Empty

Sac. An Empty Sac.

6w3d.

A Gestational Sac measuring 5w5d. A Yolk Sac barely visible. No Fetal Pole.

That's it.

My options:

1. Continue progesterone and estrogen and return for another u/s next week, with a 1%-3% chance that something will change.
2. Stop progesterone and estrogen and wait for natural miscarriage.
3. Take the drug, misoprostol, to induce miscarriage.
4. Schedule a D&C.
5. Schedule a D&C and have genetic testing done on the tissue.

We drove the 6 hours home yesterday in mostly silence interrupted by my occasional sobs. When I spilled the coffee, when my mom texted me, when I thought about how I had been losing symptoms over the last few days, when I thought about how completely unfair infertility is or that tomorrow will be 2012. I thought about many things on the way home.

I stopped the progesterone and estrogen and aspirin. This morning I stayed in bed wondering if I made the right decision. If I should have scheduled a second u/s. If a miracle could happen. Yet knowing that I am no longer pregnant.

6 weeks

I feel like I've passed some sort of milestone by making it to 6 weeks. At the same time, it feels like nothing. I am so far from being out of the woods.

There are a few more symptoms, but still not much to speak of. Still no nausea. And that is okay.

My primary fear is that we will see and hear nothing at the ultrasound on Friday. Yes Friday. I just can't wait, yet if it means that this is over, I never want it to arrive.

Don't Get me Wrong; I Do Have Moments of Pure Joy and Excitement

This post on the heels of my hard times. I want you all to know that while I am terrified of losing this, I am overjoyed that this really may be happening. My excitement is quiet and reserved, but it is still there.

F and I are taking one day at a time. Which makes waiting for the ultrasound excruciating.

Thank you for your patience and support.

Hello? Embryo? Are You Still There?

It seems that around 10am all sensations of pregnancy disappear. I feel thinner. My breasts aren't sore AT ALL. I just don't feel pregnant anymore.

This morning I just couldn't let go of that heavy feeling of discouragement and pessimism. I wanted to cry. I convinced myself that the embryo was no longer growing, that I was not really pregnant.

It is 10am. F persuaded me to go out and get another pregnancy test. Which I did. And was terrified.

Thankfully it was still positive. The darkest line yet. But the test only confirmed the the thing that is making this wait so long and difficult. We won't really know anything until we can see with our eyes that the embryo is doing okay. That won't be until next Friday.

Deep Breaths.

5 weeks

I am 5 weeks pregnant today. Of course I have no idea what is actually going on in my uterus, with the embryo, with this pregnancy. My fears speak loudly. I try to quiet and distract them.

I focus on symptoms. Last night I read through all the IF blogs I subscribe to searching for the early symptoms of others, or lack thereof. Mine:

1. Swollen breasts, hot to the touch at night. Though sometimes even this symptom is completely absent, usually during mid morning when I have a freak out of negative thoughts.

2. Maybe slight dizzyness, what I describe more as loopyness or feeling woozy when I'm out walking my dog (not to be confused with nausea, because I have not been graced with that symptom, though I long for it).

Umm....that is all. That is it.

Am I still pregnant? I really have no idea. I hope so.

Beta #2

Today has been excruciating. I arrived at my local small town medical center at 7:30 this morning to ensure that there would be time today to send the labs out and get the result to my clinic so that they can get the result to ME the same day. Only to find that the medical center doesn't open until 8 am.

My phone has been in my hand all day long. Even when I fell asleep at lunch.

When the nurse finally called, I could tell by her voice that she did not have bad news.

Beta #2 is 263. We have doubling! A doubling time of 44 hours.

This may be for real, folks.

Beta #1

My first Bhcg was yesterday.

I got the call from the nurse that afternoon. Because I cheated, I already knew what the answer (pregnant, not pregnant or maybe) was. I knew I was pregnant, just not how pregnant. More than anything I did not want her to say, "For now, let's just be cautiously optimistic." So when she said, "Congratulations, you're pregnant." I quickly said, "What is the number?" In my mind it went, WHAT IS THE NUMBER, JUST TELL ME THE NUMBER!!

I didn't tell them that I cheated and already knew.

My hcg level was 124. They want to see over 50 at the first beta, 9dp5dt.

Of course, I am still cautiously optimistic. My hcg levels still have to double. The embryo still has to grow. And stay put. And have a beating heart. Whew, I will try to take this one day at a time.

We talked about my horrible breakout, which may or may not be caused by high levels of estrogen. They decreased my dose of estrace to 2mg once a day. I hope that helps.

As for symptoms, I am experiencing some cramping on and off. Some moments I don't feel pregnant at all. My boobs aren't sore. At night they feel full and hard, but not sore. Yesterday I was tired. What I mean is, I really don't have any symptoms.

I Cheated. I Tested Before the Beta.

7dp5dt.

It was positive.

8dp5dt.

It is still positive.

We are still not celebrating yet. Beta tomorrow.

5dp5dt (and a non-post about eSET)

Five days past five day transfer. 4 days to go.

I wanted to do a post about Elective Single Embryo Transfer, something about how the few studies that have been done, mostly in Europe, show no significant difference in success rates when compared to transferring 2 embryos on day 5, or, how at my clinic, they know that 50% of those who achieve pregnancy (after transferring 2) have twin pregnancies, but that they don't have a whole lot of data about eSETs because so few of their patients choose that option. It was an option for us, we knew we would choose that option if it was available, and so on Sunday after a good discussion with the embryologist, that is what we did. It wasn't easy when it came down to the moment.

I know that many patients are not good candidates for eSET, I do know this. I also know that many of my favorite bloggers are having multiples and I think that is wonderful! Maybe that is partly why writing a post about eSET seems so difficult. There are many issues involved that complicate the decision, the cost of a fresh IVF cycle being just one, and so I don't mean to simplify in this post/non-post about eSET.

Maybe someday I will write the post I want. For now, I just want to acknowledge Elective Single Embryo Transfer. Because I really hope it worked for us.

-------------------

Now, back to 5dp5dt. And the worst part of IVF so far.

The worst part of IVF so far is the horrible breakout of tiny pimples, almost like a rash, extending from my jaw line down to my chest, and down my back. It looks like baby acne in the way it is clustered and size of the pimples. It looks like the measles when I stand in front of the mirror.

I am. hideous.

Please someone tell me you have experienced something similar? I can handle a zit or two, or few, but this? I better be pregnant.

Also tell me your thoughts on Elective Single Embryo Transfer. Would you choose it? If you could have but didn't, why?

OK TRANSFER!

Every time the phone rang in the days leading up to day 5 my first thought was, "Oh no, it's the clinic calling to tell me that all the embryos died!" It never was. Thankfully.

We still weren't entirely convinced we would have any to transfer as we made the drive to Portland the day before the transfer. I was awake at 6am with a crampy feeling that convinced me that my uterus was not going to accept any embryos anyway.

We had an appointment with the embryologist and the RE at 9:15 to talk about our embryos. We got up, showered (this would be my last shower for the next 48 hours. I suddenly became more worried about the mess made by the endometrin and instantly mortified at the thought that Dr H would see it. Later I will realize that he will also "flush" the area to clean said mess, or maybe just my cervix), and headed for the clinic early so that we could take our dog (who is always along for IF travels) for a good walk around the Nob Hill neighborhood. It was good to walk before the transfer. Also my last walk for a few days.

Ok, are you dying to hear the number of embryos we had on day 5?

We had 3 high quality blastocysts and one slightly behind. We talked to the embryologist about the number to transfer. F and I had been talking about the number to transfer for days and we really wanted to be able to do a single embryo transfer.

And that is what we did. We transferred one blast. It was a scary and difficult decision but it was what is best for us.

To our surprise on day 6, we had four embryos suitable for freezing. This means that out of 10 eggs retrieved, 9 fertilized and half of them made it to blastocysts.

One super blast is inside my uterus, hopefully implanting as I type this. Implantation should begin to happen within 48 hours of the transfer. I am staying in bed for an extra day, not caring if I am being overly cautious or that my back is starting to hurt.

I should probably take a shower.

How do people maintain bed rest for weeks and not get an unbearably sore and stiff back?

Fertilization Report

Out of 10 eggs retrieved, 9 fertilized.

As of yesterday we have 9 fertilized eggs (eek!).

Some clinics keep you updated on the fate of your eggs--how many make it to the embryo stage on day 3, how they are graded and growing and the number of cells. Not our clinic.

"You will not receive a report today."

We won't know how many embryos we have or what our options are until the day of transfer. Additionally, under our IVF refund plan, we can only do 5 day transfers (but I think most transfers they do at this clinic are 5 day, at least that is what it sounded like at the IVF orientation, as they did not even go over 3 day transfers).

