Taking a Bullet

So yeah, I took the statistical bullet last week. I'm pretty sure we all do at some point, but I figure someone else can have the honor next time, okay? That actually sounds kinda shitty. I don't wish this on any of you. I sincerely hope all of you who got your BFPs and excellent fertilization reports appreciate my sacrifice! (And in case it was unclear, that was intended to be humor. I'm a wee bit dry.) Unfortunately, this leaves me disinclined to blog for the moment. In keeping my Bullet Theme, you're getting a list today:

• All of my meds have been refilled (at no cost to me, since I met my co-insurance in May) and are boxed up and waiting in the back of my closet for the do-over IVF. It wasn't until I started IF treatments that I even knew what co-insurance meant. If you've never been introduced, it means that I've paid my yearly limit of co-pays and for the rest of the year any covered medical expenses (excluding prescriptions) will be paid 100% by my insurance. I've spent THAT much in co-pays already this year. 
• The box of meds is in my closet because my mom and my MIL are coming for their annual summer co-visit. This is good. I love them both and they have a great time together.
• The box of meds includes a just-in-case refill of my Crinone because next week, my employer sponsored health insurance is switching prescription coverage and Crinone will be bumped into the highest tier. I'm guessing my employer is gonna be saving some serious cash because my prescription costs are about to go up. Bastards.
• These are the same Bastards that have neglected to respond to the letter I sent in honor of NIAW. I console myself with the virtue of having sent it at all.
• I've fallen of the Fitness Wagon. I haven't exercised in... months. I am consistently exceeding my calorie limit for the day. Granted, my daily calorie limit is ridiculous at a mere 1,200. I AM at least maintaining. My weight has not gone back up, but the loss has plateaued. If only I could convince myself to get off my ass and back on the elliptical. It would probably also help if I could refrain from restocking the ice cream supply in my freezer.
• If I have to see one more 5-6 month pregnant woman pushing a one year old in her grocery cart, I refuse to be held responsible for my own behavior. The produce section is a perfectly acceptable location to lay down and beat the floor with my fists while screaming.
• Fortunately, I can avoid the produce section for the most part in the near future since our CSA box started back up last week. Dude, I LOVE garlic scapes. And having an excuse to see my BFF more often.
• BFF thinks I'm depressed. She's probably not far off. 

This shit sucks.

Oh FFS...

I got home from work today and checked the mail to discover a small padded envelope. What could this be? What had I ordered... hmmmmm? OH right. The internet-cheapie HPTs. That I was going to use to test out the trigger shot... that I didn't get to take because my IVF cycle got cancelled.

Nice. Have a nice weekend!

Even better, I discovered this was what the envelope contained, not by reading the shipping label to see who the sender was or even by opening it to examine the contents. I knew what was in the envelope because the INSTRUCTIONS for use were in a nice clear adhesive sleeve on the OUTSIDE of the envelope. This is one medical supplier that missed school the day they taught the lesson on treating your clients with discretion.

And the best part? Apparently, they also missed the lesson on truth in advertising. These so-called midstream HPTs actually require urine to be collected in a container and then applied to the test window using a dropper. Four drops precisely. What exactly in this procedure indicates anything "midstream"?

Seriously. FFS.

Cancelled

After our last monitoring appointment, it was fairly clear that we weren't going all the way to retrieval, even without knowing the estrogen level. We were obviously feeling daunted and beaten down.

The sun was shining, there was a scattering of little fluffy clouds and a light breeze. Such a beautiful day and such a disappointment. We stopped at the curb for a quick hug before heading into our respective days. Suddenly, I could not abide the thought of driving into work and sitting at my computer all day and the tears started.

My dear, sweet Professor gave me a big squeeze and suggested we go for a walk in the park that backs onto the medical complex where our RE has his office. So we walked along the tree line till we found a gap, and picked our way through, dress pants/shoes and all. We didn't go far and we didn't talk about anything in particular, but by the time we picked our way back through the brush to the parking lot, a few of the clouds had blown away and the day seemed a little less bleak.

