This morning as I was walking to the fertility institute I saw a woman carrying a gift bag that I immediately thought was decorated with colorful, striped, and polka dotted sperm. They were birthday balloons. It was a birthday gift bag. I think this helps to illustrate how much this process has taken over my life. I no longer feel that I have a full-time job other than trying to keep straight all of my medications, appointments, and continually researching and reading about assisted fertility. The good news is that by virtually ignoring everything else in my life I don't feel terribly overwhelmed. Yet.
I got my period on Wednesday like clockwork (two days after stopping the progesterone) and so I went in today to start the IVF cycle. I've still been taking the ovary-suppressant injection, so as of this morning my ovaries were clear and calm. The doc said everything looks good, so I stopped that drug and started on the follicle stimulating hormone today.
Instead of doing one injection as I did the first two IUI cycles, or two like I did in my third IUI cycle, now I'll be getting a quadruple dose. But the cool part is that they want me to put it all in one injection. So I use one syringe of water but mix in four vials of powder. Sounds like a crazy amount of hormones, but at least it'll be all in one injection. They gave me two this morning and I will do two more tonight, but for the next couple days i will do four vials each night. I go back on Monday to see how things are progressing.
If all goes according to plan, the egg retrieval will take place on Tuesday, November 8. That's assuming that my ovaries respond to the stimulation as they should and I have enough developing follicles by then. If not, we may have to continue stimulation a bit longer. I am guessing I will be going in for frequent ultrasounds to check on progress, even more than with IUI. And of course this is a much longer stimulation period than with IUI. Hopefully the meds don't make me feel awful or go crazy. And hopefully they work! I don't want this to drag out any longer than already expected.
I have all of this paperwork to take home for the hubby and I to read and sign. I had some consent forms with the IUI, too, but nothing like this. Today I had to sign off on all of the medications, saying that I understand their purpose and the side effects, and on the IVF procedure itself. I was interested to see that they asked us to consent not just to IVF but also to ICSI (intra-cytoplasmic sperm injection), which is when they determine that sperm quality is too low to fertilize on its own, so they inject it right into an egg. (This may be an issue for us since we know the hubby's morphology wasn't great in his analysis last fall.) We also have to consent to assisted egg-hatching, which I think is when a fertilized egg can't break out of its shell and continue developing into an embryo. I knew about both of those procedures but thought they might occur in a later IVF attempt, perhaps if there were problems with earlier tries. I asked the doctor about this and she said they leave those decisions up to the embryologist but that very often they will decide to take those additional measures; we need to consent to them just in case. This made me happy - it's nice to know they're going to pull out the whole bag of tricks on the first try if needed.
We also need to give consent for them to freeze any embryos that we don't use this cycle and make all kinds of decisions about what happens to them afterwards - say if one of us dies or if we don't need them for future cycles. Which is kind of a strange situation, to have little frozen possible babies of ours in a lab somewhere. Weird.
Overall, I am still feeling mostly excited and optimistic about all of this, so let's hope that continues. With not too much hormonal craziness. Fingers crossed.
Friday, October 28, 2011
Monday, October 24, 2011
IVF, here we come
and it's official: i am not pregnant after round 4 of IUI, and we're beginning the IVF adventure.
there was a time when i never thought i'd be in this position. but now that i'm here, while it's overwhelming, i'm kind of excited to up our odds once again and see if we can make this work. don't get me wrong, i'm dreading the medication and the time i'm going to miss from work and everything else. but it's the next step, and i'm ready for the next step.
i've been taking the ovary-hostage drug since last week and it's pretty much given me a non-stop headache. i'm not even exaggerating. the number one side effect is headaches, and man... they weren't kidding. pain meds help a little bit, but it never actually goes away. the injection itself is easy and painless. i even gave it to myself while camping with 5th graders. no sweat. and of course i've been using the suppositories (ugh), same as always.
today i went back to the doctor for the pregnancy test and i really never even thought it would be positive. i'm not sure if it was just because it was round 4, or because i have my mind set on doing IVF because things are already rolling, but i was not expecting anything other than another big fat negative, which is exactly what i got. so now i stop the progesterone and continue the ganirelix (the ovary-hostage taker). when i get my period, which should be by wednesday or so, i go back in and they tell me what to do next.
