Sunday, October 10, 2010

Testing, Testing, 1..2..3

A big update:

After the transfer, I asked the doctor how soon I could start doing pregnancy tests at home and she responded that I should wait until the morning of my first beta test.  A beta test is a blood test to see how much HCG (a hormone that indicates pregnancy) is in your body.  My first beta test was scheduled for October 6th, which meant I was supposed to wait ten days to do a test.

So, four days after the transfer, I took a home pregnancy test.  Patience when I'm looking forward to something has never been my strong suit.  The test was faintly positive.  From my obsessive internet research, I had learned that a positive home test could be caused by the trigger shot I had taken on September 19th.  The trigger shot can cause a positive pregnancy test up to 14 days after you take it, and I was only 11 days past the trigger shot. That said, most people on the online forums said that the trigger shot is out of your system after 10 days, so I really wasn't sure whether the positive test was a lingering trigger shot or a real positive.

Only way to find out - test again!  I tested the morning of the 5th day after the transfer and got another positive, but this one was even more faint.  Again, there were two ways to interpret that.  Either that meant the trigger shot was still causing the positive but going down and almost out of my system, or it was simply another positive test.  Pretty much anyone will tell you that even a faint positive is a positive, so it was possible that it was positive on both day 4 and day 5.  Well, all day I kept wondering, so the evening of day 5 - yup - I took another test.  This one was also positive, but it was about the same color as the day 4 test.  I was starting to think I was really pregnant, and I was starting to think it was twins, because that's awfully early to start testing positive.

I took day 6 off from testing, but then tested on day 7,8,9, and 10.  I continued to get positive results.  I even switched to the digitals for the last few tests just so I could see the word "Pregnant" in bold letters.  Finally October 6th rolled around and I went in for my first beta test.

The appointment took no time at all.  I was there just long enough for them to take one vial of blood.  I told the tech that I thought it had worked, and she had responded in a non-committal fashion, making me think that a lot of women must say that and then turn out to be incorrect.

After the test, I went off to work.  By 10:45, my curiosity was getting the better of me, so I called and left a voicemail for the IVF coordinator to find out whether she had the results.  She called back a bit later and I was so excited when I saw "Unknown" pop up on my phone - that's always the clinic!

I could tell right away that the news was good just by the tone of her voice.  I thought she would sound all serious if it was bad news, but she sounded pretty chipper.  Sure enough, she said, "I have great news!  Your test results came back very high - your level was 526.4!  Either you have an EXTREMELY healthy pregnancy or you've got twins in there!"

Okay, backing up:  there's a wide variety of numbers thrown around online about what is considered to be a positive number for pregnancy.  From what I can tell, typically 30-50 is the minimum to be considered officially pregnant (although some people start out lower and then it grows and they are really pregnant).  I think that around 150 is "average" for a singleton pregnancy. 562 is pretty darn high.  However, what they're really looking for is an increase in HCG in your bloodstream.  Therefore, they test you three times to see if the number is doubling every 24-36 hours.

So.  We started at 526.  Two days later I went in for my second beta test.  This one came back at 1518.  My HCG not only doubled, it had almost tripled.  "It is very likely it's twins." said the coordinator.

Today I went in for the third and final beta test.  This one came in at 4389 - again, coming close to tripling.

We're scheduled for our first ultrasound on the 22nd, and that will be what confirms whether or not there are actually two in there, but we are pretty convinced that we got a buy-one-get-one special.

To be honest, we really didn't think IVF would work the first time around.  We thought we'd have to do at least one frozen embryo transfer or even a full second round of IVF.  Therefore, it is pretty much a shock that it worked and an even bigger shock that it's probably twins.  On the one hand, I feel really overwhelmed about the idea of having two infants at once.  On the other, I feel really guilty about feeling overwhelmed and think I should just be grateful to be pregnant at all.

As with everything else in this process, I've been really open about the status of everything with friends and family.  I know that it's early and that we could very likely lose one or both of them, but I would rather spend the entire time being happy and excited than being worried.  If I lose either one I'll be sad one way or the other, so I might as well enjoy the time I do have.  Plus, a friend of Mark's pointed out that if you keep a pregnancy a secret and something bad happens, there's no one there to lean on because no one knows it was even happening.

For now, we are cautiously optimistic, and I am frantically researching everything I can about twins!

Monday, September 27, 2010


The day after the retrieval, the IVF coordinator called to tell me that 8 of the embryos had fertilized.  They didn't know yet whether they would be doing the transfer three days after the retrieval or five.  If the embryos weren't growing well on day 3, they would transfer them that day under the theory that they might do better in the uterus.  If they were growing nicely on day 3, they would wait until day 5 so they would reach the blastocyst stage.  A blastocyst is formed when the cells have divided enough that you have an inner cell mass that will become the embryo and an outer cell mass that will become the placenta.

On day 3, the IVF coordinator called to say that the fertilized eggs were doing great.  Five of them were 8 cells and three of them were four cells.  It was decided to wait until day 5.  This was good news for us, because it's likely they would have put three in if they had decided to move forward on the 3rd day, since the embryos would have a lower likelihood of surviving.  This would have introduced the possibility of having triplets, which would be overwhelming to us. Holding off until day 5 was good news.

The transfer was pretty amazing.  The instructions were to drink about 32 ounces of water starting 90 minutes before the appointment and finishing up 45 minutes before the appointment, and to take a couple Valium with those last few gulps. The Valium is supposed to help you relax before the procedure and I think also assists with cramping. I had been warned that I would be extremely uncomfortable even before the appointment started due to the amount of water I had to drink, but I wasn't. It wasn't until the procedure actually started that I began to feel a bit uncomfortable and it never got to be too terrible.

The appointment started with a medical assistant telling us what to expect, and then the embryologist came in with our embryo reports.  I had been a little concerned that we'd lose all of them between day 3 and day 5 (that's the risk of waiting), but the embyrologist told us that we had two fantastic embryos ready to go.  One was graded 5AA and the other was graded 3AA.  The number indicated the degree of expansion of the blastocyst (1 being the least expanded, six being the most expanded).  The letters indicated the quality of the inner cell mass (the part that would become the embryo) and the outer mass (the part that would become the placenta).  A is the highest rating.  AA is the best rating, and both of our embryos got it!

The embryologist also told us that two of our fertilized eggs didn't make it and that they were watching the remaining four to see if they would grow enough to be frozen.  Everyone wants to be able to freeze extra embryos as it's a lot less expensive to do a frozen embryo transfer than it is to go through the whole egg retrieval process again.

After telling us about our embryos, the embryologist gave us a picture of the two they would be transferring.  And here it is:

As you can see, one of the embryos is larger than the other - that one is the 5AA. The other is the 3AA. The embryologist assured us that the size doesn't really mean anything at all in terms of success rates.  I read online that boys tend to develop more quickly, so I'm kind of hoping that this means we transferred one girl and one boy.  This, of course, is based on absolutely no scientific knowledge.  They could both be boys or both be girls.  IVF seems to tend to produce more boys than girls, from what I've found online.

The doctor came in and I got to have a normal, stomach-centered ultrasound (instead of the other kind) but then she inserted a speculum, so.  You know. Maybe not so comfortable, but not bad at all really.  Straight in front of us on the wall was a flat screen t.v.  The embryologist had moved to the lab, in the room directly next door and she had control of the t.v.  She first flashed a shot of the container holding the embryos that had my last name and my birthdate typed on it.  After that, she gave us a live video feed of the actual embryos.  Okay, I admit it, I was all "AWWW!  Look how CUTE!"

