Issues, I Haz Them

On Twitter a few days ago, I likened myself to a spoiled brat of a three year old, stomping my feet and wailing "Why meeee? Not Faaaair!"

And that terribly mature thought brought me up against a hard wall of realization. This may well be the first time in my life I that haven't been able to achieve what I set out to do by dint of hard work and perseverance... perhaps the first time I've needed to confront my motivations and the true strength of my desires.

Am I using my fears and ambivalence about parenthood to paint a child-free future into a rosier picture, just so that I can tell myself it was what I really wanted all along? Is it any wonder that I now doubt myself and my ability to be a good parent, faced with the first major failure of my life?

Nothing Owed

Thanksgiving was hard.

Our parents came to visit for a few days to celebrate the holiday with us. Keep in mind that they don't know we are TTC or that we have been doing treaments. Over the years, it has become clear that they have decided that we just don't want kids. They no longer press us about grandchildren, but the subject does come up in their conversations. Not so much that they want grandkids, more the acknowledgement that there won't be any. They don't even say anything to us directly, they just mention it between them in our hearing. So there was that.

And then there was a phone call that I overheard. I don't know if my Dad even knew I could hear him from the other room. The comment I heard was:

"He said, 'Doesn't she know she OWES you a grandchild?" And I said 'She doesn't OWE me ANYTHING... that's bullshit!'" Blah, blah, blah... at which point I kind of wanted to vomit. I was so proud of my Dad, even through the red haze of outrage that he was having to field those kinds of comments. Better him than me I suppose.

I laid in bed for hours that night, with those words running round and round through my head. The arrogance and ignorance behind them is appalling. I am still incredibly angry. I don't know who said that to him, and I won't ask. If it was a close friend or family member, I prefer not to destroy my relationship with them over that knowledge. BUT. God forbid they use those words in my presence, I will not be held responsible for my reaction and it will not be pretty.

If someone were to (or has) said this to you, how would (did) you respond? How did you wish you had responded?

WTF (do we do now)?

We had our WTF follow-up for the most recent failed (un)IVF cycle earlier this week. There is no more tweaking the protocol. We've tried both agonist and antagonist with the maximum dose of stimulation and DHEA to boot. The upshot is we've thrown everything we can at my ovaries and they simply failed to respond. My ovaries are cut from the team. My overwhelming feeling about this is relief.

The RE was very kind but clear. We won't be doing another cycle with my ovaries. He laid out the standard next-step options (donor eggs, foster/adoption, childfree) and gave us some information on our clinic's DE program. He let us know that if we wanted to go with DE, there is no need to hurry. The clock is effectively stopped as far as success rates go. You might even say, the clock would be wound back in time.

Prof and I have discussed all of these possibilities in the abstract over the last year, and we are in agreement that foster/adoption are not right for us. Our decision now is between donor egg and childfree. There are pros and cons to both and we will need some time to work through our feelings about them before we know which way we want to move.

I also had my first meeting with the infertility therapist this week. It was really just a get-to-know-you sort of session, background stuff, but I liked her and I hope that she will be able to help us find our way through the decision making process in front of us.

We have some thinking to do, some decisions to make.

I am OK. We are OK. We will BE OK.

POAS

When we embarked on the IVF process last Spring, I decided that I would pee on a stick every day from transfer to beta, just to watch how the lines would change from one day to the next over the two week wait. So I invested in a 25pk of cheapie early detection tests from Amazon.

Since we finally managed a cycle that DIDN'T get cancelled (even if it did get converted), and since I had a feeling that I was ready to stop treatment and plan my childfree future, I decided this was my chance to pee on those sticks. For posterity, the results were as follows.

7dpIUI = BFN
8dpIUI = BFN
9dpIUI = BFN
10dpIUI = BFN... 30 minutes later, one last look. Is that a line? Hard to say... maybe.
11dpIUI = BFN... Perfectly clear.
12dpIUI = BFN
13dpIUI = BFN

Last night, I started cramping and shortly thereafter, bleeding. Even though I was still on Crinone. Ah well. Beta this morning came back negative. Obviously, this was NOT a surprise.

We have our WTF appointment after Thanksgiving. I don't know if we will continue treatment. That will depend to some degree on what kind of explanations and change of protocol the RE presents at our WTF. I'm approaching 40 years old and my ovaries are apparently done. We've talked about donor eggs, but realistically I don't think we can afford it and we don't know anyone who we would feel comfortable asking to be a known donor.

I will also be meeting with a psychologist who specializes in infertility related therapy. To say I am conflicted would be putting it mildly. Most days, I just want to walk away and get on with my life, childfree. I'm so tired of being indefinitely "on hold". I want my body, my paycheck and my LIFE back. Believe it or not, I can actually see a number of positives to this path. Then there are moments when some tiny thing brings my future crumbling down around my ears in a flurry of memories I will never get a chance to create. A photo of a friend's three year old dressed up for Halloween, the new set of Christmas lights we just bought, a birth announcement for a baby with our favorite boy or girl name.

I do realize that if we go the donor egg route, we could take some time off to save up. However. That would effectively still be keeping us "on hold"  and in the IF game, and even if we bypass my very tired ovaries, any resulting pregnancy would still be high risk due to my age alone.

We have a lot to think about, a lot to discuss.

My Trench is Taking on Water

This is probably more of a post for my peeps still in trenches with me, as it were. I kind of feel like not only am I still in the trenches, but my trench is filling with water and I'm drowning in this hole I've dug myself. Those of you currently pregnant or parenting are surely drowning in a nearby though totally separate trench and I hope you understand that I'm not actually asking anything of you here and I'm not trying to hurt your feelings. I'm also fairly certain I've seen others write posts just like this before. I'm feeling a little derivative, but this is where I'm at. I know I'm not alone, not the first infertile to visit this space. That's really what will make me hit publish. So that maybe someone else will see they are not alone.

I know "Once infertile, always infertile", but my Twitter timeline and my blog reader have made a significant and painful shift recently. Huge numbers of the internet friends I made when I first stumbled into this community have now crossed over to the pregnancy/parenting side of things. Most days, it feels like all I see is pregnancy plans and questions with a healthy dose of nursing/diaper habits. It's really starting to get me down. Like Thinking-of-Seeking-Therapy Down. Even my online support group is becoming just another reminder of the ways my body is failing and the dreams I can't seem to fulfill. I am feeling worse and worse by the day about my chances of completing an IVF cycle, to say nothing of a take-home baby. Hell, with the failure of this most recent attempt at an IVF cycle, I'm even feeling jealous of those of you who just make it to retrieval. Relieved for you, but jealous all the same.

My initial instinct is to unfollow out of self-preservation and it may yet come to that, but I don't really want to lose my connection to these women. They are still infertile, they have been supportive, they have been where I am (and where I hope to be) and they have feelings too. I don't want to hurt them by disappearing.

For those of you who have written this post before me, how did you handle this?

IVF The Remix (Conversion)

For those of you not on Twitter, my Monday morning monitoring revealed only TWO viable follicles at 22mm each and estradiol holding steady below 200. Basically, fuck all.

My clinic has a 4 follicle minimum for IVF retrieval, so they recommended to convert to IUI. When I explained the situation with my FSA money, they gave me the option to move forward with IVF if I really wanted to. But. The success rate for IVF with two follicles versus IUI with two follicles is the same. Obviously, IVF comes with some risks that IUI does not have. It is surgery and there is no guarantee that they will actually collect the eggs.

There is no chance of another IVF cycle this calendar year. I called the FSA administrator and they confirmed that if the procedure is not performed before December 31, 2011, I WILL lose the money in my FSA. So we are now poring over the eligible expenses list to see what we can use the balance to purchase.

