend for life. Not everything will always be rosey - life just isn't that way. Friends who stick around and support you through the tough times are people to truly treasure!

* Sometimes a good, ugly cry (as Oprah puts it!) can be a nice temporary fix! That's right, even more than talking it out at times. But keep in mind that it's often a temporary fix and talking it out with someone generally has to happen to make it better.

* No matter how much you want them to, some people will never be able to understand what you're going through. I can't tell you how much in the beginning I just didn't get this. There were a few people who I desperately needed to lean on and God is beginning to show me that He will place other people in your life to pick up where others leave off.

* It takes LOTS of really, really good communication to survive something so B-I-G! It took about 8 months or so before my husband and I really connected enough for it to make a positive impact on the situation. Every day we continue to grow more and more in this area.

* The desire to be a mommy is far greater than I ever knew! I always wanted to have kids, but now I want to BE A MOM! To have those warm hugs, genuine giggles and even the chance to do silly things like folding teenie tiny laundry. Maybe it's because I am having to work so darn hard for it, but I don't think I've wanted anything so great in my entire life.

If it takes infertility to show me those things - really and truly and that I wouldn't have "got it" any other way - then maybe this will all be worth it in the end. Of course, we're still praying and hoping our dreams do come true one day soon.

In the In-Between: Preparing & Waiting for IVF

2009-04-21T09:21:00.013-05:00

With our recent decision to do IVF in August of this year, and knowing that today is April 21st, we're in somewhat of a holding pattern... waiting for "our" time. Really though - on the whole, three months isn't that long at all, especially considering we'll probably start some meds for our August cycle in July... at least I think. I haven't got a confirm back from my doctor yet as to which exact protocol I'll be on.

For now, I fully intend to use these next few months to prepare myself. Like, educating myself on the IVF process - what to expect, look out for and how to prepare for our cycle. Trying to eat a little bit healthier; basically cutting back on sweets and trying to incorporate a few new healthy foods into our diet. Exercise - getting in shape for pregnancy! There are plenty of little projects that need wrapped up around the house. Our old daily routine of getting up late and getting home late and never feeling accomplished is a thing of the past (and thank goodness, because it was getting so old!). No time like the present to build new friendships and strengthen the existing - good friends can never be taken for granted, especially in times like these. We have never needed more reason to stop and enjoy life and just destress - if ever I needed to learn to just "Let Go and Let God", it is now.

Speaking of, this statement has really been on my mind and heart these last couple of weeks. It's so easy (especially for me) to put tons and tons of energy and worry into something, when in reality a lot of things are just simply out of my control. The sooner I learn to accept that, the better off I, and my family, will be. I've always had a hard time depending on other people for things - don't ask me why. This has, unfortunately, translated to also having a hard time releasing things to God and letting him work in my life.

I can't tell you how many times in the past two weeks I've been given little reminders to Let Go and Let God, whether it was in something someone said, or a song I heard. I know this isn't a new, or even trendy phrase (though maybe it should be), but it's one that is very simple and true. When I say it I picture all of the stress and frustrations that I'm dealing and this literal burst, releasing all of the tension and worry that consumes me, with a little "ahhhhh!" at the end like I just stepped out of the spa! If I can just keep my focus on allowing Him to be in control of our infertility issues (and just life in general), I'm sure that I will be at peace more than I ever have before.

So, in case you were wondering, that is what I'll be up to these next few months. Pacing myself, enjoying the last month of spring & a few warm days of summer and keeping my eye on the prize :-)

We're a go! Doing IVF with SIRM in August!

2009-04-14T20:45:00.009-05:00

It's official, though I'm not sure if it's quite set in yet! Our appointment with Dr. Ahlering on Monday went well, as I anticipated, but I don't believe we learned all that much new. Prior to our appt, I made a list of questions that were slightly different than what I posted previously. I find that when I make the list it is a chance for me to run down the conversation in my head, with the goal that I don't forget any major points. By the time we actually get to the appt, I pretty much have the list memorized, but it's nice to have in front of me so that I don't get caught up in the conversation and leave something out. As you'll see, I do need to learn how to set-up my questions better so that, hopefully, they are answered a bit more on target... oh well, there will be plenty more appts for me to try this out on, I'm sure. :-P

Our final list of questions were:

1) What is positive that we have going for us, and what will be our challenges?
As I look back on how this question was answered, I don't think we had a definite clear answer on this from the doctor. Not because he was trying not to answer it. I should have framed my conversation better. After I asked the question, he was like "well that depends..." and then I backed up and stated IVF and he took time to elaborate on how he thought that really was the best approach for us, given our IF issues, and from a monetary standpoint and controlling multiples standpoint. When it comes right down to it though, I do feel fairly confident that I know what we're up against. My husband's issues can be "fixed" via HRSS (high-res sperm selection) ICSI. My issues will be a matter of getting a good number of eggs from the one ovary and then getting them to fertilize into embryos, all the while trying to avoid OHSS. Right now, age is on our side and the fact that my one ovary has so many follicles is a good thing. We won't really know how I'll respond to stims until we try it.

2) Are there any other tests we can do to gauge how I'll respond to meds, besides my FSH (5.5), Estradiol (55) and antral follicle count (15+), which are all within good, normal ranges.
When I framed this question I, again, was wayyy too wordy. I tend to do this sometimes when I get nervous. As a result, it's too much for the other person to remember and they end up not answering everything in the manner I'd hoped. So, scratch that question. From what I'm finding online, there isn't really a way to tell this, other then the above things already mentioned. I think they just begin a protocol that they feel will best address your issues and then adjust throughout the cycle and, if no BFP, further adjust in the next cycle. Not the best scenario possible, but it is what it is. If anyone is reading this and knows of any additional things they can test for, please comment and let me know!

3) Regarding the issue of hydrosalpinx tubes, is the FUS (fluid ultrasound) enough to rule this out, or should we do an HSG? If we ended up needing to do a laparoscopy, would that only cause more pelvic scarring, thus risking further damaging my ovary?
Ok, so this is the point in the appt that I must have woke up (about time, don't ya think!). I remember this answer quite clearly and even took notes on it. He basically confirmed that, yes, he doesn't feel we should be worried about a hydrosalpinx, because our FUS didn't show signs of an enlarged tube. He said that, yes, we could do a laparoscopy and that he would for sure if he thought there was a real cause for concern, but as of now we'd be don't it just because and since I have had a previous abdominal incision (a long vertical one), it makes it more challenging to do a laparoscopy and increases the risk for bowel injury. He said that at this time, it's not a risk that would be worth taking.

4) What about our personal infertility issues lead you to believe we should only purchase a 2-cycle package?
Honestly, he didn't form an answer that was extremely directed to our situation. Rather, he focused on their success rates and the fact that a majority of their BFP cycles happen within the first or second transfer. Based on that, he said he believes that would then be the most cost-effective path for us would be the 2-cycle. We did want a more direct answer, however, we're realistic and know it would be difficult to give a highly pinpointed answer (I don't believe they ever truely know how a cycle will turn out).

5) Should we consider CGH, given that PCOS are high responders and tend to have a disproportionate percentage of eggs which are chromosomally abnormal (or aneuploid)?
He said he doesn't recommend this for us at this point in time. The PCOS isn't cause enough to do CGH as a first line approach. He said he would do it if we asked for it, but he doesn't think it's the best way to spend our money right now. That it wouldn't tell us all that much more, other than the exact one we should put in, vs. transferring 2 embryos. He did say though that in rare cases were tons of eggs fertilize, it can be challenging to determine which 2 of the bunch to put back in. Typically, there may only be one or two babies in the entire group, so it's difficult and often becomes a trial of elimination. CGH, in that situation, would be helpful. I'm guessing we would cross that path if that ended up applying to us.

6) IVF Protocol - What is the likely path for my circumstances?
Dr. Ahlering said that he would most likely start me out on the the "classic" Lupron protocol, or L3C Protocol, as they refer to it as SIRM. More to come on that. I don't know specifics from SIRM yet, but you better believe I've been googling my heart out :-)

So... good news!! August will be here before we know it I'm sure!

Happy Easter weekend!

2009-04-10T15:37:00.005-05:00

I feel like I have so much to write about, and write I will... but probably not for a few days. This weekend looks like it will be pretty busy. Getting ready to leave work and spend the evening doing fun kid stuff with my two little cousins (now 5 & 12... I believe it's 12 - man they grow up too fast), who I've always felt like an aunt to because of the age gap, but who cares. They're cute and full of energy and give me a good excuse to act like I'm 6 again! We're going to see Monsters vs. Aliens 3D tonight and then we'll probably do mini golf or laser tag tomorrow late morning before we shuttle them back home to Illinois.

Then, tomorrow evening we're heading to church for Easter service. I'm really looking forward to it! Each year it's so neat to pause and reflect on the fact that God did all of this for us! The idea that He would ask his only Son to die so that we could be saved is amazing, especially considering how much each of us IF women try and try to have a child. This past Sunday, Palm Sunday actually, was the first time we had communion with the congregation of our new church and it was awesome! This church feels so "real" and non-churchy and that is JUST what we are looking for. In fact this past Sunday, Pastor Mike spoke about "Churchianity" and how we should be anything but that.