it's just amazing how much time and energy this whole process takes... and i know IVF will be so much more intense than IUI has been. i've had nothing but drama since thursday with the insurance company. i've practically maxed out my "specialty" prescription benefit, which is a LIFETIME benefit (and who knows what qualifies as a "specialty" medication as opposed to regular). so that means i can't really order most of the drugs i'll need from the pharmacy anymore. instead, i will be buying them at discount from the doctor's office or trading in things that i already have for things that i need more. this morning i traded in ten of the follicle stimulating hormone for five more ganirelix, since that's what i need right now and they cost a bajillion dollars from the pharmacy. it has been so confusing -- i finally asked the doctor's office to call the insurance company and work it out so they have a handle on things now. now they'll just strategically place only orders for things that are still covered and not for things that i'll have to pay out of pocket. it's insane how much some of these things cost. for a two-week supply of one of the drugs it was going to cost me over $3000. yeah, you read that right. INSANE.
but hopefully the out of pocket costs for this first round won't far exceed the $5k we'll have to pay for the procedure itself. seems like we should be able to work all of that out this time. and if we have to make the decision to do it again, we'll have to weigh all of the costs as part of our decision-making. but either way that won't happen until next calendar year. honestly, the thought of having a break from all of this is as exciting as moving on to this next step. maybe more so. after this round of IVF, whatever the outcome, we're not doing anything except having plain old-fashioned sex until january. i can't wait.
there was a time when i never thought i'd be in this position. but now that i'm here, while it's overwhelming, i'm kind of excited to up our odds once again and see if we can make this work. don't get me wrong, i'm dreading the medication and the time i'm going to miss from work and everything else. but it's the next step, and i'm ready for the next step.
i've been taking the ovary-hostage drug since last week and it's pretty much given me a non-stop headache. i'm not even exaggerating. the number one side effect is headaches, and man... they weren't kidding. pain meds help a little bit, but it never actually goes away. the injection itself is easy and painless. i even gave it to myself while camping with 5th graders. no sweat. and of course i've been using the suppositories (ugh), same as always.
today i went back to the doctor for the pregnancy test and i really never even thought it would be positive. i'm not sure if it was just because it was round 4, or because i have my mind set on doing IVF because things are already rolling, but i was not expecting anything other than another big fat negative, which is exactly what i got. so now i stop the progesterone and continue the ganirelix (the ovary-hostage taker). when i get my period, which should be by wednesday or so, i go back in and they tell me what to do next.
it's just amazing how much time and energy this whole process takes... and i know IVF will be so much more intense than IUI has been. i've had nothing but drama since thursday with the insurance company. i've practically maxed out my "specialty" prescription benefit, which is a LIFETIME benefit (and who knows what qualifies as a "specialty" medication as opposed to regular). so that means i can't really order most of the drugs i'll need from the pharmacy anymore. instead, i will be buying them at discount from the doctor's office or trading in things that i already have for things that i need more. this morning i traded in ten of the follicle stimulating hormone for five more ganirelix, since that's what i need right now and they cost a bajillion dollars from the pharmacy. it has been so confusing -- i finally asked the doctor's office to call the insurance company and work it out so they have a handle on things now. now they'll just strategically place only orders for things that are still covered and not for things that i'll have to pay out of pocket. it's insane how much some of these things cost. for a two-week supply of one of the drugs it was going to cost me over $3000. yeah, you read that right. INSANE.
but hopefully the out of pocket costs for this first round won't far exceed the $5k we'll have to pay for the procedure itself. seems like we should be able to work all of that out this time. and if we have to make the decision to do it again, we'll have to weigh all of the costs as part of our decision-making. but either way that won't happen until next calendar year. honestly, the thought of having a break from all of this is as exciting as moving on to this next step. maybe more so. after this round of IVF, whatever the outcome, we're not doing anything except having plain old-fashioned sex until january. i can't wait.
Tuesday, October 18, 2011
my ovaries: hostage
I went back to the doctor this morning to get started on one of the new drugs I will need if we do end up doing IVF. They did the sonogram, determined that nothing was going on for next cycle yet (I'm only at Day 18), and showed me how to use the new drug. It's called Ganirelix, and it basically takes my ovaries hostage. It will render them incapable of doing anything on their own, which is exactly the way we want it if we do IVF. Unlike with IUI, when we were just stimulating my natural cycle and ensuring timeliness by using the trigger shot, there is nothing natural about IVF. They will control every step of the process.