At first the idea of no embryo updates was disappointing. But then I started thinking about the stress involved in daily or every other day reports. How important is it to hear that half of the eggs did not divide properly? Or that the embryos we do have are growing slowly. Of course, if none make it to embryo stage then they will obviously call us to cancel the transfer, but this way, we plan for the transfer, keep our fingers crossed that we have 1-2 good blasts to transfer (and more to freeze) on Sunday and let the next 3 days go by quickly.

3 days is not so bad. And since we have a day of travel (again, ugh!), it will be like we only have 2 days to wait, today and tomorrow.

5 day transfer is scheduled for Sunday at 9:15 am!

"How many eggs did we get? Can I have a glass of water, now?"

I had a dream last night that Dr. Not H. only retrieved 3 eggs. F and I made bets this morning on what the actual number would be. I said 8. He wanted me to win (so he says) so he guessed 7.

I did win.

"How many eggs did we get? Can I have a glass of water, now?" This phrase was repeated over and over to F, followed by laughter, as I was waking up from the retrieval. No crying this time, instead, I caught the giggles.

The number is 10. 10 eggs retrieved. Dr. Not H, who did the retrieval, told F that there were a few follicles that were difficult to aspirate. I guess a few of those eggs did not want to come out! I wonder what their fate will be.

We will know the fertilization report tomorrow.

Thoughts Before Retrieval

• I am sitting in a motel room drinking as much water as possible until midnight.
• I am not focusing on numbers (but if you are you can visit AdvancedFertility and read about IVF success and number of eggs retrieved).
• I am wondering if I should trim up the nether regions tonight? or just go with how I feel, which is, "I don't want to shave and I don't care what they think of my hairy cooch" Maybe I'll shave for the transfer.
• I hope the anesthesia doesn't make me cry when I am in recovery. That tends to be my reaction and I don't want to cry until I hear the number of eggs retrieved and then the fertilization report.
• I don't feel bloated enough. I can barely feel my ovaries and think I could probably handle a moderate workout.
  
• At least I won't be at risk for OHSS.
• The nurses showed a great video of an egg retrieval at the IVF orientation. I wanted to post this video on the blog, but I can't find it or one online that is as detailed as the one they showed. I can't settle. Sorry, no video.
  

Stims and Monitoring: Day 9

I am maxed out.

I did not realize that I was taking the maximum dose of both Follistim and Menopur. I feel silly for thinking, "well at least they did not increase my dose...."

When I asked the holiday RE (not my RE) if he thought my follicle count was low going into trigger, this was his answer:

"Well, we are working with all that you have. You started with 11 at your baseline scan. We can't make eggs that are not there. You have been taking the maximum dose of the medications."

Oh.
No words of encouragement or comfort. Not even close.

I am glad he is not my RE. Though, still, I was in tears today because he was the holiday RE at the last monitoring appointment before my retrieval. So he might as well be my RE. He asked me the same stupid small talk question he asked me on Friday, not even pretending to remember us. I have to trigger tonight with his words in my mind. And then I go into the retireval of my first IVF with the fear that I haven't produced enough eggs to make this work.

I don't think I have to tell you how emotional I am today. My feelings are hurt. I feel vulnerable and discouraged. I am scared.

Follicle Report: 11 follicles. Largest measuring 19-21mm. Smallest around 14.
E2: 2,384
Lining: 12

Tonight I finish the Follistim, Lupron and Dexamethasone. Trigger at 9:30 pm.
Retrieval scheduled for Tuesday 11/29.

Stims and Monitoring: Day 7

I am not feeling like a superstar.

Follicle Report: 11 contenders (the leaders being around 17 mm) and at least 4 small followers, too small to count.

E2 is up to 1,127.

Lining is around 11.

The holiday RE thinks I will be ready to trigger on Sunday night.

Stims and Monitoring: Day 4

Added to the Lupron injections, 2 vials of 75 iu Menopur and 300 iu of Follistim AQ. Today is Day 4 of these stims and my first follicle monitoring appointment.

The Report:
Lining: 5.5
around 10 follicles, all under 10 mm.
E2: over 300 (maybe 315? I didn't quite catch the number)

This is my first IVF and I feel like I know nothing about what is supposed to happen. Are you thinking, "only 10???" Now tell me it is early and more will develop--like DOUBLE! E2 is good though, no?

The nurses had a power point slide at the IVF orientation teaching. A triangle that showed the typical fate of eggs during an IVF cycle, with average numbers ("DO NOT FOCUS ON THE NUMBERS," they said):

20 follicles --> 15 eggs --> 12 mature eggs --> 10 fertilized --> 6 good quality embryos on day 3 --> 4 blasts on day 5 --> 2 transferred and maybe 2-3 to freeze

So yes, I would like my current number of follicles to double. But do they double or do they decrease at this point? How can I not focus on the numbers?

I will not focus on the numbers...

Go Away UTI (or Whatever You Are)

Apparently low estrogen can make your lady bits fragile. Going into IVF, I knew about vaginal dryness, the susceptibility to yeast infections from antibiotics--all that misery--but urinary tract infections? I don't know what it is for sure, I just know that it burns. And unless the dildo cam at a major fertility clinic is passing around chlamydia to its patients, I can pretty much narrow it down to my urethra.

The burning started the day after my suppression check and has been the only symptom I have experienced. My course of action has been to chain drink only water in an attempt to flush my system (I would have added cranberry juice, but neither F nor I managed to get dressed that day, let alone leave the house, instead, we worked in bed with the tv on all day, being both productive and lazy at the same time). The constant flushing of water seems to be working. Minutes after my first shot of Menopur (at 7:30 on a Saturday morning), I lay back in bed (gulped a full glass of water) and imagined a rush of estrogen hydrating my female orifices.

It is now Sunday night and the burning has subsided ( That is the last sentence in which I will use the word 'burning,' I promise). I go in again on Tuesday and will mention it to the nurse (or whoever is looking under the sheet that morning).


Has anyone experienced a side effect like this?

Well, Hello Dr. H, Very Nice to See You

As I waited in the exam room for my suppression check yesterday, I really had no idea what medical professional would walk through the door. Nurse S, who performed my mock transfer, doppler and SIS? One of the other 3 REs who make up the practice? or will it actually be Dr. H this time? I'm at a great clinic, but so far I have only seen, only met, my RE, Dr H., once. This was at our consultation way back in March. F and I have joked that we we may make it through the entire IVF cycle without ever seeing Dr. H.

At the IVF orientation the nurses explained that our protocols are decided by the entire IVF team. They sit around a table and go over our charts and histories. I felt important for a moment imagining this. And wished there was a picture of F and I to go along with our chart so that Dr. H, who could not possibly remember us, could at least know what we looked like (when he was making decisions about a patient's treatment whom he had never seen in the exam room).

On a side note, I wonder if at follow up meetings to discuss patients' progress, if the doctors and nurses discuss the variety and assortment of socks encountered in the day's or week's appointments. I wonder this because my socks seem to be discussed more in the exam room than what we are looking at on the ultrasound monitor. The routine of sock discussion has to get old for them, no? Does every monitoring appointment start with, Nurse: "Oh, I like your socks." RE: "We see some great socks around here."

It was Dr. H who walked through the exam room door, who agreed that he liked my socks, and who told me everything looked good to start stims on Saturday the 19th, as long as my E2 looked good as well. It did; the bloodwork came back at 24.

I am sufficiently suppressed!

Saturday morning I start with 2 vials of Menopur, then 300 iu of Follistim at night and continue the Lupron, dexamethasone and aspirin as well.

Lupron Sweats

The Lupron injections have been easy. Super easy. Sometimes I don't even feel it. Other times I feel the pinch of the needle or a slight burn of the injection. Minimal. If I weren't looking at a needle going into my stomach I probably wouldn't even register the feeling. Only once did I think, "Ouch." No bruising or tenderness at all at the injections sites.

After about 4-5 days of injections, though, I have started feeling blah. Less energy during my swims. This weekend has been visited by hot flashes, especially at night. I've experienced pre-menstrual night sweats for awhile now (I actually have a paranoid blog post about them). These lupron sweats differ in that they are accompanied restless sleep, waking up sweaty at 4 am and not being able to fall back into a good sleep. Instead, I toss and turn in a sweaty half sleep. For the past 2 days i have felt constantly like I need a shower. Not necessarily sweaty, but like I have been sweaty.

Though really, the lupron hasn't been bad at all.

I go in on Thursday for the suppression check. Hopefully, everything looks quiet and I can start the Follistim and Menopur on Saturday. Then I will feel better. Until I feel bloated. Wish me luck.

___

I took my last birth control pill on Friday. Today I started spotting. My calendar says I should get a period this week. I wonder if this period, which I think of as a fake period, is considered the first day of a new cycle or a continuation of a long IVF cycle. It doesn't matter at all, but I like continuity, especially visual continuity when looking at a chart. I think my cycle will continue, long and uninterrupted.

Let the Suppression Begin!

Today I start Lupron injections, tonight, 10 units.