Just a few seconds later the best part happened.  The embryologist was pulling the embryos out of their liquid with a catheter.  I didn't notice the catheter at all, but all of a sudden both little embryos just seemed to scurry off to the left of the screen, one after the other.  It was the sweetest little thing.  A moment later the lab door opened and the embryologist brought the catheter in to the doctor.  The doctor inserted the catheter and used the ultrasound to pick the best spot to place the embryos in the uterus.  I couldn't really see the screen much at that point, but after she finished I could see where she had marked where each embryo had landed.  Everyone said that it couldn't have gone more smoothly and we were feeling pretty optimistic.

After getting all of the medical stuff removed, Mark and I stayed in the room with me lying down for fifteen minutes and then I ran out to use the bathroom (remember those 32 ounces of water? pretty darn uncomfortable at this point).

Instructions were to go home and stay mostly in bed for the remainder of Sunday and all of Monday.  I've been on the couch for most of the time (which explains my sudden batch of posts!)  Everyone seemed to think I'd be worried that the embryos would fall out, but I'm not worried at all about that.  I'm worried that I'll move around too much and they won't be able to latch on.  Kind of like being on a rolling sailboat in a storm - you just start thinking you're going to be able to grab something to hang onto and the waves roll you away again.  I hope that's not what it's like for the embryos.  I'm also already feeling like I need to hold my stomach when I walk around, which I admit is completely and totally ridiculous, but it's this weird impulse I've got.

Last night I added two little Vivelle patches, which are estrogen patches to my medications.  I put them on Sunday and Wednesday nights, on my stomach.  With all of these hormones, every time I have a stressful moment I end up stopping and wondering if it's the hormones.  So far I'm fairly even keel though.

They called today and let us know  that three of the remaining embryos made it to blastocyst stage and are being frozen.  I didn't think to ask about their grades, but it doesn't really matter to me just yet.  We'll get our results on October 6th.  Until then, progesterone shots and estrogen patches plus a whole lot of positive thoughts.

It has occurred to me that if this works, it does have one major advantage over natural childbirth.  I get to see the baby (babies?) from the very beginning.  I got to see the moment they arrived in my uterus, and I have a picture of them.  It's not enough to make me want this to happen (for anyone!), but it is a tiny silver lining.

Sunday, September 26, 2010

Egg Retrieval

The instructions prior to the egg retrieval were to avoid eating or drinking after midnight the night before the retrieval, and wear comfortable clothes with warm socks.

Mark did his part at 7:00 am, and then my appointment was at 8:00.  After a short wait, they took me into a room and had me change into one of those nice little hospital gowns.  Then they brought me a warm blanket to keep me cozy until the procedure.  When it was time, they had me move to a different room where the procedure would take place.

There was a bed all set up for me and after I settled in, they gave me a shot in my hand to numb it up before the IV. The initial medication in the IV made me feel a little weird, but then after everyone had entered the room they started the full-on anesthesia. The anesthesia felt like pressure going down my arm. I noticed that all of a sudden all of the medical staff were standing over me, watching me, and I realized that they were watching to see me pass out. It's kind of strange to have four people standing over you waiting for you to be unconscious.

After I woke up, they told me that they had retrieved 11 eggs.  That was a lot better than I thought they were going to do because I thought we only had 7 mature follicles.  Four more must have caught up between Sunday and Tuesday.

I recovered extremely quickly from the anesthesia.  I didn't feel sick, and I was completely alert.  My friend who had come to give me a ride home went out to lunch with me and then I took a nap for the afternoon.

On Thursday I started progesterone injections.  Okay, up until this point, everything had gone extremely smoothly and the shots were no big deal.  The progesterone injections are completely different for me.  I'm not sure why they're so bad for me, but they result in a spot about the size of a fist in my muscle being sore for the day of and the day after the shot.  I tried numbing the area with ice, but that seemed to make it worse.  Then I tried using Emla cream (applied an hour before the shot) and heating the area for 30 minutes before and ten minutes after.  That worked pretty well the first two days, but we did that today and I think the Emla cream didn't work this time because I felt everything.  The gauge on the needle is pretty large, it's a long needle, and it goes into the muscle.  I don't like feeling all of that!  I think these shots keep going until at least the pregnancy test, potentially longer.  Ugh.

Next up - Transfer!

The last week - Ultrasounds Galore

Okay, so to pick up from where we left off, the next step in the process was to go in for an ultrasound to see how the medications are working out.  The first ultrasound was on the 14th, and it was done the same way as the SIS ultrasound.  Dr. Sparrow turned the monitor so I could see what he was doing, and he pointed out where the ovaries were and how many follicles were growing in there.  It was looking pretty good - we had seven follicles on the left side and five on the right.  Dr. Sparrow took measurements of each follicle with the computer by clicking on the top, bottom, left, and right edges.  You can see the measurements on the screen while they're being taken, and you're looking for the average of the two diameters to grow to be around 18mm per follicle (this is not likely to happen early on!!)  I didn't pay much attention to their size at this appointment because I didn't know what size we were trying to get to yet.

The same day as the ultrasound, they took blood to check my estrogen level.  It came out at 125 and everyone seemed happy with that.  Dr. Sparrow was guessing that we'd be doing the retrieval on Tuesday, the 21st. I went home and kept giving myself shots.  I don't remember the exact date that I started the Ganirelix shot, but it was around this time, and that meant that I was now doing two shots in the morning and two shots in the evening.  This still wasn't bad at all.

Two days later, on the 16th, we repeated the whole process, only a resident was there to work with Dr. Sparrow.  It was kind of funny, because she was supposed to be trying to find the follicles on the left side after he had found the ones on the right, but she was just really struggling with it.  After letting her try for several minutes, Dr. Sparrow took over and two seconds later, my follicles were on the screen.  I felt kind of bad for the poor resident!  This time, Dr. Sparrow sounded a little bit less enthused about my follicles.  He changed his prediction to doing the egg retrieval on Tuesday or Wednesday. I didn't say much when he said that, but I was a little worried because that meant that I needed to figure out coverage at work for both Tuesday and Wednesday in case it did get delayed.  My co-worker has been absolutely amazing about covering, but it's still stressful to be gone.  I've only called in sick once in four years, so taking time off for medical stuff is not something that I'm very comfortable doing.

Thankfully, my next ultrasound was scheduled on Saturday. This time Dr. Sparrow was out for the weekend, so Dr. Sheep did the ultrasound.  She was great.  She also wasn't sure whether I'd go on Tuesday or Wednesday, and scheduled me for yet another ultrasound the next morning.

Sunday morning, looking at the ultrasound screen again.  This time, everyone was happy!  We had seven mature follicles ready to go and Dr. Sheep told me to do the "trigger shot" that night.  The trigger shot is a shot of HCG (human chorionic gonadotrophin) that "triggers" ovulation so we can do the egg retrieval.  It was an intramuscular injection, which meant a big long needle, so I made Mark do it for me.  I also freaked out like a little kid (maybe something about not being in control?) and squealed while kind of laughing through the whole thing.  I always laugh when I'm kind of panicking over some medical treatment, it's a weird trait of mine.

The day after we did the trigger shot, I had a break from all shots for a day (yay!)  Then it was time for the egg retrieval.  And that deserves its own separate post.

Saturday, September 18, 2010

And we're back...