This was our choice. And we chose the IUI. As badly as I want to close the book on this process and as heartbreaking as it is to essentially get cancelled again... this feels like the right decision. Silver lining: No PIO and we get to have sex as soon as the IUI is done.

Not-Penny's Baby Shower

Today is Elphaba's virtual baby shower. Everybody say "Hi" to our guest of honor and our lovely hostess Mo... Now grab yourself a drink (punch or tequila, as you please) and a tasty treat and plop your butt on the couch with the rest of us Infertiles while we celebrate one of our own as she prepares to cross the Finish Line!

According to our hostess, I'm supposed to write a little bit about what Elphaba's pregnancy has meant to me, but I'll admit to feeling slightly inarticulate just now. I've been excited for her, worried for her, relieved for her, proud of her, impressed by her (and worried for her and relieved for her again) and finally... insanely jealous of that amazing Canadian maternity leave. I will probably never be as eloquent as Elphaba, but I sincerely hope that someday, I get the chance to be as cute and feisty a pregnant lady as she is!

Elphie, I hope that these gifts will bestow upon you some peace and quiet (and a touch of sanity) here and there.

Obviously, since I'm still battling Primary Infertility, I don't have any significant personal experience with newborns. I do however, have scads of fertile friends, and they tell me these two items are life savers. So here's to Elphaba and Mr. M and Baby Girl Yolk. She will always be "Penny" in my mind!

IVF The Remix (Update #3)

So yesterday sucked. That about covers it. For those of you who are playing along at home and require more in depth analysis of the game thus far...

Saturday AM monitoring revealed:

Lining: 7.2mm (Really? How did it get thinner?)
Estrogen: dropped to 164 (drop ascribed to Ganirelix)
Left ovary: 2 follicles at 14-15mm, 5 follicles at 7-8mm
Right ovary: 2 follicles at 13-14mm, 3 follicles at 5mm

This is very disappointing. Even the RE seemed a little bummed by these numbers. I'm stimming more slowly than anticipated given the total lack of suppression with this cycle and the 4 months of preparatory DHEA. We're basically looking at four follicles of viable size. Yes, there are several little ones hanging back. Yes, I know "it only takes one". But. The doctor basically dismissed the 5-8mm follicles as not viable and that abysmal AMH level from last year is haunting me. I just don't have many eggs left, and apparently all the gonadotropins in the world aren't enough to really get my ovaries in gear.

They've upped my Menopur dose to 225. Still at 300 for GonalF. And FYI, Ganirelix has a sneaky afterburn to it. At least the Menopur headaches have gone. Look at me finding a silver lining.

IVF The Remix (Progress Report)

FIRST THINGS FIRST: Thank you all so much for all of your lovely comments in the last few weeks. You kept me from drowning in my own misery. At this point I'm doing pretty good to string a complete sentence together, but I need you to know how much I've appreciated your thoughts and words.

As I knew it would be, work is totally insane right now, so this is just a quick update on my monitoring this morning.

Lining 7.4mm
Estradiol: 371
Left: 11mm, 13mm, 9mm, 7mm
Right: 12mm, 12mm, 6mm

We lost a couple off the right ovary and progress is slow but steady. My dosage remains at 300 GonalF + 150 Menopur. I start Ganirelix Friday night to prevent ovulation and go in for another monitoring on Saturday morning before I go to work. For a 14 hour day. Hold me.

I'll check back in on Sunday.

IVF The Remix (First Peek Inside)

For my own records as much as anything else. After three days of shots (300 GonalF + 150 Menopur), the first monitoring appointment revealed:

Left Ovary: 4 follicles (9mm, 10mm, 7mm, 6mm)
Right Ovary: 5 follicles (10mm, 10mm, 6mm, 6mm, 8mm)
Estradiol: 141

The dosage remains the same and we recheck on Thursday. For the sake of comparison, I looked back at IVF Cycle of Fail and we now have double the number of follicles with half of of those at larger sizes than last time. The nurse was pleased with this progress, so I suppose I shall be as well.

Beats the crap out getting cancelled!

The Knowing

My RE's office is in a building that is dedicated solely to providers of women's health services. It is usually bustling with activity... patients and their loved ones, doctors and staff and those ubiquitous pharma reps. My midwife is in the same building, as is the breast imaging center where I've gone for mammograms in the past. I've lost count of the number of times I've visited this building over the last ten years.

But. My RE is the only provider in the building that sees patients on the weekend. In a town with limited options for infertility treatment, I'm pretty certain at least a couple of you have been to my RE. I've seen regular blog hits originating not only in my town, but in nearby smaller towns as well.

When I walk through the building on a Saturday morning and see only a handful of others (almost always couples on the weekends), all heading to or from the same door as I am, I know. We all know. The atmosphere in the building is just a little more relaxed, a little more open. People's voices are not quite as hushed as they are on weekdays. Because we all know why we're there and we're all there for the same reason. And I always wonder if I'm looking across the waiting room at someone who reads this blog, or whose blog I read myself.

That curly headed girl whose face lit up when she spied the pumpkin spice K-cups at the coffee station in the waiting room last weekend? That was me.

IVF The Remix - May I Vomit Now Please?

I went in first thing this morning to get my blood levels rechecked. Just got the call. My progesterone dropped and my estradiol was right on target.

I start stims tonight for IVF The Remix: 300 GonalF & 150 Menopur. First monitoring on Tuesday.

Seriously. I may vomit.

Once More, With Feeling! (UPDATED)

I called it at about 12:30 this afternoon. CD1.

Baseline appointment will be tomorrow (Thursday) just after lunch. Since the appointment is so late in the day, I probably won't get a call with my blood work results till Friday morning.

Deep breaths.

UPDATED: Same song, second verse... lovely ovaries aaaaaaaannd elevated progesterone. Retest on Saturday, but I've already given up hope. Fuck.

Is It Time to Panic Yet? (UPDATED)

I have a sneaky feeling I'm fucked.

iPhone says CD1 should be Monday and I'm just now starting to get some mild cramping and backache and acne. Just like last cycle (with the wonky progesterone levels), there are a few PMS symptoms that are missing. I have been running through various scenarios in my head surrounding the beginning of IVF The Remix, and none of them are particularly good. At this point, the only possible start date that won't end badly is if my CD1 is about a week late.* Not beyond the realm of reason, but not bloody likely either.

So this is sort of like one of those "choose your own ending" stories, but much more expensive. Here are the most plausible story lines I've worked out.

OPTION ONE: If CD1 shows up between now and next Saturday, and we get the all-clear to start stims, we are nearly guaranteed that retrieval will occur around the 21st-22nd. This is, naturally, the absolute most important two days in my entire work year. Roughly equivalent to the convenience of having retrieval on Christmas morning. Please believe that I am not exaggerating.

OPTION TWO: If CD1 shows up between now and next Saturday, and we do NOT get the all-clear to stim due to a repeat of last cycle's weird blood levels, I will probably be put on BCP for suppression. This would lead to a stim cycle with retrieval likely the week of Thanksgiving, when we have family staying in our house for the holiday. Oh joy.

In this eventuality, if we start stims but do not get to retrieval... we will not be permitted to try again in December. Which means I will lose the $5,000 still sitting in my FSA for this purpose. A not-insignificant chunk of my already small salary that I have worked for and would be forced to forfeit. This would also mean another year of maxing out my FSA (and the consequential tiny paychecks).

OPTION THREE: If we are stuck with Option Two and do not get the all-clear to start, then there remains a very slim chance that we could roll with an early December cycle. But really? If it reaches that point, I have absolutely no faith that anything might go our way.

Can you tell I've given this a little thought?

