Saturday, July 31, 2010

Strategery

It is amazing to me how many hard choices we've had to make in recent years and how much strategy is involved. Hopefully we'll decide on a winning strategy for how to play this cycle. We've found out that we have options that we didn't think were open to us, so that's a load off! Here's the scoop:

Another appointment this morning showed follicles at 17, 15, 13, 12, 12, and 11. Lining at 10. I'd probably be more optimistic about this whole thing if my doctor and nurses were. On stim day six the nurses were already mentioning cancelling and on day eight the doctor herself called and said how surprised she was with the low response. With some IUIs I'd responded almost too well on super low doses and made her nervous. With this IVF protocol, though, the stim dosages were seriously misunderestimated (two Bushisms in one post!). I began at 75 Menopur and 100 Follistim and it's been bumped up incrementally until the Menopur dose was doubled and the Follistim tripled.

Tomorrow is another ultrasound, after which I'll decide with my doctor whether to go through with the IVF or convert to IUI. Yes, with IVF it can "only take one", but it's a numbers game and higher numbers give you better odds. I've fallen hard on the wrong side of the statistics too many times to think I'm going to be the lucky one who beats the odds here.

My clinic's financial guru called the cost sharing program about the situation. Since this is my first attempt and the meds were seriously off according to the doctor, they are willing to let me convert this to an IUI and NOT count it as one of my three IVF tries. I'd feel better if I had that in writing right now, but they say all I have to do is sign an addendum stating we will pay the clinic directly for any outstanding costs for this cycle. We've only invested about $400 of our own money into this cycle and that was for drugs. Of course there's also the investment of time and all those shots, but I was surprised at what a cakewalk that was. I've developed a shockingly cavalier attitude about injecting myself! The rest of the cost this cycle was covered entirely by insurance. Speaking of insurance, just about the time we finish using the $20,000 in IF coverage on our current Cadillac COBRA policy, we get a new pot of money on the policy with hubby's new job. Sweet. Insurance companies have been hating me since 2001.

I have two additional reasons to cheer up today. Number One is that The Other Clinic finally refunded the money they owed us (almost $1000!). In addition, I successfully argued that they should drop all charges not paid by insurance since it was their decision not to treat me. Number Two is that comedian Brian Regan is coming to the Twin Cities in October and we have tickets!! I'm a big fan because he's hilarious and clean - a rare combination.

Friday, July 30, 2010

The Lone Ovary Rides Again


The Lone Ovary is moving along at a trot, but at least it hasn't completely fallen off the horse. It's stim day 8 and this morning's appointment showed five measureable follicles: 17, 13, 12, 11, and 11. Lining grew from 3 on Wednesday to 7 now. So we're moving in the right direction but I am still bummed. I was hoping (still hoping I guess) to get at least 8-10 eggs. With only one ovary, I knew going into this that the number wasn't going to be the impressive 20+ that some women can get. I had reasonably low expections, but so far I'm not even meeting those. My hope is to get enough eggs to I can end up with two good embryos to transfer.

Wednesday's appointment left me so depressed that I decided to go running that evening. Running is my drug of choice - love that endorphin high. Unfortunately the endorphins were countered by the disheartening realization that all that bouncing around didn't make my ovary sore. Not one little bit. For months I've been dogged by ovary soreness because of stupid cysts, and now when I desperately want my ovary to be big and swollen and sore - nothing. Still not sore at all.

This morning it was nice to meet up with Baby on Mind after my appointment (we go to the same clinic and both had appointments this morning). She had her beta today, so make sure to stop by her blog.

Anyway, today is less depressing. Maybe I'll go out today instead of lying around the house weeping. Or maybe not. The doctor herself called me a moment ago about my poor response. You know that's not a good sign. Blah. She predicts I'd get 3-5 eggs if I go through with this.

Wednesday, July 28, 2010

Stim Day 6

I had planned to go to a lake with some friends today, but instead I am so depressed I don't want to leave the house. Today was my first ultrasound since starting stims. I have only two - yes TWO - follicles (14 and 10 mm)and my lining is only at 3. The nurses were not impressed with this. Two days ago after bloodwork results came back low, the clinic called and said to up my Follistim dose from 100 to 225 and Lupron went down from five units to two. Now they're jacking the Follistim up to 300 but I wonder if it's too late to do me any good.

Just a couple of days ago I was talking to a friend and saying how I've been unusually happy the last few days because I felt like there was some HOPE. I said being happy and hopeful is nice but also very scary for me because it seems like every time I have any happiness, a severe beating is sure to follow. I try to be positive, but sometimes the cost for going there just feels too high. 


