IVF #4 = 1 Embryo

I haven't had time to post, last week was super busy with all the Halloween activities.

The results of my IVF #4 Cycle = 1 Embryo

Details:

I had my retrieval on Tuesday, October 30, 2018.

• Eggs Retrieved: 3
• Eggs Mature: 2
• Eggs Fertilized: 1

To say I was disappointed... is an understatement. I received updates on Day #1, Day, #3, Day #5, and Day #6: 

Day #1: Is when I found out that only 2 were mature and it looked like only 1 fertilized 

Day #3: The fertilized embryo was looking great and was at 8-cells 

Day #5: The embryo was looking good, but wasn't ready for biopsy (early blastocyst)  

Day #6: The embryo finally was ready for biopsy and was frozen 

The Embryo is a Grade 1 (which is my clinic's highest rating). My son was a Day 6 embryo and a Grade 2 embryo. 

I tell you... it was a rough week emotional-wise. I wasn't sure what was going to happen and the stress was so intense. Not to mention, we were just so busy as a family - so many Halloween activities going on. 

Next step is waiting for the PGS results of the embryo.... with my age, there's a 50-50 chance the embryo will be normal. I don't like those odds very much... 

Thoughts: 

I'm trying not to think too far in advance... BUT, I can't help it. Things jumping through my mind: 

- If the embryo is abnormal - I would need to switch clinics and go to a cheaper one. I would need to save enough money to do another cycle, so I wouldn't be able to cycle until Feb/Mar of 2019. I am willing to do ONE more IVF cycle with my own eggs. But I need a different IVF protocol and I need a more affordable clinic. 

- If the embryo is normal - this would be AMAZING! However, PGS-normal embryos don't always lead to a viable pregnancy. I believe it's a 60% chance. There's also a chance the embryo wouldn't survive being thawed. My thoughts on this: maybe I will push up a FET date to early 2019 (originally I wanted to wait for a FET until July 2019), that way if it doesn't work I can fit in another IVF cycle in summer 2019. The rush? I turn 39 this year... I'm sure the results will not get better the longer it takes for me to do an IVF cycle. The sucky part of doing an earlier FET is that if it works, I won't have the 3 year age gap I was hoping for... I also have some work career goals I wanted to meet in 2019. 

BUT, as all things with fertility treatments - nothing is guaranteed. I'd rather have a closer age gap between the kids vs. not being able to have another baby. I'd also put off all career aspirations for another baby. You know? Having another baby trumps all that. 

- Then there's the thought of doing donor embryos, in the event this embryo is either abnormal or doesn't lead to a pregnancy if normal, and another IVF cycle has similar results... 

- Or possibly doing IUI's - which I don't think is cost effective and then there's the egg quality issue. But maybe I'd get "lucky?" 

Lots of things running through my mind... and I have to wait TWO more weeks to have a clearer picture on what to do next. 

Needless to say, I've started a few projects to keep myself occupied! I'm working on decluttering the house (yes - AGAIN), I'm working on multiple photo books (I WILL complete at least ONE), I've started some new cleaning / house management routines, and I've been reading books on strong-willed children - because I have two of those :). 

Trying to keep busy... hoping time flies by fast... praying this embryo is PGS-normal... 

IVF #4: I have an Egg Retrieval Day

A little behind on posting... but to cut to the chase, I have an egg retrieval day! Retrieval will be on Tuesday, October 30, 2018 @ 11:30 a.m.

Now... the details.

Monitoring Appointment #3, Friday October 26, 2018, Stim Day # 9

I thought this appointment would be the day where this cycle would be clear. But it really wasn't... there were maybe 5 follicles to work with and my estradiol levels were 722.7.

At this point I knew we weren't going to have the egg retrieval on Monday (10/29). There was still a possibility of canceling the cycle.

Monitoring Appointment #4, Sunday October 28, 2018, Stim Day #11 

So, it was weird to stim longer than 10 days because I only had supplies for 10 days. The nurse told me on Friday that I should just not do my morning injections until after my appointment. Well, I didn't have any Menopur left anyways. The RE told me to just use ALL the remaining Gonal-F and do the Lupron shot - then I'd be done with injections.

My estradiol level was 1141.7. If you estimate about a level of 150 per mature follicle, you're looking at maybe 7-8 follicles. But from my ultrasound, he was only really able to see 3-5... So, I don't know what that means for retrieval or if estradiol levels are really reflective of the # of mature follicles. For my IVF #2 they were pretty aligned (estradiol level as about 1400 and they retrieved 9 eggs / 8 mature) - but they were also able to see 8 eggs during the ultrasounds.

Trigger Shot

I received notice to trigger @ 11:30 p.m. tonight and that my egg retrieval will be 36 hours later on Tuesday, October 30, 2018 @ 11:30 a.m.

Thoughts

It's hard not to be disappointed. I can finish this cycle with absolutely no embryos... I'm trying not to think that way, but I'm also trying to be realistic here. If they are only able to get 3-5 eggs -- how many will be mature? How many will fertilize? How many will make it to blast? How many will be PGS normal? The percentage goes down with each "how many" and when you don't start off with "many" -- you can see my non-mathematical brain doing the numbers here.

As much as my brain is doing these calculations... I am really hopeful that the ONE future baby egg is in there...

I'd lie if I said I wasn't already thinking about next steps, because I totally am. I love my fertility clinic, but they are pricier than a lot of other places. I've mentioned that I've basically exhausted my lifetime max of fertility benefits with this cycle... so, if I move forward with another cycle it'll be 100% out of pocket. Meaning, I need to go to a different clinic. Also meaning I need to save money to fund another cycle. I'm not getting any younger here, so time is of the essence.