As promised, we took a break and started everything up again in August.  Here's what has happened (other than buying a house, moving, and getting a new puppy):

After my July cycle, I went in to the clinic for an SIS ultrasound and went on the pill for the first time in about eight years.  The SIS (saline infusion sonohystogram) went a lot easier than I had read online it would.  I took a few advil before going in, and they injected me with some saline so they could take a look at my uterus.  It's a little strange when a woman you don't know is exclaiming, "You have a GORGEOUS uterus!" but I guess that was a good result!  The whole procedure went so quickly I didn't even have to pay for parking - I was out before the 30 minute grace period ran out.  I went straight back to work and all was well.

In terms of the pill, I was surprised to find that the only side-effect I had were really sad dreams at night.  For a couple of weeks there I was regularly waking up in tears due to the dreams.  Daytimes were great though - no side-effects at all.

I went through one packet of pills and then took them for three more days on a new pack (I skipped the placebos).  After that, we went to the clinic for what's called a suppression check.  They do an ultrasound to see how everything looks before you get started on your meds.  I'll try not to be graphic about this, but in the interest of giving people who are going to go through this accurate information, the ultrasound is not like an ultrasound checking on a pregnant woman's baby.  It does not involve your stomach.  It involves a big wand, a condom, and some gel.  That's probably enough said, except that it doesn't hurt.  My ovaries looked fine, so they gave me the go-ahead to start taking the medications at home.

Okay, medications.  I had heard that it was financially best to go to a variety of different places to get your medications (maybe one medication is cheaper at pharmacy A, another medication priced well at pharmacy B).  When I talked to Dr. Sparrow about that, he said that the team was in touch with all of that information and would set everything up for me.  That was mostly true.  The IVF coordinator did set up all the prescriptions and arranged for them all to be sent to me, but they all came from one place and in one big box. So I don't know whether I got the best price or not and I learned that I should have been more specific about it.  Anyway, someone had to be home to accept the shipment because a lot of the medication needs to be refrigerated.  NOTE:  not all of the medication needs to be refrigerated!!  Mark was the one who accepted the package and he just took the whole box and put it in the refrigerator.   I assumed that he had gone through the box and didn't pay much attention to it.  We ended up losing $300 worth of medication because it was NOT supposed to be refrigerated.  So, our loss could help you - check the boxes of the medications for storage instructions and don't assume it all gets refrigerated!

Something that some of you (all of you?) know is that Mark is a doctor.  At first I thought that I would just have him administer the shots for me, but when it came right down to it, I wanted to do it myself.  I started off on two medications - Follistim and low-dose HCG.

The Follistim comes in its own special kit.  It has a pen applicator and cartridges you drop in instead of a normal syringe-type needle.  There's a dial at one end of the pen that you turn to indicate the correct amount of medications (225 for me).  Then you swab the other end with an alcohol wipe, screw on a needle to that end, and pick a spot for the shot.  It just has to be a fatty area.  The first time I did it, I sat there with the needle poised, pointed at a spot I was pinching on my stomach for at least three full minutes.  Finally, I closed my eyes and pushed the needle in.  That part actually wasn't bad at all.  After it was in, I peeked at it to make sure it was in, and then pushed on the other end of the pen so the dialed-in part would push down and dispense the medication.  It clicks while it's going down.  Even that part didn't really hurt.  A minute or two afterward, though, I got a bit of a dull ache that lasted for about a half an hour or so. The Follistim needs to be refrigerated until you start a cartridge - as soon as you've started one, you can leave it out until you've finished it.  For me, each cartridge provided just under 3 doses.

The low-dose HCG is only taken in the evenings.  It's a more traditional set-up, with a little vial of medication and insulin syringes.  You poke a syringe into the vial, draw out 20cc's, then pick a spot and give yourself the shot.  For some reason, the liquid from the HCG hurts more than the Follistim.  The medication stays in the refrigerator, but I let it warm up for a while before administering it in the evenings.  I put it back in the refrigerator aftewards.

I do have a lot of bruises from the shots.  They range from the size of a quarter to the size of a pinhead.  They don't hurt and I don't notice them.  I also have had absolutely no other side-effects.  I'm not emotional, nothing hurts.

I have to take my puppy out now, but more later about the last few days of the process so far.

Sunday, May 16, 2010

No really - when we say slowly, we mean it!

We're in the process of buying a house (kind of a spur of the moment decision) and we aren't going to do anything about IVF until at least August.  Stay tuned...I'll be back later!

Saturday, April 17, 2010

Moving to IVF...Slowly

Over the last few weeks we've been thinking about alternate options to pregnancy. We looked into international adoption options, domestic adoption options (private and foster-care), and the idea of just not having children.  We had our IVF consultation earlier this week (more on that later) and afterwards it felt really strange to me that it was so scientific and lab-like.  That's when we considered just not having children.  It's kind of tempting to skip the whole kid idea - we could do a lot of fun things and have a lot of freedom without a kid.  After a couple of days I changed back, though.  Ultimately, if I make it to be old and grey, it is more likely that I will regret not having children than I would regret having children. Mark concurred.  So, that's how the decision was made to keep trying.

We also considered adoption pretty seriously.  To be honest, I am much more comfortable with the idea of adopting out of the foster care system than any other way.  I guess I just know those kids and feel a responsibility to them.  However, Mark wants to bond with his child in the first two years of life, and doesn't want a special needs child, so adopting out of foster care is highly unlikely to work out.

We then looked at international adoption, starting with China.  China is enticing because we if we had our way we'd like a girl (Mark only wants one child and if we have a boy I'll want to try again for a girl) and we think (maybe naively) that it's easier to get a girl from China than from other countries.  It seems that in international adoption most people want to adopt girls so there is a longer wait for them than it is for boys. That said, the current wait for an infant from China is 4-5 years and may never even happen.  I then looked at other countries, but the wait times are similar for the babies and I don't want to adopt from a country where they don't sign on to the Hague Convention.   In the midst of all of this, the whole Russian child fiasco went down and it seemed like maybe the timing of that was meant to tell me something.

So we considered domestic adoption.  The local adoption agency that has the best reviews on line is hideously expensive ($25,000-$30,000 minimum - that's if a birth mother picks you and doesn't back out - if one backs out it's about another $10,000).  They have a great success rate - they don't take many families at once and the reviews I found online were all matched within 3-8 months.  That said, they also require you to hand over the last $9,000 at the hospital when the baby is being discharged to you, and that just felt like baby-buying to me.  I didn't like that at all.  So, we won't be doing that.

Back to IVF.  We went for our consultation.  Dr. Sparrow explained the process again, and said he'd be using IVF with ICSI (see my first couple blog posts for explanations) and implanting 2 embryos if we grow enough healthy eggs and they fertilize properly.  We would have a 25% chance of getting twins.  We talked about starting in May, but I've decided to push it off until June because things at work have been really crazy and I also have a short trip planned that would directly interfere.  Here's the process:

Day 2 of Cycle:  Start birth control pills.  I'll take them for three weeks.  I will be a horrible, crying soppy mess during this time as I have never dealt well with birth control pills.  One time when I was working at a different company (not as an attorney) I had just gone on the pill a few days before and the CFO was attempting to explain a complicated spreadsheet to me.  I was having a hard time following him but instead of asking rational questions, I just burst into tears.  Poor guy practically ran away.  I'm expecting this to happen frequently.  In court.  During negotiations.  It's going to be a mess.  Dr. Sparrow asked if there was anything that had helped me deal with that in the past and my answer was, "Yeah, I stopped taking the pill."  Not an option for this process.

Day 22 - Stop the pill.