*I realize there is one last option, but we're not going to discuss that here. Seriously, please don't even bring it up. I will flip my shit.

UPDATED: In response to the first comment, because my IVF meds are covered in exchange for my final, un-used, covered IUI cycle and I've already met my co-insurance for the year... any meds I order before the end of the year will be covered at 100%. While this is lovely, it means that none of that will come from my FSA. And I have already paid the remainder of the IVF cycle in full, but the insurance (and thus the FSA) don't process any claims until the procedure is actually performed. So yeah, if IVF doesn't happen before December 31, 2011, that FSA balance is forfeit.

Dream Vacation

It's been quite a week in my dream life.

Last night, I dreamed that our fertility clinic was in Paris. Every time we had an appointment, we would fly over and book into the Ritz for the night. As you do. The coffee was amazing. And every time the front desk clerk gave me the bill for our stay, I exclaimed "Really? That's all? It's so reasonable..."

That doesn't take much thought to interpret. I'm starting to get the message that the cost of treatment is weighing heavily on me. What do you think?

Sabotage

Realization: I've been poking tiny holes in my chances of success with IVF.

I've been slacking on my efforts to be healthy in preparation. Nothing major. A glass of wine here and there. Not as much exercise as I should be getting and I still haven't dropped the last ten pounds to get me into the "Healthy" BMI range. I'm having a cup of coffee almost every day (granted, most days it's decaf *ptooie*). Prof hasn't been taking his vitamins and I haven't been pushing him to remember.

Yeah, I'm taking my prenatals and my DHEA. I'm doing my acupuncture. But I'm also letting a lot of little things slide. I admit, I'm sick and tired of staying on top of all these details. I'm starting to wonder if I'm setting myself up with excuses for what I see is the inevitable failure of this yet-to-begin cycle.

In My Dreams

As promised on Twitter...

I've been having some trouble getting to sleep lately (hmmm... wonder why) and the last couple of nights, I've added nightmares into the mix. Suffice it to say I'm getting a little wacky with the lack of sleep. Anyhoo, I woke up from this particular dream very distressed and was unable to get back to sleep. It took me a good twenty-four hours of subconscious "chewing" before I had one of those ubiquitous Ah-HA moments. I'm not sure Freudian is the right word, but for what it's worth, this is for all you dream enthusiasts:

The backdrop is present day reality, and the Professor and I are due to start our IVF cycle in a week. The dream starts out moments after I've had unprotected sex with a drug dealer. Yeah, I know. He wasn't anyone familiar, just a generic composite of a vaguely nerdy guy. So I'm trying to talk to this guy and freaking out about this unbelievable thing I've done, terrified I might get pregnant, terrified I might wind up with some horrible disease. I grab my purse to go home and confess to Prof, and when I look inside it, my wallet has been stolen.

Like I said, it took me a good twenty-four hours to "get" it and when I did, I laughed out loud. Need me to spell it out?

Drug Dealer = Medical Establishment
Unprotected Sex =Infertility Treatments
My Fears = My Fears
Stolen Wallet = Cost of Treatment

Not a Happy Thought

I'm in a particularly morbid place right now, so I understand if you want to skip this one. I just needed to get these thoughts out of my head and into the light. I've been doing a lot of thinking about what happens in the event of a positive beta. One unfortunate side effect of infertility is the all the extra time we spend thinking about what might happen when we finally get what we want. I'll tell you right now, I don't have answers. Only in an infertile's mind does this potential outcome spiral into a nightmare of epic proportions.

I'm putting the cart before the horse and wondering, if we do get a pregnancy out of this IVF (assuming we ever get to complete this IVF), how long do we wait to tell our friends and family? It seems like such a mundane question. Until I start to play out various possible scenarios in my mind.

Your average fertile couple seems to be sharing photos of the positive HPT within days. Cautious fertiles deem ten weeks to be the safe zone for sharing. This is clearly out of the question, but then, how long do we wait? Most of my IF tweeps seem to settle around the end of the first trimester, which seems... almost long enough. Until I consider all the things that could go wrong for a woman my age at any of the critical "seeing shit more clearly" appointments that seem to occur between 15-20 weeks. And the incompetent cervixes that seem to fail between 20-23 weeks.

And suddenly I realize, this is getting ridiculous. If I waited even as late as twenty weeks to tell, my family would be furious that I hadn't told sooner. So obviously, I would have to come clean before I felt safe. Cue epiphany.

If there's one thing I've learned from my involvement in this community in the last three years, it's that we are NEVER out of the woods. There will never be a point when we know everything will be OK. There may perhaps come a time when the fear abates, when we manage to relax or even forget about mortality for a while. Or maybe not. I'm one of those people who believes that the moment you get complacent and stop worrying about something is the moment things will go wrong. I have been told that I worry too much, that this simply isn't logical, but I'm wired this way. I don't know how to turn this off.

No parent should ever have to bury their child, but it happens all too often. As a child, one of my friends lost her little brother in a freak playground accident. As a teenager, I lost one friend to cancer and another to a car accident. In my twenties, I lost a friend to an overdose. In my thirties, a family member lost her five year old and the doctors never even found a reason. They all died too young and they all had mothers and fathers who will carry that loss for the rest of their lives.

This year, my thirty year old cousin buried her two year old son, and my eighty-nine year old aunt buried her fifty-eight year old son. We are never out of the woods.

If you made it all the way to the end of this post, I kinda feel like I should buy you a drink, or at least a cookie. I did warn you.

IVF Remix

So, in the wake of my second cancellation... no change of plan.

I call with CD1 for another baseline.

Based on the series of progesterone levels they took, the clinic believes I ovulated maybe the day before I got my period last week. They tried to tell me that it was "dysfunctional uterine bleeding" and not a period, but I'm not buying that. They think I'll get my period next week. I'm betting on early in the second week of October, because that would be the absolute worst possible timing for me to be out of work for retrieval later that month (and right on schedule according to my iPhone).

Any takers?

Limbo

Merriam-Webster's second definition (after the Roman Catholic meaning):

lim·bo

noun \ˈlim-(ˌ)bō\

2 a : a place or state of restraint or confinement

   b : a place or state of neglect or oblivion

   c : an intermediate or transitional place or state

   d : a state of uncertainty 

 

 

I'd say that about covers it.

Cancelled

Again.

Before I even got started.

Progesterone levels are still going up. Recheck on Tuesday to try and get a better idea of what's going on. Looks like I'll have to do BCP with my NEXT CD1 and then try again. The timing really can't get much worse.

IVF The Do-Over, Please Hold

Yesterday was CD1 as expected.

Yesterday I was home sick from work with a cold.

Yesterday we had a plumber in first thing to make some updates in our basement before we start our post-flood renovations. No water in the house for several hours.

I called to report to the RE right after breakfast, and they wanted me to be there for a 2pm baseline. Exactly what I wanted to do in my unshowered, snot-filled haze. I was also a little concerned that they might cancel the cycle due to excessive snot, but apparently, as long your excessive snot isn't overheated with a fever, you're OK.

The RE Himself did the scan and the ovaries look quiet. Just a few tiny follicles on the left gearing up... or perhaps I should hope they were actually settling down.

Today I am still home sick from work.

Today I missed the call with my blood results.

Turns out my progesterone is elevated. I gather from the rambling message the nurse left that this is a problem. So now I get to worry all day today that this cycle will be cancelled before it even starts and then I go in early tomorrow (Saturday, day of rest and my dreaded birthday) to have the progesterone rechecked before I can (please, please, please) start stimming Saturday night.

Thus, I am hoping those little follicles were corpus luteum (luteii?) that were just settling back down (since the scan was on CD1). If I just think that hard enough, it should do the trick, right?

Holy Self-Centeredness!