Trying to be optimistic about the odds... but also trying to be realistic on what the next steps may be.

For now, just hoping and praying that there is at least ONE good egg in there that will be future baby...

IVF #4: Monitoring Appointment #2 (Stim Day 7)

I had my monitoring appointment yesterday. I'm not really sure what to make of it!

The Right Ovary 

There were 4 follicles:

- 1 is way to big, most likely a cyst
- 2 are also big, but not as big as the possible cyst
- 1 is the "right" size, about 10 mm

The Left Ovary

- There are about 5-6 follicles, but they're all small, about 7-8 mm

Apparently, the follicles on Day #7 of stims should be closer to 10mm. The follicles in the left ovary are more like Day #5 of stim size.

From my Piper Patch IVF Notebook ((https://www.piperpatch.com/):

When I received my E2 levels, I'm at a 494.9. My portal message:

No changes to your medications! Please continue your most current dosing and continue to follow the calendar instructions at this time.
See you at your next appointment on FRIDAY.
If you have any questions please feel free to call us.

The cycle was not cancelled.

The thought process is, if the follicles in the left ovary keep progressing, we would skip the follicles in the right and aim for the left. Which may lead to extra stim days with a possible retrieval day of Halloween. Not ideal, but it would be worth it to get 5-6 eggs. If the follicles in the left don't grow, try to get the ones in the right... but since they are growing so fast - will probably not result in anything. There was talk about just doing an IUI... but since I have polyps from my saline ultrasound, it's not really an option. Not to mention, I want a wider age gap from my youngest.

I'm not really sure what to think or expect from this cycle. It's kind of been all over the place really. I have another monitoring appointment tomorrow (Stim Day 9).

Random Stuff

I'm running out of real estate on my stomach. Starting to get bruised up and not many places to put my injections. My son has also gotten curious about me doing my injections. Can you imagine I went through fertility treatments for 2 years and he never once noticed me doing shots? I also went through the majority of my pregnancy doing insulin shots and he never noticed. But now, he totally notices.

What's also interesting is trying not to freak out while doing my injections (it's still hard for me to stick the needle in) - while having my toddler cry and my preschooler yelling. LOL. Talk about distractions! Can I get a minute of quiet to give myself a shot? Nope. LOL. I've had no choice but to just suck it up and inject, so I can take care of business. I guess it's good in a way or I might stand there forever hesitating!

Since yesterday I have started to get some aches in my ovaries. I don't remember if I ever had aches or pains when I was stimming before... not like this. I tried reading some of my old blog posts to see if I mention any aches or pains. It's VERY uncomfortable. Then... when you have two kids body slamming you during story time... Ouch!!

I also noticed an increase in my CM. I'm hoping that's a good sign for my E2 levels. From what I recall, I believe my E2 levels really need to double by tomorrow...

Thoughts

I had an interesting situation at my appointment yesterday. My son had an appointment in the morning and my monitoring appointment was right after his appointment. So, I had to bring him with me to my monitoring appointment. I think with all of my fertility treatments, I have only had to bring him maybe twice in all that time. He's older now... and curious. I thought it would be a bit awkward to have him in the exam room while having a transvaginal ultrasound!

One of my SMC friend's was so sweet and offered to come to my appointment and sit with my son in the waiting room. So very nice of her! I am so grateful to have a friend like her and willing to go out of her way for us.

What I've also found difficult about going through IVF this go-around is that I'm also very busy at work. Making these appointments has not been easy. Going through stims has not been easy. Having a potential moving egg retrieval day has not been easy. Trying to not tell my manager that I'm going through IVF has not been easy (I've chosen not to say anything). Work commitments are going to be hard to shuffle around next week. I'll make it work, of course, but it's just an extra stressor.

I'm not really sure how I'm feeling about this cycle... My RE said I do a good job of being optimistic, while also being realistic. LOL. I think I had prepared myself for the cycle to be cancelled yesterday. But when it didn't... and we are still going... I really want to get to an egg retrieval at this point. I'm now 8 days into stims and I can't do an IUI. I would just hate for all of this to have been for nothing.

A bit concerned about the appointment tomorrow, but holding my expectations in line.

With all things IVF, it's one step at a time. And of course, keeping my Fingers crossed.

My October calendar so far:

Let's see what happens... 

IVF#4: Monitoring Appointment #1

I had my monitoring appointment yesterday. In my early blog entries, I mentioned that my clinic has a "baby wall" that includes pictures of all the babies born with their help. When I went into the exam room, guess who is now on the wall -- my baby boy!!!!

It brought so many emotions seeing his newborn picture on the baby wall. I used to cry looking at the pictures and wondering if I would ever be able to have a baby and if he/she would ever be on the wall... and now he is :) It brought me back to the reality of life and out of the funk that TTC can put you in.

I always love seeing my RE. I showed him some pictures of my boys from the pumpkin patch and he gushed over how big my babies have gotten. He's such a nice guy.

Back to the monitoring appointment... it didn't go so well. From my Piper Patch IVF notebook (https://www.piperpatch.com/):

There are 3 follicles in the right ovary, but they're growing too fast. One is so big, that they aren't counting it - it's most likely a cyst. The 3 on the left are growing at the right pace. So really, working with maybe 5 follicles. My estradiol level was 322.4. 