If it happens. Because, remember, I could be pregnant from our 4th IUI. Probably unlikely, but possible.
Anyway, the Ganirelix injection comes already mixed together, so it will be slightly easier than the follicle stimulating hormone, Gonal; that's when I get to be a chemist mixing powders with liquids and switching needles and whatnot. This one is all ready to go. But it has to be given subcutaneously (under the top layer of skin, I think is what that means) rather than intramuscularly like Gonal. Basically Gonal I just stab straight into the center of my leg. Ganirelix I inject at a 45 degree angle into a hunk of skin that I pinch together on my leg. Not much of a learning curve, really.
The nurse showed me how to do the first one at my appointment this morning, and then told me that I have to give myself the injection every morning at the same time. Which means I'll be stabbing myself in the school bathroom and - even better - on our 5th grade camping trip this week. That'll be fun to maneuver when I'm sharing a bunk with six 10 year old girls. I was also told to continue the progesterone (bane of my existence) until I either get my period or come back into the office for the blood test a week from today. If I'm not pregnant, I'll continue to Ganirelix until they determine it's time to start inducing ovulation for IVF.
The GREAT news of the day is that my good friend and colleague who has been going through all of this fertility stuff for way longer than I have is finally pregnant! Her second IVF did the trick and she's now almost 12 weeks along. She told me today and of course was nervous that I'd be upset. But I was truly so thrilled for her. I cried, entirely from happiness. She and I have have gone through so much of this together and I could never not be happy for her after everything she's been through. And it bodes well for me... it's so nice to see that it works out. She has also been doing acupuncture and is convinced that did the trick. AND another one of our colleagues also had a successful IVF over the summer- that news was just made public. We always have tons of pregnancies at school... maybe this year is the year of the assisted pregnancies!
So - optimistic vibes all around here. I go to acupuncture tomorrow and, of course, back to the doctor in a week. We're pushing ahead, one way or another. Oh, and one more weird thing that I don't think counts, but still: the hubby has a client who's a shrink, and she asked him out of the blue last week if we were expecting a baby. She said she just had a feeling that he was going to be a father. Maybe it's just my acupuncturist's theory about the parenting journey beginning once you're trying that came across. But my husband is the most skeptical person on the planet about anything other than science determining anything, so the fact he even mentioned this to me in a semi-serious, hopeful way is saying something.
If it happens. Because, remember, I could be pregnant from our 4th IUI. Probably unlikely, but possible.
Anyway, the Ganirelix injection comes already mixed together, so it will be slightly easier than the follicle stimulating hormone, Gonal; that's when I get to be a chemist mixing powders with liquids and switching needles and whatnot. This one is all ready to go. But it has to be given subcutaneously (under the top layer of skin, I think is what that means) rather than intramuscularly like Gonal. Basically Gonal I just stab straight into the center of my leg. Ganirelix I inject at a 45 degree angle into a hunk of skin that I pinch together on my leg. Not much of a learning curve, really.
The nurse showed me how to do the first one at my appointment this morning, and then told me that I have to give myself the injection every morning at the same time. Which means I'll be stabbing myself in the school bathroom and - even better - on our 5th grade camping trip this week. That'll be fun to maneuver when I'm sharing a bunk with six 10 year old girls. I was also told to continue the progesterone (bane of my existence) until I either get my period or come back into the office for the blood test a week from today. If I'm not pregnant, I'll continue to Ganirelix until they determine it's time to start inducing ovulation for IVF.
The GREAT news of the day is that my good friend and colleague who has been going through all of this fertility stuff for way longer than I have is finally pregnant! Her second IVF did the trick and she's now almost 12 weeks along. She told me today and of course was nervous that I'd be upset. But I was truly so thrilled for her. I cried, entirely from happiness. She and I have have gone through so much of this together and I could never not be happy for her after everything she's been through. And it bodes well for me... it's so nice to see that it works out. She has also been doing acupuncture and is convinced that did the trick. AND another one of our colleagues also had a successful IVF over the summer- that news was just made public. We always have tons of pregnancies at school... maybe this year is the year of the assisted pregnancies!