Mine all mine, and I feel the need to own it.

I mentioned recently on Twitter that I've been spending a lot of time wandering in Memory Lane the last week or so. Sort of a slow motion Life-Flashing-Before-My-Eyes experience. Navel-gazing, moping, reliving good times and bad. I'm not sure where this extraordinary degree of introspection is coming from, but I'm guessing it's a combination of the changing season (Fall never fails to bring out my nostalgic side) and the impending start of IVF The Do-Over and the knowledge that I probably only have the wherewithal for this one IVF cycle. I feel like I am very near my limit with this process. I am ready for things to change. I either want my baby, or I want my life back. It's time to break out of Limbo.

In the process of this little memorial road-trip, I've also spent a lot of time contemplating the various branching points in my life that led me to my current place, and wondering where I would be and what my life would be like if I had made different choices. Wondering if it is too late to make some dramatic changes. And I know that, actually it is not too late. My mother went back to school at about age 40 to get her masters and start a new career. No reason I can't do the same.

It was thinking about my mother and some of her choices that really stopped me in my tracks this week. One of the memories that bubbled to the surface was from my early childhood, and it hit me quite hard. I guess I've never mentioned this here, but when I was about four years old, my mother had a miscarriage. I'm not sure how far along she was, but it was far enough that she was showing and everyone knew she was expecting (even me). Because I was so very young when this happened, it has always just been a piece of my family history, a simple fact of life like my grandparents divorce.

Only in this last week of soaking in memories and un-actualized potential, did the reality of my mother's loss sink in for me. And I feel horrible. How is it that in my nearly three years of struggling to get pregnant and one miscarriage of my own, I never made this connection? How is it that this was always so much a background fact that it didn't even register with me? You don't need to bother telling me in the comments, I know I'm a self-centered beast.

My mother has always been a steadfast figure of calm and caring. Who took care of her? Did my father give her the emotional support she would have needed, or maybe her sister did? Did she have close friends to help her heal? I'm not sure I could tell you who my mother's best friend was when I was four years old. I know there is one photo of my mother and I, taken just before she found out the baby was gone, and she keeps this photo out where she can see it. She has mentioned on numerous occasions that it is the only existing photo of her with both of her babies. And all I can think is, "Oh god, my poor poor mother."

On Your Mark... (UPDATED)

Thursday was CD1, so I called the RE to check on my calendar and confirm my protocol for the IVF Do-Over. Turns out, when the IVF team had their planning meeting for the next round, they decided to change my plan a little.

No BCP. No Lupron. No suppression at all.

They decided that since there was sufficient possibility that the BCP contributed to my complete and utter lack of response last time and since my cycles are so quaintly regular, that they would not risk repeating the previous failure. This means that on my September CD1, I will have completed my three month course of DHEA (to boost ovarian response and egg quality) and will go straight to stims unsuppressed.

This should be interesting.

UPDATE: I suppose I should have mentioned, they are going to stick with my original IVF protocol (minus the BCP suppression), adding Ganirelix near the end to suppress the LH surge and keep the follicles from popping off on their own.

Batter Up

Or something like that... I don't do sports, so I can't be 100% certain. I'm anticipating CD1 any day now (started spotting today, just ahead of schedule) which means a call to the RE to set the IVF calendar and recheck the med supply for the adjusted protocol.

Work continues to be batshit crazy, in spite of this being the down season and our busy season begins... well, this week I suppose. So much for a summer break. I think I took two whole days off all summer. Next opportunity for time off will be Thanksgiving. If you don't count the days I plan to take off for retrieval and transfer... because those should be such a refreshing break from the work week, ya know.

Hold me.

Until lift-off, I'm just taking my DHEA and drinking my wheat grass. Thrilling stuff here people, thrilling stuff.

No More Needle Naps

It just occurred to me that I never updated you on my first visit to the new acupuncturist. I know you were all holding your breath waiting for that information, so you can relax now - I'll put you out of your misery. First a quick recap.

Short Story: I've been seeing the same acupuncturist for about 10 years for various ailments here and there. She occasionally tried to get me to take herbs, but I'm not going there. Just can't do it. She got pushy, so I fired her. Long Story.

Things that are different:

• New acu is a man, old acu was a woman. Wasn't sure how that would play out, but it turned out fine.
• New acu is in my town, not the next town over. The shorter commute is certainly nice!
• New acu is a fertility specialist, recommended by my clinic. He doesn't criticize my clinic - imagine that.
• He is not recommending herbs for my protocol. I asked upfront.
• He is very hands-on, makes constant adjustments. He schedules one patient at a time and never leaves the room. 
• He doesn't take insurance. I'll have to submit claims myself, but at this point, whatever.

No more needle naps for me.

Losses

Two cousins.
One uncle.
One grandfather.

All lost to my family in the last twelve months. Two long-anticipated, and yet still mourned. Two tragic and untimely, grieved in shock and disbelief. And the unspoken question on my mind (is it on anyone else's?): What next?

Living IRL

I know. I've been a little low profile in bloglandia and the Twitterverse. I'm not going to apologize though. I've been making a concerted effort to get out of my own head and engage with the world around me. Major excitement (can you sense the sarcasm there?) that has kept me busy IRL for the last few days include:

• Yardwork. Prof and I got out there together for a while just before the sun went down Friday. That was about the only time it got cool enough to be functional outdoors. Normally I do the yardwork by myself, but he joined me by special request and it was kinda nice!
• Salon time for Slackie. I got waxed and then had a lovely spa pedicure, foot massage and all. I even broke out of my mold and tried a new color - and I love it. You should all be very proud!
• Business gathering with the Professor. I usually skip out on business socializing with Prof's colleagues, but I put on my big girl pants and went to the party with him. I even talked to nearly every person in attendance. Trust me, that is a big deal for ME.
• Met BFF(B) for coffee. Girl chat, catching up, a little cooperative bitching and moaning and I think we both felt better.
• Housecleaning. Above and beyond the usual weekend laundry and dishes. We are planning to have dinner out with friends and there is a chance they will drop by our house afterwards. So a little extra TLC in the public spaces.
• I am heading to Seattle this week for a conference. I will have a small amount of free time to myself, so I'm meeting up with BFF(3) and I'm so excited about that! I wonder if she's up for the aquarium?
• The day after I get back home, I have my first appointment with the new fertility acupuncturist. I'm really looking forward to it, though I'm also a little nervous. I hope he's lower pressure than my previous practitioner with the herb situation.

I will be even more out of touch for a little while, but I promise we'll catch up when I get back. Pinky-swear!

Hi-ho, Hi-ho... Ho-hum

Sorry to drop off the face of the internetz there. I feel like I owe y'all a post, but I still don't have anything to report. No news, no progress, no travel or interesting IRL adventures. I've just been slogging through my Monday-Friday and zoning out on the weekends. Work has continued to be unusually busy. Summer is normally our major down-time, and a to be honest, a little boring. Not so this year. We are still going flat out, but unfortunately, have all of our less critical, large projects that we put off till summer when we expected to have more time to work on them. Ugh.

We had intended to be traveling for a wedding out of country this weekend, but IVF and its cancellation have kinda bitched our finances. For those of you who don't have to deal with the All-American ordeal that is health insurance: We had to pay the clinic cash up front because IVF isn't covered by our insurance. I contribute pre-tax money from my paycheck to a savings account (FSA) at my insurance company that will then reimburse me for expenses that the insurance doesn't cover (up to the total amount that I contribute). The benefit is that the government can't tax me on that income. Since we got cancelled, the claim hasn't been submitted to insurance to be denied, so the FSA hasn't paid out a reimbursement. We could have had a refund, but it seemed more prudent to leave the payment as credit with the clinic so we wouldn't be tempted to frivol the cash away in our sorrow. Sometimes being responsible sucks.