With Doxycycline (an antibiotic for both F and I),
Dexamethasone (a low dose steroid that suppresses androgen hormones and may have a beneficial effect on egg quality),
81 mg Aspirin,
and prescription PreNatal Vitamin and DHA.

I will continue taking birth control pills, Desogen, this week. Last pill will be Friday.

I Begin.

I feel like I have been waiting for a very long time. The time is finally here. I have my IVF calendar. Moments ago I divided a payment of $15, 850 onto two credit cards for the Refund Plan deposit. The only other thing we will have to pay for now is the anesthesia for egg retrieval. And medications, which I will order next week.

Today I start birth control pills for sixteen days. I start Lupron in eleven days for the Lupron Overlap IVF Protocol.

I really know very little about IVF protocols. At the group IVF orientation when the nurses instructed us to pull out our IVF calendars, I discreetly attempted to peak at the calendars of other couples around me to see the differences. I noticed that mine had more text in each calendar day square, no blank squares, and I am guessing, more Lupron.

( Lupron is used to suppress the body’s own production of stimulating hormones to the ovaries. Some protocols include more days of Lupron injections than others, depending on how the RE thinks you will stimulate and how much suppression you may need.)

F quietly scolded me for invading the privacy of our fellow infertile comrades. The nurses reminded everyone not to compare your calendar to anyone else's calendar. I sulked.

----

So here I am with my calendar, penciling in possible travel days F and I will make together, and separately, to Portland this month and next. We begin. I still can't believe we are actually doing this.



I've read many Lupron horror stories. What was your experience? How much Lupron did your protocol require?

"Congratulations!"

I opened an email from the financial coordinator who manages the paperwork for the IVF Refund Plan. The first line read, "Congratulations!"

We have been approved to move forward with the refund plan. It struck me as perhaps inappropriate to offer congratulations. As if we had been accepted to graduate school, or won a trip to Iceland (the first destination that came to mind, for some reason). And that it was sent via email rather than a phone call. What about the people who don't qualify? Congratulations to those who do just makes the whole concept seem exclusionary and elite. I guess in a way it is, and it made me uncomfortable.

The IVF nurse at the group orientation for couples going through IVF for the first time said, more than once, that we were lucky. Lucky to be at our clinic. Lucky that we won't have to give ourselves IM shots of Progesterone in Oil. Lucky for this and lucky for that. I wished she would stop. I'm sure no one in that auditorium felt lucky. I bit my tongue. But to be fair, I do feel I am at a good clinic, in good care. And I am so relieved that we qualified.

So maybe I am lucky to be where I am, considering our circumstances. And compared to many in similar circumstances I am lucky to qualify for the refund plan. No, still not lucky. Lucky is not the appropriate word. Neither is, "Congratulations!"



more updates to come

Clomid Challenge Test Part 2:

I took my last dose of clomid last night, shortly, it seemed, before my cervical fluid seemed to dry up and my desert of a vagina decided it was closed for business until absolutely necessary (for ridiculously futile clomid enhanced baby making?) (also, we forgot the pre-seed).

Infertility Ruins Sex.

This was the night before my CD 10 FSH blood draw…the one that could qualify or disqualify our participation in the IVF Refund Plan.

CD 10 FSH: 9.2

RELIEF!

And now just a few more things to check off the list.

Clomid Challenge Test Part 1:

I’m not sure what I was expecting when I first walked into my new fertility clinic’s suite at the medical center in a cute uptown neighborhood. Not multiple receptionists with headsets. Not many patients in the waiting room. Not the phone ringing constantly. Not having to stand in a line to check out.

I guess I wasn’t prepared for how emotional the IVF process has been so far. And how alone I feel in my travels.

I do have a fairly long checklist for my pre-ivf testing. Maybe I shouldn't’t carry it around like I’m waiting for signatures. Maybe I shouldn't look at it multiple times a day.

Annual Pap Smear and Breast Exam: done. Infectious Disease Panel: done

I was at the clinic that day for the Clomid Challenge Test: Part 1: My CD3 bloodwork and u/s. Here are the results:

FSH: 7.08

E2: 31

AMH: 1.1

Antral Follicle Count: R: 6 L:5

My hormones are looking good for qualifying for the IVF Refund Plan! This lab wants FSH to be under 13 on CD 3 and again on CD 10, after 5 days of 100 mg of clomid. They do not want to ‘share the risk’ with someone who may not stimulate well. They also stand to make more money from a patient who has a high chance of taking home a baby after 1 IVF cycle. Note: My skepticism has doubled after reading Budgeting For Infertility. It really is a great resource, if you can smarten up about infertility treatment without getting angry and depressed. I called F crying after reading and skimming most of the book in one sitting. In all actuality I think it was the clomid as I am super emotional this round.

Anyway, economic injustice of infertility aside, 7.08 sounds great to me. And I am thankful for each test and result that indicates the possibility for a positive outcome. Reminder: It may indicate a good outcome. It also indicates nothing.

IVF Refund Plan

The clinic we will be using for IVF has an Refund Plan for both OE and DE IVF. It is one of the reasons we decided to switch from our previous smaller and closer fertility center to this larger and more reputable center (at least that is what we are telling our previous RE--well, you don't have a shared risk program...). A typical OE IVF cycle at this clinic costs somewhere around $14, 000 (that includes about everything needed for one cycle). The refund plan for OE IVF requires a deposit of $15, 000 prior to the start of the cycle which includes everything except pre-cycle testing, medications and anesthesia. We will end up paying around $20,000 for our first (and hopefully only) cycle.

The refund plan includes 3 fresh and 3 frozen cycles. If IVF #1 fails, then we do an FET (if we have any frozen embryos, that is), then a fresh, then a frozen and so on. If all attempts fail to result in a live birth with my own eggs then we can get 70% of the $15, 000 deposit back (which is enough to cover DE IVF in the Czech Republic. Yes, I am already that far ahead).

If you are a math person, you will be better than me at computing the cost savings of subsequent cycles with the refund plan but I will attempt to break it down. Two cycles without the refund plan would add up to around $28,000, whereas two cycles with the refund plan would add up to around $24,000-$27,000. So the actual cost of this plan is set around the cost of two fresh IVF cycles and the real savings would occur with FET and a third fresh cycle. Three cycles with the refund plan would add up to around $30,000 compared to $42,000 of paying for three individual IVFs. Further, if we do get a baby on the first round, then we have only paid around $6,000 more than what we would have paid for an individual IVF cycle (only! I know this is actually a lot of money, but we will just think of it as an insurance package, a cost we will be happy with if this actually works on the first try and we are DONE).

What we like about the refund plan is that our next step decisions will already be made for us if a cycle fails. We won't have the financial stress of coming up with (as) large sums of money after a cycle fails. We won't wonder things like, should we try this again? or can I do this again, should we really try a third time? It will all be set. And of course, we can request a refund at any time or get a refund at the (devastating) end to use for further treatment (or a down payment on a house, which is originally what all this money was saved for, but houses are for fertiles anyway, right?).

This however, is all contingent on qualifying for the IVF refund plan. This is what has made me so nervous about the clomid challenge test. Not that I won't stimulate well, but that we won't qualify. Here is the center's list of basic criteria for approval into the Refund Plan (for OE IVF):

1. patient must be under age 37 and cycles must be completed before the patient's 38th birthday.
2. FSH and E2 levels must be within "acceptable range" and tested at ORM.
3. Normal fallopian tubes and uterine cavity
4. Height/weight proportional
5. No previous IVF or 2 consecutive pregnancy losses.
6. acceptable ejaculated sperm is available
7. general good health
8. no insurance coverage for infertility

Other considerations specific to F and I will be evaluated as well in the decision to approve us or not. So far, we meet all basic criteria with the possible exception of #2--to be determined by the clomid challenge test. They don't say what their "acceptable range" for FSH and E2 is, but Dr. H did express concern with my previous levels. So please wish us luck in the next month or so as we complete the testing and paperwork to qualify!




P.S. This is my 100th post.

Pre-IVF To Do List #1

Number 1: Clomid Challenge Test

A test I must pass.

Normally my clinic requires a clomid challenge test for women over age 35 (not quite there yet). Last November my day 3 FSH measured 9.3. Dr. H thought this was slightly elevated for my age.

The Clomid Challenge Test includes day 3 hormone levels, a baseline u/s, 100mg of clomid on days 5-9 and then FSH levels on cd 10. The results will determine not only our predicted success with IVF, but whether or not we qualify for the shared risk program. This is a big deal.

Hormone levels can vary from lab to lab due to differences in equipment used to measure FSH. At ORM, they want to see FSH levels under 13 mlU/ml on both cycle day 3 and cycle day 10 and E2 levels under 100pg/ml on cycle day 3. Borderline levels include FSH levels between 13-15 miU/ml and anything over 15 is considered abnormal and indicative of poor egg quality.