And, on Sunday, while we will have to skip out on the annual Easter egg hunt and lunch at my grandma & grandpa's (which stinks), we are going to have a great day out at our first Cardinals game of the year. Shhhh... hubby doesn't know it yet. It's a surprise for his upcoming 31st bday. Should be a great weekend!

I'll post more soon, I promise. I'll definitely have even MORE to say after our Monday RE appt! :)

Diagnostic test follow-up appt made!

2009-04-03T13:02:00.000-05:00

This is a long time coming. Having had our tests done all the way back in late December, I just finished marking our calendar for Monday, April 13 as the day. Boy does it feel good to be moving forward. We both agreed we would prefer to have a face-to-face with Dr. Ahlering to go over our collective tests that were run. Yes, I already did this once, but hubby was unable to attend, and truthfully it was a phone follow-up so I didn't feel like everyone was entirely focused. Now that we have a lot of the other things nailed down, we're ready to get down to business!

At our appointment, we hope to have the following answered...

1) Specifically what about our personal infertility issues lead him to believe we should only purchase the two-cycle package?

2) Are any other tests or things they can do to gauge how I'll respond to meds, besides antral follicle count?

For example, what about the Clomid Challenge Test? We want to know this because if there ARE other test we can do BEFORE making a decision on how many IVF cycles to purchase, we should do pursue them. I wonder though, if a test came back as questionable, would they still allow us to buy the 3-cycle Refund Package? I would assume not, if it goes against what is in the agreement you sign when you purchase that package. So, given that, is there any point to doing the tests? Wait, did I just answer my own question? :) Better ask the professionals at least!

3) What unique approaches will he recommend for our IVF protocol, taking into consideration PCOS, one ovary and sperm quantity and abnormality issues?

More about the Clomid Challenge Test
I just ran across a write up on IVF1 Infertility Clinics's website and wonder if I might be a good candidate for this as a pre-IVF test, given that I've had an ovary removed and therefore may have egg count issues. The article does say that "There is one concept that must be stressed above all else. A normal clomid challenge test tells you nothing. It does NOT prove that your ovaries are working well. It simply fails to prove otherwise. The clomid challenge test is not a sensitive enough test to identify every woman with decreased ovarian reserve. Some women with very poor egg quality (this may apply to me because I have PCOS) are going to be missed."

However, according to their website, "an abnormal clomid challenge test has specific predictive value. These predictions are very accurate and have been confirmed by a number of different studies from a large number of investigators. It is well documented that women with an abnormal clomid challenge test: *Respond poorly to injectable fertility drugs (gonadotropins), *Have higher cancellation rates in IVF, *Have fewer eggs retrieved in IVF, *Have much lower pregnancy rates in IVF and IUI, *Have higher miscarriage rates and *Increased risk for chromosomally abnormal embryos."

If we did this test (which would be fairly inexpensive to do) and found out that it was abnormal, while we may still have to buy a 2 cycle simply because we may then be disqualified from buying the 3-cycle Refund Package, it might tell us if we need to pursue other things like CGH testing on our embryos. I also wonder if it will help inform my RE as to how he should structure my injectable protocol.

In the end, maybe Dr. Ahlering won't tell us anything that we haven't already discussed, but either way, it will be nice to get his undivided attention and hear everything coming directly from him. Following our appointment, our plan is to be equip enough to make a final decision on how many cycles we'll buy at once and exactly when we'll start!

Day 3 Bloodwork for Infertility

2009-04-01T22:10:00.002-05:00

I should have posted this a long time ago... really for my own records, but also because you never who who might stumble upon this and see something that I didn't from these numbers. Here is a guide I found online that helps to interpret these numbers. Not all were listed, however. I've also listed the ranges that were noted as acceptable on my lab paperwork, since I'm sure this is what they also go by to gauge if there is a problem or not. Even still, I know that varies from lab to lab.

Below are the hormone results I got back from my CD3 bloodwork I had done back in Dec '08. At the time. I expected to see the typical PCO results, as described here, saying "While many women with PCOS still have LH and FSH still within the 5-20 mlU/ml range, their LH level is often two or three times that of the FSH level."

Unless I'm reading into these numbers incorrectly, there are really no other cause for alarm other than the PCOS indicator mentioned, so that's good. If your reading this and feel like I've overlooked something, please don't hesitate to speak up. In fact, I welcome it, as always. :)

LH: 23.7 (try four times higher than my FSH)
follicular phase is 1.9-12.5

FSH: 5.5
follicular phase is 2.5-10.2

TSH, 3rd Generation: 0.81
normal range for my age is 0.40-4.50

Fasting Glucose: 77
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L) Normal fasting glucose

17-Hydroxyprogesterone: 50
Normal levels are 3-90 ng/dl in children, and in women, 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase.

Androstenedione: 218
follicular phase: 35-250

DHEA Sulfate: 243
range of 45-320

Insulin: <2
*this seems low... which I guess is ok? Here is an interesting article on lean PCOS women with normal insulin levels. Not sure if it really means anything at this point or not though.

Prolactin: 13.0
non-pregnant women range 3.0-30.0

Estradiol: 55
normal follicular phase range is 11-212

Testosterone Total: 36
range is 2-45

Testosterone, Free, as a percent: 0.88%
range is 0.50-2.00%

Testosterone, Free: 3.2
range is 0.1-6.4

My blood type is: A Positive (can you believe I didn't know that!)

Antral follicle count and IVF success

2009-03-29T11:20:00.002-05:00

When I had my fluid ultrasound (FUS) back in December '08, and then received my records a few weeks later, I totally overlooked the fact that they DID record my antral follicle count that day. Originally, I guess I missed it in the sea of accronymns that was my doctor write-up. So... drum roll... my antral follicle count on my one existing ovary was "15+". I don't know if that means they stopped counting at 15 or if they counted approximately 15. Either way it's indicative of PCOS. This isn't the first time I've had a doctor say I have a PCO ovary - all my OBs confirmed this as well. While your antral follicle count does vary from cycle to cycle, it's still nice to have something to go off of for now.

Below is some info I found on the web in regards to what your antral follicle count is and what is a "good" count. The Advanced Fertility Center of Chicago has an entire page dedicated to this topic and below is their chart on what are some "general" guidelines. To read their information in it's entirity, go here.

Total number of antral follicles	Expected response to injectable ovarian stimulating drug (FSH product) and chances for success
Less than 4	Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should seriously consider not attempting IVF at all. Rare pregnancies if IVF attempted.
4-7	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10	Somewhat reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy as a group.
11-14	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually good. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group only slightly reduced compared to the "best" group.
15-26	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 26	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group have egg quality issues and lower chances for pregnancy.

Going off the above, it tells me it might be nice to know in the future if I really do have +15... as it seems that might be a bad thing. For now, I won't be overly concerned. I'm just glad the one ovary is still working!

I also came acoss a medical journal article from November 2006, titled "Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization," concluded that "AFC (antral follicle count) performs well as a test for ovarian response being superior or at least similar to complex expensive and time consuming endocrine tests. It is therefore likely to be the test for general practice.

They reported the following, regarding antral follicle counts in relation to follicles AFTER stimulation: "We defined a 'poor' ovarian response as less than 6 oocytes after ovarian hyperstimulation in an IVF treatment and a 'hyper' response as more than 20 oocytes after such an IVF treatment. Among women undergoing in vitro fertilization, the chances of a live birth are related to the number of eggs fertilized, presumably because of the greater selection of embryos for transfer. The low success rate when only two eggs were fertilized reflects the lack of choice among embryos for transfer. We have in our laboratory the experience that we have an overall 50–60% chance of fertilization. Taken this together, at least 6 oocytes are required for three or more fertilized eggs. We defined a hyper response when there were > 20 oocytes. This was based on the knowledge that the pregnancy rates do not increase when > 20 oocytes are retrieved. Moreover, such cases have a significant risk of a severe OHSS."

Guess we'll just wait and see what my antral follicle count is at my next ultrasound, which most likely won't be until right around the time I start my IVF cycle (TBD).

IVF in '09... back in the running?

2009-03-26T22:49:00.012-05:00

Just as we think we finally have a game plan, it would seem as though God may have something else in store. As you well know by now, we have done a lot of financial analysis in these past few months to get an idea of just what we could afford with regards to infertility. One minute we were just sure we were going to sell our home - the next we weren't. Then we decided to refi... ok we've actually stuck to that and have been making some progress.

Which brings me to my first newsworthy item. Our house appraised for about 13,000 more than we had even hoped it would. Which, in turn, means we have the option to put less money down as equity when we redo the financing. And, guess what that means. We now have more liquid cash in our possession to put towards IVF treatments. Actually, the amount that we now have "left-over" is just about the same amount that my husband kept getting stuck on. The figure that we would have been able to save by waiting several additional months, which is why we were going to wait until January.