I'm still mulling over my career as well. Or perhaps I should say "a career" because I don't feel like I have one right now. I really need to earn more money. Which is how I got where I am. Being an artist is the thing I'm best at, the only thing I'm actually educated for. But I wasn't making a living at it, I was just keeping afloat. I wanted to make more money, so I shifted my focus to my current field and got an entry level job making more than I had been. I expected to see at least some advancement after a couple of years, but am realizing now that isn't likely. All I can see are the negative aspects of the next level positions, the many ways a promotion would add stress and impinge on my home life. So I've been contemplating my strengths and skills and trying to imagine what other field I could explore that would give me another salary boost without dramatically increasing my stress levels. The problem is finding something I'm good at and mentally suited for that actually pays but doesn't put me to sleep.

First world problems.

We did see HP7TheEnd last night. It was pretty good, but I never felt the urge to cry that so many others have mentioned. Perhaps because I know the books so well and did my crying over them (and did I ever). Perhaps because it's hard for me to get past the inconsistencies and discrepancies in the storytelling. I spent too much time in the movie thinking, "But... that never happened!" I don't know, but I can say without a doubt that Alan Rickman once again acted circles around everyone else in the movie. Gary Oldman didn't have enough screen time to give him any competition in this one. Seriously love those two. And Helena Bonham-Carter does a great Hermione-pretending-to-be-Bellatrix - you can really believe it's Emma Watson in a Bellatrix suit. Hilarious moment!

Now I need to go figure out something creative to do with last night's leftover stir fry chicken and veg. I think I'll do a faux-pho... (heehee. I kill me)

Without A Doubt

I've been taking my DHEA for over a week now. The warnings on the bottle are a little alarming. There is even one that warns against use by women of childbearing age... which was, as I'm sure you can imagine, a little confusing. I had a persistent headache for the first five days or so, but that has abated now, thank goodness. I have also had VERY vivid dreams, just before waking, every day since I started taking the DHEA. Not nightmares or sexy dreams, just weird nonsense dreams that I remember clearly after waking (which is unusual for me).

I did a little online research and read some promising things about this treatment. Things that actually gave me hope. I almost wish I hadn't. Because as much as DHEA appears to increase the odds of a successful pregnancy in circumstances like mine, we all know there are NEVER any guarantees are there? There will always be someone for whom things just don't work out. If that's going to be me, it would be so much easier to go into it without much hope. I'd rather not have to deal with the crash. I wish there was some way to know in advance if I will be one of the lucky women for whom DHEA is the answer.

Our local S*bux has a Magic Eight-Ball on the pick-up counter. We stopped in on our way home this evening, and of course I just had to go there. The answer:

Without a doubt.

IVF Update (WTF)

Sorry to be absent, both here and on Twitter, but we have out of town guests and I'm focusing on them right now. Since they are all sleeping in this morning, I thought I'd do a quick update.

We did have our IVF follow up consultation last Wednesday. Basically, no real answers. The IVF team was baffled by my lack of response. All of my pre-testing and my previous injectible cycles were good and gave no indication that something like this might happen. Apparently, sometimes you just have an off cycle (I did have ONE injectible round where my response was slightly lackluster). My RE feels like it was probably a fluke, but rather than waste another shot, he is tweaking the protocol just a bit.

• I started DHEA on Wednesday (75mg/day)
• Lupron is back on the menu (microdose flare)
• BCP are optional*
• I will continue to drink my wheatgrass and minimize my caffeine/alcohol consumption.

The major disappointment is in the timing of the do-over. The clinic closes for the second half of August, so that their employees can take vacation. So I would either need to start right away (not ideal with upcoming travel this month) or wait until September (not ideal as that begins our busiest season at work).

The RE is pushing for September because of the DHEA, which is starting to be used more often as a means of increasing ovarian response. Apparently all of the literature shows that its effectiveness is optimized at three months use. So we wouldn't be likely to see any benefits until September, making an immediate cycle more of a gamble in terms of "WTF was with that poor response?"

So September it is.

*The BCP are only being used to time the start of the cycle to coordinate with the clinic's IVF rotation. If it looks like my CD1 should be in the right range anyways, I won't have to take them, though this still involves a bit of a gamble. If I don't use the BCP and we miss the right timing, I have to wait till my CD1 falls into the correct window. SO... I'll probably end up using the BCP at least briefly.

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.

I'm A-Scared

I admit it. I'm scared to do this IVF. I keep having this irrational urge to cancel the whole thing.

What if it works? Shit y'all, I'm nearly 39 years old. Will I be able handle such a major life change with my sanity intact? And what if it doesn't work? Will I be able to let that go? Will I feel compelled to accumulate more debt just to keep trying? Will I resent making that monthly payment on the debt we've already acquired to make this one shot possible?

And then there are the longer-term repercussions. My mother had estrogen sensitive breast cancer. I have been pumping my body full of excess estrogen for a couple of years now and IVF will raise that bar exponentially. Does that make me even more vulnerable to the same disease? My right boob was killing me the other night (it has stopped now), and all I could think was, "What if we go through all of this, and I end up with cancer like my Mom? Would it be better or worse to at least have a baby to show for it?"

I don't have an answer.

IVF Update

I took another BCP this morning. Three more to go.

Dramatic stuff here.

All of the meds are in the house. Estimated retail value: $7,683.

What's For Dinner?

I made a crazy-tasty dinner tonight, so I though I'd share. It wasn't from a recipe and doesn't have a name, but it was basically a Tex-Mex quinoa salad. I served it with fresh sliced avacado and a cheese quesadilla.

Recipe for the quinoa salad:

3 C quinoa, cooked
1 can black beans, rinsed well
1 medium tomato, chopped
1 fresh jalapeno, seeded & chopped
1/2 red onion, chopped
2 cloves garlic, minced
juice of two limes

Spices to taste:
salt & pepper
red chili powder (1/4 t)
ground, toasted coriander seeds* (1/2 t)
ground, toasted cumin seeds* (1/2 t)
chopped fresh cilantro (1/4 C)

Mix well and chill before serving. Makes about six cups.

You could use another grain or rice, but quinoa has been getting a lot of press lately as a superfood, and it's also a favorite of the gluten-free crowd. I was suprised how much I actually liked it!

*About ground, toasted coriander and cumin seeds... we always keep these whole seeds handy and toast as needed in a miniature skillet, for 2-3 minutes. Grind toasted seeds with a mortar/pestle. It really doesn't take much extra time, but the flavors are amazing. Toasted coriander particularly adds a nutty, citrus-y note without the acidity of lemon or lime.

Oh My Hell, or Wednesday in NYC

Sorry for the delay in posting, but this week truly kicked me. Hang tight: this might take a while, but I promise it all ends up OK.

For anyone who is not yet aware, there just happens to be a national (I'm in the US) shortage of Lupron. There are still a few pharmacies here and there with stock, but it's getting incredibly hard to find. No one has been able to offer me any kind of explanation for the shortage.

I was scheduled to start Lupron injections for IVF#1 next Saturday.

WEDNESDAY
 
All seemed to be going quite well until mid-day Wednesday. I had a business trip to NYC that was supposed to be less than 12 hours on the ground. This was the culmination of all the work stress I've been under for the last few weeks. Big Day. I would even have ONE hour to spare after our business concluded, and I planned to meet up with @the2weekwait and @thisispersonal for coffee before heading to the airport for my flight home.