Just for some comparison, here is what it looked like at my previous cycles: 

Monitoring Appt #1 (Stim Day 5)	IVF #1	IVF #2	IVF #3	IVF #4
Uterine Lining	11.56 mm	5 mm	4.5 mm	N/A
E2	280.5	252	254.5	322.4
Right Ovary Follicle Count	4-5	3	3	2 + Cyst
Left Ovary Follicle Count	2 + Cyst	5	2 + Cyst	3
Total Potential Follicles	6-7	8	5	5

Looking VERY similar to my cancelled IVF #3 cycle... 

So, I'm not really sure what to expect... I knew by my second monitoring appointment that the cycle would be cancelled. I guess we'll see what happens then. But when you think about it... at IVF #2, my stats were: 

• Retrieved 9 eggs, 8 mature, 7 fertilized with ICSI, 4 made it to Blasts. 

My embryos weren't tested... but they were all transferred and resulted in 1 baby.

When you start thinking of the odds. For my age, about 50% of embryos would be abnormal. I know it only takes 1 egg... but gosh, it worries me considering not all eggs will make it to blast.

Feelings 

It's hard not to be disappointed... and to contemplate next steps if the cycle is cancelled. I know there's absolutely nothing I can do about being a low responder, unfortunately. I am healthier now than I was on my previous cycles. But I'm also older... so I expected to have a low response due to my AMH levels.  

So - why do I feel so sad about it all? 

I was playing with my kids last night and I was thinking "I am so lucky." I have two little miracles already... will I get a third? I almost feel greedy in a way wanting another miracle. But then I thought about what things would look like if I stopped trying for Baby #3 and I had an ache in my heart. 

I don't know what that means or what choices I'll make. I'm still very hopeful this cycle will lead to an egg retrieval and that one of these follicles will lead to Baby #3. 

Next Steps: 

• Monitoring Appointment #2 - 10/24/18 
• Monitoring Appointment #3 - 10/26/18 

Stay tuned...! 

IVF #4: Started Stims - Stim Days 1-4

I started my Stims on Thursday, October 18th. It took me awhile to get into a rhythm with mixing the Lupron, Menopur, and Gonal-F. Four days in, I think I've finally got the hang of it and don't need to read any instructions anymore!

Now... giving shots. It's still hard. I still have to do some deep breathing. A few times I've bled from my injection site, which historically has been rare for me. Today, on day #4 of stims, the needle burned going in. I did hesitate both times, which may be why it burned. Ugh. It doesn't make it easier for me to do my injections.

Day #1 of Stims: 

Other Things: 

• I did start my period after I stopped birth control. I don't think I've started my period each time before cycling, but I did this time. It wasn't light either... which I think it's supposed to be. But when I'm on birth control and other meds, my cycles are never "normal" really. 
• Headaches... not sure if it's due to my crappy week (more below) or if it has to do with the meds. But man... headaches galore!!! Like lingering, deep in your skull, throbbing, headaches. 
• My patience is depleted. Stick me with hormones and I'm just a mess! Poor kids, don't mess with Mama right now. LOL.
• Hot flashes.... hot flashes... hot flashes... these started on Day #3 of stims. 
• I received an email to register with the PGS testing company. I signed all their consents and I guess I'm in the clear to use them now. 

IVF #4 Shot Count: 12

Crappy Week

I had an uncharacteristically crap-tastic week. First, I had a work deadline that just went wrong-wrong-wrong. Second, I had to put my dog down :(  Third, I started stims and my hormones are a mess. 

I'm a bit of a mess over putting my dog down... he was a great pup. Even though I knew it was coming, it was such a hard and difficult decision. Though, I know it was the right choice to make for him. The hardest part about it all... is having to explain to my kids that our dog has died. Having my oldest go downstairs and call/look for the dog because he forgot he died. Having my youngest throw his food on the floor and call for the dog to come get it. It just all around sucks. Not to mention, I miss my dog :(  It's strange all the small things you do for your pets, you don't even realize how much it's a part of your routine until you don't need to do it anymore. I found myself opening the screen door multiple times to let him outside or looking for him in his normal spots or seeing him when we first get home. Ugh... hardest part of pet owning. I think it's going to be awhile before we get another pet. 

Next Steps

Tomorrow is kind of a big deal for me, it's my first monitoring appointment. During my cancelled IVF cycles (IVF Cycle #1 and IVF Cycle #3), Day #5 monitoring is when I knew there was a possibility of the cycle being cancelled. 

I almost feel "blind" in a way going into this monitoring appointment, as I have no clue how many follicles I'm working with, as I never had an Antral Follicle Count, which I've always had in my previous cycles. The only thing I can think is different this round is that a different doctor did my scans and she wasn't as thorough as my normal RE is. 

My calendar from my Piper Patch IVF notebook (https://www.piperpatch.com/): 

I've really been enjoying using my Piper Patch notebook. I keep it on my counter and look at it each day. I like physically checking off the calendar days and having a page designated for each day. I also really appreciate the daily affirmations. From my Day #1 cycle page it reads "I trust my body." I need to repeat that one right now!! 

I'll update again after I have my monitoring appointment, to see where I stand on this cycle. I wish I had a gut instinct on what I *think* was going to happen. But really, at this point - I have absolutely no clue. I always find this monitoring appointment "funny" in a way... I will technically be half-way through stimming... so half-way to an egg retrieval. But it always ends up being a tipping point - retrieval or cycle cancelled. Two completely opposite directions. Crazy. I can't do an IUI this cycle, so if it's cancelled - all the time and money gets washed down the drain. 

<sigh> I just can't help but try to mentally prepare for the possibility of a cancelled cycle. 

Need to think positive though! Fingers crossed for a good monitoring appointment and for a continued cycle. 

Stay tuned. 