By this point in my post I should have added at least 10 exclamation marks!!!! after each sentence, but I'll save them for another day. It's not that I'm not happy, it's just that I'm being cautious. Anyone going through this knows that the higher you climb in your emotions, the harder you fall. I will say that we have a bit more talking to do and will probably try and make an appt. with our RE to talk about why he's recommending the 2 cycle package, vs. the 3 cycle/outcome based one. At this point I'm not sure he'll tell us anything new, but it will be nice to get the three of us talking. Maybe just hearing it come directly from him is what we need to firm up a direction. I will say that last night, when we sat down for a short time after my girl's meeting, I, for the first time in a long time, heard excitement in his voice about this whole thing. I think that's probably what bothered me the most about when we talked and "decided" to wait a few weeks ago. His heart just seemed so far removed from it all. I half wonder if he was being that way just because he felt it's what he needed to do in order to make, what he felt, was the right, head-strong decision. In any case, I am glad that our "everything" is back into this. Now, let's just see where it takes us. Hope to have our IVF month determined in the next couple weeks. Will it be August or January... TBD!

St. Louis Infertility Support Group
And can I add that still, after all these months, I totally enjoy and look forward to my girl's meetings! Being able to get together with other women who are battling infertility to listen to and share stories with is very releasing. I can't thank them enough! If you're reading this and are from the St. Louis area, feel free to drop me a note. I'd love to share more information with you about the dates and time we meet - anyone TTC with infertility issues is welcome!

Infertility on daytime TV, and me?
On another weird, but exiting note, I got a call from the Tyra Show tonight! A couple weeks ago I sent in my infertility story after coming across an upcoming show they're going to do. I figured the odds of me actually getting called was slim-to-none, but it was worth a shot. The woman I spoke with said that she was going to pass my info on to producers to see if they could work me into the show. We'll see if it amounts to anything. You're probably thinking - why? Why would you send your info in like that? The very idea that I could possibly share my story with other women and have them walk away feeling more empowered is just awesome. Simple things like how your cycle works, what really goes into being fertile and the things to look for and ask of your doctor so that when she is telling you to "relax" you can know that you need to move onto a new doctor. Other things like being an example of how many women need ART treatments to simply be able to have the same pregnancy chances that "normal" women do. In this past year of trying, we've only really had two cycles where we could have even had a chance, simply because I rarely ovulate on my own. Also, most of us do not have infertility insurance and, as a result, this will have a huge long-range financial impact on our families despite how hard we've worked and will continue to work to provide and save for our family. I don't think that law makers really get that. So, we'll see where that leads me!

What's this? I started my period! :)

2009-03-24T19:09:00.013-05:00

Most women, especially those trying to conceive, wouldn't be excited about this, but I definitely am. I started my cycle today - ON MY OWN!! This is huge for me. I think this is only my second cycle on my own since stopping birth control in April of 2008. During that particular cycle, it took me 67 days to start on my own, and I'm not even sure if I ovulated. It's hard to say though. I was still new to the whole charting thing (it was my first cycle ever charted when we started TTC), however, I certainly didn't write down any "symptoms" around the time that I would have ovulated, so that's why I'm so doubtful.

In my little corner of the world, this is very exciting! It's nice to see that my body WILL work, if nothing else just some of the time. Can you believe this makes for only my 2nd cycle where we've actually had the *chance* to have a baby (ie. I ovulated) in what will be almost a year of trying to conceive?!! Since I didn't know for sure I had at the time, it was the easiest 2ww ever! :-)

I'm excited, but I definitely realize that even when I DO ovulate, the likelihood of my remaining tube being able to function properly and pick up an eggie is pretty slim with all of the existing scar tissue that has formed due to my surgery years ago. Even still, I have HOPE!! For the next week, I will be reminded that I am indeed a woman - roooarrrr! :P And I will love every minute of it!!

For your viewing pleasure, here is my complete 93 day long cycle. Above is a snapshot of the very end, around ovulation . Our first cycle where we weren't actively trying, I guess you could say. That basically means, we weren't BDing every few days, I wasn't taking my basal body temps, doing any of those lousy OPKs or drugs or anything. In fact, you can see that in late December (when this cycle started), I stopped taking my metformin and, and yes I probably shouldn't have cut this one, but I also stopped taking my prenatal pills. Those things totally suck and I just needed a break.

The above chart snapshot indicates the days when I was having certain ovulation-like symptoms - starting with headaches off and on, very sensitive nipples and my ovary was sore, as in I when I barely pushed on my stomach it hurt, and then on Day 81 I just happened to check my cervix and it was open. Based on all of this, I *believe* I probably ovulated on either CD 81 or 82, but it could have been anywhere in the green outlined area I suppose. As you can see we did BD a several days prior to that, and one day right in that key time frame. Even though BD timing wasn't "perfect", it wasn't awful either. I'd give it a 3.5 out of 5 maybe. Just good to note. It's always nice to test my body out and give it a chance to shape up on it's own, but I'm not holding my breath. I know God can work miracles, so I just continue to pray!!

Infertility on primetime thanks to 24!!!

2009-03-23T20:26:00.005-05:00

I'm probably WAYYY more excited about this than I should be. Tonight, on the Fox TV show 24 in a scene with the main man, Jack Bauer (aka hunk that saves the US single handedly every stinkin episode!), he's talking with a security gaurd who just got off the phone with his very pregnant wife. We're sure he's a goner (it never fails they always kill a new bit character who is in a vunerable situation like that), but as Jack is questioning why he got involved with the bad guys, he says something to the effect of "Don't take me the wrong way. I did it for my wife - for the money. They say that getting pregnant is natural, but after three long years and IVF treatments that insurance doesn't cover, it has cost us a lot of money. Now the idea paying for twins, well it is pretty overwhelming."

SERIOUSLY!! Can you believe this!! SCORE ONE FOR INFERTILITY! Ok, so a small step, but still - how awesome is that. I mean, in about three sentences he pretty much summed it all up... well most of the big stuff that a lot of the general population have a hard time understanding. What a great delievery technique :)

That pretty much made my night!! Thank you 24!

More from our RE regarding IVF

2009-03-16T17:51:00.002-05:00

Following up to my two most recent blog posts, I wrote Dr. Ahlering on Saturday with three questions (yes, he does answer his own e-mails... not always as thorough as I'd like to receive, but they are coming from him, so I'll take what I can get for now).

My questions were:

1) Knowing that we had testing done in Dec '08, do you feel it would be detrimental to our IVF success for us to wait until next January to begin IVF?

This was left unanswered. My feeling is that, no it probably wouldn't impact us that much, given our ages and health issues. However, there is always the small *chance* that something could happen to my only ovary. This past week I have been having soreness near where my ovary is located (like soreness when I push on my stomach from the outside). Who knows what is going on... maybe I'm actually going to ovulate on this 90 day (and counting) cycle I've been on since the beginning of January. Anyway, taht type of thing always gets my nerves jumping thinking "what if" some gianormus cyst is forming on my ovary and will forever kill my only chances at conceiving. I try to block this out of my mind and pray for the best.

2) Without us knowing how my one ovary will respond to fertility drugs, what is your professional opinion as to if should purchase the 2 cycle or 3 cycle package?

To which he answered "I think the 2 cycle plan is best for your situations."

3) I also asked him about the CGH plan I mentioned in my last blog post. My question, specifically, was: Can you tell me, would this be something you would think our situation (one ovary, PCOS and male factor) could greatly benefit from?

His answer: "CGH is something to consider for anyone that has RPL (Recurrent Pregnancy Loss), or IVF failures and decent ovarian response. Or, if someone is looking at fertility preservation/egg freezing. The thing that people do not like sometimes is that one has to freeze the embryos for later transfer."

It's worth mentioning that RPL or IVF failures doesn't apply to us (not at this time, and hopefully never) and we don't yet know how my ovaries will respond, since I've never undergone a cycle with injectables. I'm not sure how the mandatory freezing of embryos would affect our situation. I know they have improved the freezing/thawing techniques so that fewer are lost in process, but if we don't respond very well and get a lot of embryos, it may hurt if we loose even one. I suppose something to think about is that they stated if you don't produce at least 5 ovarian follicles, you could opt out of the CGH plan and covert your cycle to a fee-for-fee service, which is basically like going with one of the plans we'd already been considering. I'm assuming that if you had to convert, you would be converting at the single cycle cost (not the "buy in bulk costs" of the 2 or 3 cycle plan), which would mean it would cost more if you had to do another fresh IVF cycle.

I'm still digesting all of this. I can't help but rethink things a little, knowing Dr. Ahlering is thinking about our health situations and recommending the 2 cycle to us, vs. the 3. I would think that he feels pretty positively about us getting pregnant in 2 cycles or less, otherwise he wouldn't have said it.

Not wanting to be pushy, I brought it up again with my husband via IM today at work. As you can imagine, IM isn't the best way to talk about these things, but sometimes it just has to be that way. Our conversation starts by him commenting on something else entirely, that happened to mention us in relation to IVF... (sorry sweetie, but I'm putting our convo in my blog!)