I started the day in the airport with a phone call from my RE telling me they had found a pharmacy with Lupron in stock and I should expect a call to arrange delivery AND even better, my insurance company confirmed my meds would be covered. Awesome! I boarded my plane, shut off my phone and was off to the Big Apple. When I turned my phone back on in the taxi, there was a voicemail from the pharmacy.

Long story short, they do have Lupron in stock, but are refusing to fill prescriptions for new customers unless it is part of a complete cycle order. So I'd need to order a cycle's worth of GonalF as well. In spite of the fact that I already have all I need. I escalated up the chain of command, but this company just doesn't care. Since I've never ordered from them before, they won't fill my prescription.

I called my RE and left a message explaining the Lupron situation and they called me right back. They were changing my protocol from Lupron to Ganirelix and sent in a new prescription to my usual pharmacy. I called my pharmacy thirty minutes later to get the ball rolling, only to be informed that they were out of Ganirelix. Because of the national Lupron shortage. Everyone is being switched over, just like me. Smack in the middle of this phone call, a coworker walks up to me, cell phone to his ear. He mouths, "Our flight home just got cancelled". Due to weather. And not just ours, lots of flights.

Cue full blown panic.

My IVF teaching appointment is scheduled for 9:30 the next morning. After thirty minutes of frantic googling and phone calls (God bless my iPhone), I had a new flight out. But I'm in Manhattan and need to be at the airport in an hour. It's 5:30 PM. Rush Hour. Fifteen minutes of arm waving and one burst of hysterical tears later, a rather shell-shocked cabbie is taking me to LaGuardia against his better judgement. He kept handing me kleenex and granola bars and offering to charge my iPhone. I got through security with about 10 minutes to spare. As he drove, I texted Jay and Jen to let them know I couldn't do coffee. Poor Jen had had an even worse Wednesday than I did. What a bummer. At least I got home before midnight.

THURSDAY

The first thing I did when the nurse called us back for our teaching appointment was tell her the names of everyone at the clinic that I felt the need to apologize to after the previous day. She seemed amused by that, particularly awkward since her name was on the list.

Then I told her about the out-of-stock Ganirelix (I never got a chance to relay that information the day before). To my amazement, they already knew. She had a brown bag full of Ganrelix samples that she handed me. All I will need for my cycle. The Internetz seem to put this at about a $600 value. And they just gave them to me. I *may* have cried just a little.

She then ran us through our protocol and calendar, and demonstrated each of the new meds for us (we already have experience with GonalF, Ganirelix and Ovidrel). For the record:

BCP through 5.31
Baseline 6.1 (Pay-Up Day)
GonalF (375iu) starting 6.4
Menopur starting 6.9
Ganirelix starting 6.9
Ovidrel trigger TBA
Retrieval week of 6.13
PIO (50mg) starting day of retrieval
Antibiotic & steroid starting day of retrieval

Assuming we get eggs, they will perform ICSI on all of them. Assuming embryos develop, they will perform assisted hatching the day of transfer (Day 5 if possible). The antibiotic and steroid are in aid of the assisted hatching, which can make the embryo more vulnerable to potential infection during transfer and to prevent my immune system from rejecting the embryo as "foreign matter".

TODAY

I had a phone call first thing this morning from my pharmacy. They were calling for my approval of the co-pay amount for the Menopur, antibiotic and steroid: $146. It will ship Monday. I am so lucky.

We are still waiting to get the final dollar amount to be paid at my baseline, but it's looking like right at $7K. I keep telling myself how lucky we are the price is that low and my meds/monitoring will be covered just this once.

I Need A Moment

I old my Tweeps I'd post an update on the IVF prescription situation tonight, but this migraine is taking precedence. All is well & I'll fill you in as soon as I can get rid of this headache.

Can We Just Skip This One?

Nothing new to report, no cycle progress, no funny stories to tell.

Work hell continues, but will let up considerably after this week. I try not to talk much about my work online, because that's not really what this space is about, but it's kinda all consuming at the moment. I've even been dreaming about work stuff and I really resent it.  I have to take a day trip on Wednesday which will be exhausting and mind-numbing all at once, but at least I'll be home and sleeping in my own bed at the end of the day (technically very early the next morning, but that would be splitting hairs). I'm not a great traveler. I like being other places, but I don't enjoy the process of getting there/back. Airplanes make me anxious and nauseated. And I have to admit, as much as I appreciate my immediate coworkers, I have trouble relating to them on a personal level and this makes me feel very isolated and lonely, very "other". Throw travel into the mix, and it's not a fabulous day.

Aaaannnnddd... I have some serious thinking to do about my job. It was originally supposed to be a foot in the door, to get me in with this great employer. Now it's been two years, and I'm pretty comfortable in my position. Maybe too comfortable. I've learned a lot and built some new skills and confidence. I'm really quite lucky in the people I work with on a daily basis, but there are certainly aspects of my work that make me want to bash my head against the wall. For all that, the thought of leaving my department is scary, but it's the only way I'll be able to move up at all (if I even decide that I want to move up). But with the whole IF thing still in mid-air, do I really want to try making a big change? I just don't know, so I'll sit on it for a while and revisit the question in a few months perhaps. I have made a preliminary investigation, and didn't really find any appealing open positions elsewhere in the company, so it's not as if I feel like I'm missing out on anything in particular at the moment.

When I get up (later) Thursday morning, we'll head to our teaching appointment and get our official Plan. I'd like to just skip to that, please.

Meanwhile...

I never have had any hint of acknowledgment of my NIAW letter to Human Resources requesting the addition of IVF coverage to our health plans. Crickets. Disappointing, but not surprising.

All of our pre-IVF testing came back clear. Prof deposited his back-up swim team at the clinic. Our medication teaching appointment is set for next Thursday and the IVF Team (we have a whole team!) has presumably created our plan, but no one has called yet to share it with me. I'm guessing we'll get it at the appointment next week.

I did speak with a nurse a couple of days ago, and she gave me a tentative meds list:

BCP (already taking them)
Lupron
GonalF
Menopur
Ovidrel trigger
PIO

I've already got all my GonalF (13 pens... ugh) and my Ovidrel thanks to leftovers from my covered IUIs. It only just occurred to me that the BCPs were covered by my insurance when I went to pick them up. Nice.

I also spoke to the IVF financial coordinator at my clinic in preparation for making payment arrangements, and she called my insurance for me and found they will cover my IVF monitoring appointments since I still have one unused covered IUI left on my plan. HUGE help there! She is submitting paperwork for me to find out if they will also cover the rest of my meds.

Sneaking up on IVF, one step at a time.

Anyone?

Am I the only infertile in the history of ART to walk eyes-wide-open into an out-of-pocket IVF*, fully expecting it fail? And I'm doing it anyways, because if I don't... how would I be able to live the rest of my life at peace? How would I ever be able to look my darling husband in the eyes if I didn't at least try?

*That was a lot of hyphens.

A to Z of TTC

This has been making the rounds and it's kinda fun, so here you go: TMI Central!

A. Age when you started TTC: 36

B. Baby Dancing or Sex: Groovin'

C. Children wanted: Two

D. Dogs/Cats/Fill in Children: Two cats

E. Essential Oils/Vitamins/Snake Oils: Prenatals & the occasional shot of wheatgrass

F. Fertility Meds I’ve taken: Clomid, GonalF, Ganirelix, Ovidrel, Crinone, First Progesterone

G. Gain: 20 pounds since ditching the BCP (have now lost 13, looking to drop another 12)

H. HSG (Hystosalpingogram): Whooo-buddy, check it out.

I. Infertile Pet Peeves: People who complain about how long it's taking to get pregnant, after trying for all of three months. SUCK IT!

J. Job title: Director of LaundryFolding (yeah, what-of-it?)

K. Kid’s names you’re afraid will be taken by the time you can use them: Seriously? If I tell you, you'll just steal them, because they're THAT cool. Nice try though.