I will do the CCT next cycle, in about a month. We are getting our paperwork in for the refund plan and I need a pap-smear (with all the fertility treatments, I haven't scheduled a pap since 2009!) and all the infectious disease testing. F needs this testing, too. We will do this with our general physicians. Finally, something our insurance will cover!

It will be weird going back to my CNM for the pap. It was with her that I first talked about my trouble conceiving. She just delivered a friend's baby. I really hate the thought of going back after 2 years, still without a pregnancy, like a walk of shame. She once shared with me how difficult it was for her to get pregnant at age 38. It took her 6 months.

Anyway, stay tuned for more of my Pre-IVF to do list and thank you all for your encouraging comments on my previous post.

What Progesterone Did and Did Not Do

I started my progesterone suppositories the day after the IUI. 100 mg to divide into 2 doses a day.

It made me feel so tired. Then six days past the IUI my breasts were sore (yes!) and I was having major crampy twinges that kept me constantly reminding myself that no matter how much I (inaccurately) imagined them to be feelings of burrowing blasts, it was just the progesterone.

Can someone please explain crampy twinges? What the hell are these?

10 days past the IUI my breasts were no longer sore. But it was still early. At 12 days past I woke up and felt like my body had deflated. Completely deflated. I'm sure you know the feeling. For me it means the impending arrival of AF. All feelings of bloating, puffy-ness, swollen-ness in all the right places had vanished. Gone. Deflated.

And I knew even before the spotting that I was not pregnant. I tried explaining this feeling to F and my mom. It must be a feeling only female Infertiles recognize and understand. We just know, and there is no consoling us, no words that can keep us hopeful until the test. It is absolutely useless to tell me that there is still a chance. I am not being negative, I just know, you know?

So at 12 days past the IUI I grieved and cried (And F and I decided that we were moving on to IVF at ORM, but more about that later), so that yesterday when I peed on a stick, I didn't have the energy or emotion to cry. I didn't examine the test in every possible light at every possible angle as usual, instead, I put a pad on and went back to bed with F. I am still angry that it didn't work, but I am ready to move on.

--------

Maybe it is a blessing that the progesterone did not make me feel pregnant or delay my period. I could still be in limbo right now, writing an entirely different post, waiting for the nurse to tell me to stop taking the progesterone, waiting for my period, repeated negative tests. Even though I tried to plug my cervix with one last suppository so I could at least make it to my POAS test date, I knew the answer. No beta even needed.

The suppositories did however, ruin a few pairs of underwear, yes even with a pantyliner. The progesterone gave me constipation. And one unmentioned side effect? Your sex partner may want absolutely nothing to do with your oily vagina.


I can't believe we are moving on to IVF. It has been two years, but I really just can't believe it.

The Broody Hen

This is Yellow. She is a broody hen. Yellow really wants to be a mother. Sometimes chickens go through a phase where the instinct to incubate and hatch a brood of chicks overwhelms them. She is not sitting on an egg, she hasn't even laid an egg in quite a while, but yet she sits and waits in the nesting box, every day, all day.

Dear Yellow, I can relate.

Multiple Fears

F and I have always been weary of injectable cycles and its goal of super-ovulation. I have written about it before. We do not want multiples. Our original plan then, was to skip injectables altogether and go straight to IVF, with the hopes of qualifying for a shared risk program and having enough predicted success for single embryo transfers. We chickened out of our plan, however, and are in the 2ww of an injectables cycle. I had 4-5 follicles at the time of the trigger, though 2 might have still been immature at trigger, but I can safely say we for sure had 3. Part of me wonders if a more conservative RE would have canceled the cycle with the possibility of 5 follicles, which, from what I have gathered online, is the maximum before cancellation (or maybe Dr A suspected that 2 wouldn't make it in time? but for the purpose of this post, let's assume I had 5 follicles). So of course we talked about reduction. When Dr. A said I should ovulate around 5 eggs, I asked if 5 was too many (Most REs want 3-4 for IUI). and Dr A replied, "You are open to reduction if necessary?"

Absolutely. We only want one.

However, many infertility patients want twins. And I totally understand that desire. This will be our only attempt with fertility treatments. A singleton means a singleton, no siblings. Sometimes I find myself fantasizing about life with twins; there are many healthy twin pregnancies and I have friends who are twins and friends who have twins. It is the pregnancy and birth of twins that scares me. Many bloggers have beautiful twins, many bloggers have lost beautiful twins. I'm not going to go through all of the risks of a twin pregnancy because we all know them.

The New York Times Magazine published an article about the growing request for fetal reduction in twin pregnancies. Many of the interviewees were infertility patients and all of the pregnancies discussed were healthy (at the time of reduction) twin pregnancies. The article asks, what is it about reducing a twin pregnancy down to one that is so much more controversial than reducing triplets to twins or aborting a single fetus? It is worth a read.

The article points out the medical warnings given by REs--that it is definitely best to avoid multiple gestation--but also points out that most doctors do not believe reduction below twins is medically justified, and many refuse to perform reductions on twin pregnancies. Many of the couples interviewed had to travel across the country for fetal reduction. The couples who chose to reduce from 2 to 1 all have differing reasons but none of them seem to be medical, which I found odd. But then again, despite listing the medical risks associated with multiple gestation, the article was really asking ethical questions about fetal reduction in twin pregnancies, especially for those who are pro-choice, as well as for those who did not prevent multiple gestation, but accepted (ignored?) it as a very possible risk.

While F and I have discussed our fears about this cycle and agreed in a matter of seconds that we would reduce any pregnancy over 2, neither of us had heard of fetal reduction for twins. If you have 3 should you reduce to 2 or 1? That suddenly makes me feel really uneasy.

The article does discuss the secrecy and controversy of twin reduction, in fact many of the couples never told anyone about the procedure. Fetal reduction carries its own risks; for someone like me who could probably make a healthy twin pregnancy work, both in my body and at home, the decision is a no-brainer.

Since the IUI on Sunday, my 2ww fears are oscillating between thoughts that this didn't work, we are going to have to move to IVF, and that it will work, but that it will be a multiple pregnancy. It is either nothing or twins, and each outcome carries with it its own set of emotions, fears and decisions (no, not the decision to reduce). I can say though, that if those are my two options for results of this IUI, I CHOOSE TWINS. In a heartbeat (two heartbeats).

Baby Bird

For the past 2 weeks (since cycle day 2 to be exact) I have been watching over a baby bird that fell from the family nest in my front yard. The first evening I found it crying at the base of its tree, the parents on the nearest branches crying out with it. Risking dive bombs from the birds in the tree, I grabbed a towel and picked up the baby bird to find a safer location for it to spend the night, out of sight from the neighbor's cats who roam our yard. It was a Scrub Jay. It did not yet have its tail feathers.

I made a warm little towel and straw nest next to the wood pile in the dog pen for it to spend the night, still close enough for the parent jays to hear it calling for food. In the morning it was still in its new hideout and a parent was there with it, leading it back to the tree.

My job was now to keep the cats away, keep the baby out of the chicken pen where the mean rooster might peck it to death and watch it grow. And it did grow.

In just a couple days it was too fast for me to catch and bring into the pen. It was able to jump into the low branches of the laurel trees, off the ground and away from the cats. One night I caught one of the cats stalking. I was vigilant. The parents seemed to let me in on the alarm calls when the baby was in possible danger.

As I would watch the clock in the evenings, waiting for injection time, I would check on the baby bird. Sometimes I couldn't find it and then other nights it would show up in the yard, in the pen, in the bushes. The longer this baby bird survived out of the nest the more hopeful I became that this cycle would work. This baby and its parents were giving me hope. So I put all of my hope into this baby bird. I would think to myself, this is working.

On the night of my trigger, the baby bird was back in the pen. It was hopping around and I noticed that it now had its tail feathers. The next night I found a small blue tail feather in the backyard. I thought maybe that meant that baby bird took flight. Our IUI would be the next morning.

Not yet. Yesterday the baby bird was in the backyard. Looking huge! I almost thought it was an adult. It still couldn't fly, but seemed as if it could be any day.

I just couldn't help but think this baby bird was some kind of sign in for this cycle. I was watching over it and it was thriving and growing, a symbol for this cycle. And everything was working. The tail feathers, my follicles. The shedding of the tail feather, ovulation. Now just waiting for flight.

Last night I said goodnight to the baby bird and started my progesterone suppositories. I am almost 2dpiui.

This morning I was devastated to find the baby bird in the backyard, lifeless. After doing so well, surviving for 2 weeks, so near to flight, doing everything I could, it didn't work.

The Last Night

Today's results:
Right Ovary: 16mm, 14mm, 14mm
Left Ovary: 16mm, 16mm
E2: 622 or 683, I can't remember
Lining: 11

Trigger tomorrow night. IUI on Sunday.