Day 24 - Suppression Check - the whole point of taking the pill is to sort of stop my cycle and take control of it.  This is the day they check to see if it worked, with an ultrasound and blood-draw.  This is also a day when they might call the whole thing off.  I read a lot about people getting ovarian cysts and then having to stop their cycle until that's taken care of and then start again from Day 2.

Day 25 - Start the cycle by taking injectible medications, morning and night.

Day 29 - Start blood draw/ultrasound appointments.  These are going to happen pretty much every other day.  I have to go to work and get a form for my doctor to fill out so the time off of work will be protected by the FMLA.  Otherwise, it's a ding against me at work to be gone at the last minute for so much time.  Once the follicles have grown to 14 mm, I go on another injectible.

Day 34 - They give me what's called a trigger injection in order to force ovulation.  I can stop that extra injectible medication on this day, and then get instructions about the others.

Day 36 - Egg retrieval - they knock me out for a minute with conscious sedation, extract all of the eggs they can find from all of those follicles they've been growing, then wake me up again.  While they're doing that to me, Mark provides another sample.  After I wake up they'll be able to tell me how many eggs they retrieved.  They'll then try to find the fastest, healthiest little sperm they can find, pick them up individually in little tiny needles, and inject them into the eggs.  I go home and sleep it off (they say it's going to be painful).

Day 40 - Start progesterone injections.

Day 39 - They might to a transfer of the embryos on this date.  It depends on how good they look.  If they only have 2 and they're not looking so great, they're going to transfer.  If they have more and they look like they're doing well, they will wait two more days to try to let them grow a bit more and let any embryo that isn't going to make it die off before transfer.

Day 41 - Hopefully we transfer two embryos. Hopefully we have left-overs to freeze.  The instructions we received say that I'm supposed to have two "quiet" days - the day of the transfer and the day after, but I don't know what that means.  I hope it just means I shouldn't go crazy at the gym or something but that I can still go to work.

Day 56 - Pregnancy test.  Crazy!

Monday, April 5, 2010


I haven't posted anything because we haven't really been working on baby stuff ever since I got annoyed with IUI.  I finally called Dr. Sparrow's office last week and told them that I want to start IVF in the next few months.  Joy said that I would have to come back in to have another consultation with Dr. Sparrow.

I'm pretty annoyed about having to have another consultation.  We already went in for a consultation.  Before the first consultation, they told me that we would get a tour of the lab and all of that kind of stuff.  It sounded interesting back then, but instead we went to the meeting, I explained everything I knew about IUI and IVF, Dr. Sparrow said that I had clearly done my homework and then encouraged us to try IUI because it is inexpensive (comparatively) and might work.  No one offered to give us any kind of a tour, nor did we really need one.

Now they tell me that I have to go back in for the tour and information about IVF.  So, that will be another $200 by the time all is said and done.  I think this is really stupid because I don't care about the tour.  Just give me a timeframe when we might start, tell me when to start the meds, and let me figure it out as I go along.

Maybe I'll be pleasantly surprised at the tour.  Maybe I'll learn important new things.  I suppose I should have a more positive attitude.  In general, I am a person who likes to set the goal (have a baby), then figure out the steps to reach the goal (Meet with doctor, Try IUI, Try IVF, Reassess, Consider Adoption, Reassess, Go Childless), and then start working on each step.  I'm extremely linear. I feel like this second consultation is taking me several steps backward.  If we're going to do it, let's just do it and stop talking about it.

Wednesday, March 17, 2010

IUI is Boring Me - And Cliffhanger Answer!

So, I flunked again this month.  I'm supposed to call Dr. Sparrow's office after flunking to find out what to do for the next month, but I just don't even want to deal with it.  They'll tell me to do another round of IUI, which won't work, and I don't want to.  I'll call them tomorrow, but I'm probably going to tell them we want to wait until July and then try IVF.

BUT!  I can take baths!  I checked all the paperwork and they restrict some dietary choices, but not baths.  Yay!

Wednesday, March 3, 2010

IUI v.2

I went in for my second IUI on Sunday morning.  The procedure was the same, but they kept me waiting a really long time instead of whisking me in and out like they did the first time. I also had Dr. Sparrow in person instead of the physician's assistant.  He explained that Mark's numbers should really be above 10 million viable sperm after the wash, while they were actually at 7.5 million the first time and something around 6.8 million the second.  So, we're not doing all that well.

But since I've decided I don't really believe in IUI for us, no matter.  If it works, great.  If not, I won't be terribly surprised.

It's going to be quiet days around here for a while - really nothing new to report.

New financial update:

Initial Visit with Dr. Sparrow: $280.00
Bloodwork for Me: $23.29 (insurance actually covered a lot of the bloodwork costs)
IUI: $175.00
Semen Analysis: $100.00
Sperm Wash: $225.00
IUI v2: $175.00
Sperm Wash v. 2:  $225.00
Total:  $1203.29

Monday, February 22, 2010

Slow Week

A friend of mine told me last week that I seem to update on Monday evenings.  I didn't really realize that, but it seemed like as good of a reason as any to start updating on Monday evenings when I'm having slow weeks. 

So, this post is just to say that it's a slow week.  I'm anticipating doing the second IUI on this next Sunday or Monday. 

I'm supposed to be following some dietary restrictions and lifestyle changes and for the most part I am.  I'm not supposed to drink excessive alcohol (I don't) and I have to check but I think I'm not supposed to take baths.  That's starting to be really annoying, so I'm hoping that if I check my paperwork again it will not say that.  Maybe I just read it on the internet.

I'll let you know how that goes.  If I tell you now whether or not I can officially take baths, I won't have anything to say next Monday.  I hope you can all concentrate on your other life events with that teaser hanging over your heads.

Tuesday, February 16, 2010

As Expected

Every month when I find out that I'm definitely not pregnant, I just say I flunked. I flunked again this month, as expected.

To be honest, I really, really don't think IUI works much better than no intervention at all (especially without medications - but I don't want the medications either).  That said, it's a lot cheaper than IVF and just in case it does work it seems like it's worth a try. Since Mark's numbers were up this past month, we'll do another IUI round this month and then evaluate whether to do a third and then a fourth.

I'm getting better about not buying ten zillion pregnancy test kits and starting to test a week and a half before anything could even show up.  I only went through three tests this cycle.  Believe it or not, that's a huge, huge improvement!!

Speaking of money, we've just received our first official bills so now I can really break it out.  Here's how it looks so far for one round of IUI:

Initial Visit with Dr. Sparrow: $280.00
Bloodwork for Me: $23.29 (insurance actually covered a lot of the bloodwork costs)
IUI: $175.00
Semen Analysis: $100.00
Sperm Wash: $225.00
Total:  $803.29

Adds up quickly, doesn't it?  The next round won't be as expensive since we won't need bloodwork, an initial visit, or the analysis. Just the IUI and the wash. 

So far this process isn't all that stressful. It's pretty sobering to think that we just spent $800 for essentially nothing.  Also, now that I've been through the IUI once, the novelty of having the new experience is definitely wearing off and it sounds more like a tedious errand to me than anything exciting, probably also because I have absolutely no confidence that it's going to work.  When we get to the IVF part (assuming we do) I think I'll be a lot more excited because I think the statistics for IVF are so much better for us.

Monday, February 8, 2010

For those who wonder...

I am getting close to five days post-IUI and I don't feel pregnant in the least.  Not a single symptom.

I don't think most women do get symptoms this early, but if you do a search on google of pretty much any physical malady followed by "early pregnancy symptom" you'll come up with a ton of links.  Seriously.  Try it.