IVF #4: Started Lupron

It feels "official" now... I have started Lupron.

I have to admit to feeling a bit intimidated with giving myself shots again. Which I think is so odd because I gave myself shots all throughout TTC and also throughout my pregnancy. Maybe I'm a bit traumatized by it all? 

It took me a few minutes to calm myself down. I did some deep breathing, but I finally was able to do my injection. The morning one was the hardest! The evening one went a little faster, though I still hesitated. 

But it's done. Day #1 of shots. Not officially "stimming" yet, but almost there. 

Thing I'm glad I remembered to do: pump the needle. The needles can be hard to inject - by moving it up/down a few times before collecting the medicine, it makes it easier to push the plunger. 

Here's my calendar from my Piper Patch Notebook (https://www.piperpatch.com/) and a picture of my meds / lupron needle: 

I really like the daily affirmation for today in the Piper Patch notebook :)  

I'm going to keep a "shot count" this cycle. I wish I would've kept a record of it for my other cycles and throughout pregnancy, then I could say "I did XXX number of shots." I suppose I can go back and count them, but that's just too much work! 

IVF #4 Shot Count: 2

My Thoughts 

This cycle is so strange in a way... it almost feels like I'm not really going through IVF again. Starting this process brings back so many memories and so many years of having this "dream" of building my family. Yesterday I was watching my boys play together outside and it brought happy tears to my eyes. I feel so fortunate and so grateful to be their Mama. 

I'm starting this cycle in a different place than I did back in 2014/2015. Back then, my oldest was still my foster child and I wasn't sure I would be able to adopt him - so much uncertainty around his case plan. My youngest was a dream I was chasing, which I would chase for almost 2 years and tens of thousands of dollars - all worth it. 

As I sit here thinking about my family and this life we're building together... I can't help but feel like any potential future baby would be so lucky to have my boys as his/her brothers. And also how lucky my boys would be to have a new baby brother/sister. I am grateful that I'm able to try for another baby. 

Next Steps: Continue Lupron for another day, then start Stims! 

IVF #4: The Insurance Dance

I swear... the most stressful part of going through IVF isn't going through stims... or having endless monitoring appointments. It's trying to get the darn approvals through my insurance.

What an absolute headache.

Medical Insurance

I received my approval for infertility coverage, which was good. But then I found out that they would not cover ICSI. Why? Because they said they only cover it if there is a semen analysis (SA) issue. The reasoning is: I'm using donor sperm, therefore there is no SA issue. Doing traditional insemination with IVF isn't really that reasonable since ideally you would have more sperm. The donor I have is an ART vial, meaning there are less sperm in the vial. It's itty bitty. I'm contesting the decision, but I can't help but be annoyed / irritated that they would say any one using donor sperm doesn't qualify for ICSI coverage. There is a reason people use donor sperm.

Reminder of what ICSI does:

Pharmacy

I ordered my meds last week and I barely just received them today. Why? Apparently they needed all these approvals and they didn't let me know they needed them and they didn't try to get them on their own. When I finally figured it out, I had to wait for them to go through their process of approving the coverage. Then, they ended up shipping my meds at the wrong time. Just an absolute mess.

Cycle Pay Day and Injections Training - 10/11/18 

Which led to my cycle "pay day" and injections training. I ended up having to pay for ICSI, which was unexpected and more than I budgeted for. Costs breakdown:

IVF Clinic: 

• Co-Insurance: $330 
• PGS Biopsy: $2,250 
• ICSI: $1,525

Meds: $1,579.55

Total for this week: $5,864.55 
Total Year to Date: $6,018.67

Costs TBD: PGS Testing - $150 per embryo + $150 Shipping

I've officially hit my max out of pocket for my insurance for the year. Even with insurance coverage, not a lot is covered. 

I had my injections training... which you would think wouldn't have been a big deal - but you'd be amazed at how much I've forgotten. It was a nice refresher! Also, all the paperwork!!! Oh my... Signing my life away with waivers and deciding what would happen to my embryos "if" such and such happened. 

They even talked to me about "family planning" and if I wanted to choose a boy/girl for transfer... I think most people expect me to say "I want a girl" considering I have two boys. But really, I just want another baby. Boy or girl. It doesn't really matter to me. I also don't know if I'm going to have options, so I don't want to get stuck on a boy/girl just this moment. 

Before the injections training, they did do a quick ultrasound to check for cysts. No cysts, I'm in the clear. But they didn't count the follicles, so I feel kind of in the dark about how many follicles I'm working with this cycle... if we go off what they found last month - there were 9. 

BOB Arrived 

Even though the week kind of sucked trying to deal with the insurance and pharmacy issues... hours and hours on the phone. (Just to note, I had a stressful week at work and worked over 50+ hours - so it sucked just that much more trying to find the time to call.) Receiving the Big ol' box of meds was... amazing! 

There's something about receiving all my meds that made this feel so real. It also made me start feeling all the feels about, "I really want another baby." I may have shed some happy... anticipatory tears... at the possibility of this potential baby. 

Piper Patch IVF Notebook

A local SMC friend, that went through IVF, developed this amazing IVF notebook!! I was so excited to receive one. I loved the package and the cover. I'm absolutely loving the notebook for tracking this IVF cycle, I feel so organized :) I really wish I would've had something like this when I was cycling the first time, it's super useful. I'll be sharing some pages from the book as I use them. 

Link to the website: https://www.piperpatch.com/

My IVF Notebook: 

My IVF Calendar

Here's my calendar spread from the Piper Patch IVF notebook: 

Next step is to stop birth control tomorrow, 10/13/18.