[14:25] cathy@thinktpi.com: "as we prepare to start IVF in January"
[14:25] cathy@thinktpi.com: that means that Dr. Ahlering's comment from yesterday didn't change anything, did it?
[14:26] Jay: I thought we were waiting on pricing information
[14:26] Jay: I'm all for starting sooner if it's cheaper for the risk
[14:27] cathy@thinktpi.com: well, yeah, i mean there were two things. 1) this whole CGH thing... we are waiting on pricing for that package 2) but then there's the thing where he said "with your situations, i would recommend the 2 cycle", which is seperate from the CGH.
[14:28] cathy@thinktpi.com: i mean that's his opinion and we just have to consider how much we want to factor it into how we feel
[14:28] Jay: sure, but we'd already gone over how two cycles this year leaves us in a bad spot financially if we do somehow end up with multiples.
[14:29] Jay: we can do a two-fer in january to save even more money, but that's about all that his comment really changed.
[14:31] cathy@thinktpi.com: oh... see it thought it may have changed the timing. especially if he's recommending 2, and that, or less than that really does work. (which i would assume he's betting it would, otherwise he wouldn't recommend it, but who knows). anyways, i just wanted to see how you felt about it. i still feel that if we did 2 this year, we'd have to agree to wait until some time next year to do another 2... and we haven't really even played out that scenerio financially, so who knows. i just wanted to make sure we thought about it enough, since he did give us his opinion, that's all.
[14:32] Jay: His comment basically makes me feel good that, were we to do it this year, we'd probably be successful.
[14:32] Jay: The other stuff I mentioned is really unchanged by his comment.
[14:38] cathy@thinktpi.com: i just hope you can see where i'm coming from... the idea that he believes we could be successful with less tries, just makes me wish all the more that it was happening sooner than later. i just wonder what it would look like if we got pg on the first cycle and had twins... i mean, less money towards IVF, so more money left over if i had to go on bedrest... i suppose it seems that it could even out somewhat, but i don't think we've done the numbers for that. sorry to open the can again... just want to really make sure we've thought this through.
[14:39] Jay: Doing a two-fer this year becomes viable if... a) The cost goes down substantially, b) the probability of multiples drops substantially, c) we find a way to make substantially more money.
[14:40] Jay: If CGH comes back as a reasonable option, I can see us strongly considering this year since we'd have a dramatically lower chance of multiples.
[14:41] cathy@thinktpi.com: k
[14:41] Jay: *kisses*
[14:41] cathy@thinktpi.com: :(
[14:41] Jay: Kisses are good things...
[14:56] cathy@thinktpi.com: fwiw, CGH doesn't really have an impact on multiples for us, since the most we'd ever put in are 2 (at least right now anyway, because of my age and no failed IVF history). Where it cuts down on multiples is when women have a hard time getting pg so their Dr puts in a handful, just hoping one takes. the only way it could impact us is if we did CGH and had one embryo that was "perfect" so we only decided to transfer that one. doing so, though, in and of itself lowers our chances because you're lowering the odds, so to speak.
[14:56] cathy@thinktpi.com: so yeah, i think i just shot myself in the foot
[14:56] cathy@thinktpi.com: whatever

Based on that, unless I sit down and run the numbers again and want to rehash this all, it's probably still that we're waiting until January, because we know the cost for IVF most likely won't go down and there really isn't a way for us to make more money, given our economy right now. Unless of course I win the lottery! (that I don't play, but hey, you never know!) And I don't see how this CGH thing will be cheaper, but we'll see. I'm still waiting on financial numbers for CGH cost from SHER.

Sorry for the long winded post, only to find out we're back at square one, but it helps me to write it all down, for sanity sake.

SIRM's New CGH-Risk Sharing Plan = Increased IVF success rates!

2009-03-14T15:45:00.008-05:00

How interesting.... The Sher Institutes of Reproductive Medicine (SIRM), otherwise known as SHER, announced on March 9, 2009 the the world’s first CGH-Risk Sharing Plan that guarantees qualified IVF patients a baby or offers a full refund of the clinic’s medical fees. Read more here.

What is CGH?
Well, the article above does a good job of describing what it is, however, I'd like to elaborate. CGH testing is supposed to be better than Pre-Implantation Genetic Diagnosis (PGD), which in the past was "the" way to detect chromosomal abnormalities. CGH is better than PGD is because they test for these chromosomal abnormalities at the embryonic stage, rather than testing just the egg (which is what PGD does), allowing them to catch defects in the embryos and transfer only the most viable ones. The somewhat new process of vitrification (the process they use to cryopreserve/freeze and thaw eggs or embryos), vs. the old and more widely used "slow-freezing" method helped to pave the way to improving this process. SHER clinics have been using this vitrification technique for quite some time now and together, with CGH, it's looks as though it could really greatly improve future IVF success rates. For more technical info on how this has all come about, check out this article written by Dr. Geoffrey Sher of the SIRM, back in early 2007. Additionally, here is a video on CGH from '07 that explains the impact it can have on success rates. As you'll see they've been working towards this for quite a long time. Personally, I think that if SIRM is willing to offer this money-back guarantee, they must have quite a lot of faith in it's success.

What does that mean for us?
Well, I'm not exactly sure just yet. Bare minimum it means that without a doubt our chances for IVF success rates per transfer go up significantly. In turn, that would mean we would need less tries, or transfers, to achieve success and bring home a baby! I suspect that the cost for this plan is fairly high... maybe as high as SHER's 3-cycle refund plan, however, it might be better to go this route because of those benefits.

As usual, I hate to get all worked up. But, I was definitely super excited to stumble on this today. We both were. We agreed, the more things you can do prior to transfer (and after for that matter) to up your chances, the better. Which means, pursuing CGH is probably very real for us. Especially since PCOS women are know for producing questionable quality eggs, which in turn often result in embryos that are less than perfect quality. My instinct is that this would help to counter act that.

How the CGH-Risk Sharing Plan would work?
The article goes on to say.... "If the patient does not have a baby after all her CGH-normal embryos (from the same IVF egg retrieval) are used up, she will be eligible for a full refund of SIRM’s medical services, as well as for a second try should she so choose. Moreover, if following stimulation with fertility drugs the participant does not produce at least 5 ovarian follicles, she can elect to opt out of the plan and convert to fee-for-service IVF."

I've e-mailed Dr. Ahlering to see if he thinks we'd be good candidates for this and to get some additional info about costs. I'm excited to hear back and will fill you in when I hear more!

Say it ain't so... looks like IVF will have to wait :(

2009-03-12T20:02:00.004-05:00

Two nights ago me and the hubby sat down to go over, for the billionth time, finances. I could puke finances by now. The idea of money controlling my life just absolutely frustrates me to no end. Even still, my head tells me to consider it. Obviously, you shouldn't bring a baby into this world unless you're prepared to be able to feed it. After months and months of chewing over numbers - we finally laid out our options.

We are certain that we're doing IVF... it's just a matter of when. Do we:
1) Buy a two cycle package and start the first fresh cycle this August. Then, if that doesn't work, we would need to wait until sometime towards the summer or fall of 2010 to be able to buy another package...Or,
2) Do we wait until January of 2010 and buy a three cycle package all at once.

Note that in either case we would buy the stated # of fresh cycles, which also includes any frozen (FET) cycles that would come about as a result of the previous fresh cycle. Who knows if we'll have any embryos left over, but it's nice to know that those costs are included.

I thought it over some more yesterday and really feel like my heart is telling me August is the way to go. I was really looking forward to gauging what he was thinking. Let's just say it was the complete opposite of my view. He'd rather play it super safe and wait until January. Why? Well, by waiting those additional months we'd be able to save about $10k more and he feels like in an extreme circumstance where we get pregnant with twins, we'd be glad to have have the additional buffer.

So... how do I feel about this? Not sure if that question even needs a reply. It's given right?! My heart totally sank. Infertility has a way of making you feel so powerless. Here is this great big meaningful thing (adding another life into our family) and my body is completely taking away my ability to just go with the flow. And then, as if that's not enough, money is now controlling this whole situation simply because our health insurance system is screwed up and doesn't make infertility coverage available to everyone. Oh, and while I'm on my soapbox, my husband's job is playing a role too. This was a fantastic time not to convert him into an employee position AND to cut his salary by 10%.

What a strange powerless position. I guess when I heard him tell me he wants to wait until January it just was another dagger to the heart. I know that if these things weren't affecting us, he wouldn't want to wait at all, but the truth of the matter is that they DO exist and he feels that it would be best to wait. Most people who know me realize that I don't generally take no for an answer ;) (what an annoying trait), but in this instance I would feel awful trying to convince him of something he's not sure about on his own. Not this time. Not about something this major. It just wouldn't feel right.