L. Length of time TTC: Two years, four months

M. Miscarriages:  One, blighted ovum. Full story here.

N. Number of times you’ve switched OB/GYNS, REs, FSs: Assuming since TTC (not lifetime), none. Did get a second RE opinion, but went back to the first RE afterward.

O. Ovarian quality: No known problems

P. POAS or wait for AF: Varies by cycle, depends on how hopeful I am. Hope = POAS. No Hope = Why waste the money?

Q. Quote from an obnoxious fertile: Honestly, I'm very fortunate that there aren't any of these in my life. I've wracked my brain and come up with zero anecdotes. Please God let it stay that way!

R. RE, OB/Gyn or other? RE

S. Sperm: Above average in every factor

T. Time you tried naturally:  10 months to start, occasional un-medicated cycles since starting treatment

U. Uterus quality: No know problems. Once described by my RE as "beautiful".

V. Vagina: Yep. I got one of those.

W. What baby stuff do you already have? One sling.

X. X-tra X-tra Hear all about it! How many people know the ins and outs of our crazy TTC journey? Aside from us & our medical team? Maybe three or four. Oh, and thousands of people on the internet.

Y. Yearly Exam (do you still go in even though someone sees your lady parts most months?): Indeed, very compliant over here.

Z. Zits: Only with my period, and then it's worse than when I was a teenager. Which actually is still not that bad.

So now you’ve read mine. What are your IF A to Zs?

Show Me the Money (Updated)

Money is such a sticky subject, and one that is constantly at the forefront of most discussions of fertility treatments. We do OK. We don't sleep on a pile of Benjamins, but we know we are better off than so many others. If you remember, we paid off our car last Fall. Turns out it was a good thing too.

Our IVF cycle is coming up soon (OH-SO-SOON) and we'll need to pay between $7,000 and $9,000 up front. I maxed out my FSA this year, so it will reimburse about $6,000 of that, but only after the fact. We have to pay UP FRONT. We have a little money saved up and a little room on our credit card, but even those two options combined are insufficient to the task. After countless calls to our bank, we determined that our only reasonable option for raising enough cash to prepay our IVF cycle was to take a personal loan using that paid-off car as collateral.

(sigh)

Fortunately, the application process was quick and easy to complete over the phone. All the bank needed was a copy of our title showing all liens paid off. Oh snap! We never ordered that when we got the release after the payoff. So a quick trip to the DMV to order the new title and then wait for it to come in the mail. After about a week, it occurred to me that we had no idea how long to expect the new title to take.

Off to the internet I went and lo and behold the DMV website states that when requesting the removal of a lien, the new title can be expected in 60-90 days. OMG OMG OMG. This was our only viable option!

(Cue panic)

After 5-6 hours fraught with the fear that our lien release would not get processed in time to get the loan pushed through before our IVF start date, I checked the mail to discover the title had been delivered that afternoon. Five days. Whatever, I'll take it.

The loan was approved, the funds are sitting in my checking account. So that's that. Now we just have to wait for CD1. Today is CD1. Blood work tomorrow and BCP start Tuesday. Here we go!

UPDATED: What I neglected to mention above is that my leftovers of refills from my last (insured) IUI are almost all I need for meds. I will need to buy the BCP, Lup.ron and PIO. So, not too bad really for prescription expenses.

Letter to Human Resources

Last year, we saw Project IF for National Infertility Awareness Week. Keiko's WhatIF video made me want to start talking about infertility to someone other than my husband and my doctor. The biggest step I could convince myself to take was to start up an anonymous Twitter account and this blog.

In honor of National Infertility Awareness Week this year, I sent the following email* to my Human Resources department. I used the template provided by Resolve and made a few edits to tailor it to my situation. It's not much and at a large employer like mine, I don't know what the impact will be. But it's not anonymous and it was time to do SOMETHING:

Dear AVP of Human Resources,

I have been an employee of This Company for over two years. This Company is a valuable asset to our community and the wider region, providing innumerable benefits to employees and community members alike. This week is National Infertility Awareness Week, and I am writing to request that you consider adding coverage for in vitro fertilization (IVF) to the health benefit packages This Company offers.

Statistics indicate that one in eight couples of reproductive age in the United States suffer from infertility. That translates to 7.3 million people suffering from a disease that receives little recognition or respect for the traumatic experience that it truly is.

Recent studies have shown that the psychological impact  of infertility diagnosis and treatment is equivalent to that of cancer. According to the World Health Organization and the CDC, infertility is a disease. For many patients, IVF is the only effective form of treatment for the form of the disease from which they suffer.

Some critics of infertility treatments and insurance benefits for those treatments claim that infertility is a lifestyle choice. While it would be disingenuous to deny that some patients seek treatment as a lifestyle choice (namely to delay child rearing to a later, more stable point in their lives), those patients represent only a small fraction of the total of those in need of treatment. This criticism erroneously assumes that age is the only factor contributing to infertility. Even patients whose age might be considered a factor may only have come to seek treatment after years of trying unsuccessfully to conceive without medical intervention.

Employers often believe that adding infertility coverage benefits will increase health care costs.  However, studies indicate that including comprehensive infertility coverage in a health benefit package may actually reduce costs and improve outcomes.

For example, an employer survey conducted by the consulting firm William M. Mercer found that 91 percent of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage. For more on the survey, click here.

As proven in the following studies, the perceived cost of infertility treatment is typically overstated.

• Often patients select treatment based on what is covered in their health benefit plan rather than what is the most appropriate treatment.  For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000 -$13,000 per surgery.  Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy.Infertility as a Covered Benefit, 1997). According to William M. Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer,

• In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002).  Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations which often result in multiple births and a high rate of complications during and post-pregnancy. Read more here.
• Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month.  According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000), insurance premiums now indirectly provide coverage for “hidden” infertility benefits such as surgeries to remove scarring in the fallopian tubes for women or varicose vein removal for men, were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization. 
• The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998) 
• In vitro fertilization accounts for less than three percent of infertility services. According to the American Society of Reproductive Medicine (ASRM), 85%-90% of infertility cases can be treated with conventional medications.

Additional information on issues surrounding infertility can be found on Resolve.org. I hope The Company will consider extending infertility coverage to include IVF and support our family building efforts.  Thank you for your consideration.

Sincerely,

Moi


Baby steps people, baby steps.


*All names changed to protect my privacy.
The internet is forever, after all.

All the Cool Kids Have One

Happy NIAW!

My sweet friend Jen over at This Is More Personal is doing a fundraiser for Resolve in honor of NIAW. Go check it out and pick a little #hope for yourself!

Old Dog Searching for New Trick

Depression has been a factor in my life since my childhood. Both of my parents suffered from it. My mother sought therapy and has been on anti-depressants since before I left home. My father didn't admit he had a problem till long after my mother divorced him, but he's now on anti-depressants as well.

I've never really felt like I personally had true depression. Sure, I had down times, I had periods of situational depression. Who doesn't get a little depressed every now and then? But on the whole, I feel equipped to self-manage my blues.

I made my first foray into therapy just after I finished college, returning occasionally until I completed grad school. My diagnosis was chronic anxiety and panic attacks. I was uncertain of my path in life and needed an objective listener to talk through my desires and decisions.

One day a few years ago, I started crying at work and couldn't understand why or figure out how to stop. I left work and drove straight to my GP, which led to a diagnosis of a severe vitamin D deficiency and a temporary prescription for an anti-depressant. I took the first half dose and the side-effects were so bad (heart palpitations and hallucinations) that I was unable leave the house. I threw the rest away. Fortunately, my doctor also prescribed a mega dose of vitamin D which kicked in within a week or so and my depressive symptoms abated.