I Hope She Didn't Notice

On Sunday I went in for my first monitoring appointment. It was cycle day 7 of my lepori/hmg IUI cycle.

Follicles:
Right Ovary: 4 follicles (down from 8 on cd3), with one dominant follicle at 11 cc.
Left Ovary: 7 follicles (down from 10 on cd3), all under 10 cc.
E2: 219
Lining: 6.1

The nurse thought I was off to a bit of a slow start and wondered if Dr. A would increase my hmg dose. It sounded like they expected to see more than just one follicle over 10 cc (they measure anything over 10). The call came later that day to continue with the same dose and to come back on Thursday 8/4 for another blood draw and u/s.

Meh. I'm not sure how to interpret this. I don't seem to be progressing much differently than my clomid cycles. I know it is still early. I've heard slow and steady from other people, too. At least I am not at risk for OHHS?

-----

I am house and pet sitting in the city where my RE's office is located. F comes to visit for long weekends, and for important cycle days when he is especially needed. The mother of the woman I am house sitting for lives a few blocks away and comes over to work in the garden and take the dog when I will be away for more than a few hours. Today as I was leaving, she pulled up and as usual we chatted for a few minutes. She had just been blueberry picking and wanted to store some in the freezer. I said sure, told her to go ahead and let herself in and do whatever as I was leaving.

On the way to my destination I remembered that I posted my cycle calendar on the fridge, showing all of my appointments and meds and doses and follicle counts, with words like transvaginal and insemination and injections.

I wasn't expecting any visitors. Hmm, I hope she didn't notice. If so, I wonder what she is thinking!

"Don't You Ever Talk That Way About Your Eggs!"

I have a friend who says silly things.

Sometimes it is her insensitivity and bad listening skills. Sometimes it is her personal philosophical understandings of the way the universe works. Sometimes it is her just her naivete. I love her, but when I share my issues and life with her, I end up having to explain infertility 101 over and over each time we talk. This is the friend who, when I first told her about my year and a half struggle with infertility, said, "Well, maybe it just means that now is not the right time." I said a year and a half struggle.

A year later we are in the pool talking about kids when she offered me her daughter as a joke (you know the one where parents say something like, "You really want kids? Here, take mine!) So I replied, "Be careful what you offer, you know what they say about Infertiles--we'll steal your children!"

Her response? "What?! Infertile?! Who said you are infertile?"

Dear Friend, do I really have to take you through this again?

She reminds me of just how little people actually know or think about infertility. Even when those who are close to them are experiencing it. I don't talk about it alot with her ( for the reasons mentioned at the beginning of this post), but she is my oldest friend. I've learned over the years since we've been adults to lower my expectations about what kind of support she can give, so I don't get hurt anymore.

Instead of disappointing me (well, I guess I will always feel a little disappointment), the silly things she says just accumulate in the humor section of this journey.

This section contains comments from her such as:

Well, maybe you and F just aren't genetically compatible. You are very similar.
Don't you ever talk that way about your eggs! Your eggs are strong and fertile and just waiting for the one that is meant to lead to your child.
You had a miscarriage? See, you're not infertile! That shows that your uterus knows exactly what to do and is just waiting for the right baby.
Your body must still be healing.
Maybe I am infertile, too. Boyfriend and I have not been careful at all about protection lately.
Maybe I had a miscarriage, too.

And I am not kidding about the last two.

Antral Follicle Counts

Do you record all the data for each cycle? Sometimes I wonder if it would be easier not to know any of the numbers or measurements or counts and just rely on the RE's statements like, "There is your right ovary...beautiful..."

Beautiful is good. But.

I am a list maker and like to record, and I want to know everything I can about what the data from each cycle means, even if I stay up until 1 am reading all I can about the predicted success of a cycle based on antral follicle counts (even though the data is for IVF patients). Even if it is the same text I read after my last baseline scan. Only this time I had a count of 18 follicles resting on my ovaries, compared to 11 last time. So I read everything all over again. I went from the fair category to the good category (as shown here)

So I guess "beautiful" can be translated to mean 'good,' and I should just take that information, cross my fingers and be satisfied.

What do you do with the information given to you during your cycle?

First Injection

I held a roll of flesh and stared at the needle for thirty minutes. I had the camera aimed at my belly as well, so F could watch the injection via skype. He told me I could do it. My skin suddenly seemed so impenetrable, thick and tough as to break the needle. I didn't think it was going to hurt, I just didn't think it was going to be possible. I practiced on a plum last minute.

Okay, that was easy. Sheesh. Silly.

Infertility seems to have its own series of initiations. The semen collection room, the HSG, the transvaginal ultrasound, the first injection.

You know what? You are, we are, and now I am, too, BRAVE.

We are very brave. Self-congratulations and welcome back to the club.

Jill's Infertility Document Reaches One Year

And I am back, after much deliberation. I have spent the entire morning and early afternoon debating whether or not to sign in to blogger and write a post, some thoughts verged on never signing in again. This break was much needed, and as much as I love following the journeys of my fellow iffers and sharing my experiences and support, I have dreaded this reinstatement to the land of IF. I have returned from visiting family and my brother. I waited 3 days since my return to call the Fertility Center, 4 days to google my favorite infertility blogs, and finally, 5 days since my return to sign in.

Here I am. I have a lot of catching up to do. I will begin by giving an update on my treatment.

4 months ago, F and I decided we were not comfortable with the risks of multiples that go along with injectable gonadotropins and IUI. We planned on one more clomid + IUI this summer and then to begin the IVF process this fall.

Well...

Maybe it is cold feet, maybe it is utter disappointment with clomid, maybe it is that infertility treatment feels like a gamble no matter what path you choose, but the closer it came to another clomid cycle, the more inadequate and inefficient my treatment seemed. Yet, jumping from clomid to IVF seemed like a huge distance to cross, even if it had been a year in time. I simply felt like we were skipping a possible success. Decisions are so difficult. What if we could get pregnant with just one round of injectables?

So we are changing our plan and gearing up for an injectables cycle with IUI.

We have been economical in our choices in the past, because money is a big issue for us and fertility medications are expensive. After adding up costs with the nurse, we decided on IVFmeds.com. Instead of paying $2000 at a pharmacy in the US, we will pay $700 (plus needles and syringes) for a generic HMG (human menopausal gonadotropin) from Europe. Additional savings comes with a sacrifice: these are intramuscular injections. The vials for I/M medications are $18.75 each, compared to $38.75 for sub-cutaneous. I hope this painful choice is worth the $500 it saves.

I do not know much about medications yet, but it seems that most patients take Follistim or Gonal-F, which are FSH only, rather than HMG like Repronex or Menopur that contain both FSH and LH. Maybe I am wrong? I am trying not to question what medication Dr. A has decided on. Of course the questions begin to form after the medications were prescribed and ordered. Honestly, I did not realize that there were differences, that some REs do not use LH to stimulate follicles, that sometimes synthetic hormones make a difference, or maybe they do not. It is amazing that you can still feel like a tiny rookie a year into treatment. I hate that I missed asking an important question. Was the decision based on my diagnosis and outcomes so far or was it based on finances? What is the difference? Does Dr A always use HMGs as opposed to rFSH?

Meanwhile, I will not worry about the medication, will not compare my treatment to others' treatment, will stop googling generic HMG, Menopur or Repronex. Feel free to share your thoughts though, and medications that you used, if I still have any readers! Also, if you know of a good resource that breaks down all the fertility medications and how/why they are used, please share the link.

One year ago I started this blog. Happy Anniversary?

There is Time

I have disappeared as of late. It has been 24 days since my last post. I stopped commenting and checking blogs, though I still think of you often.

There has been another natural cycle that did not end in pregnancy, and then a family emergency that has made my infertility less urgent, put treatment on the back burner, in postponement. We have decisions to make, but we will make them later. There is time. I will blog more, and comment more later, maybe in a month or so. I need to take my time.

I am actually in a good place, this place of not thinking so much about not being pregnant, despite the event in which my brother almost killed himself. Instead of checking the blogs, I call my mom for updates, text my brother, as he still cannot speak, to keep his spirits up, update friends and wait for my temporary job to end so I can go be with my family, with my brother.

Things happen outside of our bodies that derail our efforts to get pregnant. Sometimes we barely notice, sometimes it ends up letting us off the hook, in a way. That is how I feel, like this tragedy has let me off the hook for a while. There are other things to think about.

Meanwhile, today I cheered F on as he ran a 10k in the rain. Then the sun came out and we finished our garden beds; the earth looked fertile. My cheeks are rosy from the sun. I came in the house this evening with dirt on my knees and opened up a bottle of beer. It was effortless, I didn't hesitate. Things really are okay.

I'm friends with my RE on Facebook?