So - optimistic vibes all around here. I go to acupuncture tomorrow and, of course, back to the doctor in a week. We're pushing ahead, one way or another. Oh, and one more weird thing that I don't think counts, but still: the hubby has a client who's a shrink, and she asked him out of the blue last week if we were expecting a baby. She said she just had a feeling that he was going to be a father. Maybe it's just my acupuncturist's theory about the parenting journey beginning once you're trying that came across. But my husband is the most skeptical person on the planet about anything other than science determining anything, so the fact he even mentioned this to me in a semi-serious, hopeful way is saying something.
Monday, October 10, 2011
less uncertainty and more acupuncture
got the results of the bloodwork, and they indicate that i did ovulate. so it's the monitor that's a little bit off. i guess out of the three (my own body sense, the numerous medical assessments, and the monitor) it makes sense that it's the thing that isn't totally on top of things. i'm assuming i ovulated yesterday, which is why my temp hasn't gone up yet. so fine. timing of this round was ok. not perfect like last time, but ok. they want me to start the dreaded progesterone suppositories tonight (whimper) and then i go back next monday to start getting prepped for possible IVF.
i had a lovely acupuncture session this afternoon, too. i like that we do something different each time. it reinforces my belief that he really knows what he's doing and that he tailors my treatments to the time in my cycle and what else is going on with me. he could tell (of course) by "scanning" my body as he calls it (basically just holding his hands over different parts of me) that i had some blockages that caused me to have a wicked headache and some digestive issues over the weekend. which i totally had, and blamed on my body adjusting to various hormonal changes. he spent a long time figuring out where the most severe blockages were the treated only those today (three spots: two on my feet and one on my head) and then also did some work on my back for the first time. he says the back is the way to target the causes of the physical symptoms: the fears, anxieties, feelings that create problems in the first place. it felt much more targeted and technical-seeming than any other treatment i've had with him: there was a lot of consulting manuals and charts and measuring where certain spots were on my body in relation to other spots. i'm fascinated with the whole process.
he said that i'm responding really well to treatments and that he can already sense the changes in my body. i can too -- last week when the temperature dropped down into the 60s i think i reacted to those temps like normal people do instead of remaining my usual sweaty self! it was amazing. that balancing out of my yin and yang (cool and heat) is one of our biggest goals... i'm too hot and dry. he told me that water -- both literal and metaphorical -- is what i need more of in my body to calm and balance me, and that one way i can increase that in the metaphorical realm is to have more time to myself. meditative and calm = water. we talked about my age-old habits of overscheduling and overtaxing myself, and how i load myself down with "fun" social things in an attempt to try to balance out the amount of time i spend working, but that it's counterproductive. he wants me to do less and "be" more. i know it sounds like hippie nonsense but i get it. i really do. and i know he's right.
so what am i doing this afternoon? well, i'm working my ass off on school stuff that just can't be avoided. but tonight i get to sing my heart out at choir and then the rest of the week is relatively peaceful. we'll see how i do with this meditative calm stuff. not exactly my thing... but hey -- not much i've done these past few months has come easily or naturally.
i had a lovely acupuncture session this afternoon, too. i like that we do something different each time. it reinforces my belief that he really knows what he's doing and that he tailors my treatments to the time in my cycle and what else is going on with me. he could tell (of course) by "scanning" my body as he calls it (basically just holding his hands over different parts of me) that i had some blockages that caused me to have a wicked headache and some digestive issues over the weekend. which i totally had, and blamed on my body adjusting to various hormonal changes. he spent a long time figuring out where the most severe blockages were the treated only those today (three spots: two on my feet and one on my head) and then also did some work on my back for the first time. he says the back is the way to target the causes of the physical symptoms: the fears, anxieties, feelings that create problems in the first place. it felt much more targeted and technical-seeming than any other treatment i've had with him: there was a lot of consulting manuals and charts and measuring where certain spots were on my body in relation to other spots. i'm fascinated with the whole process.
