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 

Our Breastfeeding Journey, Part 1 - Jaundice, Supplementing, Tongue Tie Revision

I wish I would've been able to keep up with the blog to track our breastfeeding journey. Through early struggles, a tongue tie, pumping at work - I did manage to breastfeed until my son was 14 months old. I'll try to write a summary!

Jaundice
The first month was tough with Baby C having jaundice. We began supplementing with formula right away and I started pumping right away. Not what I had planned. The first month was difficult, where I would try and nurse, then supplement with formula, then pump - to keep my supply up. Very little sleep during that time.

Nipple Shield
When he hit one month, my pediatrician finally gave the green light to stop supplementing and exclusively breast feed (EBF). Then the next issue came, trying to get off the nipple shield. The nipple shield worked great for the beginning, as my baby had a horrible latch. It took about one week of purposefully trying to get him off of the nipple shield before he would latch on his own.

Thrush
I thought we were getting the hang of breastfeeding, when all of a sudden I had a lot of pain. My pediatrician told me it was thrush. Thrush it it's own monster... both of us had to get on meds for it. Couldn't use breast pads for very long, had to wash bras constantly. It was a mess. I decided to go to a lactation consultant (LC) at that time.

Lip and Tongue Tie
Turns out... it wasn't thrush. My baby had a lip and tongue tie. Which EVERYONE missed. I had gone to a breastfeeding support group and the LC there missed the ties. The hospital LC missed the ties. My pediatrician missed the ties. After I had gone back to work, he got his tongue tie revision at 3.5 months old. Which, kinda sucked because he had just started sleeping for longer stretches of time and I had to wake him up every 4 hours to do tongue stretches. It was also VERY hard to have him go through the procedure, I cried when they took him away and cried when he came back crying. It was quick and fast... but it just sucked big time.

His latch did get better. I'm not sure if it was because of his tongue tie revision or just because he got older and more efficient? However, it did push back his sleep patterns and he wouldn't start sleeping through the night until closer to 6 months old.

I would say by 4 months old, I felt like breastfeeding was going extremely well. I had a bit of an oversupply, but I was happy to have that extra in my freezer (which I would eventually use when my supply started to go down!).

I'll write another entry on pumping and nursing an older infant (Biting and niplash!).