So, I don't expect that I should be getting any pregnancy symptoms, and I'm not getting any.  Whether that's because I'm just not pregnant or if it's because it's too early for symptoms remains to be seen.

Thursday, February 4, 2010

A couple things I forgot to mention...

I forgot to mention that I was able to go straight back to work with no problems whatsoever as soon as I was done at the clinic.  In fact, it was like it had never happened.  I felt maybe a tiny bit different inside, but that might have been because I had KFC for lunch. Similarly, I'm feeling a little bit weird on my left side tonight, but it could be just ovulation or it could be something I ate.  Hard to say.

Also, we've got an update on expenditures:

Clearblue Easy OPK -      $29
Sperm Wash -                  $225
IUI -                                 $175
Current Total:                 $429

First IUI

I left that last post at 12:45 in the morning, so I think everyone was thinking that the first IUI is scheduled for Friday, but it actually took place today.

I was half-right about the procedure starting later than 8:30. They had me wait until 8:45 and then brought me into the exam room and had me wait another five minutes.  So, they started before 9:00, but not much!  It was okay though - it went really quickly so everything worked out.

Mark went to work very early this morning in order to get through a lot of his work before rounds started at 7:30. He left work and went to the clinic at 7:00 am to give his sample. Then, he dashed back to work in time to start rounds with his team.

After he left the clinic, the lab took his sperm sample and put it through a wash.  They put the sperm in a container that I imagine as a cylinder.  The container has a few filters in it along with some kind of liquid.  The sperm are inserted in the bottom and they have to try to swim to the top, through all of the filters.  Sperm with no tails don't make it. Sperm with large heads don't make it.  Slow, lazy sperm don't make it. They started with 23 million sperm and after the wash they had 7.5 million left.  Those 7.5 million were put into a little syringe.

I showed up just before 9:00. I was shown into a regular exam room, just like you would go to for an annual exam.  The procedure was done by a physician's assistant who came into the room and explained everything before she began. She showed me the syringe and it appeared to be connected to a catheter that I couldn't see because it was still wrapped in a bag - from what I could tell it was pretty long, but very thin.

The procedure started out just like an annual exam, with the speculum. She checked my cervix to make sure it was all healthy and ready for ovulation. After she determined it was, she inserted the catheter. I could tell when she had inserted it, I could sort of feel it moving up inside me. She then injected the sperm using the syringe/catheter.  Around this time she told me the sperm were going in, but I couldn't tell a difference from just the catheter.  I started feeling a little crampy, but nothing terrible.  Then she just pulled it out and the procedure was over. The whole thing probably took less than five minutes once she started.

At this point, she told me to just lay there for 15 minutes and give the little guys a running start.  So, I grabbed my iPhone and looked up my horoscope.  It was this:

LEO (July 23-Aug. 22). You just got home, so you're not anticipating another trip. But you might have to adjust your activity forecast when an interesting invitation arrives. When have you ever turned down a new adventure?

Tomorrow - First IUI

Day 2 and 3 of the ovulation predictor kit were much more successful than day 1.  Today the test indicated that I have a surge in my luteinizing hormone and am therefore about to ovulate.  To explain that more fully, when your egg is developing each month it is held in a protective follicle. As the follicle matures, your estrogen level rises. Once your estrogen level has risen to a certain point, it triggers a surge in your luteinizing hormone. That prepares the follicle for ovulation (the release of the egg) and conversion of the follicle into a corpus luteum.  This conversion takes place while the egg is traveling down the fallopian tube in search of a willing sperm. If the egg is fertilized, then the corpus luteum secretes progesterone which helps thicken the lining of the uterus to assist in implantation of the egg.

So.  Today my body had the surge in the luteinizing hormone and an egg should be released in less than 24-48 hours.  This is where the scrambling comes in. After receiving the test result, I called Joy and she said we have to go in tomorrow for the IUI.  Mark has to give a sample tomorrow morning at 7:00 am, and I'm supposed to go have the insemination done at 8:30.  Officially they don't do inseminations until 9:00 am, but I've begged them to let me in early because I have a meeting at work that I do not want to miss for one of my youth clients (it's already been rescheduled once.)  They say they'll let me in, but they sound very dubious, so I have the feeling they're going to let me in to sit in the waiting room until 9:00.  All I can do is try, I suppose.

I'll post tomorrow about the whole experience.

Monday, February 1, 2010

New Characters and Little Blue Lines

First - I've named some new characters:
Dr. Sparrow - my reproductive endocrinologist
Joy - his medical assistant

The first step in doing one IUI cycle for us is to monitor this month's ovulation. I've been monitoring my ovulation cycle for seven months using a ridiculously expensive (yet pretty darn accurate) fertility monitor.  Unfortunately, Dr. Sparrow prefers to have his patients use Clearblue Easy Ovulation Predictor Kits.  I was given instructions to use the first test on day 10 of my cycle, and today is day 10.

Most of the kits tell you to use the test first thing in the morning.  However, Dr. Sparrow prefers his patients to use the tests on the second trip to the powder room of the morning (can everyone tell I'm trying to be as delicate as possible about this? Is it actually making it worse?!)  Dr. Sparrow's method means that I actually have to take a test to work with me and try to take it in the bathroom with no one noticing.

So, at about 10:00 this morning, I used the trick one of my high school friends taught me for sneaking to the bathroom with a tampon - pay attention all you riveted teenagers - I slipped the test stick up my sleeve and held it in place by just holding the sleeve next to my wrist with my fingertips and then casually sauntered to the restroom.

After doing what I had to do to take the test, I looked at the results window.  I was supposed to be able to see at least a control line to show me the test was working. And then, there was supposed to be another line and if it was lighter than the control line I was not ovulating. If it was darker, I was ovulating.  It wasn't there.  No line. No control line.  Blank.
So I waited.  I waited for several minutes.  Blank.  Maybe a little smudge of blue, but really no line at all. Then, horror of horrors, one of my co-workers walked into the bathroom.

I was standing in the stall doing nothing at all and was certain my co-worker was going to notice. I don't know why that matters, but it does. It also matters that I had no desire to be caught with an ovulation predictor kit test stick at work. So as soon as she closed the door to her stall, I grabbed the stick and zoomed out to the sink to wash my hands. I tossed a paper towel on the counter, then the stick, and then another paper towel on top to cover it up (because *that* won't look suspicious).  The girl apparently really didn't need to go to the bathroom at all, because before I could even finish washing my hands at hyper-speed, she was out and fixing her hair at the mirror - with my stick sitting on the counter between us covered up by a measly paper towel. We did the obligatory greetings and I carefully watched for her to have a convenient difficult-hair-adjustment moment. She finally started working on putting a clip in to pull her hair up and I quietly slid the paper-towel-and-stick package off of the counter while she focused on shoving a bunch of hair in the clip.  I then found myself walking down the hall back to my office with this strange package in my hand.

Once back at my desk, I peered at the stick again. Nothing. A blue smear in one corner.  I tossed the stick in a desk drawer and decided to just focus on work for a while.  About an hour later, I looked again - two lines. Both blurry. Was the left line darker than the right? Couldn't tell. Were they the same? Not sure. They were both kind of just smeared lines.

I called Joy.

Joy suggested that I go in and do an ultrasound. This sounded like a silly idea to me.  After all, we aren't expecting this cycle to work at all. Going in to do an ultrasound would set us back several hundred dollars in addition to the cost for the IUI itself.  I am not excited about spending $1,000 on a useless cycle.  I called Joy back and she agreed with me that the ultrasound wouldn't make sense.  Instead, she instructed me to try the stick test again tomorrow.