When I texted him to let him know we were officially cancelled, he replied, "We've still got each other."

I love my husband.

IVF Monitoring #3

Cancelled.

Nine days of stims.
Lining at 8mm.
Six follicles between 9mm - 11mm.
Estrogen just over 300.

Not good enough. They will not convert to IUI, as even that would require too much longer on meds. They are concerned about diminishing egg quality by stimming for so many days. So we cut and run.

Fortunately, I refilled my meds last week in anticipation of longer stimulation. Now I have leftovers for another shot at this even though our coverage is all used up. We will have a follow-up with our RE in two weeks to discuss changes to the protocol and getting back on the schedule to start over.

For tonight, I'm drowning my sorrows in junk food.

Gratitude

I just wanted to say a huge thank you for all of the thoughtful comments you've been leaving this week. You are truly a balm to my spirit.

Thank you.

IVF Monitoring #2

After six nights of stims, at what the nurse tells me is the highest dose they are willing to prescribe for me, my lining is at 5.7mm and I now have an underwhelming seven follicles brewing:

(L) 8mm, 7mm, 8mm, 8mm
(R) 9mm, 9mm, 7mm.
My estrogen is an equally underwhelming 75.

This leaves us in a quandary. I am making progress, seeing increasing number and size of follicles. My estrogen is increasing. Just enough to keep the RE from giving up, but not enough to be particularly promising. So we continue stims at the same dosage and re-check on Monday. At which point we will either see definitive progress or the cycle will get cancelled. At least, we hope it will be one or the other. I'm not sure how long I can stand to be caught here in Limbo.

After less than a week, I've had to refill my Menopur already. I have been on the phone with the specialty pharmacy three times this week trying to sort out billing errors that go back months. The woman I spoke with today told me that due to the complexity and frequency of the errors made on my account, I would be dealing with her exclusively from this point forward on any billing questions. That's right, I now have my own personal billing rep. She does seem to know what she's doing, and she did make one really nice comment at the end of our call.

She said, "I'm looking at the medications you're taking and you really shouldn't have to be dealing with all of this on top of what you're going through. I'm sorry."

In answer to the many inquiries that came up on Twitter, it seems that I was over-suppressed. Four weeks of BCP, no Lupron. They already have me on the highest combo-dose of GonalF and Menopur that they would give me, so not really any room to tweak or add meds. Insurance was only covering meds for this one cycle. I had one unused medicated IUI left in my coverage, so they let me use the meds credit toward this IVF cycle. Otherwise IVF expenses are not covered. We are burning through the meds and I'm worried that if we cancel, I'm going to have to come up with thousands of dollars to replenish the vegetable crisper.

To Pee or Not To Pee (UPDATED)

The age old question of the Infertile in a treatment cycle. Oh hell, let's be honest. There doesn't have to have been any actual treatment. Just the possibility of an egg and the hint of a sperm together in the same room at around the right cycle day, and it's time to break out the HPTs!

So for IVF, when every little thing is so documented and "known" and there is so much riding on the cycle, the temptation to POAS is nearly unbearable. For months now, I have been debating the idea of buying a stock of internet cheapie sticks and "testing out the trigger". Right up until beta day.

But.

My Mom and my MIL will both be arriving for a visit just a few days before beta (give or take depending on retrieval date). I know, I know... what was I thinking approving that itinerary? It's going to be hard enough to keep those PIO shots under wraps, much less find a way to store and dispose of countless HPT strips.

But.

I seriously want to do this. I want to know if there is even a glimmer of a pregnancy. I need to know.

Also.

Any suggestions for hiding the PIO ritual from the Moms in a house with only one bathroom?

UPDATED: The internet cheapie sticks have been ordered! Here's hoping they get here before transfer. More importantly, I wanted to say a huge thank you for all the thoughtful comments over the last week. You guys are the best!

IVF Monitoring #1

We've done three days of GonalF at 375iu. I didn't know quite what to expect, but it wasn't this. Only four follicles: 6mm, 6mm, 7mm, 8mm (two on each ovary). Even the nurse had a hard time disguising her lack of enthusiasm for this level of response to stims. When the blood work came back, my estrogen levels had actually dropped.