I went to bed last night telling myself that the only way I am going to be able to make it through these next very long 11 months is to have lots of other distractions. Other things to put my energy and focus towards - otherwise, I really feel like I might not make it out of this thing with my head held high. These past few months have taken their toll on me. I've found myself not really caring at all about exercising, about going out and having fun or even doing regular things like cleaning the house. I'm ashamed to say that up until last Sunday, my house hadn't been vacuumed in 3 weeks. That is totally sick!! I wouldn't say I'm a complete neat freak, but that's just uncalled for.

I think I'll have a long talk with him tonight and lay it on the line. Things have to change. This year has to be a year of progress, fun and a chance to clear our heads and prepare for our baby in 2010.

How much will having one ovary effect IVF success?

2009-03-06T14:12:00.005-06:00

Now that we know we're doing IVF, it's now just a matter of when, we're wondering - with me having one ovary, will our IVF success rates be lower? If so, how much less of a chance will we have?

I asked my RE and was, truthfully, hoping for a more informative response. His reply was "If that ovary has a lot of eggs, that is what matters." I wanted to know:

1) Compared to the "average" woman with two polycystic ovaries, how many eggs would you expect to retrieve from my one ovary during a fresh cycle?

2) Assuming we'll have less eggs retrieved, should we expect that it's likely we'll not have any additional embryos left over after each fresh transfer?

Not satisfied with the answer he gave, I did some searching of my own and came up with a few insightful links. One was from a study that was done back in 1998, the treatment outcome in women with a single ovary versus patients with two ovaries undergoing in vitro fertilization and embryo transfer (IVF/ET) was "comparable to those with two ovaries." (click here for a PDF of the link).

I also googled to see if there were any other personal stories of women having one ovary and doing IVF and came up with these:

A blog by a woman who has only one ovary and one fallopian tube, has never had regular cycles and has PCOS and did IVF and got pregnant on the second transfer.

And another blog who has one ovary (has half of the other after having a laparotomy, but it doesn't' appear to work well) and was only allowed by her RE to do two IUIs and is now getting ready to move her first cycle of IVF. She also has endometriosis which is why, more than anything, they are moving more quickly.

That's all I could find during the time I looked, but I will be sure to keep this post up-dated if I find any other informative links. All in all, I'm feeling slightly better about at least being open to the idea that our chances might not be cut in half, which is nice. Still not sure how many tries we'd need though to keep the odds of IVF success in our favor. TBD...

Random Happenings - Turning 27, My Great Grandma and My "Baby" Dog

2009-03-04T16:12:00.002-06:00

Time for a real-life update... you know, less "facts of infertility" type info and more of what's been going on in my life.

Another year older!
I think I mentioned this in a previous blog post, but I'll state it again. I turned 27 this month and that's just plain freaky to hear. I suppose it wouldn't be so weird for me if it were not for the fact that I can very clearly remember my own Dad turning 30. To be even somewhat close to that really seems weird to me. I still want to be a young parent, so I'm glad we're working fairly aggressively towards getting pregnant now, rather than wait until I'm in my 30s. Anyway, overall it was a pretty good birthday. My Dad, of all people, made me a three-layered birthday cake. It was perfect - just the right amount of moisture, spice and tastiness. The icing was whipped and spread all nice and neat too, which sounds simple, but it can be tricky getting those little crumbs to not show on the surface. I really appreciated the effort - Lord knows he probably spent more than half of his day putting it together. Brownie points! :) Thanks Dad. We had my family over that same weekend, so I didn't spend my bday all alone, which is always good. Of course my husband came through big with a birthday breakfast AND dinner no less, roses, a DQ ice cream cake (yummy) and a nice toasty fire in the fireplace. I was in heaven! I'm going to be a good sport - here's to 27: May it be a year to remember!

My great grandma passed away last week...
Switching gears, I'm both sad to say my great grandma, Ella Marie Payne, passed away last Friday and today we laid her body to rest on Tuesday. It hadn't occurred to me until we were sitting in the chapel during her service that if it weren't for her, nearly half of us in the room wouldn't be here. What an amazing thing! While I didn't really get to know her until a couple of years ago (like talk to her one on one), she was always so concerned with how life was going for usI and she absolutely adored my husband. It was so cute to see the two of them watch the game show network together and I'll never forget about the time that he told her our church was holding a talk at a local brewery. As a long time Baptist, she said "oh we'd never do that!" :D I'm glad my last image of her burned into my mind is when, just a few weeks ago, I helped tuck her into bed and had the chance to look into her eyes and tell her I loved her. My heart almost broke right then and there as I just knew in my sole that was the last time I would see her. Can't wait until the day when I'll get to see her pretty smile again.

Our dog is a newborn baby?! :)
My last, somewhat random life happening is pretty off the wall, but I wanted to make a note of it because it was so totally freaky! One of my dogs, the little sassy one, Madison, woke me up in the middle of the night a couple of weeks ago when she made noises that sounded exactly like - and I'm not kidding here - just like a newborn fussy baby sucking on a passie!! Seriously, I know what you’re thinking “you are a completely obsessed crazy, I can’t leave my kids around you kind of lady” But ah ha! Even my husband woke up to it. When I heard it I sat straight up in bed and started looking around the room, thinking that I had neglected some child I suddenly forgot I was pregnant with and gave birth to. I’m no expert, but I’m pretty sure I won’t forget something like that.

I can't tell you how incredibly weird of an experience it was. Right after I woke up, my husband woke up and thought I was asleep and didn't want to wake me. That's when I nugged him and was like "do you hear that! It's Madison!". I couldn't put my finger on how to describe the sound and he was like "it was just like a fussy baby" and I said "yeah!, like fussy, but trying to put itself to sleep with a passie in it's mouth". Anyway, it was too weird. Who would have thought - the first "baby" dream-like thing to happen for me would be something like that. Guess they really are my furry kids :)

My RE affirms IVM isn't beneficial, compared to IVF

2009-02-28T21:33:00.004-06:00

Wouldn't you know that AFTER my husband and I thoroughly discuss the positives and negatives of IVM and decide that it's just not for us, I ran across a show produced by the infertility radio show I listen to discussing new infertility technologies and one of the subjects was IVM. The guest on the show was none other than my own RE, Dr. Peter Ahlering. What's funny is that his position on IVF vs. IVM is pretty much the exact reasoning we arrived at - that ultimately it's not effective enough, or cheap enough, to be sensible. We were worried that if we went down that road and didn't end up with a baby, we'd have no money left to try what I call the "end-all-be-all" for infertility - IVF. Anyway, it was just good to hear a trusted medical opinion on this topic and I wanted to share it with the rest of the world.

As usual, below are my notes from the show.

Disclaimer - Please note that the information below is my personal synopsis of the free online radio program hosted by Kim Haun, founder of Conceive Magazine, with guest Dr. Peter Ahlering, an ob/gyn and medical director of the Sher Institutes for Reproductive Medicine in St. Louis. It is in no way meant to quote the either of the parties mentioned above.

Listen for Yourself

Scroll down in the archive to:
Date: 1/29/09
Title: "New Fertility Technology".

Dr. Peter Ahlering's thoughts on In Vitro Egg Maturation (IVM): IVM is where you stimulate the ovaries with drugs when they are very small. Egg retrieval of immature eggs, probably two steps behind where you'd be with IVF. In order to be competent for fertilization, they have to mature these immature eggs in the lab. This procedure has been around for many years and it's an extremely complex process still that involves maturing an egg to the point that it's capable of being fertilized. With the process of IVF, you wonder if people really need to do IVM. Yes, successes have been reported, but not that many because it's not that applicable to that many people.

Is IVM safer for PCOS patients?
People talk about how it's safer for women who have polycystic ovaries because they can avoid hyperstimulation... this is true, but there are other ways to avoid this through IVF and still have very high outcome. Prolonged coasting and other types of protocal medication alteration to avoid hyperstimulation. In Dr. Ahlerings opinion, less than 1% of patients would suffer from hyperstimulation.

Is IVM more affordable than IVF?
What about cost? Isn't it more affordable? Isn't it easier on the woman? Yes, the process itself is cheaper, but if you're trying to save money on the goal of having a baby, it just won't work because you'll have to try more times, so the cost goes up and is most often higher. Do we even know how the eggs will respond to this outside of the body? You have to get a lot of eggs to make a baby with IVM (25-30 mature eggs), compared to IVF (10-12 mature eggs) because a lot of them are lost through the process. An article about IVM where success rates are in low teens. That same young PCOS patient would have a 50-60% single cycle chance.

Egg retrieval for IVM
How do you retrieve the eggs given they're so small? It's just like IVF in a lot of respects. A mature follicle at the time of ovulation is 18-22mm, whereas an immature follicle is much smaller - more like 5-6mm because it's an immature egg. Those immature follicles are always there in a PCOS patient. You can go get eggs and you retrieve just like you would during IVF. During an IVM retrieval you might get 30 immature eggs. And after 24-48 hours you would have a certain number of mature eggs.

Genetics of the egg following IVM
Have we seen enough babies yet to know if we're harming the baby? There haven't been enough studies done. It's doubtful that the process itself would increase birth defects. The problem is that most eggs won't make it to the point of baby.