Not really. I am friends with the clinic where I had my second opinion consult back in March, with Dr. H who will be Re #2 for IVF, if it comes to that, in the fall. Their posts manly consist of their running tally of IVF births, news coverage of the clinic, including top success rates, interviews with the doctors and other media, as well as posts by patients expressing gratitude and gushing about how wonderful the clinic and staff is (and having to remind the clinic that it was National Infertility Awareness Week!).

It took me 2 months to build up the courage to send the friend request after finding out from their website that they were on fb. What if someone sees that Jill is now friends with a fertility clinic and 3 other people? You can delete that information from appearing on your profile page and the news feed so I sent the request last week, hoping to be sneaky. It just so happened to coincide with NIAW, when we are supposed to use social networking sites to raise awareness about infertility. That I was now friends with a fertility clinic also happened to coincide with a few other friend confirmed friend requests. My profile page read, Jill is now friends with Stacey Shaw and 5 other people, in which one of the 5 other people was the clinic. Unless people were so curious as to click on 5 other people, they would not see fertility clinic. So, in honor of NIAW, I decided not to delete from view the news that I was now friends with a fertility clinic. Courageous, huh? Well, we do what we can.

Last summer I wrote a post about why I choose to keep my infertility relatively private, and one way that F and I can both be advocates for ourselves and this disease while maintaining privacy. Almost a year later I still struggle with the same questions, with my silence. We have told a few more people since then, mostly family, and have talked more about it with family since starting treatments. But I still cannot imagine posting a status update about infertility. I have read many of the insensitive comments our community has received last week as a result and I just don't think it is worth the heartbreak we endure from acquaintances and so called friends. If you go to Resolve's facebook page you will see who in your friends list also likes that page. I have one friend who also likes Resolve, just one out of close to 300 people. If 1 in 8 couples struggles with infertility, where are the 37 other friends?

An interesting thing I have noticed that has happened since talking more with family about treatment is that they are the ones that go out and talk about infertility with their friends. I actually love when I hear my mom say, "I was talking to my friend Diane about how expensive infertility treatment is and she was just shocked that couples are forced to do things like sell their homes and spend their savings." or "My friend Barbara called me the other day and told me to DVR Oprah because that amazing story about the 60 year-old Mother who was a surrogate for her daughter's baby was going to be on." I know this means that my mom is talking to her friends not only about infertility, but about my infertility, and this is ok with me. I know it is not gossip, I know that it means that my mom has sought support from her friends because infertility affects her, too. And if her friends then go out and talk about "how we hear about more and more people struggling with infertility, like my friend's daughter...," well, that is just as, if not more, satisfying to me as posting a status update about NIAW on facebook. Let someone else have that argument for me.

Myth: Lifestyle Changes Can Cure Infertility

Bust An Infertility Myth for National Infertility Awareness Week. Here is one that I am especially passionate about:

A little over two years ago, at age 31, my partner and I decided we wanted a child. The first thing I did that very month was quit caffeine because I wanted to get pregnant. I switched to decaf coffee and limited my morning consumption to 2 small cups. A year and a half later when I was diagnosed with unexplained infertility, I turned to TCM and reluctantly attempted to quit coffee altogether for the summer at the recommendation of my acupuncturist. I bought a book that offered a 'cure' for infertility and followed the dietary suggestions, omitting things like raw and cold foods to help warm my uterus. I read about fertility diets that called for the elimination of dairy, wheat, sugar, fruit juices and of course, alcohol and coffee, even decaf. I came across a sentence that has both haunted me every time someone offers me a piece of cake and a glass of wine, and has fueled my anger about my infertility: "why wouldn't you sacrifice anything you could, just to know that you did everything you possibly could to conceive?"

After sacrificing many lifestyle pleasures, from hot yoga to lattes to abdominal workouts to sugar and all junk food (even though a fertile, pregnant friend just posted a status update about eating doritos. I NEVER eat foods like doritos, in fact, I wouldn't even think about it!), and still having no pregnancy to show for it, I got angry.

After my first IUI didn't work, a friend asked, "Is there anything you can do differently? I read an article that said eliminating wheat from your diet can help with infertility, have you heard of that?"

The idea or promise that there exists a fertility diet, magic supplement or lifestyle change that can cure unexplained infertility in otherwise healthy individuals is as much blaming as it is myth making. I am tired of feeling guilty for being infertile, for feeling like I am not doing everything I can to conceive.

I think it is important to make healthy choices about what we put into our bodies, and I acknowledge that diet, exercise, and smart lifestyle choices are necessary for anyone wanting to become pregnant, but if dietary restrictions are causing you to feel guilty when you cheat, to feel stress and anxiety over food, or making you feel even more out of control than IF does alone, then your diet is causing more harm than benefit.

My lifestyle is not to blame for my infertility, I am not causing my infertility because I occasionally eat and drink all the things that people without infertility eat and drink without question. I am doing everything I can to help my body conceive.

As infertility patients, we have already been taking our pre-natal vitamins for 2 years or longer, limiting alcohol always or at least during fertility treatment cycles, practicing yoga, fertility yoga, meditation and other stress reducing activities to manage our disappointment and depression, eating organic, balanced diets, finding exercises that we can continue during treatment. We are vulnerable, but we are most likely healthy (even if our eggs are crap, or we don't ovulate on our own, or we have abnormal semen parameters).

I refuse to deny myself small pleasures like a cup of creamy decaf coffee in the morning, or a bowl of ice cream for a treat now and then, or a glass of wine on a Saturday night with friends, while struggling with infertility. I am absolutely willing to make sacrifices for my future baby in utero, but I have decided that I am unwilling to make those sacrifices for infertility month after month and year after year. Infertility has taken too much from me already. I refuse to let infertility take over my life.

To learn more about infertility, please visit RESOLVE

To get involved in National Infertility Awareness Week, please visit NIAW

And click here to read more myth-busting blogs!

welcome iclw

15dpiui

I'm not in the best place to extend a welcome for iclw. Actually, after spending the past three days breaking into sobs every few hours, today is better, so welcome to the tail end of my two week wait after IUI #3.

I am waiting for AF to arrive so I can finally say, after multiple BFNs, that it is over. Our plan is to do one more IUI this summer before beginning the IVF process in the fall. I really put all my faith into this time being the charm and I am paying the price.

With IUI #1, in November, I didn't think it could possibly work on the first try, with only clomid, after almost two years of trying naturally, so I was shocked and hopeful when it ended with a very early miscarriage. Then, IUI + clomid #2, in January, was horribly mistimed because we chose to save money and go unmonitored. I knew we didn't have a chance that cycle and was happy to have it end so we could move on and try again, the complete opposite of IUI #3, where on paper there is no reason why it shouldn't have worked.

I was convinced I was pregnant, though preparing to be devastated, anxiously excited and hopeful after the results of my progesterone level, and as it turned out, tragically optimistic about the success rates of IUI + clomid. It seems that the one chemical pregnancy is more like a fluke rather than a prediction of my success with clomid and IUI. Maybe it was the effects of it being my first time on 100 mg of clomid that made me cry harder than I have ever cried in the past two years of trying to get pregnant. At the time I thought, despite the BFNs, that my extreme emotions were a symptom of actually being pregnant. Did you know that the blue +/- dye tests will bleed into the test line and turn positive after a few hours?

I was thinking yesterday of those of you who are IVF veterans, how much admiration I have of your persistence and courage and the ways I am learning about those strengths from your blogs, that success stories do give me hope, but so do those stories of trying again after it didn't work. Thank you for those.

Imaginary Line

11dpiui

I probably tested too early, but the result shut down this whole cycle for me. F hummed "...it ain't over till it's over..." all day yesterday.

At three minutes past peeing on a stick, I was sure the faintest of lines was about to appear. The test is just too wet and blurry to really see it yet.

At ten minutes past peeing on a stick I saw an imaginary line.

At thirty minutes past peeing on a stick I cried. My chest was heavy with disappointment.

When I examined the test at an hour past peeing on a stick I cursed myself for not waiting 2 more days to test.

I returned to the test over and over throughout the day. At one point I realized that my friend who is getting married this summer will be pregnant before me. I remembered Mother's Day is coming up. If you hold the test up to the light you can almost see through it, leaving a shadow of a test line.

When I studied the test with tears in my eyes at 7 hours after peeing on a stick, the control line was so dry and solid and dark against the white test window that I was finally convinced it was really negative and threw it in the trash. I told F he was not allowed to try to cheer me up. We ate ice cream under blankets and binged on BattleStarGalactica episodes all evening.

No Progesterone Supplementation Needed

7dpiui: 25.74

I am very happy with that number. It means I responded very well to 100 mg of clomid. The last time we tested, my progesterone levels 7dpiui were 16. Unmedicated cycle numbers were around 10. Anything over 10 can support a pregnancy. Dr. A likes to see numbers above 12. FertilityPlus reports that doctors want levels above 15 when the cycle is medicated. For once I am not borderline. I am taking that as a good sign, though trying not to get excited.