At work.

Total Costs Thus Far:
$29 - One box of Clearblue Easy Ovulation Predictor Kit Tests

Saturday, January 30, 2010


I wonder if it's normal to go through a cycle of "This will all work out great!" and then "I don't think this is going to work At. All."  I'm in the latter part now.

Monday, January 25, 2010

Argh. One step forward, two steps back.

We got my labs back today and they don't look so great.  Here's how they came out:

Estradiol – Normal – 58.3 (normal is 80 or less)
FSH – 11.6 – slightly elevated (11.3 or less is necessary to be considered fertile, below 9 is best)
TSH – 1.55 - normal - (between 0.4-4.0 is normal)
Prolactin 17.3 – normal (25 or less is normal)

So, things aren't looking so rosy.  The FSH means that my ovulation is probably messed up, or my eggs are, or I'm not ovulating properly.  I have to research that more.  In short, the RE is now recommending that we do just one round of IUI, mainly to see if Mark (new name picked!) has had any improvement in his counts.  If he has, then we can still do the four IUI's.  If he hasn't, then we're doing one IUI, then straight to IVF. The only weird thing is normally estradiol is high with FSH, so it's strange that the estradiol is normal.

Oh, the journey. Got upset about it for the first time today.  But then I ran through little things I've learned through reading books by Pema Chodron and pulled myself out of it.  Onward.

Sunday, January 24, 2010

A New Name for Joe

A few posts back, I gave a pseudonym of "Joe" for my husband. Those of you who know us may know where that name idea came from, but I've decided that he just isn't a "Joe". So, I need to pick out a new pseudonym for him.  Any suggestions?  "Nick" is striking me as a good name for him, but I'm not sure yet.

First Official Step - Bloodwork

Today I took the first official step to either IUI or IVF - I had my blood taken. This had to be done on day 2, 3, or 4 of my cycle. Day 3 is the goal, but since today is not a work day, I opted to go in today (day 2).  The clinic I'm going to is open weekend mornings for just this sort of thing.

Giving the labs themselves was very simple - just like giving blood for testing at a normal doctor's appointment. I was in and out of the office within five minutes.  By the way - the flat rubber-ish tourniquet they wrap around your arm before they take the blood makes a wonderful jar opener at home.  If you can get your lab technician to give it to you, do it and keep it in your kitchen drawer.  Very handy!

The labs they are testing are:

Follicle Stimulating Hormone (FSH) - This is a hormone that is released from the pituitary gland near your brain.  It signals your ovary to begin maturing the follicles and eggs.  They test this hormone to make sure your ovaries are healthy.

Estradiol (E2) - One of three types of estrogen that a woman produces.  Estradiol indicates whether follicles are developing. It should be lower in the beginning of the cycle and gradually increasing. It's a good hormone to measure to see if a woman is entering menopause, because it will be very low in menopausal women.

Thyroid Stimulating Hormone (TSH) - Having an underactive or overactive thyroid can result in fertility problems.  If the thyroid is underactive, the hypothalamus and pituitary glands increase levels of TSH and a hormone called thyroid-releasing hormone (TRH).  TRH both prompts the pituitary glad to release TSH and to release prolactin. Prolactin is a hormone that can interfere with ovulation by suppressing leutanizing hormone and FSH.  This is a common problem with fertility. There can also be a problem with excessive thyroid hormone.  It can block estrogen's effects, which causes problem with the uterine lining.

Prolactin - Mentioned above, prolactin is a hormone released from the pituitary gland. It's also tested at this time, and a substantial elevation indicates there may be a pituitary tumor.

So, that's what they tested today.  I should get results in the next day or two and will keep you posted!

Wednesday, January 20, 2010

First Appointment with RE - Didn't Go How We Expected!

We had our first appointment with the reproductive endocrinologist today and it didn't go at all how we expected it would.  That said, it went very well and I feel really good about the clinic we chose.  Here's what happened (in blow-by-blow detail for those about to go through it themselves).

When I arrived at the clinic, I filled out the registration form and waited with Joe to be called in. When it was our turn, the medical assistant took us into what was called a Consultation Room. It wasn't a normal exam room, it was more like a small office with a desk for the doctor with a computer on it and two chairs for us. We left Joe there for a minute and then went and got my weight and blood pressure. That was it in terms of medical examination.

After I returned to the consultation room, the doctor joined us. He seemed pretty familiar with our file and pulled up Joe's semen analysis to go over the numbers.  He then started talking about trying IUI instead of going straight to IVF. We had originally thought we would go the IUI route, but the nurse practitioner had encouraged the IVF path instead.  We had been against IUI, because the success rates are pretty low for IUI and we thought the cost was several thousand dollars. Plus, we thought that with low morphology, we would be out of the running from the very beginning.

It actually turns out that an IUI cycle would only cost us about $450 and because all signs are that I am likely fertile, I wouldn't have to go on any medications - we would just do it on my regular cycle. So, we would have a few months to save up for the big hit if we have to go to IVF and we might get lucky in the meantime and not have to go to IVF at all!  The downside to the IUI is that the success rate is only 13%.  But, the doctor pointed out that trying naturally only has a success rate of 20%, so it's really not that low, comparatively.

AND: Since I don't have to go on medications, I wouldn't be at increased risk for multiples!!!

So, in terms of decisions, we've decided to try IUI for four months. To be honest, I don't think it will work due to our low morphology. However, it's worth the gamble and it gives us time to set up finances better for IVF. Plus, the removal of the risk of multiples is a huge plus.

Questions I had during the appointment and the answers:

1. When would we begin the BCP or stims?

We won't have to do the birth control pill or stimulating hormones because we switched to IUI for now. We can start our first round of IUI as soon as my next cycle begins (within a week or so).

2. What medications would I be on and can I get a list of them with a calendar for usage?

3. What are the side-effects of the different medications?

4. How much time might I need to take off from work in a cycle?
Very little - I only go in once on day 3 for bloodwork (can go in as early as 7:00 am) and once when I ovulate at about 8:30 or 9:00 in the morning. The procedure will probably take about an hour or so and I can go back to work afterwards.

5. What are the stats for success for male factor issues when a single embryo transfer is done?
N/A - no embryo transfer!

6. Should we do PGD?
No! Preimplantation genetic testing could be done, but it's very expensive and the older technology has been found not to be all that reliable. The newer technology could be pursued, but unless there's a known genetic problem in our family histories (I don't know of any, but I also don't have a full medical history on my side) it's not necessary and not indicated.

7. If we do PGD, do we have to pay for it again if we do further FET's later?

8. What can we expect to pay, bottom line, all-inclusive?
For the IUI, $450 per cycle, plus labs prior to the first cycle (~$300)

9. Do I need to change diet or exercise?
Not anymore than I already have - stay on prenatal vitamins, eat healthy, all the normal pregnancy precautions.

We actually had a pretty long conversation about the different options and procedures. When it was all over the doctor explained that I likely won't be seeing him for the actual insemination unless we happen to do it on a weekend day when he's on call.  It's more likely we'll see a nurse practitioner or another doctor on a weekend. I thought it was nice that he pointed that out - in reading reviews of other clinics, people get really upset when they don't see much of the doctor, but I can see why it would work that way. I appreciated that he didn't want us to be surprised.

I also really appreciated that he didn't try to talk us into anything and actually talked us out of more expensive options. We had thought we would do a refund plan for IVF, where you pay more up front and can get some money back at the end if it's not successful. He says that they offer that because some people want it, but really our chance of success is such that we would end up spending $6,000 more going that route.  He also talked us out of PGD, which would have been several thousand dollars. I really felt like he was being very straightforward.