There have been a handful of times in my life when a case of the blues developed into what can only be described as a Black Cloud that cast every aspect of my life in gloom and shadow. At these times, I felt that there was absolutely no point in continuing my life as I knew it and the only solution I could see was dramatic and all consuming change. In short, I would drop everything and run. Nothing like walking away from your life and reinventing yourself to force yourself into Hope for the future. Not the healthiest strategy perhaps, but a fresh start was 100% effective.

This is the first time since getting married and buying our house that I've spent so much time under my Black Cloud, and my usual tactics won't work here. Running is not an option anymore. Perhaps that's why I feel so hopeless and desperate this time. I need a new strategy and I'm at a loss. I need a new trick.

Romeo

OMG y'all. So funny I just had to share.

The temps are quite lovely today, so we've got the windows open around the house. We're just hanging out and we can hear people outside talking and calling to each other down the street. All of a sudden we hear someone calling their dog:

"Romeo! Romeo! ROOMEEOOO!"

And Prof exclaims:

"How can you not finish the line!? WHEREFORE ART THOU ROMEO!"

I'm dying here. He kills me.

I Don't Know What to Say

My husband asks how my day was, and I don't really have an answer.

My parents call on the weekend to catch up, and I have nothing to tell them.

My colleagues ask how my weekend was, and I can't remember what I did.

My BFF texts to check in, and I don't even know what to text back.

I read your tweets and blog posts, and I don't know how to comment.

I open a new post on my own blog, and I just don't know what to say.

Holla Georgia!

Hiya! I know I have a bunch of readers in Georgia and I'm hoping you lovely peaches will head over and give my bloggie buddy Waiting Vicky the benefit of your experience. She's contemplating traveling to the United States for treatment and is looking for recommendations in Georgia, specifically in the Atlanta area.

Thanks y'all!

Much Ado & Motivations

I've been lurking in the online IF community for years. After NIAW last year and Keiko's stunning What IF video, I created my IF Twitter identity and opened up a line of communication (albeit anonymous). Shortly thereafter, I started this blog. And over this last year I've "met" hundreds of you who are riding the same roller coaster I am. Hoping, trying, losing, hurting and surviving to hope again.

In the last week, so many in this community have lifted their voices in outraged response to the ignorant and disrespectful publicity stunt by PETA, and our combined voices turned out to be loud enough to bring about change. There is something inspiring about watching scores of my online friends "coming out" about their infertility in response to their outrage against this ubiquitous ignorance. And something so satisfying in seeing A Result.

When we think about the amount of effort it will require to make an impact in our governments or to change the way society as a whole views infertility, it can seem daunting and overwhelming. It can seem like too much of a fight for one person to sustain. And that's partly because we are all so accustomed to feeling alone and isolated, that it FEELS like we are fighting this alone.

I'm grateful to PETA for providing such a catalyst to our community. NIAW is important to us as a community, but it is OF our community. Having a common target, and one we perceived to be within our sphere of influence, was motivating in a completely different way. PETA has proven to us that we can act together and as such we can make a difference.

I am only one voice, but I know that many of you out there are also making yourselves heard. I want to say an extra Thank You to Keiko and Katie who have both been so persistent and so eloquent on our behalf for more than just the last week. This community needs people like them. Please let them know how much their advocacy means to you.

Can we be loud enough to make ourselves heard by our "elected leaders"? Can we be loud enough to make ourselves heard by our individual employers? Can we be loud enough to make ourselves heard by our friends and family?

March

Now that we're in April, I can announce that I hate the month of March. It's the most miserable month for weather. Every climate I've lived in has basically sucked in the month of March. In Texas it was windstorms and pouring rain and tornadoes. In Florida, it was generally nice enough but not quite warm enough for the beach (a truly grave disappointment in my early 20s). Now that we live so far north, March wavers between more damn snow and rain that melts what snow there is, leaving everything a gloomy mud color.

The weather is the least of my dislike though. Year after year, the blasted month of March drops some kind of bombshell on me. I've grown accustomed to it. Every year, I hope this will be the year that breaks the streak even as I brace myself for whatever might be around the corner.

This year, I thought that by NOT mentioning it, I might be able to break the streak. When we had reached the second to last day of March with no disasters, I kept my mouth shut lest I jinx this seemingly brilliant luck. I should have known better.

As disasters go, it certainly wasn't dire, but on March 31st, we got our tax forms in the mail from our accountant. I then had to wave good-bye to nearly $2,000 that I'd been hoping would go towards IVF. As disasters go, I guess it could been so much worse. Other years have certainly dealt more serious blows and at least we had the cash saved up and could pay up without penalty and interest. Still.

Public Service Announcement (UPDATED)

I feel like a total idiot, but I need to share this with you all just in case you are as un-observant as I am.

I was cleaning out my fridge this weekend and organizing my crisper full of Gon.alF by expiration date and I made a discovery.

The expiration date on the pharmacy's prescription sticker was NOT the same as the expiration date on the actual box the pen came in.

Big revelation, huh? I hadn't even realized there was a date on the actual box. I only saw the one printed on the pharmacy sticker. My pharmacy is part of my health insurance company. Those sneaky bastards put an expiration date FIVE FULL MONTHS earlier than the one printed on the box. And the most recent batch of meds I received... the pharmacy sticker has a date that is THIRTEEN months earlier than the date on the box.

Anyway, the moral of the story is check your prescriptions carefully to be sure of the expiration date. Don't let the insurance bastards put one over on you.

UPDATED: (re: Rx expiration vs Meds expiration) Excellent question C, and one I asked myself at first as well. But no. I know this because when I called the pharmacy in January to order a refill, they told me the Rx had expired and I would need my RE to call in a new one. The last box of medicine I had left over from the previous Rx had an expiration date of 3/01/2011 on the pharmacy sticker. More than two months after when the pharmacy told me the Rx had expired and yet five months earlier than the date printed on the box.

Siren Song of a Seed Packet

The ground is still covered with a light blanket of snow. The temperatures have been topping out in the low 30's. I hate working out in the yard at any time of year.

And yet.

With the imminent change of seasons, out come the display racks filled with colorful seed packets. And I can never resist. Last year it was parsley. This year, I bought cilantro seeds because I always resent buying the huge bunches in the produce section at the grocery (seriously, who needs that much cilantro?). Whether or not I will actually PLANT the seeds is another question entirely. But I just couldn't resist the little yellow envelope. I never can.

Hope springs eternal in almost every aspect of my life. I cannot for the life of me fathom how or why.

I'm OK

Just don't have anything to say at the moment.

Things to Feel Good About

So now we wait. Again. There really is no end to the waiting in this game is there?

I call with my next CD1 and we do a bunch of baseline stuff & blood work. Depending on our calendars and my cycle lengths, I will probably start BCP in early May. In the meantime, I don't really have much to report. I'm trying to focus right now on the good stuff, things I can be grateful for in the midst of all that is so unfair about this situation.

Aside from the fabulous support group I've found here and on Twitter...

• I already have most of the meds I will need for IVF and what I don't yet have, shouldn't be too costly.
• Our cars are both paid off.
• My student loans are all paid off.
• Our back taxes are all paid off.
• Our only remaining debts are our mortgage and one credit card (though it IS a doozy).
• Prof has contracts booked through the end of 2011. This is huge!
• 2010 tax materials have been passed to the accountant and she said they "look good". No whammy, no whammy!
• We have not yet needed to use the (tiny, tiny) savings we put away last year (knock on wood).
• The weather should only improve from here on out.
• My boss is back in the office, so my work stress should decrease.

These are all good things. Breathe in, breathe out. Let go.