There is no mid-luteal level that predicts pregnancy, I repeat, There is no mid-luteal level that predicts pregnancy.

Bellies, Blood and Progesterone

I know that mid-luteal progesterone levels are not predictors of pregnancy, but I am so anxious to know what my 7dpiui progesterone reading is. My clinic is not prompt when it comes to giving me results of tests like progesterone. I am patiently waiting for their call. I'll give them until noon.

Wednesday was 7 days past the IUI (only 7!? and today is only 9!) and I was going in for a progesterone blood draw. Wednesday I was also a substitute teacher, for a pregnant acquaintance, whose class I may take over when she begins her maternity leave in mid May. I felt awkward and guarded as she rubbed her belly when we discussed the possibilities of my long term sub (why does she have to do that?). I felt cursed with infertile, bad luck as we walked and talked and she stumbled down three steps and almost fell belly first (she didn't, she just stumbled, thankfully), like I was responsible for what almost, possibly..., no, we won't even think about that. Just keep that infertile away from the pregnant women!

After school I went to the medical center in my small rural town where my RE's office had faxed the lab order a week ago. The medical center here doesn't do these sorts of labs on site but sends them off to the nearest hospital. I wished to live in the same city as my fertility center as soon as I walked in. The people at reception couldn't find the fax so they gave me an updated (faster, as they described it) fax number. Ok, this has actually happened before. I call the Fertility Center and ask them to fax it again, to the new number. Done. The medical center says they didn't get it this time either.

Are you sure? Does it take awhile? I know they sent it.
No, I don't know what to tell you. It's not here.
I'll wait a few minutes and then call again, I guess.
(Waiting)
Oh, you know what? Maybe the lab has it, I'll call and check.
(Hello, isn't that where it needs to be anyway?)
They have it, I'll have to go downstairs and get it.
(Waiting)
Ok, here it is, it was down there all along! Now just take this down to the lab.

Now I am in the chair waiting for the nurse who bruised up my arm during the drawing of hcg, from the non-doubling betas in December. The room is freezing and I can feel my veins shrinking with each second. I have an impulse to jump to the floor and begin doing push-ups. I am hoping she does not remember me. Clearly she does not because this is the exchange that ensues:

She says: Ok, progesterone! Jill! you were born in 1977, the same year as my son! I could be your mother. Do you have any kids?
I reply: Nope.
She says: Neither does my son, what is it with your generation?
I say nothing, absolutely nothing.

She is holding in her hand the order for a progesterone draw, she even said progesterone. The order in her hand has big letters at the top that reads Fertility Center.

Bust An Infertility Myth Blog Challenge

What is the biggest infertility myth and how has it effected your life or the life of your friends and family members?

Resolve is inviting all bloggers to write a post that busts a myth about infertility for Infertility Awareness Week, April 24-30.

To learn more about Infertility Awareness Week, The Bust An Infertility Myth Blog Challenge and how to participate visit:

http://www.resolve.org/national-infertility-awareness-week/bust-a-infertility-myth-blog-challenge.html

Motel Bathroom Lights

I hate them. I didn't know I had so many grey hairs. They stand out like antennas in motel bathroom lighting, picking up the voice of Dr. H, what he said to us in Portland 2 weeks ago--that my FSH was higher than to be expected for my age. Grey hairs did not bother me up until that day, mostly because I thought I only had two or three. It was especially disheartening to scrutinize, to lift up sections of hair and find grey ones, more grey ones, then move my gaze down to my face, where the side effects of clomid had popped up on my neck, jawline and lower cheeks. One shouldn't have to deal with both grey hairs and acne at the same time.

----

I arrived at the motel on Monday night for a follicle check the next morning. It would be cycle day 12 and the opk was almost positive before I left on cycle day 11. Early, but consistent with how I had been feeling over the weekend. I felt more relaxed than ever during a treatment cycle because I knew I did not need to rely on that test. Huge difference from the last two IUI cycles.

Constipation. Another possible side effect from clomid? I think I have only been constipated once in my life. Horrible timing to be constipated the morning of any appointment in which someone will be prodding around in your abdominal region. At least the speculum was not involved that morning.

The ultrasound showed one mature looking follicle on my right ovary measuring 23 mm and one mature looking follicle on my left ovary measuring 21 mm. Dr A usually gives HCG as a trigger when follicles measure 18-20 mm. An IUI is usually done 24-36 hours after the trigger depending on the size of the follicles. I expected to have the ultrasound, be sent home with a trigger shot and instructions for what day to take it, and drive back up with F later in the week. Instead Dr A asked, "Can F be here first thing tomorrow morning?" He will have to be. A nurse came in and gave me the trigger shot.

F would be arriving late that night, stressed. His numbers would be great the next morning, but not as great as previous samples. It is interesting to see how fatigue and stress affect sperm samples.

The IUI went fine, with the exception of the brief awkward moment when the nurse called F by the name Matt while looking at the results of the semen wash, worrying us and herself that F was holding someone else's semen warm in the syringe in his fist. We checked all labels and then laughed.

-----

My lining measured 7.9 mm on cycle day 12. They want to see an endometrial lining of at least 8 mm at the time of maximum thickness in a cycle. Dr A was sure that it would be fine for implantation. I'm picking up a pineapple today. And thinking of distractions to pass the time during this two week wait.

April Fools by Clomid, Part 2

My April Fool's Day joke:

The nurse called me back late yesterday afternoon and told me to take a pregnancy test.

Spotting before ovulation is not a typical side effect of clomid. My ovaries have been feeling tender since the first couple days of taking the pills, which can be a symptom ("abdominal discomfort"), as can dizziness, and so as it happened yesterday, I felt faint in the shower.

The nurse told me to take a pregnancy test because these are also symptoms of pregnancy. Yes, they are.

I agreed even though I knew I was not pregnant. 1. my BBTs are low. 2. I always take a pregnancy test before starting clomid, however silly I feel, just as a precaution, and on Sunday cd3, it was negative. I even posted about it. Regardless, being told to take a pregnancy test by my RE, via the nurse, because my symptoms sound like pregnancy, made me think that maybe there was a chance I could be pregnant.

I had to go out on a Friday evening to buy a test and take that test on April Fool's Day. Cruel.

Of course it was negative, and of course I studied it for several minutes the same way I did five days ago. I've been had. By clomid and my own body. and encouraged by my RE to fall for it.

-----


I started testing with ovulation predictor kits today just in case I am ovulating early this time. Things are definitely happening in there, I can feel it with every use of my abdominal muscles. Other side effects of 100 mg are more pronounced as well--headaches, breakouts-- not only on my face, but on my chest and back as well (gross! unfair!).

Despite an unexplained episode of spotting that led me to take a pregnancy test on April Fool's Day, I am feeling more confident and relaxed about this IUI cycle than compared to cycles past. Insemination will most likely be mid-week if everything looks good on Tuesday.

April Fools by Clomid

This morning I woke up while having a small orgasm (it happens, right?). Then later in the morning after taking my dog for a walk, nothing that would get my heart rate up other than walking up the giant hill at the end of my street, I felt wet, down there, wiped and saw pink blood. On cycle day 8.

AF usually lasts 3-4 days, with the last day, either cycle day 4 or 5 mostly just spotting. AF ended 4 days ago, on cycle 4. So why am I spotting pink on cycle day 8?

This cycle I was prescribed 100mg of clomid, an increase from 50 mg. I took my last pill yesterday, on cycle day 7.

The other day, just 1-2 days into clomid treatment, I was swimming laps and felt a twinge on my right side, nothing painful, just an awareness that I do have working ovaries in there. The next day or so I felt bloated, with an increased awareness of my ovaries. Even gentle yoga, like moving from plank to downward dog and stepping my foot forward into a lunge, felt too strenuous. Maybe I am a bit tender. Tender sounds normal, after all my ovaries are being stimulated, but it seems a bit early for enlarged ovaries?

The spotting is confusing, as well. It is not a side effect listed on my clomid therapy handout provided by my clinic. Lightheadedness, or dizziness, is a side effect listed on my handout. After discovering the spotting, I hopped in the shower. And then almost passed out. To be honest, the spotting freaked me out.

Has anyone experienced mid-cycle spotting while on clomid? I didn't find anything helpful online, other than call your Dr, which I did and am waiting for a callback. I'm sure it's nothing, and my u/s follicle check is Tuesday, so if there is anything there, like a cyst or something, we will see it.

Meanwhile, I am skipping swimming laps this evening and will take it easy over the weekend. Fingers crossed that everything looks good on the ultrasound for ovulation and insemination next week!

The Second Opinion-Pre-IVF-New Patient Consult

This is me working through our treatment plan:

Last week F and I drove 6 hours to the clinic where we will do IVF, if it comes to that, to meet with Dr H. We thought it would be a good time to get a second opinion regarding our timeline, treatment options and treatment so far.