he said that i'm responding really well to treatments and that he can already sense the changes in my body. i can too -- last week when the temperature dropped down into the 60s i think i reacted to those temps like normal people do instead of remaining my usual sweaty self! it was amazing. that balancing out of my yin and yang (cool and heat) is one of our biggest goals... i'm too hot and dry. he told me that water -- both literal and metaphorical -- is what i need more of in my body to calm and balance me, and that one way i can increase that in the metaphorical realm is to have more time to myself. meditative and calm = water. we talked about my age-old habits of overscheduling and overtaxing myself, and how i load myself down with "fun" social things in an attempt to try to balance out the amount of time i spend working, but that it's counterproductive. he wants me to do less and "be" more. i know it sounds like hippie nonsense but i get it. i really do. and i know he's right.
so what am i doing this afternoon? well, i'm working my ass off on school stuff that just can't be avoided. but tonight i get to sing my heart out at choir and then the rest of the week is relatively peaceful. we'll see how i do with this meditative calm stuff. not exactly my thing... but hey -- not much i've done these past few months has come easily or naturally.
uncertainty
i do think it's ridiculous that IVF costs as much as it does. but the further i get in this process, the more i understand why. the female reproductive system -- even when closely monitored -- is incredibly unpredictable and complicated. the ability to eliminate a good portion of that uncertainty is probably worth $10,000.
this morning my ovulation monitor told me i would ovulate in the next 48 hours. wtf. i kinda thought it was just confused and that it wouldn't tell me i was ovulating at all. i mean, it's one thing to miss it. but to mis-detect it??? i took my temperature, and it hasn't spiked above the typical baseline, which would mean that i haven't ovulated yet (or that it just happened yesterday). yesterday -- according to my body -- makes sense... i had just started to notice the tell-tale mucus and some other symptoms that are probably just TMI. so why would the monitor (based on me peeing on a stick) indicate today or tomorrow? especially when the size of my follicle and the fact that i took a freakin' ovulation trigger shot seem to indicate saturday? you would think that a day on either side wouldn't matter that much, considering the inability to narrow it down more precisely, but it totally does matter. if i did ovulate yesterday, the IUI on saturday still has a decent chance of being effective. decent, not great. if i was to ovulate today (or tomorrow!), it was pretty much pointless.
insane.
so i went to the doctor as planned, told the doc all of those details, and she -- of course -- said we'd check things out. the sonogram wasn't totally conclusive. it showed a collapsed follicle, which means i most likely ovulated. generally when i've gone in for the post-ovulation sonogram the follicle has been completely dissipated -- not visible at all. the internet tells me it's usually only there for a day or maybe two after ovulation, but i've gone in two days post-IUI before and have never seen it. the doctor admitted that this wasn't a definitive sign, but that the bloodwork that they'll do today will tell us for sure if i've ovulated or not. i have to call them this afternoon to get those results and to find out when i have to start taking the progesterone (ugh). either way i have to go back in a week to start taking a new drug, ganirelix, to get me ready for theoretical IVF. it's an ovulation suppression medication, to make sure that things don't start too early. yes, it's another injectable. so i'm glad i enjoyed this little respite from stabbing myself, because it's about to get amped way up.
unless i get pregnant now. which is, theoretically, possible regardless of my doubt. i am going to acupuncture today so hopefully i did ovulate and he can do his magic to make things come together as they should. i'll write later about bloodwork results and next steps... there's never a dull moment around here, that's for sure.
this morning my ovulation monitor told me i would ovulate in the next 48 hours. wtf. i kinda thought it was just confused and that it wouldn't tell me i was ovulating at all. i mean, it's one thing to miss it. but to mis-detect it??? i took my temperature, and it hasn't spiked above the typical baseline, which would mean that i haven't ovulated yet (or that it just happened yesterday). yesterday -- according to my body -- makes sense... i had just started to notice the tell-tale mucus and some other symptoms that are probably just TMI. so why would the monitor (based on me peeing on a stick) indicate today or tomorrow? especially when the size of my follicle and the fact that i took a freakin' ovulation trigger shot seem to indicate saturday? you would think that a day on either side wouldn't matter that much, considering the inability to narrow it down more precisely, but it totally does matter. if i did ovulate yesterday, the IUI on saturday still has a decent chance of being effective. decent, not great. if i was to ovulate today (or tomorrow!), it was pretty much pointless.
insane.