Is hyperstimulation deadly?
Can women die from hyperstimulation? Maybe that's why a lot of women find IVM appealing. No, practically speaking I don't know how it's possible where you would run into a circumstance where hyperstimulation would be so bad that she would end up in the hospital and be close to death. People who have lots of follicles and eggs are prone to a condition called ovarian hyperstimulation syndrome. For all women who undergo IVF, to a large degree we create a controled hypersimulation of sorts in the sense that they are creating lots of follicles (not just one like you would during a typical non-IVF cycle). The common rule of thumb is that you get a lot of follicles and there is no illness from it.

IVM success rates too small, so we're back to IVF

2009-02-26T18:01:00.004-06:00

Our basic, personal conclusion on doing IVM in Canada or the UK is this: Looking at statistics, at the end of 4 tries of IVF with Dr. Peter Ahlering, we would have an 80% chance of walking away with a baby. It sounds weird to put it in those terms, but it's true. Those odds are pretty high if you think about it and it really doesn't get any better than IVF, in terms of mecical infertility capabilities.

"What if" IVM didn't work?
With IVM in Canada (I can't speak for the UK, because they don't provide very detailed success rates), you would have to try about 7 times to have those same odds. Seven times! That is a heck of a lot. If they were next door it might not be as big of a deal, but by the time you add in travel seven times over, it is just as expensive as IVF. PLUS, and this is my big hang up, say we did 3 rounds of IVM, but were unsuccessful, would we have the stamina to stick it out to 7, or would we get scared that we'd "waste" all our money on something that just doesn't have as good proven success? Trying to think way in advance, I personally think I'd get a little worried that in the end, after 7 rounds of IVM, if we still didn't have a baby in our arms, that I would have wished and would wonder if IVF would have been the thing to do the trick.

Having only one ovary most likely makes our odds even smaller
Then, there is my own personal health issues that have to factor in. Given that I only have one ovary, that isn't even accessible from all sides (remember it's glued to my uterus on one side), they might not be able to retrieve all of the eggs they need for the maturation process. When I e-mailed the clinic in Oxford, their reply was "Mr Child has said that for IVM you would need a total antral follicle count of 20-30 with all being reached with a needle via the vagina." While I've had many internal ultrasounds, I have never "officially" had my antral follicles counted. Even my RE just said you you have a "good number of follicles in the one ovary" - obviously that's not nearly specific enough, but I still highly doubt I have 20-30.

IVM live birth rates almost half of some IVF clinics
Yes, in IVF they also do a retrieval which is very similar, however, because you've gone through all of the stimulation drugs, the follicles are larger and therefore easier to see and access. Having said that, I would imagine that my personal "success rate" would be quite a bit smaller than the average woman with two ovaries. Maybe not half of what her chances would be, but still enough that it would probably have large impact, seeing as how the chance of success for a "live birth" in a given IVM transfer is only around 21% for women under the age of 35. Who knows how much lower it would be for me - this factor alone would mean that I would need even MORE than 7 cycles of IVM to have the same chance at a live birth, compared to IVF. In truth, this is my opinion having researched things and I don't know for certain my chances will decrease that much.

Ugh. So really we're more than likely back to square one. I mean I still want to ask Dr. Ahlering how our chances will be affected with any treatement, including IVF, because we will need to know going forward how many trys we'll more than likely need to make this happen. The last thing I want to do is buy a single cycle at a time and end up paying WAY more as a result, as Dr. Ahlering's office offers what I like to call a "bulk discount". If you buy 2, it's technically cheaper per cycle - same with buying 3 and with 3 you get a small fraction of your money back if you don't have a live birth at the end.

At this point it's just frustrating. Frustrating that there seems to be some other safer form of treatment that is ultimately most likely unattainable because of my health, the distance from those particular clinics which are far and few between and that this is one situation where it really probably doesn't pay to find something cheaper. If we're going to do this, we should find someone who is really good at baby-making and just go for it because in the end, if we didn't end up being able to have biological children, we'd want to look back and know that we gave it our best effort at the time.

First we're selling. Now we're not... Finding a way to pay for IVF.
This has been a weird past two weeks. First we thought this stupid recession stimulus bill would have a house credit in it and, as a result, we were pretty for sure we were selling our home. Then Congress took that out of the bill and the economy continues to worsen, including the housing market. So our choices were - refi our current home which will drop our monthly bill down quite a bit OR still try and get our house ready and see if it will sell. The main difference between the two was that with a new house we would save just slightly more each month on our bill, we'd have to pretty quickly get our home ready to sell ourselves and then we wouldn't have much room to move on price if we did get an offer. The refi would allow us to skip some of the unknown, the stress and the headache of dealing with a new house. Every person that's close to me pretty much thought refi was the way to go. While I still have mixed feelings (I wondered if we should at least "try" to sell first, but that would cost us each month we wait to refi), but ultimately my husband feels like this is probably the way to go.

The other part of that story is that we might have to wait a bit longer to do IVF - mostly because we may need to build our savings up a bit more so that we have more money to live off of in the situation where we have twins and I can't bring any income in. Ultimately I only want to work part-time (and WAH if possible) so that we don't have to put our baby in childcare, so we need to do what makes the most sense for the long run. Man is it hard to be ok with just waiting another solid year. Waiting while friends and relatives get pregnant, have babies and watch their kids take their first steps. I am starting to feel like I'm in some weird time warp where I'm standing still and everything else is moving right along before my eyes.

Even still, I need to be mindful that so many people are faced with so many things right now that are far worse than what we are dealing with. I need to be humbled and keep things in perspective for sure. God give me the strength!!

A side note - I'm now 27 and the sound of that just freaks me out. Why does that have to seem so much older than 26??!!

Or, how about low cost IVM in Canada?

2009-02-19T23:25:00.005-06:00

Looks like this may be on the table for consideration too! I just got through posting the thing about Oxford, and I came across a forum that listed this site: http://www.mcgillivf.com/e/mcgillIVF.asp?s=834183253347DEH&page=193.272

McGill Reproductive Center. They're based in Canada and it would seem they offer IVM and have some really good prices too. At least at first glance. Unfortunately, I'm very tired and am getting yelled at to come to bed :) so it will have to wait. I have plenty of stuff to research this weekend, that's for sure!

We're considering doing IVM at a clinic in Oxford!

2009-02-19T21:54:00.009-06:00

Ok people. I'm super excited about this. In fact, I don't think I've been this excited in quite a long time. After getting some financials from the IVM clinic in Chicago (IVF1, w/ Dr. Morris), it revealed that doing IVM really wouldn't be more cost effective compared to doing IVF with SHER. In fact, per single cycle it was a bit more expensive simply because they don't have a true multi-cycle "discounted" package like SHER does. Instead, they said they offer a $2,000 discount for each additional IVM cycle. Even that isn't enough to make it worth my wild.

To also stay relevant, I should say that we recently (like as of this past weekend) decided to not try and sell our home. After many, many, MANY exhausting hours of considering the advantages and disadvantages with selling/buying or refinancing, we've decided that refinancing will probably be the most predictable solution. Given the awful housing market we really don't know what we could expect from selling and would probably get a very low price for our home as a result. We decided that if we want to sell in 5 years (or so), hopefully it will be worth the wait. So, long story short, while it felt good to have an decision made, it made me a little sad. In making our decision, we also came to the conclusion that it also probably made sense to wait a little longer to pursue IVF. The longer we wait, the more we can save each month so that we have more of a reserve to fall back on once we do have our baby.

We were still in the middle of coming up with that time frame when I heard back from the IVM clinic in Oxford, UK, known as the Oxford Fertility Unit, a non-profit clinic (how cool is that!). As a long shot, I e-mailed them almost a week ago to see if they thought I would be a good candidate for IVM, since I only have one ovary that is probably partially blocked due to scar tissue and it being adhered to my uterus. The main reason for e-mailing them was the fact that their website listed the prices for their services - prices that are more than half of what they cost here in the U.S. Even with travel factored in, it would still be about 40% less than an IVM or IVF cycle here in the U.S. I was a bit sceptical as to if the prices were even accurate. So, with those things in mind, I sent my e-mail off.

And today, I received this response -

"Mr Child's reply to your email is: If both ovaries are accessible vaginally and of polycystic appearance then IVM should be possible. We do treat patients from abroad and the costs are correct."

I don't want to get too excited. I still need to confirm that my only having one ovary wouldn't disqualify me. However, I wanted to outline the costs a little more precisely to make sure I wasn't looking at something incorrect. The price difference just seems too good to be true. For approx. $10,000 we could undergo a single IVM cycle - that includes pretreatment testing, retrieval, ICSI, transfer, drugs and travel costs (flight, hotel, food and an misc expense allowance)!! That is compared to $16,000-$18,000 per IVM/IVF cycle here in the U.S.

Months ago when my husband mentioned the idea of doing a "vacation infertility treatment" my reaction was "no way! absolutely not". I couldn't imagine doing something so major outside of the U.S. - it just doesn't seem safe. My mind is slowly changing for three reasons:

1) This is Oxford, England, not a third-world country. I would feel safe while traveling and would trust that the hospital would be held to high standards.