Feelings

My relaxation going into this cycle is completely gone and is non-existent after this week!! Dealing with the insurance, the extra costs, the pharmacy, the approvals, work deadlines, and work "issues" -- I've just about had it this week.

I'm also really feeling the "I want another baby" feelings... which worries me if the cycle doesn't turn out the way I hope it does. Would I even be able to afford another cycle at this point? I don't know if I will... But I also don't know if I won't try anyways... My heart is "all in" with adding to our family, I just have to make sure I keep my head in the game and make good decisions.

After a rough week, I'm going to try and get back into a more mellow frame of mind and relax. I'm going to try and enjoy spending time with my boys this weekend.

Here's to hoping and wishing and dreaming...

IVF #4: IVF Calendar has officially arrived

It feels like such a long time to get this IVF cycle started... and here I am -- ALMOST there!

Since the last time I wrote: 

1. I stopped birth control on 9/17/18, as directed from my RE. 
2. AF arrived on 9/20/18. I called my RE's office and my next directions were to start birth control again on 9/22. 
3. TODAY I received my IVF calendar. 

Some random things I forgot: 

• I tend to spot while I'm on birth control. So, it was kind of hard to determine if I was having the start of my period or just spotting from the birth control. 
• The WAITING for everything feels so very long... like insanely long. I thought I'd get my IVF calendar right away. Nope, just got it. 
• I have to give up caffeine during stims.... oh no... what ever will I do without my one cup of coffee in the morning... I feel total sadness over this, which is silly. LOL. But man, I love my morning coffee! 
• My mood swings on birth control are so bad. I swear, I hate being on it. I know it's going to get worse when I start stims. 

Things I didn't know: 

Apparently I needed to register with my insurance for something called the "Women's Health Program." I don't recall having to do this before. Maybe I did? Maybe I didn't? Maybe it's new? Who knows... But, this has to be done in order to get my insurance fertility benefits to kick in. So they asked me all these questions like, "have you been trying long to have a baby," "Do you have irregular periods?" etc etc. It takes about 5 days before they approve it. I'm waiting for the call back from a nurse to see if they'll even approve my fertility coverage... which I think is odd since I don't believe my employer has any stipulations on the lifetime max fertility coverage. 

My response: "I have not been trying long as I'm single and will be using donor sperm, so not like I could be trying." Then: "I've also been diagnosed with unexplained infertility, which should be in my records." Because umm, my insurance provider has not changed. Man... insurance companies annoy me. Jump through hoops, I swear. I'm concerned they're going to deny coverage or something, say I need to try 6 times before coverage kicks in or something like that. But I'm not going to stress about that at the moment and cross that bridge if it comes. I have low AMH, so I believe I can also use the "diminished ovarian reserve" argument as well. Will see. 

Medication Order: 

My medication order was submitted to a different pharmacy... which I thought was weird. I had to call them to request them to send it to my normal pharmacy. Which means I should be getting my BOB (aka Big Box of Meds) either late this week or early next week... When I receive that... it'll start feeling extremely real to me. 

IVF Calendar: 

1. 10/10/18: Injections Training and Cycle Pay Day 
2. 10/13/18: Stop Birth Control 
3. 10/16/18: Start Microdose Lupron 
4. 10/18/18: Start Stims - Protocol: Microdose Lupron Flare Protocol  
5. 10/22/18: Stim Day #5 - First monitoring Appointment 
6. 10/29/18: Estimated Day of Egg Retrieval 

Thoughts: 

Everything with IVF is so completely unpredictable. I have no clue if I'll respond well to the protocol or not. If I'll even make it to egg retrieval. I want to say I'm optimistic... and I am, in a way. However, with everything that I went through before - I know I need to be real with myself. I'm trying not to have too many expectations and just go with the flow. So far, I've managed to do that and just roll with it. But at the end of all this... I really want another baby. I feel totally invested in adding to my family. 

So... fingers crossed and baby dust sprinkling all around that there's at least one good egg in there. 

IVF #4: Saline Ultrasound

I had my saline ultrasound (SHG) this week. I’ve had this test two times (?) prior. The first time was with my initial fertility tests when I first started back in Dec 2014/January 2015. At that SHG they found some uterine defects, which they thought were fibroids: 

https://creatingfamilyc.blogspot.com/2015/01/sonohysterogram-fibroids.html

This finding delayed TTC since I had a hysteroscopy and turned out that I had a polyp: 

https://creatingfamilyc.blogspot.com/2015/02/surgery-i-survived.html

That was my first ever surgery (besides wisdom teeth removal). 

Going into this SHG, I didn’t really think much of it. I wasn’t really nervous or worried too much about the results. Mostly because worrying doesn’t change the results. I actually expected them to find polyps. 

The actual SHG wasn’t too bad. Some cramping and discomfort, but nothing crazy. Well, turns out I have a lot of uterine defects this go around. Like a bunch! They are most likely polyps. 

The suggestion is to have another hysteroscopy to remove them a cycle prior to a transfer. 

A few things to consider: 

1 - I won’t be doing a fresh transfer. There won’t be time to do the hysteroscopy prior to the October retrieval week (unless I pushed it back - which I don’t want to). 

2 - when do I have the hysteroscopy? If I do it this year, the cost is significantly lower because I’ve met my deductible and have almost met my co-insurance. If I wait until next year, it would be approx $1400 vs $250 this year. 

3 - it’s better to do the hysteroscopy the cycle prior to a transfer because it’ll serve as an endometrial scratch. Which I did for my successful FET that led to my son: 

https://creatingfamilyc.blogspot.com/2016/08/fet-2-cycle-11-endometrial-scratch.html

4 - I wasn’t planning a transfer until summer 2019. Do I move it up? Maybe do the hysteroscopy in Dec and a FET in Jan? 