so i went to the doctor as planned, told the doc all of those details, and she -- of course -- said we'd check things out. the sonogram wasn't totally conclusive. it showed a collapsed follicle, which means i most likely ovulated. generally when i've gone in for the post-ovulation sonogram the follicle has been completely dissipated -- not visible at all. the internet tells me it's usually only there for a day or maybe two after ovulation, but i've gone in two days post-IUI before and have never seen it. the doctor admitted that this wasn't a definitive sign, but that the bloodwork that they'll do today will tell us for sure if i've ovulated or not. i have to call them this afternoon to get those results and to find out when i have to start taking the progesterone (ugh). either way i have to go back in a week to start taking a new drug, ganirelix, to get me ready for theoretical IVF. it's an ovulation suppression medication, to make sure that things don't start too early. yes, it's another injectable. so i'm glad i enjoyed this little respite from stabbing myself, because it's about to get amped way up.
unless i get pregnant now. which is, theoretically, possible regardless of my doubt. i am going to acupuncture today so hopefully i did ovulate and he can do his magic to make things come together as they should. i'll write later about bloodwork results and next steps... there's never a dull moment around here, that's for sure.
Sunday, October 9, 2011
#4
we did the IUI yesterday and all went well, as usual. the specimen was especially great for some reason: 96 million and 61% motility! the doctor was super impressed. and it's really funny what those stats do for the hubby's machismo. the doc said that i would probably ovulate yesterday afternoon or last night, based on the size of the follicle and the fact that i got the trigger shot on friday morning... but my monitor still hasn't given me the sign. as of this morning it still said high fertility but no ovulation. of course, there was another cycle during the IUI process when it thought that i never ovulated. and i do feel like i'm ovulating. so i'm not super concerned. we also gave it another try on our own this morning, so that can only help matters. at this point, i'm not stressing over it. it will work, or we'll move onto phase 3. i go back to the doctor tomorrow so that they can check my ovulation and hormone levels, and then they'll tell me what our next steps are. as long as there are next steps, i can't complain.
Friday, October 7, 2011
IUI #4, east vs. west, and other rambling thoughts
it's amazing how quickly the first part of my cycle goes when i'm not giving myself injections every day. i barely even noticed, and suddenly i'm pre-ovulatory. i went to the doctor this morning and i have one nice, big, fat follicle about ready to go, so we're doing IUI tomorrow. they gave me the trigger shot before i left, which is also great because that's the worst injection of all (it hurts and makes me sore afterwards) so i didn't have to worry about doing it myself OR having a sore leg because they give me the shots in my arm. the doc said because of the timing we will only do one insemination this cycle, which is fine by me. and i love that it's happening on a saturday... much less stress and i can go home and back to bed afterwards!
in related news, i've really been enjoying acupuncture. and no, not just because the guy is a hottie. it is such a completely different experience than the fertility stuff that is happening at the doctor... it seems incredible that they both can be intended to serve the same purpose. the divide between eastern and western medicine has never been so clear to me. frank, my acupuncturist, was upset by the fact that the head honcho doctor said, "time is of the essence" at my last appointment. well, he was as upset as a buddhist can get. which isn't really upset. but he had a lot of things to say about it. he said anyone who would say that to a patient doesn't understand the mind-body connection: what he thinks is the most important aspect of it all. not that he doesn't see truth in the fact that older women tend to struggle with fertility more often. but he won't generalize just on the basis of statistics when there are so many unknown factors about each individual situation. he told me he hadn't even met his wife yet when she was 35 -- and they have one child and another on the way -- so basing something on age isn't an effective measure of success.
so he talked to me a lot about different perspectives and ways to think about this from a more spiritual way, very much from buddhist ideals which are familiar and comfortable to me. we talked about attachment and impermanence, and how my mindset can and does affect this whole situation. he said i should think of myself already on a parenting journey, and that that journey began the moment i decided that i wanted to try to become a parent and turned my body over to the possibility. he said everyone's experience is different, and this is mine. it may include me getting pregnant and giving birth, or it may take another path. but i should stop thinking that i'm waiting for the experience to begin, because i'm already in it.
accepting that there are endless possible outcomes to this adventure is actually very comforting to me. i thought that idea might make me anxious, but it had the opposite effect. there are many ways to build a family and to give back to the world, and i will find a way to do it one way or another. i'm not going to let this crush me. we're doing what we can with a lot of medical assistance -- miraculous stuff that i'm so happy they can do. but it's not the be-all and end-all. these next few months will determine a lot, and then this phase of our journey will be over... no one can know what will come next.