The nurse said we'll check again on Friday and then decide whether to cancel or plow ahead anyway. The most depressing thing is that this counts as one of our three tries for the cost-sharing program even if we don't have a retrieval. Other people in the program who are lucky enough to have two responsive ovaries get three fresh cycles and up to three frozen cycles. Looks like I may only get two cycles for the same amount of money, assuming I don't get kicked out of the program altogether for being a poor responder!

When I got my IVF protocol I was surprised at the stim dosages. It seemed low to me for IVF and I said so at the time. I get frustrated because this clinic seems to be too darned conservative for my tastes. I'm usually pretty conservative myself, but I want liberal amounts of drugs!! I'd rather deal with hyperstimulation than a try that doesn't seem like a try at all!

Monday, July 26, 2010

How We Got Here: IVF vs. Adoption

A few months ago when it looked like the end of the TTC road for me, I was shocked to find that IVF was actually a possibility and that it was the least crazy of the few crazy options we had left. We have considered adoption and even filled out the first round of paperwork, but there were a few things about adoption that were deal-breakers. I wrote about my main concerns here.

Another huge issue is that our kids would be interviewed as part of the home study and forced to be part of the long painful process. It is just not OK to drag them through that. Other issues for us are the long, long wait and the invasiveness of the process. Hubby and I have survived horrific things, but we are not superhuman. I'm afraid that spending years in the process of adoption would break us. That we'd lose the little truncated family we have right now. That instead of gaining another child, our two kids would lose us.

If we had unlimited time, money, and capacity for pain we would probably adopt a couple of kids from China. Hubby and I have both lived there. Hubby and our kids speak Chinese. It would make sense. But we don't have that kind of time, money, or stamina.

The advantages of IVF are that we can do it NOW and that this journey will end. It will END and maybe my life can go on somehow. I feel like I've been stuck in hell for four years while the world has gone on around me. My kids are growing up and I'm partly here with them but also partly stuck in a shadowy world of death with their brothers. They deserve better than that. They need their mom to be fully present with them now, even if it means giving up hope of ever having the joy of a new addition for our family.

Obviously, the other advantage of IVF (if it works) is that we could end up with a baby - our baby - in our arms again. I want my baby and I want it ALIVE. Yeah, I'm picky like that. Wouldn't it be the perfect ending to our story? It would tie up all the loose ends and bind up all the gaping wounds.

Another plus for IVF is that I suspect it would be easier to explain to any resultant child than adoption. It would also be considerably more fun: "You see, honey, when a man and a specimen cup love each other VERY much...". I'm also guessing IVF kids wouldn't have long-term issues about where they came from, but I may be wrong about that (gametes from mom & dad?! Ewww!) -



So there you have it - that's why we're doing IVF. There's no divine inspiration involved in the decision, in case anyone is wondering. We've prayed and pleaded for guidance for years and gotten nothing. So we're going with this and hoping that our family will survive it and maybe even grow.

Thursday, July 22, 2010

In Which the Anxiety Level Goes Up a Notch

Welcome July ILCWers! You can get a quick overview of my story on the sidebar. Currently I’m trying IVF for the first time, which is exciting and terrifying all at once.

I posted last week about my attempts to get my RE to start me on Lovenox at transfer rather than waiting for rising betas. With my history I want to give this my very best shot (ha!), but she has officially refused my third desperate plea. Three strikes and I’m out. I don’t see any way to prevail on this one.

She sent me an article saying heparin didn’t improve outcomes [Aspirin plus Heparin or Aspirin Alone in Women with Recurrent Miscarriage; New England Journal of Medicine; March 24, 2010] but as this article notes, there are all kinds of conflicting studies on this. Even though the cause of my pregnancy issues is unclear, I felt like we have enough clues here to justify aggressive action:

First Loss - Jeremiah (January 2007 at 21w 3d) cord hypercoiling

Moderate positive result on anticardiolipin antibody IgG; after six weeks this was retested and the level was "inconclusive"

From Pathology: “Received is placenta, umbilical cord, and fragments of blood clot and decidual tissue. Twisting of the cord appears abnormal, with more twists per centimeter than average. The placenta appears somewhat disrupted.”