So... I’ve been thinking about all these different scenarios / possibilities. I’ve decided not to really make a decision until we see how my cycle goes. Since I’ve had 2 failed IVF cycles before, I’m still really cautious to keep my expectations realistic. Nothing in my lab work is leading me to believe that I’ll have an easier time this cycle. 

Right now, the plan is to still wait until summer 2019 for a FET. I think the age difference between baby #2 and potential baby #3 is more important to me. 

Lab Results 

My AMH went down since Dec 2017 from 0.75 to 0.64. Which is bad. 

My FSH went down since July 2018 from 10 to 7. Which I think is good. 

A low AMH is supposed to show diminished ovarian reserve (DOR) and also that I may not respond well to follicle stimulation... 

Costs 

I received the cost for my cycle and it’s not too bad, considering I am in co-insurance land. I also have a lifetime max fertility coverage from my company, which I will exhaust with this IVF cycle. If I need another IVF cycle, it’ll be completely out of pocket (~$13k + ~$5k for Meds). 

- Cycle Cost: $1300 My out of pocket co-insurance - includes IVF monitoring + retrieval 

- PGS Cost: $2250 to my clinic + costs to the PGS testing company. $150 per embryo + $150 shipping 

- Fertility Meds: TBD 

Thoughts 

In a way, a lot of stuff is riding on this cycle working! Between DOR, polyps, & costs... Things can go so many different ways... I almost can’t wait to get it over with, just so the mysteries of the “what if’s” can be resolved. 

I’m still not feeling too overwhelmed with the cycle yet. However, I am pretty short-tempered on birth control and I’m also retaining a lot of water. I really hate being on birth control! 

Overall though, I’m doing ok. I just want my IVF calendar so I can start planning. I should get it next week / week after, once AF starts. 

Next Steps: 9/17 stop birth control and wait for AF 

IVF #4: Baseline Ultrasound + Bloodwork

My cycle is officially underway... kinda. 

Waiting for AF

AF finally came 11 days after my last provera pill. I always wonder if provera stalls my period from coming naturally and delays it. 

When AF finally came, I made the call to my RE to schedule my baseline ultrasound and blood work. It’s so strange... but it was really exciting to schedule my appointment and to begin prepping for my cycle. 

Baseline Ultrasound 

My ultrasound was with a different RE. She’s the newest RE at my fertility clinic and was there for one of my IVF procedures when she first started. She’s nice and all, but I really do prefer my RE. Interestingly enough, I had 9 follicles - 6 on the right and 3 on the left... which is the same number of follicles I started with when I had my one and only retrieval. 

Blood Work 

Had massive blood work taken....! Interested to see what the results show with my AMH & FSH. I really do hate having my blood drawn. 

IVF Calendar 

No “official” IVF calendar yet... they started me on birth control, which I’m supposed to take from 9/4 until 9/17. I’m only taking the active birth control pills. Then, I’m supposed to call when I start my next period. After that — I am supposed to get my “real” in-depth IVF calendar. 

I scheduled the saline ultrasound for 9/10. 

Thoughts 

It kind of feels surreal starting down the IVF path again. I guess it’ll start feeling more “real” when I start injections. But right now... it just feels far away - if that makes sense! Life is so busy with my boys and work, which keeps me pretty occupied. 

My oldest son keeps talking about having a baby sister and also has said he wants another baby brother. He brings it up himself from time to time, which is interesting! 

I am most anxious to see how the cycle turns out... I’m not sure how many times I’m willing or able to go through IVF this time. I’m really hoping that 1 retrieval will do the trick. 

I remember going into my fertility clinic when I first started and seeing all the pictures of babies on the walls... I have to say, seeing the pictures still brings so much emotion out of me. Babies are such miracles... and it’s pretty amazing how fertility clinics help these miracles come into the world. 

My miracle IVF baby is a happy and healthy 15 month old now! 

So grateful and thankful  for my boys. 

Next Steps: Sonohysterogram (Saline ultrasound) on 9/10/18 

Delay in IVF #4

It’s funny... I almost forgot how crazy doing fertility treatments can make you and how nothing ever goes as planned! 

My Period is Late 

After my consult, I was started on Provera to try and induce my period. I had just weaned and I guess my hormones are all out of whack because my period decided not to make an appearance. I started to worry, but there’s really nothing that can be done. It needed to come by 8/26 in order to make the September retrieval dates. 

The Plan: October Retrieval 

Since my period didn’t happen, my cycle will be pushed back to October. The reason October sucks: retrieval week is the week of Halloween. 

I’m hoping I’ll be able to get a retrieval date AFTER Halloween... Halloween is a big deal for my son & I don’t want to miss any of the fun stuff we do as a family. 

If I waited for the next retrieval, it would be the week of my son’s birthday. So way worse than Halloween week! Both weeks are not ideal, at all. Which... is so typical of doing fertility treatments. 

How I Feel 

I’m a bit disappointed that I didn’t make the September retrieval... it was the best one that fit into my schedule and my life. I also had a pretty crappy week! 

1) The baby got Hand-Mouth-Foot Disease (HMFD) for the 2nd time in one month. The odds? Very slim. I’ll write a separate entry on HMFD. 

2) No childcare provider will watch children with HMFD. So no daycare and no backup childcare. 

3) I had deadlines at work, so had to work from home with a VERY clingy baby. Meaning I didn’t get much done and had to work after he went to sleep. Then, he wasn’t sleeping well - so I was operating with very little sleep. 