in related news, i've really been enjoying acupuncture. and no, not just because the guy is a hottie. it is such a completely different experience than the fertility stuff that is happening at the doctor... it seems incredible that they both can be intended to serve the same purpose. the divide between eastern and western medicine has never been so clear to me. frank, my acupuncturist, was upset by the fact that the head honcho doctor said, "time is of the essence" at my last appointment. well, he was as upset as a buddhist can get. which isn't really upset. but he had a lot of things to say about it. he said anyone who would say that to a patient doesn't understand the mind-body connection: what he thinks is the most important aspect of it all. not that he doesn't see truth in the fact that older women tend to struggle with fertility more often. but he won't generalize just on the basis of statistics when there are so many unknown factors about each individual situation. he told me he hadn't even met his wife yet when she was 35 -- and they have one child and another on the way -- so basing something on age isn't an effective measure of success.
so he talked to me a lot about different perspectives and ways to think about this from a more spiritual way, very much from buddhist ideals which are familiar and comfortable to me. we talked about attachment and impermanence, and how my mindset can and does affect this whole situation. he said i should think of myself already on a parenting journey, and that that journey began the moment i decided that i wanted to try to become a parent and turned my body over to the possibility. he said everyone's experience is different, and this is mine. it may include me getting pregnant and giving birth, or it may take another path. but i should stop thinking that i'm waiting for the experience to begin, because i'm already in it.
accepting that there are endless possible outcomes to this adventure is actually very comforting to me. i thought that idea might make me anxious, but it had the opposite effect. there are many ways to build a family and to give back to the world, and i will find a way to do it one way or another. i'm not going to let this crush me. we're doing what we can with a lot of medical assistance -- miraculous stuff that i'm so happy they can do. but it's not the be-all and end-all. these next few months will determine a lot, and then this phase of our journey will be over... no one can know what will come next.
Monday, October 3, 2011
next steps: IVF
got my period on friday (in the midst of an amazing new orleans trip... i barely even noticed/cared) so i went to the doctor this morning. i told the nurse that i wanted to talk with one of the doctors about next steps instead of just plunging ahead with another IUI cycle. she brought in the big guy -- the director of the whole fertility institute, the guy who's written up every year as one of the best doctors in the city. i haven't interacted with him until today. of course i was already spread-eagle on the exam table when he walked in and introduced himself, but i guess he used to seeing women like that.
he looked over my file and did the sonogram and told me that he thinks it's time for us to move on to IVF. three unsuccessful IUIs now that i'm 35 and it's been almost six months since my surgery (which means the endometriosis could come back) indicated to him that "time is of the essence." the sonogram showed that i already have two follicles developing, one in each ovary (again on day 4... this is another early, early cycle); that in combination with the fact that they need to order some more medications for me in order to do IVF means we can't do it this cycle. but the doctor said that's actually better. he wants to start "fresh" next cycle.
BUT -- this was the best news i've heard in awhile -- we are going to do one more insemination this cycle with NO DRUGS. since there's already two follicles and he wants to get as much of the hormones out of my system as possible before IVF, he said we'll just monitor my cycle this time and give me a little "boost" just before ovulation and then do IUI again. then, if it doesn't work this time, we'll be all set to go with IVF.
i talked to the lady in billing and she said they'll double check with my insurance company but it looks like we'll have to pay $5,000 out of pocket. not exactly pennies. hopefully my in-laws will put their money where their mouths were a few months ago when they said they'd help us out. i don't want to ask them directly, because it's not that we can't afford it on our own, but they certainly have way more money than we do and if they're willing to invest in the future of their family tree who am i to say no?
so what happens with IVF that makes it so different from IUI, you ask? a quick overview of the procedure, as I understand it:
1) follicle stimulation and ovulation induction: this is pretty much what i've already been doing, except i will probably take a lot more hormones because they generally want a lot more eggs to develop for IVF than when you're just doing IUI.
2) retrieval: when the eggs are ready, they take them out of the ovaries before they ovulate themselves. this is a minor surgical procedure that involves a hollow needle inserted through the pelvic cavity to draw the eggs out. most people have local anesthesia and sedation for this procedure, though i've heard of some people having general anesthesia... not sure why.