Second loss: Miles (July 2007 at 18w 5d) cord stricture
Additional testing on me showed I am heterozygous for MTHFT mutation C677T

Lots of old blood in the amniotic fluid; his blood was also found in my circulation

I took baby aspirin during this pregnancy from 6 weeks onward

Anticardiolipin was normal this time


I do have two living children, a son born 2003 and a daughter in 2005. They also had placenta/cord issues, especially my son:

David (2003) - Lagging growth was first noticed at 20 week ultrasound and became more severe by 30 weeks

Born at term weighing 5 lb. 0 oz. with meconium and nuchal cord x1; APGAR 2/7; 5 days in NICU

We were told he had a small placenta and thin cord; this was not sent to the lab


Tania (2005)Possible partial placental abruption during labor

We were told the placenta had “two sacs”; it was not sent to the lab


I don’t think there’s any way around my RE on this issue - I'm sure my Gyn wouldn't get involved and I’ve only met with a perinatologist once almost three years ago (she said use Lovenox but I don’t think she’d overrule my RE on when to start). The hell of it is, the doctor at The Other Clinic was going to have me on Lovenox from transfer! I don’t know if Lovenox/heparin two weeks earlier would make any difference, but I sure don’t want to end up holding another dead baby and wondering “what if”. *sigh* I’m feeling anxious, desperate, and disobedient, but there doesn’t seem to be any way to get my hot little hands on those syringes.

Tuesday, July 20, 2010

It's Time to Try Defying Sanity

Good news - today's baseline ultrasound showed NO CYST! I am cleared to start stims on Friday. Some would (and have!) say I'm insane for trying this, but it's not like I have a lot of attractive options at this point.

The timing of all this has been fortuitous. My kids' crazy summer schedule of tennis, swimming, and sports wraps up this week, so things will be much more relaxed around here. Better yet, after 2 1/2 months of unemployment hubby has a new job!! He starts in mid-August, after this cycle is done. So no worrying about finding childcare during all my appointments and no worrying that Egg Retrieval/Whacking Day will conflict with his job!

So many problems could have put a stop to IVF. Money. Unemployment. Cysts. The crazy shrink. And yet here we are!

It's time to trust my instincts
Close my eyes and leap



Note: Saturday was the third anniversary of Miles being born. His story and Jeremiah's are posted on this new blog Faces of Loss, Faces of Hope.

Thursday, July 15, 2010

An IVF Primer

I rarely tell anyone that I'm doing IVF and one of the MANY reasons is that I'm sick to death of explaining the process. Everyone gets so hung up about all the shots and appointments, and I want people to know that's the easy part! On this blog I try to focus on other aspects of infertility.

Nevertheless, I was going to write about the details of the whole process because some friends and family read my blog and I'd like them to know what's involved. I've been pretty busy lately and quite frankly the topic bores me right now, so instead I have compiled some interesting links posted by others. If you're an IVF veteran or are doing it now, please add anything you think people should know about IVF, share your tips for surviving it, or link to your best IVF posts! Now let's get started:

Here's a good quick overview, though it doesn't mention the hardest part of IVF, which is the hell known as the two week wait (2ww) between when your embryos are transferred (hopefully) and when you have the pregnancy test.

Here's a video in which one woman displays and explains her shipment of IVF supplies.

Most of the IVF shots are subcutaneous (SubQ for short) and done with a 1/2" needle in the belly. The rest (progesterone and sometimes the trigger shot) are intramuscular (IM) with a 1 1/2" needle in the rear. Since I will not be posting footage of myself injecting my bum [cries of disappointment from the crowd] the curious can view videos here of how all those shots are done.

There are also MANY blogs about IVF which you can find at The Stirrup Queen's Blogroll.  You'll see a lot of abbreviations and acronyms on infertilty blogs.  If you need a little help deciphering it all, look here.

One reason IVF is so stressful is that it can come to a screeching halt at any point. You may be forced to quit right at the start because of a cyst (my big fear). Or you can respond so poorly to stimulation meds that you don't even make it to the egg retrieval. Or you can go through retrieval only to end up with no good embryos to transfer. Or you can make it through transfer only to find you're not pregnant and did all this for nothing. Or you can get pregnant only to have your baby die. It's nerve-wracking to think of how many ways things can go wrong. I'm trying really hard not to.

Right now, I'm at the beginning of the process - on Lupron to suppress my hormones. I haven't mentioned much about it because it's been very boring, which is good. Since I've already had plenty of practice with subQ injections, that part of it is drama-free. Also, I've had no side effects at all as far as I can tell.

Next Tuesday is my baseline ultrasound and assuming I pass, I'll start stimulation meds on Friday. That means two shots in the morning (low dose of Lupron and 75 IU Menopur) and one in the evening (100 IU Follistim). Retrieval is projected for August 2, but of course that's just a guess.