2) This is the clinic that pretty much pioneered IVM and is a part of the renowned Oxford's John Radcliffe Hospital. I would actually feel safer in the hands of Dr. Child's, vs. Dr. Morris in Chicago, only because Dr. Child's had an extensive amount of experience in this arena, in comparison.

3) The fact that we would be able to get away from it all and focus on this experience and nothing else - a little "infertility vacation" if you will - seems like icing on the cake. I do think we should be mindful of the possible effect flying and the time change could have on the success of the treatment and would need to discuss this more in depth with the doctor before making our decision.

Speaking of... once we hear back about my ovary situation, and provided we're still a candidate, I'm guessing that would be our next step - to make a phone consultation with Dr. Child's to talk about the big picture and what exactly this might mean for us.

EEEeeeek! Again, I really shouldn't be getting all worked up about this but the possibility of saving money, avoiding potentially risky injectable meds, possibly moving treatment time frame up and traveling to England is way too cool!!

In the end, I still need to be mindful of how good God is, regardless of how this IVM Oxford thing turns out. I mean when I break it down - yes, we are dealing with some pretty big things. Yes, we are making sacrifices in order to secure a better future for our family. Yes, we may have to undergo some uncomfortable procedures. Yes, our heart breaks from time to time with a feeling of emptiness. BUT, we are so lucky to have a warm and comforting roof over our heads. To have two fur babies that make me smile the minute I walk in the door. To have good paying jobs. To have supportive parents and a few close supportive friends. To have each other. God is the only one we have to thank for that - he is looking out for us well before we know we'll be confronted with an issue. I'm trusting that even as we deal with this, he is looking out for our future and this is just part of our journey. We will be stronger for it!

Ok so now on to the details of doing IVM in Oxford with Dr. Tim Child. Here are some resources you might find helpful. If you have any additional info to add, please let me know!

Cost Analysis - A spreadsheet I created to take a closer look at the overall costs.
http://spreadsheets.google.com/ccc?key=pRJsuX3UYPXuOMcguqjqDMw

A link to the Clinic's Prices - Costs listed on site are in British Pounds. Above doc converts them to U.S.)
http://www.fert.org.uk/index.php?option=com_content&task=view&id=13&Itemid=41

Oxford Fertility Clinic
http://www.fert.org.uk/

IVM Procedure in Detail - These sites explain the overall steps and timeline for an IVM cycle

http://www.babyworld.co.uk/information/trying/infertility_treatments/in_vitro_maturation.asp

http://www.articlesbase.com/men%27s-health-articles/ivm-in-vitro-maturation-in-thailand-442035.html

IVM Cycle Compared to IVF - A short news article on IVM as a whole
http://www.dailymail.co.uk/health/article-1084447/The-new-fertility-treatment-double-womans-chances-getting-pregnant.html

IVM babies - News story about a couple who underwent IVM with Dr. Tim Child
http://www.fertilityauthority.com/news/2009/jan/17/ivm-british-mother-births-twins-after-new-treatment

For the record....
Here is the link to the Chicago clinic that does IVM: http://www.ivf1.com/in-vitro-egg-maturation/
And here is another clinic in the U.S. that claims to also do IVM (It doesn't seem like many clinics are doing IVM yet, so I've had trouble locating another one besides the one in Chicago). I will most likely e-mail them as well just to see what they charge, but haven't done so yet. http://www.startfertility.com/

How are embryos tested and how many should you transfer in IVF?

2009-02-17T15:36:00.012-06:00

I guess you could say that a few factors led me to look into the topic of embryos.

For one, we're don't feel very informed on what it really goes into determining how many embryos will make to a quality high enough for transfer, from those that do make it, how you and your doctor determine how many will be transferred. This is important for us because we're trying to consider how many tries we think we would need at IVF in order to be successful. We're also not sure how much my having only one ovary and PCOS factors in. And of course there's the topic of the new octuplets who were just born and the question of why her doctor would have ever transferred that many embryos in the first place.

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Scroll down in the archive to:
Date: 7/24/08
Title: "How Many Embryos to Transfer in IVF".

Embryo Fertilization and Selection
The selection of many embryos is made for you by nature because so many eggs and embryos are abnormal and don't survive past a certain stage. With medications, you can get a woman to produce a lot of eggs but can't get them all to fertilize. If you had someone who had 20 eggs, why wouldn't you want to put to use ICSI with every egg to get them all to fertilize? Even if you do this, you can't always get them all to fertilize because there maybe be chromosomal abnormalities with the egg or problems with the sperm, but you can't often tell by looking at them. Certain people do ICSI on every patient. SHER uses ICSI with every In Vitro Fertilization (IVF) patient and the results are just better in order to optimize fertilization. If you fail at that, you're out at the get-go. This concept has been around for years and SHER believes this is better, even when there's no evident male factor. By doing ICSI, the percentage of eggs fertilized is better (under high magnification) - choosing the ones with minimal abnormalities, and thus has better potential to fertilize and make a higher quality embryo, which translates to more ongoing pregnancy. SHER has been doing 100% ICSI has been doing this for at least 10 years. Not every clinic does this.

If there is a male factor (qualitative or quantitative abnormalities of sperm), the only option you have is to do ICSI. The selection process is really very key.

Women get excited when they get scanned and have a lot of follicles, but get disappointed when very few become fertilized. While ICSI helps, the fact is, the majority of eggs are not going to make a baby. Starting with more eggs will be to a patients advantage to some degree because you will have more that make it through the fertilization stage, then to day 3 and 5, but nature weeds out the abnormal ones as the process goes on. The goal is to maximize the process and attempt to make sure a good egg will make it - thus doing ICSI.

When to Transfer Embryos in IVF - Day 3 or Day 5?
Are physicians and doctors still transferring at day 3, or are they waiting until day 5? The overall thought is if an embryo is going to make a baby, then it will, regardless of the day. However, as technology has advanced, you can take the embryo to a farther stage to allow (the blastocyst stage) you to select embryos that will have a better chance. Before, technology wouldn't allow you do this. The problem is you are trying to reduce the number of multiple pregnancies. Day 5 is the best way to go these days. For example, if you have 10 embryos on day 3, that all look good and the same under the microscope, you pretty much know that only half will make it do day 5. Your chance of picking the wrong ones increases when you have so many embryos. So a patient who only has 3 on day 3, it doesn't matter when you put them in (if you wait until day 5 or not), but it does increase higher multiples. So between day 3 and 5, you let them natural deselect.

Grading Embryos?
How do you compare at day 3 to see what will be the best? Two easiest and cheapest to help select embryos:

1) Natural Deselection - letting nature choose

2) Morphological Appearance at a microscopic level (chance for implantation, checking for fragmentation, etc. This is where experience of an embryologist comes into play). A high number of good quality embryos on day 3 makes it more difficult. Is there any medical reason to transfer on day 3, rather than day 5? No. The only reason is if the patient wants the doctor to (perhaps the belief that they are better on the inside than the outside). If you only have 2 or 3 good embryos on day 3, you should still wait it out.

Do you think that day 5 will be the max for how long you can grow and embryo in a dish? There are reports of people doing day 7, but it all comes back to when fertilization takes place. Going to day 6 isn't unusual, but it's more like 5.5 for Dr. Ahlering's clinic. The embryo has to hatch and once it hatches it has to attach to an endometrial lining and begin the process of implantation. Going beyond day 6, practically speaking, it probably isn't happening. It will need to be cryopreserved or transferred at that point because it will die off if it can't implant after it hatches.

New Techniques for Selecting Embryos
Day 3 objective techniques to select if you have more than 4 or 5 encourages better pregnancy rates. If you don't have a good number of embryos on day 3, you simply put them in and let nature decide. If you do have a good number, you can use these new techniques on day 3:

1) PGT or CGH - which assess the chromosomal abnormalities. The number one reason an embryo fails to implant and make a baby is due to chromosomal issues, so accessing the status is very helpful.

2) HLAG Testing - A protein marker that can be tested on day 2 to access the presence of HLAG in the culture medium of the embryo. This involves taking out the fluid that has been nurturing the embryo and testing the fluid, and leaving the embryo untouched. If there is the presence of HLAG in certain amounts, it suggest it will have better developmental potential, thus reducing the number of embryos you have to put back in. So if you choose 1 or 2 embryos which test HLAG positive, you increase the likelihood that you will will have as good or better pregnancy rate. This is a non-invasive procedure because the embryo itself is untouched - only really using about 50 micro liters, a very small amount, to test with.

Keep in mind, one of the main reasons any of the above is done is to prevent the need to put back in a large amount of embryos, thus keeping the higher multiple probability down.

How many Frozen Embryos to Transfer?
Is there a typical number of embryos transferred in a frozen cycle? Factors which will help determine this are:

1) Age
2) The day the embroys were transferred on
3) What happened with the previous fresh cycle and some of the medical issues that might factor in - successful pregnancy? Date of transfer?