3) sperm & egg party: then they get the sperm -- same procedure as before, obviously -- and they prep it for insemination. but now they try to make the fertilization happen in incubators instead of in my uterus. they put the eggs and sperms together and monitor them for a couple of days and hopefully (usually) some or all of the eggs will get fertilized. they like to have between 2 and 4 fertilized eggs for optimal results.
4) transfer: then they put the fertilized embryos (suspended in fluid) back into my uterus, and hope for the best. this is usually a couple of days after the retrieval. it seems like this procedure is much like the IUI procedure: a catheter through the cervix, shouldn't really feel like much of anything. and then... the wait.
clearly it is more invasive and intense than IUI, but that's why it's more effective. not that it's a given that it will work. they say there's a 20-25% success rate for women aged 35-37. i am hoping i'm still close enough to fall into the "under 35" statistics, which are 30-35% percent. either way, i think the doctor is right that we don't want to waste any more time. i like this plan, and i think i'm ready for all of this. and i am SO PSYCHED to not have to give myself shots this cycle but to still be able to try the insemination one more time. who knows... maybe we'll be surprised and won't even have to worry about IVF after all.
he looked over my file and did the sonogram and told me that he thinks it's time for us to move on to IVF. three unsuccessful IUIs now that i'm 35 and it's been almost six months since my surgery (which means the endometriosis could come back) indicated to him that "time is of the essence." the sonogram showed that i already have two follicles developing, one in each ovary (again on day 4... this is another early, early cycle); that in combination with the fact that they need to order some more medications for me in order to do IVF means we can't do it this cycle. but the doctor said that's actually better. he wants to start "fresh" next cycle.
BUT -- this was the best news i've heard in awhile -- we are going to do one more insemination this cycle with NO DRUGS. since there's already two follicles and he wants to get as much of the hormones out of my system as possible before IVF, he said we'll just monitor my cycle this time and give me a little "boost" just before ovulation and then do IUI again. then, if it doesn't work this time, we'll be all set to go with IVF.
i talked to the lady in billing and she said they'll double check with my insurance company but it looks like we'll have to pay $5,000 out of pocket. not exactly pennies. hopefully my in-laws will put their money where their mouths were a few months ago when they said they'd help us out. i don't want to ask them directly, because it's not that we can't afford it on our own, but they certainly have way more money than we do and if they're willing to invest in the future of their family tree who am i to say no?
so what happens with IVF that makes it so different from IUI, you ask? a quick overview of the procedure, as I understand it:
1) follicle stimulation and ovulation induction: this is pretty much what i've already been doing, except i will probably take a lot more hormones because they generally want a lot more eggs to develop for IVF than when you're just doing IUI.
2) retrieval: when the eggs are ready, they take them out of the ovaries before they ovulate themselves. this is a minor surgical procedure that involves a hollow needle inserted through the pelvic cavity to draw the eggs out. most people have local anesthesia and sedation for this procedure, though i've heard of some people having general anesthesia... not sure why.
3) sperm & egg party: then they get the sperm -- same procedure as before, obviously -- and they prep it for insemination. but now they try to make the fertilization happen in incubators instead of in my uterus. they put the eggs and sperms together and monitor them for a couple of days and hopefully (usually) some or all of the eggs will get fertilized. they like to have between 2 and 4 fertilized eggs for optimal results.
4) transfer: then they put the fertilized embryos (suspended in fluid) back into my uterus, and hope for the best. this is usually a couple of days after the retrieval. it seems like this procedure is much like the IUI procedure: a catheter through the cervix, shouldn't really feel like much of anything. and then... the wait.
clearly it is more invasive and intense than IUI, but that's why it's more effective. not that it's a given that it will work. they say there's a 20-25% success rate for women aged 35-37. i am hoping i'm still close enough to fall into the "under 35" statistics, which are 30-35% percent. either way, i think the doctor is right that we don't want to waste any more time. i like this plan, and i think i'm ready for all of this. and i am SO PSYCHED to not have to give myself shots this cycle but to still be able to try the insemination one more time. who knows... maybe we'll be surprised and won't even have to worry about IVF after all.
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