4) My older son had major issues at daycare, behavior wise. 

5) My older son ended up getting HMFD as well. 

6) I had a drama filled week at work.

7) Then - my period didn’t come and the cycle got delayed. 

Crappy, crappy week. 

But it’s funny... because even with all the variables - it didn’t feel “too” bad, like it was unmanageable or anything. Just very inconvenient! 

Where the cycle is concerned... yeah, sucks to delay it. But I figure it’s going to happen when it’s meant to happen. I’m way more relaxed about it (at the moment anyways!). Easy to say now when I’m not on fertility Meds! Lol. Really though, this stuff never has gone as planned and when things don’t go as planned it can be stressful. It doesn’t feel stressful yet. I’m really hoping my “relaxed” state will continue as I go through fertility treatments. 

Next steps: Wait for AF... 

Back on the TTC Wagon - Trying for Baby #3 - IVF #4 Begins

A few months ago I posted that I was thinking of Baby # 3 (post link: Thinking of Baby 3). Well... Ive decided to move forward!!!!

Initial RE Consults

December 2017 - Consult with different RE
When I started thinking about trying for baby #3, I started to consider another RE. I have a few friends that used another RE and they absolutely loved him and say only great things about him. I thought, hey - let me give it a try. The RE had a LONG wait list. I got on the wait list almost right after I gave birth, just to get an appointment. I scheduled the appointment in July of 2017 to get a December 2017 consult. Things that were really cool about this RE:

• All paperwork was electronic. They gave me an iPad to fill out my new patient paperwork. 
• The office is 15 minutes from my house!!! My old RE's offices are 30-40-and 60 minutes away. 
• His prices can't be beat. He's a couple grand cheaper than my RE. 
• The RE is really engaged and nice. I really liked him, very personable. 

Seems perfect, right?

Well... a few things happened that brought me concern:

1. I had my AMH blood work drawn. They were supposed to provide the results within 1 week. It took them one MONTH to get me the results. Additionally, they used a lab that wasn't covered by my insurance. I spoke to them prior to my blood work being drawn to make sure it was covered (ran into this issue before with my old RE when I switched insurance companies one year, not realizing the laboratory wasn't covered - post here - Sticker Shock). Receiving a almost $500 bill for ONE blood test - sucked. When I called the clinic, they refused to help me and said I had to contact the blood work company. Not helpful. 
2. I asked them to provide me an estimate of my out of pocket costs. They provided me a quote that did not include my insurance benefit of infertility treatments. I called and the billing lady said that's what the insurance company told her. I had to be very clear that my insurance coverage includes a lifetime max of fertility treatments. After some fuss (and a few weeks), she finally got me the quote. However, the quote was very "unclear." There was a lot of crap on the quote. I just wanted to know what the bottom line was. 
3. They required a nonrefundable $500 deposit to secure the cycle month. They required this after I had issues #1 and #2 - so I was very hesitant to give them any sort of money that I wouldn't be able to get back. Plus, I had some variables (like weaning) I had to consider and I wasn't sure I could commit to a set month. 

After all that, I decided to schedule a consult with my old RE and see if I had a better experience. IVF is way too stressful and I think my old clinic totally spoiled me with how efficient and helpful they are! 

February 2018 - Consult with old RE 
Going to see my old RE was... refreshing. The office was organized, they were helpful, they were able to provide me quotes and a clear "this needs to happen in this order before starting" - which I felt was lacking at the other RE's office. Most importantly, my insurance/costs were quoted correctly. I decided at that point that I would do my next cycle with my old RE.

Weaning Delays = IVF Delays 
The original plan was to do an IVF cycle in June or July 2018. Obviously, that didn't happen! I was supposed to wean my baby by his first birthday, which didn't really go as planned (blog entry coming on that soon). I couldn't start fertility supplements or fertility drugs while breastfeeding, for obvious reasons! So... IVF has been delayed.

The funny thing was, I didn't mind! I started to question if I should really go for baby #3. I ran into some health issues (blog entry coming on that soon) and it made me reconsider. I decided to tackle my health issues first before jumping back into IVF. I also considered the possibility of doing IUI's again vs. doing a new IVF cycle. But I didn't really want to get pregnant "now" - I want to wait until 2019 for a bigger age gap between my baby and potential baby #3. My fertility between next year vs. this year, would seriously decline... So, IVF it would be.

August 2018 - Consult #2 with Old RE 
I had another consult with my RE just this week. I wanted to talk about 1) mini IVF and 2) timing. It's funny... In June, I wasn't sure if I wanted another baby. Then in July, I knew I for sure wanted a baby - so I really focused on weaning.

I wanted to talk to my RE about mini IVF because I think that the high dosage of meds just messes me up and maybe that's what resulted in my poor response. I don't know... but I wanted to talk it through. After we discussed it, we chose not to go that route. With my age, we want a higher number of eggs because I'm going to have a higher number of eggs that are not genetically normal.

Can I just say that meeting with my RE is like seeing an old friend! He remembers the names of my boys, he remembers personal conversations we had and specifics. I know he has a lot of patients, so it's very nice that he remembers me and my story. I showed him pictures of my boys. He's such a nice person.

Well... we aren't sure how I'm going to respond to IVF again. Considering that I did the same protocol twice. The first time led to a retrieval with 4 embryos and 1 pregnancy (my son) and one cycle was cancelled for low response. Also, my fertility is way down now vs. what it was back then.