Sigh.

Next three nights' shots will be 225 GonalF plus 225 Menopur. Second monitoring appointment on Friday morning. Please let there be a few more follicles brewing, all at nice even sizes!

And while I was having my pity party, a whole boatload of my Twitter girls were enduring heartbreak and loss beyond reason. Please do whatever it is you do (pray, meditate, wish on a star) and send some love out to @LeLeIsMe, @MaternalTurtle, @BroodyIVFMummy and @MyCheapViolin.

Breaking Up Is Hard to Do

I have a confession to make: I broke up with my acupuncturist in April, but I haven't told her yet. I'm thinking she'll figure it out on her own.

I've been seeing her as needed for various ailments for almost 10 years now. When I started doing fertility treatments, she told me she wanted to add a bunch of herbs to my plan. I'm not an herbal supplement kind of girl. Yes, I take my vitamins. Yes, I try to use foods where possible to improve my health. But somehow, I can't jump on the herb-wagon. So I hemmed and hawed and told her I'd think about it, and then studiously avoided mentioning herbs ever again. I did bring it up with my RE, just to see what he had to say, and what he said was, "Do NOT take any herbs while doing these treatments." Very emphatic, no room for doubt about his thoughts there.

At my last appointment back in April, my acupuncturist started in about the herbs again. She had just been to some sort of master class and had her belief in the Power-of-The-Herbs renewed, and she felt the need to push. I told her no, I haven't been taking them and wasn't inclined to do so. She questioned that, and I told her I just wasn't comfortable with it. She launched into a lecture about balance and completeness in treatment and how doing acupuncture without herbs was only half the solution and WHY wouldn't you want to do everything you can, don't you really want to get pregnant?

If I tell my doctor I am not comfortable with a particular form of treatment, I expect them to respect my feelings. They may present alternatives, or explain potential consequences of declining the treatment, but I don't expect to be judged by my doctor. So I cancelled my appointment for the following week, and never went back.

Of course, now that I'm on the brink of IVF, I'm feeling guilty for not having this particular tool in my treatment bag. There is one acupuncturist recommended by my fertility clinic. Unfortunately, he is currently booking new patient visits two months out. So... I'm moving forward without this tool.

I'm just gonna have to let that go.

Who Me... Superstitious?

I am not assigning a number to my IVF cycle. I have never done IVF before, and I am currently operating under the assumption that this is the only IVF cycle I will do.

Thus, this is simply: My IVF Cycle.

First Base(line)

Baseline hurdle cleared! Ovaries quiet*, lining very thin, estrogen at 16, progesterone at <.5 and my checking account is down nearly $7K.

My very own RE did my exam and a quick mock transfer (which he described as "easy"). He also complimented my choice of toenail polish. Either my normally un-pedicured feet made a massive impression on him in the past, or (for my choice) he just clearly has good taste. I mean really, who doesn't like a nice frosty orange pedicure for the summer months? Having approved my pedicure, my cervix and my ovaries, he gave me permission to reclaim my pants and meet him in the consult room to review The Plan. We looked over the calendar again, completed all the paperwork, signed our consents and were off.

One little hiccup at the checkout desk, as my debit card was declined when I went to pre-pay the (exorbitant**) bill. Turns out that thing has a $3K per day spending limit. Oops. It never occurred to me to call my bank ahead of time and let them know I was making this charge. Luckily, they had it sorted in under ten minutes so I could pay up and move on to lunch with the Professor. But for a minute there... my heart stopped. The other thing I realized this morning was that I'll be getting my 1% rebate on this charge since I used my debit card as a credit card. That will make for a nice little dinner out with the Professor!

*For the sake of comparison: my right ovary measured 30mm this morning. We're ideally looking to recruit multiple follicles on that ovary at 20mm+. I have a feeling things are gonna get a little cramped in there.

**I do actually realize that my just under $7K IVF bill is far from the level of "exorbitant" that many others have to pay, but still. It's all relative.