So, different than I expected, but we feel great about the appointment and are ready to start the new cycle next week!

Amount spent:  $0.00 (still haven't gotten a bill for anything yet)

Sunday, January 17, 2010

A Lull

I don't have much to say until the 20th when I have my first appointment with the reproductive endocrinologist (RE). It's a 2 hour appointment that includes a tour of the embryology lab and a meeting with the financial advisor. I originally thought that we wouldn't be able to start a cycle for another month, but I've been doing more reading and if they can test my day 3 hormone levels while also putting me on the birth control pill, it may be that we could start in February.

After the appointment on the 20th, I'll post a full description of what happened. Until then, I keep looking at websites about raising twins with a sense of impending doom. I have to keep reminding myself that there's a 60% chance that I'll get a singleton. I'm really worried about getting pregnant with twins. So, I also have to remind myself that if I actually do get pregnant with twins, I'll probably be excited.

Wednesday, January 13, 2010


It's been really interesting having conversations with different people about the idea of IVF and whether or not it's a good idea to go through it, or whether or not it's a good idea to pursue other options.

Most of the people who I've spoken to about IVF have said that they know someone who has gone through the process and had a good result. One person I've spoken with went through the process herself and it didn't work, so she adopted. All of those people seem comfortable with the idea itself.

One close friend of mine took the opposite view - he argued that if nature is telling us not to have biological children, then perhaps we shouldn't interfere with that. There's a certain amount of logic to the position. I argued that you could take it to the extreme - you could end up arguing that any medical intervention for any purpose is interfering with the way nature is telling us things should go. So, have a headache? Don't take aspirin or advil, Nature wants you to have a headache! My friend pointed out that the slippery slope argument doesn't hold up as well with IVF because you're not trying to fix something that's gone wrong, you're trying to create something new and bring it into the world. And that takes us back to adoption, because the obvious solution to that would be to skip IVF and go find a kid who is already in the world.

Another friend of mine, upon hearing that I would consider adopting out of foster care before doing a private adoption had the most vocal reaction of concern I've experienced so far with any option. She wasn't flipping out or anything, but she was very, very concerned about the issues facing kids in the foster care system and whether or not it's a good idea to take those issues on.

I kind of figure that I know the kids in the foster care system pretty well, I work with them directly every day, and I know that at their most basic level, they're just kids, just like everyone else. So, it might be that instead of bonding to a dad or mom, they bond to a strong older kid who lives on the streets, and they continually run from foster placements back to whoever that older kid is. Is that safe? Nope. Good idea? No. But is it any more of a surprise than a non-foster kid who would go to extremes to get back to his own family if someone tried to separate them? I don't think so.

The scenario can be painted two ways by the adults in the situation - a popular description you might hear for a runaway would be: "The youth continually defies the foster parents and refuses to return to their home. The youth is suspected of being involved in street prostitution and drugs. A warrant should be issued for the running behavior and the youth held in contempt of court." The facts would likely be true. The legal sufficiency for the issuance of a warrant would be met. The youth would likely be held in contempt if/when he/she got picked up. The other way of looking at the same scenario would be: "The youth has bonded to a prominent older street kid. The youth feels safe and connected to that person, who is encouraging the youth to engage in risky, unsafe behaviors. The youth trusts the older kid to keep him/her safe, but does not trust the foster parents to do the same." All of those facts would also likely be true, but there's no neat way to sum it all up. We don't yet have a way to fix that problem, so instead we send the kid to jail for a few days and tell them to write a paper about how unsafe it is to live on the streets.

The first scenario disconnects us from the actual experience of the youth and makes him/her just seem like a huge problem. The second scenario connects us to the experience of youth and makes us see that the problem is the emotions of the youth driving him/her to make bad decisions. I don't really view my youth clients solely in light of the first scenario (although I recognize the facts of my cases). I try really hard to see the second scenarios, and because of that I think I see them just as kids with the same needs that other kids have (in this example, the need to bond). Because I see them that way, I don't really have a fear of them or their problems. Do I think it would be easy to bring a troubled teenager into my home? Not at all. In fact, I think it could be really chaotic and stressful. But any kid can grow to be troubled, any kid can turn into a runaway, or a drug addict, or a prostitute, regardless of how well you raised him/her. That doesn't mean that those kids aren't deserving of homes or families.

But. Not everyone feels the way I do, not everyone works with the kids as much as I do, so there's a lot of fear around adopting foster kids. I understand that. I also just think the concrete idea of how that would play out is really foreign - all of a sudden some 6 year old kid moves into your house and you're a parent? You look around and there sits a little boy on your couch watching tv, and he's not going anywhere? How discombobulating!

I like having the conversations. I like thinking about the options and analyzing the pros and cons. I'm not defensive of any choice, and I wonder if I will remain this way.

Tuesday, January 12, 2010

Military Hospital Option?

I read online today that some of the military hospitals (Walter Reed and Madigan) do IVF at a reduced price. It's only $8,000 (only! ha!) for a cycle, as compared to our $18,000. Joe is in the inactive reserves, so he's going to look into whether we can get on the waitlist at Madigan, which is not that far from Seattle. He's not sure he's eligible since he's not active duty, and the wait list is, unfortunately over a year long. It's only something we would do as a back-up plan if we're eligible and should our IVF cycle with our current provider not work out.

Nice to have options, though. Any military people out there should definitely look into the military hospitals for IVF.

I need to figure out how to put a little box to the side of my blog for the tracking of the money. So far, still $0.00.

Monday, January 11, 2010

Length of Treatment

I shouldn't have promised to write about the impact on my job, because I really don't know yet. So instead, I'll write about how long we're willing to try this and how many cycles we're willing to do.

In an earlier post, I gave a top-level view of the financial commitment involved in IVF. Here's a more detailed explanation of how it's stacking up for us:

We have three options.
1. Pay as We Go: We would pay $18,000 for the first round of IVF. They would freeze any leftover embryos. We then pay between $3,000 and $5,000 for each subsequent round of frozen embryo transfer (FET), where you don't do the full IVF procedure, you just have the frozen embryos thawed and implanted.

2. Refund Plan #1: We would pay $24,000. They would do one full IVF round. If that failed, they would do as many rounds as necessary to either succeed or implant all the embryos they were able to get. After 1 year if you haven't successfully gotten to the second trimester of a pregnancy, you get $14,000 back.

3. Refund Plan #2: We would pay $24,000. The process would be the same as #2, except that at the end of the year, instead of giving us money back, they would do one more IVF treatment. If that treatment failed, we would then do pay-as-we-go to implant the remaining embryos.

So, all that to say that the decision about how long to keep trying rests largely in the finances. I think my husband (who will be called Joe from here on out) mentioned that he would be willing to sign up for the full IVF treatment twice (so probably plan 3 above?) but I'm more inclined to sign up for plan 2 and hope for the best. That way I know I'm done in a year and I can move on to other solutions. I could probably be talked into trying again, though.

Joe found out today that when our insurance company says they don't cover infertility at all, they mean it. They don't even cover diagnosis. So, we'll be receiving our first bill soon. Joe wants to keep track of the finances in this blog so people can get a realistic picture of what it actually ends up being from beginning to end. That sounds like a good idea to me, so I'll keep a running tally in each blog.