General guidelines, assuming it was blastocysts that were cryopreserved, the big question - does cryoproservation negatively affect the potential of any given embroy? The answer - yes, it can probably affect the embroys viabliltity depending on how it was frozen. For example, using a process called vitrification, vs. the old-school cryopreservation. So assuming they were vitrified as blastocysts, let's use a 34 year old as an example. You would thaw and culture let, meaning you them set for 4 hours to see if they survive. Most will survive the immediate thaw, but sometimes one or two will drop out which is why you culture them - then you put in what remains. In the case where you have a lot of embryos you can use a combined approach - culture 4 and if you have only 0 or 1 that makes it thorough the culture process, you might do a quick thaw and add in 1 or 2 embryos to get a total of 3 and then do the transfer.

It definitely gets more tricky with a frozen cycle, which is why you need to work closely with your doctor to decide which strategy to take. However, using a strategy like this you can optimize the per transfer outcome and minimize the number of transfers to go through all of the embryos - thus being better on the patient and ultimately keeping costs down. You are thus optimizing the chance for an ongoing pregnancy per transfer. In summary you can afford to be more aggressive in the number that are transferred, factoring in the fact that cryopreservation can degrade somewhat. However, if you are freezing normal-grade embryos, you are probably working with a very similar playing field, however, not all embryos are tested before they are frozen.

In the example of a 34 year old, Dr. Ahlering comments he doesn't recommend putting in more than 4 cryopreserved blastocysts, because you increase the odds of having a higher order multiple. If you are comfortable putting that many in, its all in how you go about getting those 4, as mentioned in the previous techniques.

Ultimately, Dr. Ahlering likes to ask his patients how many they want to put in. The patient typically ask him how many he recommends, and he then factors in their entire situation and makes a suggestion.

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Closing Thought...
After knowing what I know now, I find it very hard to believe that a doctor would ever find it ethical to transfer 8 embryos with today's technology. The fact that so much testing can be done now days prior to the transfer would indicate that you would have no need to "increase the odds" by way of putting in more than enough. With new technology, we have come so far in the last decade even that the increasing the odds method just doesn't seem to make sense after a certain point. For most people it would seem that "point" is 2-3 and anything above that (4 to perhaps 6 max) is a very rare occasion.

I know I said in a previous post that I would leave the technical medical debate about the octuplet situation up to doctors, and while I still agree to that, I have now formed enough of an educated opinion that I find it hard to be OK with what she requested and what her doctor ultimately executed. I hope most people recognize that this isn't the norm, nor the accepted standard for this part of the medical community, and that infertility isn't given a bad name going forward. Most everyone involved, including myself, wants a happy healthy baby to be conceived and born under the best circumstances possible. It's not simply about what the patient wants but also, and most of all, it's about the new life that is being brought into the world thanks to these treatments.

Happy Valentines Day!

2009-02-13T18:01:00.004-06:00

This post goes out to my husband - the one person I know I can always count on and who has been through so much with me this past year. I can honestly say 2008 beats out all of those years when I thought I'd never see the light at the end of the college tunnel!

When we decided last year that we were "officially" ready, my life was forever changed. I don't think it was until that exact moment that I truly felt what I'll now always feel. I get excited when I think about what it will be like to see a little you running around barefoot, most likely doing extraordinarily squirrelly things just like the two of us do on a regular basis, but that is the part that makes me the most excited. It's going to be so fun to see you teach our kids how to play tennis (you are an awesome teacher! and I WILL, once and for all, learn how to score a game before that time - I promise), watch you put them to bed at night and all of the things in between. You are going to be a great Dad and your kids - our kids - are going to be a wonderful combination of keen analytical skills and vivacious independence. Not to mention a whole pile of utter cuteness! And you know how I love cute and cuddly things. :)

This Valentine's Day, I hope you know how excited I am about what lies ahead of us in the not-so-distant future. As stressful as it can, and will, be at times, it's also very exciting to think that this time next year we might be gearing up to welcome new life into the world.

I love you sweetie and am so very thankful for what we have together.

XoXoXo

To IVM or To IVF?

2009-02-12T23:29:00.003-06:00

That is the question as of now. We still need to sit down and go over all the options. I recently called the IVM clinic in Chicago, IVF 1 - Dr. Randy Morris, to get a little more info. They started by putting me in touch with a nurse who asked if things like was I PCOS, did I have a healthy BMI, did I know what my antral follicle count was. I also asked if by having only one ovary that automatically made me a bad choice for IVM - she said no, that alone wouldn't disqualify me.

She recommended I make a consultation with Dr. Morris to ask questions and so that he can get a better idea of what diagnostic tests we'd still need to do to see if we are, in fact, good candidates. All signs so far point to yes, I'm assuming. That initial consultation is $236, so we're trying to make sure we really want to be serious about considering this option before going any further.

I called the clinic again - this time to see if they could first share costs with us so that we'd know if it would even be a viable option for us. They were more than willing to share and e-mailed me some information today. As of now, it looks like they only offer a single cycle option that is slightly higher than SHER - St. Louis. Plus, our current clinic offers multi-cycle price breaks which would yield us more than one try at more "cost-effective" (it's so totally not cost-effective, but for the purpose of this convo it is :P) rate. I can't help but think I might need more than one try vs. the average woman simply because I only have one ovary (and therefore would assume I would be at risk for producing less embryos). Anyhoo, I we still need to e-mail some additional questions and sort everything out. It's just nice to be able to consider something else that might be a little easier on my body. The idea of so many shots sort of makes me nauseous.

Will update when we know more!

The octuplet controversy continues...

2009-02-12T22:03:00.005-06:00

I find this interesting and nothing more. Many people have passed judgement on this woman when they don't fully understand her story or have not gone through infertility themselves. I just don't feel like it's my place to do that. While I can't say I totally agree with each and every decision that was made (at least from what I've heard), I also know that we never imagined we would so quickly be planning to do IVF, with such a fervent passion.

It wasn't all that long ago when my husband made the comment "if we ever have to put your body through all of that, then we'll just not have kids". Ok, I shouldn't have put that in quotes because I don't remember if that's exactly what was said, but it was something very similar. And, at the time, I wasn't terribly upset by that. We weren't trying to have children then, and while we have always wanted and planned my our life so that we would be able to provide a good life for our kids, it seemed like the upright thing to say. I mean, we loved each other and knew that we will always be happy regardless of what happened or didn't happen in our life. While that statement still stands true, the day came when we just "knew" deep down that we wanted to share our life with another life - and more than one at that!

What I'm getting at is that you never really know how you will feel and what you'll do in a situation until you are in that situation. We certainly didn't know that when the overwhelming feeling of love came over us that we'd be ready and more than willing to make our life a somewhat chaotic whirlwind in order to be able to afford IVF treatments - let alone willing to undergo the physical stress of putting our bodies through such an adventure, but we're definitely here now. I'm sure that there was something that the mother to new octuplets, Nadya Suleman, felt that most of us won't be able to understand. I'm ok with not knowing what that is and trusting that she is capable of listening to her heart and will do her best to be a wonderful mom for her children.

Infertility Procedures
Technically speaking, I was curious as to what infertility procedures she underwent in the past and what she recently had done that helped her become a mother. I came across an interview from the Today Show that stated her infertility history looks something like this:

Attempting to become pregnant with her sixth, and last child, (she said she didn't want to die knowing she had embryos waiting to become life) she tried two rounds of IVF which were unsuccessful. In June of 2008, her third try, they transferred the last embryos remaining - a total of six. While most people are shocked by this, as the average transferred is typically 1 or 2, a higher number isn't uncommon. Age, embryo quality and failed attempts are all large factors in how many a doctor will transfer. The thought is that sometimes, because of all the various factors that a person faces, they actually need a higher probability of success - in this case that means increasing the odds by transferring more in the hopes that one will implant and grow into a viable pregnancy. For the record, six is also the same amount that they transferred on her two previous unsuccessful tries. The biggest concern here is that because she is only 33, that it isn't "acceptable" for a doctor to transfer that many. That I am certainly no expert on so I will leave it to them to debate. Of course, many are up in arms about who will be paying for these children, but I'd rather not go there. This is an infertility blog :-)

Who knows - maybe one of those babies will grow up to be something truly amazing. You just never know! They're here now and I wish them all the best.

If you're interested in hearing more of the Today show interviews, here are a couple videos on her recent infertility story.

New Octuplets a product of IUI or IVF!

2009-01-30T17:33:00.002-06:00

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 CN N 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!!

In Vitro Maturation - Less riskly & expensive than IVF?

2009-01-29T10:21:00.004-06:00

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!

"Be blessed, just as I have blessed them"

2009-01-25T01:22:00.004-06:00

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.

Semen Analysis: What the results might mean...

2009-01-16T06:49:00.005-06:00

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.

Count
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."

Morphology
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".

Motility
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.

Haveababy.com Live: Dr's Thoughts on Semen Analysis
In doing some research on reading semen analysis results, I came across another Haveababy.com 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!