Here is what was presented to Dr H:

excellent SA results
a normal HSG taken on 6/10
normal thyroid levels
borderline low progesterone levels on a natural, ovulatory cycle and normal levels with clomid
Day 3 FSH of 9.3 and E2 of 38
a chemical pregnancy resulting from IUI #1
a mis-timed, unmonitored IUI #2 with late ovulation on 50 mg of clomid

Our plan was to continue with 2 more clomid IUIs, monitored, then move on to injectable IUIs and then move onto to IVF in 2012, the conventional trajectory. We wanted to discuss this plan with Dr. H.

Given our success with IUI #1, he confirmed that 2 more tries with clomid + IUI could work for us. Given the failure of IUI #2, he recommended increasing the dose of clomid from 50mg to 100mg, and, of course, monitoring.

He acknowledged that my FSH was slightly higher than expected for my age but couldn't draw any conclusions based on that number. He recommended a clomid challenge test if I were to become his patient.

As for the timeline, our treatment options on that timeline, Dr H discussed the reasons why we might want to skip injectable IUIs and move from clomid IUIs to IVF. They sound a bit like word problems from math:

1. Cost. We pay $400 for an unmonitored clomid + IUI and around $800 for a monitored cycle. The price of injectable IUIs are estimated around $3, 000-$4000 a cycle. The estimated cost of IVF at this clinic, including meds, is $10,000. Their shared risk/refund plan is $15, 000, not including meds and anesthesia. If we qualify and I have not given birth within 2 years or 3 fresh and 3 frozen cycles, we will be refunded 70% of $15, 000.

2. Success Rates for my age group. IUI + clomid carries a success rate of somewhere around 8%-15%. IUI + injectable meds carries a success rate of somewhere around 12%-25%. Not a huge difference. IVF, of course, carries a much higher success rate and at this clinic it is between 60%-70% (SART) for my age group.

3. Travel. We will have to travel as much for an injectable cycle as we would for an IVF cycle.

When we put all of these factors together--cost vs success rates, success rates vs travel--injectable IUIs do seem, for us, more risk than they are worth in time, travel and money.

I use the word risk not just in reference to the gamble of choosing a treatment path, but also because we expressed our fear of multiple gestation with Dr H. This has been a long standing fear of mine in my treatment for infertility and I have always associated it more with injectable IUI than with IVF or clomid. Do I put that fear aside and try just one injectable IUI cycle before moving onto IVF or do we pull together $15, 000-$20, 000 and go for the shared risk program in 6-8months?

F is all for skipping injectable IUIs. I say, "Why didn't we talk about this back in November when I wanted to, or even a year ago when I wanted to start treatment? We could have planned our treatment for IVF this summer!" But that argument is a side note and irrelevant to the planning and decision making at hand.

OLD PLAN:
4/11: clomid IUI #3
Summer 11: clomid IUI #4
Fall-Winter 11: 3 injectable IUI cycles
summer 2012: IVF

NEW PLAN:
4/11: clomid IUI #3
Summer 11: clomid IUI #4 or injectable IUI
Fall-Winter 11: begin IVF with Dr H, hopefully shared risk program

Meanwhile, we are in the midst of IUI #3. Yay, clomid headaches. Follicle check next week.

clomid + IUI #3 begins

On Friday, AF arrived, and for the first time in over 2 years, I was actually surprised by the arrival, not watching the clock, and not disappointed. March marked a break, for a family visit, for a short trip up the Oregon Coast, from temping, from timed intercourse. It was a nice break that involved a new patient consult with a larger, more reputable clinic and RE (more on that in the next post).

Yet, even though I was in the midst of red blood on CD 3, I still have to take a pregnancy test. It is something I always do before starting clomid, a precaution, even if it is the tiniest of chances that could warrant a precaution. It feels silly to do, but I do it anyway. Even sillier is the way I hover over the test as color flushes past the window on the stick, as if I don't know it will be negative. And even as the definitive one pink line emerges stark and clear, I still search for that faint second line that does not exist, holding the stick this way and tilting it that way and then taking it to the window so I can view it in natural light. I contemplate asking F to "please come look at the test and see if you can see a faint line?" I don't. I snap out of it. I take my clomid that night. This time 100mg of it.

IUI #3 cycle begins.

Waiting...for both nothing and something

Waiting for nothing because that is what this cycle was, a month off in between clomid IUIs, a kind of giving up on trying naturally, and a void where a 2ww should be, or could be. We did engage in some fertile-time sex and so that ever hopeful spark does reside somewhere in me, which is why I say I am waiting (for nothing).

But I am also waiting for something because early next week F and I will travel up to Portland for a second opinion/early ivf clinic shopping appointment at OregonReproductiveMedicine. There will also be time to enjoy Portland, so really the consultation is just a small detour from an otherwise intended fun pseudo-spring break trip. On a side note, I will not be participating in ICLW for the first time since starting this blog and I miss you already.

The clinic we currently go to is actually a comprehensive Women's Care Facility with a separate entrance and waiting room for the 'Fertility Center.' Dr. A runs the fertility center with a staff of nurses and is the only RE at the small facility. The small clinic environment makes treatment very personal, Dr. A usually performs all procedures, including u/s and HSGs and inseminations and the cost of treatment is lower when compared to other centers (especially IVF, which is tempting). A possible downside, as I perceive things, is that the lab is also small and the number of IVFs per year is low. Additionally, Dr. A is not a member of SART and the lab is not accredited.

Everything I have read on how to choose a fertility clinic emphasizes the importance of the RE being a member of SART. F and I are pretty much cowards and have not asked WHY Dr. A is not a SART member and the lab is not accredited. We don't really know what it means for our treatment that he is not.

Larger clinics with a team of REs suggests that more research is happening, that there is a system of checks and balances with working with more colleagues, and that more procedures are happening and that, as a patient, you are more likely to find an RE who has expertise in working with your specific diagnosis. These are all assumptions on my part, but make sense, right? Larger clinics have downsides, too, which is why we decided to stay at a small clinic for the duration of our clomid IUIs (one more to go in April) and reconsider when the time came for more aggressive treatment (now, or after April).

What we really want is a second opinion, or maybe a fresh look, an evaluation of the treatment we have received so far and thoughts about the outcomes of that treatment, to enter a consultation already with test results, more knowledge about treatment, and some treatment under our belts. I think we will get much more out of this one than the last (just feelings of being completely overwhelmed). Hopefully I am not expecting too much. I need to get my list of questions together.

ORM is where we will most likely do IVF, if it comes to that. They have a shared risk program that we will hopefully qualify for (from my shopping around I know of one program already that disqualifies patients if their FSH level is above 7.5. Mine measured 9.3). But before that, we will need to decide if this is where we want to pursue the next steps in our treatment-- injectible IUIs-- or if we want to remain with Dr. A for this.

It is small vs large clinic. Any thoughts or advice? What are your thoughts on/experiences with SART?

Makena Progesterone

The price of Makena, a form of progesterone given as a weekly shot to prevent pre-term labor, has increased from $10 a shot to $1500 a shot due to the FDA recently giving KV Pharmaceuticals exclusive distribution of the drug. Prior to this decision, the production of this form of progesterone was not standardized by the FDA. KV Pharmaceuticals now markets the progesterone shot as Makena and has obscenely inflated the price. Unbelievable.

I would expect that women who have suffered multiple losses, infertility and difficulty getting pregnant would be at more risk for pre-term labor and therefore represent a larger portion of the women who need this drug. This price gouge feels like yet another attack on infertility and pregnancy loss to me. Have you or has anyone you know used this form of progesterone during pregnancy?

Read more from the AP, Jezebel and Time.

Crossing the Great Divide on The Creating a Family Blog

I've mentioned Creating a Family quite a few times in my postings here. The Creating a Family podcast is my number one resource for infertility and adoption news, advocacy, education and discussion. I am beyond grateful for Dawn Davenport.

Dawn's most recent blog post, Crossing the Great Divide: Addressing the Threats to IVF, follows a recent podcast series dedicated to infertility insurance, funding and affordability and touches upon current legislation that may threaten the availability of infertility treatment in many states. She calls upon her readers, many of whom have resolved their infertility through adoption, treatment or both, to remember those of us who are still 'on the other side' and embattled with not only our physical and emotional struggle, but also with insurance companies and legislation that defeats us financially and culturally. She calls upon her readers to stand with "those who have been left behind" because those of us "who suffer from infertility should not have to stand alone," by writing your local legislators. She has more information on how to do this, with links to RESOLVE's website in the post.

I also recommend the podcasts in the series mentioned above:
Jan 28: Grants for Fertility Treatment and Affordability Programs
Feb 23: Paying For infertility Treatment: Infertility Insurance

Do you live in a state that has insurance mandates for infertility coverage? Do you live in state that has introduced 'Personhood' or anti-abortion legislation that may inadvertently (or perhaps purposefully) target IVF treatment?