Tuesday, July 13, 2010

More About Hamsters!

Who'd have guessed that hamsters would play such a prominent role on a loss/infertility blog?! This is my second hamster post. This time, it's all about how hubby's swimmers got together with a bunch of hamster eggs.



This hamster was relieved to learn that it all happens in a petri dish. What am I talking about? The Sperm Penetration Assay, of course (aka the Hamster Zona-Free Ovum Test). The male's semen is collected and processed, then combined with numerous hamster eggs that have had the zona (outer covering) removed. The eggs are later evaluated to see how many were penetrated and by how many sperm. A good sign of male fertility is having all hamster eggs penetrated with between 6-20 sperm each.



Hubby's score was mediocre and since we'll likely be getting an unimpressive number of eggs out of me due to my lone ovary, we have been advised to do ICSI. By the way, that stands for Intracytoplasmic Sperm Injection - one sperm is actually injected into each egg with a microscopic needle. High tech. Thus, the check we recently had to write out for IVF was even more painful than anticipated. The good part is, though, that whatever eggs get sucked out of me will get a better shot at fertilizing.

Sunday, July 11, 2010

Lovenox / Heparin Question

After losing two babies in 2007, both at 5 months gestation, I was advised to use Lovenox in any subsequent pregnancy. I still haven't had the chance to try it, but I'm about to do IVF. The trouble is that my RE refuses to let me have Lovenox to start after retrieval, saying we'll see about it after (if) I have rising betas. Also, the dose would be low - a prophylactic dose of 40 mg/day rather than a therapeutic dose of 60-80 mg/day.

So I have a question for anyone out there who has used Lovenox/heparin in absence of definite proof of thrombophilia: When did you start and at what dose? And why exactly did you use it? With what outcome? I'm looking for personal experiences and also any references to studies/articles about any advantage to starting Lovenox before pregnancy is confirmed.

After my losses I was tested for everything under the sun. All results were negative except the following:

First Loss - Jeremiah (January 2007 at 21w 3d) cord hypercoiling
Moderate positive result on anticardiolipin antibody IgG, which we're told is not significant; after six weeks this was retested and the level was "inconclusive"

Normal chromosomes (except a pericentric inversion of chromosome 9 [inv(9)(p12q13)] inherited from mom - we're told this is insignificant

Second loss: Miles (July 2007 at 18w 5d) cord stricture
Additional testing on me showed I am heterozygous for MTHFT mutation C677T, which we're told is "not clinically significant"

I took baby aspirin from 6 weeks onward

Anticardiolipin was normal this time

I do have two living children, a son born 2003 and a daughter in 2005. They also had placenta/cord issues (esp. my son). I don't know if we're on the right track at all with the thrombophilia hypothesis. Maybe it's genetic? Something else? Any thoughts are appreciated.

Up until a few days ago, my time and energy went into fighting for the chance to even try IVF and then into arranging all the details (getting drugs, paying, etc.). Now the stress is really hitting me. I think my chances of getting pregnant are decent, but what about staying pregnant? I think with my terrible track record it's best to be aggressive with the Lovenox, but how can I when my RE refuses because the "cord isn't even formed that early". I wonder if my babies' cord problems are just a symptom of a larger implantation problem caused by thrombophilia. I'm terrified of having another dead baby.

Friday, July 9, 2010

The Plant in Poo Corner

This scraggly little plant was featured in a previous post. At about the time life was dumping a load of crap on us (hubby's job loss, my last failed IUI cycle, and more) I planted it in my garden along with a load of manure:


Here it is atrophied and yellowed a month later. This is when we hit the roadblock at The Other Clinic that threatened to destroy our last hope for trying to complete our family:
Here it is now, when we're about to attempt IVF, finally showing some robust growth:


It's been a little hope meter of sorts. I pray that both the plant and I will soon be fruitful and multiply!

Monday, July 5, 2010

Dirty Deeds Are Not Dirt Cheap

We are doing IVF through a cost sharing program. The deal is that if don't end up with a take-home baby after 3 fresh cycles and up to 3 frozen cycles (if we have any embryos to freeze, which I doubt) then we get a 100% refund. If not for this program, we would simply not be doing this. Only by taking away the financial risk can we even consider taking on all the other considerable risks.

It also helps that we had the necessary funds saved, so we remain 100% debt-free. Even so, with hubby still unemployed (though we have reason to hope that's about to end!) it's very stressful to see our savings plummet. This is definitely far more painful than any of the physical aspects of IVF.