So far:
Financial Outlay: $0.00

Sunday, January 10, 2010

Decisions, Decisions

Turns out we lost our motivation to go to the gym, so now I have time to write a little more...oh, and I've posted a link to this blog on a support website I've joined as well as emailed the link to close friends and family. Most of these blog entries are intended for people who are going through the same thing, so friends and family may find them boring...or not.

We have a number of choices to consider. We could do the IUI or IVF (with or without ICSI). We could just ignore the analysis and keep trying the way we have been. Or, we could switch tracks entirely and adopt either a child in the foster care system or adopt through a private adoption. Finally, we could just choose not to have children at all. This post is all about the pros and cons of each choice, as I see them.

1. IUI - The best part of IUI is definitely that it's one of the cheaper options and since we don't have coverage for fertility issues in our medical insurance, this matters. I think you can do IUI for $3,000-$5,000 per try (not positive about those numbers). It's less invasive than IVF. The downside is that it's not as likely to result in a successful pregnancy, and we could end up spending a whole lot of money on IUI just to have to switch to IVF anyway. If the problem was mostly motility, IUI would be a lot more enticing.

2. IVF - The best part of IVF is that the success rate is the highest of all of the intervention options (the success rate is still around 30-50%, so not a sure thing). That's pretty much the only benefit to it. It's more invasive than all other options, it's more likely to result in multiple births (which would be cute and all, but it makes the pregnancy higher-risk and as a practical matter I don't know how people handle two babies at once (or 4, in the case of my mother-in-law who had a boy, then twin boys a couple years later, and then a girl a couple years after that!)). The worst part of IVF is the financial hit - well, and the potential repeated disappointments.

3. Natural Pregnancy - We could just keep trying. This would be the cheapest option, but it's also the one that is a complete unknown in terms of chances for success. I do frequently read that people in very similar circumstances go through fertility treatments, take a break, and then conceive naturally (just got a note about one today on another website I subscribe to). This would be the best thing we could have happen, and so we are still trying, but I have to admit that my instincts have been telling me for a while that this just isn't going to work that way. That said, I could be wrong.

4. Adoption through Foster Care - Those of you who know my line of work must have guessed that this is an idea that has been seriously considered. I even found a little guy on the Northwest Adoption Exchange website who I think would be a great match for our family. He looks like a miniature version of my husband. Because of my history, I've thought a lot about whether adoption is a choice I would make for myself, and I've gone back and forth. In the last year, I've become more and more open to it, but I'm mainly open to adopting out of the child welfare system rather than a private adoption. My husband would really like to have a biological child and if it ends up that we can't do that, he's open to adopting but would rather go through a private adoption. The best part of this option is that we could quickly have a child (a 6 year old son, to be specific). The scariest part is that we could quickly have a child (a 6 year old son, to be specific).

5. Private Adoption - So I could be talked into a private adoption as long as it would be an open adoption. The drawback here is mostly that my husband would prefer to have a biological child and if we can't do that I would like to adopt out of foster care. So, it's not really the top choice for either of us. However, if we ended up going down this route, the typical drawbacks would likely involve a lot of waiting and some financial outlay as well. The best part is definitely that you end up with a baby!

6. Live Child-Free - This would definitely be the least expensive of all options! We could travel and be independent. However, I can't imagine not having a child at all and I can't imagine growing older and not having any family following behind.

In writing out these options. I ended up putting them almost in the order in which we've thought of them. I guess we could move natural pregnancy to the beginning since we thought we originally were going to go that direction. The plan is currently IVF. Current concerns about IVF are:
1. How will this treatment protocol effect my job?
2. How long or how many cycles are we willing to try?
3. Should we do genetic testing and if so, for how many genetic disorders and should we do gender selection?
4. What are the medications going to do to me?
5. Are IVF pregnancies more likely to result in miscarriages?
6. How many embryos should we have implanted?
7. What if I end up pregnant with triplets?
8. Am I being too obsessive about all of this? (I already know the answer to this one)

Next post will be on how this treatment protocol may effect my job.

What We've Learned So Far

As I mentioned in the introduction, our urologist recommended IUI, while the nurse practitioner at my ob/gyn has recommended IVF. Here is what we've learned about these two different techniques - please keep in mind that I am not a doctor and a lot of the information I have is still kind of sketchy. In other words, it may be somewhat inaccurate or it may be completely wrong. Please don't rely on it for your own purposes!

My understanding is that IUI is a process by which sperm are collected, washed, and then injected into the woman's uterus. I think it's primarily used when the sperm are having a tough time making it all the way to the egg. The urologist recommended this method, and I think he did so because it's a less expensive and less invasive method than IVF. It does still involve the woman going through injections and Clomid medication in order to make sure she is ovulating at the time when the insemination of the sperm through a catheter will be made.

IVF is a more invasive and much more expensive method. In IVF, the woman first takes a series of medications (oral and injection) to stimulate the growth of extra follicles in order to try to harvest numerous eggs. After she starts taking the medications, she goes in for ultrasounds and blood tests to see if the medications are working and to track potential ovulation. The hope is to get a lot of eggs, so the woman's ovaries may grow from the size of a walnut to the size of a human fist with the medications. When it is determined that it is the right time, the woman goes in to the doctor and has the eggs extracted. At that point, the eggs are either placed in a petri dish with a bunch of the sperm to allow fertilization or the eggs are individually fertilized by a specialist in a process called ICSI. The eggs are then monitored for several days to determine which ones successfully were fertilized and which ones are growing into blastocysts or embryos. Once the successful embryos are identified, they may be tested for genetic disorders (this is optional) and then the woman will return to the doctor to have between 1 and 3 embryos implanted. Two weeks after the embryo(s) are implanted, the woman returns to the doctor for a pregnancy test.

We think we're going to end up doing IVF plus ICSI because the problem for us is that our sperm don't have good morphology. Morphology describes whether the sperm are shaped properly for fertilization. When the sperm have the wrong shape, it may be difficult for them to fertilize an egg. Our sperm count is at 15 million sperm per milliliter. In order to be considered to be officially fertile, you need to be at about 20 million per milliliter, so we are low but not terribly low. Similarly, our motility (the movement of the sperm) shows that 30% are moving fast enough. Again, low, but not terrible. The bigger problem for us is that our morphology is only 2%. That means that only 2% of our sperm are shaped properly for fertilization. To be considered fertile, you need to have at least 14% shaped properly. Therefore, our best chance at a successful fertilization may involve locating the healthiest sperm and injecting them straight into the egg via ICSI.

Tomorrow (or maybe later tonight if I'm motivated), I'll talk about the financial differences and challenges and the other options we have.

An Introduction

A disclaimer: This blog is likely to be too much information for many people. I've decided to write it anyway, because while I can find numerous forums for questions and answers, I've had a really hard time finding information online about what it's like to go through this process from beginning to end, and I think it would be useful to others. Be forewarned, and please be kind.

My husband, and I have recently begun trying to have a baby. We had put it off as long as possible, mainly because neither one of us were really ready yet for the major changes a baby would bring. I've also never been sure how it would work to have a child and still be able to work (I really love my job) and he has been going through residency, so he wanted to wait until that was over.

After we finally started trying, we ended up having no luck. I was surprised because I always thought that it would happen pretty much instantly. I went through several months where I was convinced every month that I was pregnant, only to be completely wrong. We decided to go in to make sure that everything is okay with us medically, and found out that my husband's sperm counts and types are not good enough to fertilize an egg. His urologist recommended IUI (intra-uterine insemination),and my ob-gyn recommended IVF (in-vitro fertilization). This blog will be about the process we go through as we navigate our choices and attempt to have a family.