Lab Work (so far): 
AMH: 0.75
FSH: 10

I'm not really sure how many cycles I can afford this time... So, I'm not even going to think about that! TTC has so many variables. I'm hoping to be a little more relaxed this go-around and maybe have a little more luck this time too!

Things to think about and consider: 

• What if I don't respond well, would I want to do an IUI? 
• If I get less than 2 embryos, should I test them? 
• If the embryos don't look good, would I defer to a fresh cycle? 

The reason these things are important to consider is, that changes my IVF protocol and fertility testing. Since I'm technically not planning to transfer until June/July 2019, I don't have to do some of the other testing now (i.e. saline ultrasound, uterine lining biopsy, etc.). I haven't decided the best course of action... as doing a IUI or a fresh transfer would mean my youngest kids would be closer in age than what I want (if it's successful). However, would I totally waste the cycle and not do anything? 

Lots to consider and decide! 

The Plan

• Start CoQ10 and DHEA 
• Continue taking prenatal vitamins 
• Started on Provera to get AF coming (AF needs to start by 8/26 for a September retrieval) 
• Call on Day #1 of my period to schedule Day 3 tests and baseline ultrasound 
• Egg Retrieval would be the week of September 24 
• Protocol: Microdose Flare - same as IVF #2 and IVF #3 
• Freeze all and planning to do PGS testing 

Yup - SEPTEMBER... like in a few weeks September! Eeek. It's what I wanted... as the other options were: October during Halloween week or December during my Little Guy's birthday week. But geez, talk about jumping right into a cycle! And to think - it'll be almost exactly 2 years from the FET that brought me my son. 

My Thoughts
It's funny... even though I had to go through 11 cycles to get my son... I feel so optimistic and excited to move forward with adding to my family. I'm really hoping for a great response to this IVF cycle and that I'll have PGS normal embryos to work with... I'll write more on my feelings in a separate blog post.

But man... trying for baby #3 feels so "right" to me. It feels good. I have absolutely no doubts that this is the right decision.

Next Steps: Waiting for AF to arrive to scheduled day 3 blood tests and initial ultrasound.

Our Breastfeeding Journey, Part 2 - Pumping

Man oh man... pumping at work was extremely hard to adjust to!!! It took me a few weeks to really get down a rhythm. Here's what ended up working for me:

Work Days: 

• Nurse baby when he woke up. 
• Early days: Pump before I left home (I had an oversupply and would leak on the way to work). Eventually I would cut out the morning pump, when my supply regulated and my baby started waking up/nursing closer to the time we left home.
• Pump at work 3x's a day, every 3 hours (scheduled on my work calendar). 
• Nurse baby at daycare pickup or right when we get home. 
• Nurse on demand throughout the night. Night feedings stopped when my baby was about 6 months old. When he stopped nursing at night, I would sometimes pump at midnight (or 3 hours after his last nursing session) because I was engorged and leaking. 

Weekends: nurse on demand and pump (1-2x's, if engorged) 

My baby started daycare a little after he turned 3 months old. He started with only 3 oz of breast milk, every 3 hours. This would start increasing to 4 oz. By the time he was 10-12 months, he was drinking 5-6 oz. Never went above 6 oz. 

Anything I pumped would be saved for the next day. If I had excess (in the beginning), I would either freeze or carry over to the next day. Monday's I used what I pumped over the weekend or used frozen milk. 

Kiinde System 

I used the Kiinde system and LOVE It. I was pumping directly into the bags, but then I stopped doing that and would pump into the bottles - then transition to the bags. The reason was, I was trying to get the right ounces in each bag. My baby used the slow nipple that came with the Kiinde and we never changed that. 

Daycare

I will say, I love our daycare. I really do. But they are very uneducated on breast fed babies. I tried to teach them to Pace feed - but I know that they didn't always do it - would depend on who was feeding him. They told me to change to a fast pace nipple, I told them no. The told me to up his ounces, I told them no. I tried to educate, but didn't force anything. Just told them why we weren't going to change anything. 

Low Supply Issues 

Eventually, my supply started to go down. It started when we started introducing solid foods at 6 months and he stopped nursing throughout the night. I went from an oversupply to barely being able to pump enough for the next day. By 6-7 months, I had almost used ALL of my frozen supply - which freaked me out. 

However, even with low supply issues - I managed to make it to one year without having to supplement. I did add extra pump sessions in, when I could, to make up for the gap. 

Nursing Attire 

The one big challenge I had with nursing and pumping is that I had to wear nursing clothes all the time. Since I was pumping at work, I needed "access" - so always wore a nursing bra and clothes everywhere. I stopped using a nursing cover for various reasons: 1) it was too hot, 2) my baby hated it and would push it away, and 3) I became more comfortable using the double shirt method. I always wore a tank top under my shirt. I nursed in a lot of public places and never had anyone comment on it. It wasn't always comfortable for me... but really, you couldn't see anything. I never thought I would be comfortable nursing without a cover... so was very surprised that I managed to do it for so long. I think we ditched the nursing cover at about 2-3 months old.

Pumping Supplies

• 3 sets of flanges (I left one at home and brought two to work) 
• Extra duckbill valves (replaced every 3 months)
• Dry/Wet bag to put my pumping items into and place in the refrigerator 
• Pumping bag 
• Milk bag
• Bottles 
• Kiinde bags 
• Labels (I would label the Kiinde bags at work) 
• Blue ice packs 
• Pumping bra 
• Manual pump 
• Medela sanitizing bags 
• Extra nursing pads (disposable and reusable) 
• A burp rag to protect my clothes (had instances where breast milk spilled on my work clothes) 

Next Breastfeeding entry: Nursing an older infant