Cycle #7, IVF #1: Post-Cycle Consult + Next Steps for IVF #2

Had my Post-IVF #1 Consult with my RE today. There's no way to really tell why the cycle didn't work, just need to change the protocol. I did find out that my Estradiol levels were good for my first two blood draws. But my third blood draw, the levels weren't high enough.

IVF #2 Plan

My RE wants me to do the following precycle for at least 1-2 months prior to my IVF cycle:

• DHEA: 75 mg/day 
• CoQ10: 2x's/day 

The plan is to be more aggressive with the meds. RE said that I'll be on the highest dosages that I'll get on.

• IVF Protocol: Lurpon "Microdose" Flare. I'll be on Lupron 2x's a day, but a very low dosage. Also, instead of 10 days before the injections begin - I'll start only 2 days before injections. 
• FSH/LH Injections: will be 2x's a day. 
• AM: 150 iu Gonal-F, 75 iu Menopur
• PM: 225 iu Gonal F, 75 iu Menopur

I'm starting Provera today to try and induce my period this month. We are aiming for a February Egg Retrieval, but the timing may not work and it may have to be in March. 

• February Egg Retrieval: Week of 15-20. Period needs to start by January 17th.
• March Egg Retrieval: Week of 14-19. Period needs to start by February 14th. 

The weirdest part is: the time between cycles. With IUI's my cycles were monthly. Now, with IVF#1 being cancelled - it'll be 4-5 months since my last IUI (in October) before I can even "try" with IVF #2. Feels odd not "trying" every month and instead "waiting" or doing "stims". I just hope that the change in protocol and the increase in meds leads to an actual egg retrieval! Will see how it all goes down. 

One of the staff members told me to "keep my chin up" and to stay positive. They are so supportive and sweet. I can't imagine ever leaving this RE's office because of how nice they are to me! I also was able to donate my PIO shots to my RE's office. I received them after my cycle was cancelled and they expire in 30 days. Hopefully another woman can get it for free and save some money. 

Another interesting thing about moving forward is insurance coverage. I am changing providers beginning 1/1/16. My "coverage" stays the same, since it's through my employer, but just hoping things are still smooth running. 

I wish I can say how I feel about this whole thing. Truth is, I feel a little disconnected from the process right now. Not really sure why? I guess because I have absolutely no control over what happens next or how my body will respond to the meds this go-around. I need to think about things and decide how I'm going to handle it, so I have realistic expectations for IVF Cycle #2. 

Next Steps: 

• Start Provera to induce AF in December. 
• Call RE's office when AF begins this month. 
• Order DHEA and CoQ10 

For more details on my IVF process, see my IVF Calendar/Timeline.

Thoughts on IVF #1 being Cancelled

It's been a few days since my IVF cycle was cancelled. Now that I'm off stim medication and have a little more perspective (AKA not emotional), I think I'm OK writing about it now.

Originally when the cycle got cancelled, there was so much disappointment around it. I've been focused on this IVF cycle since IUI #6 failed in October. That's 1 1/2 months worth of anticipating all that is involved in IVF-land. Since I responded so well to my IUI injectables, the thought of being a non-responder to the medication didn't even occur to me to be within the realm of possibility. Now, I know better. IVF is such an intricate process. Every-single-step in the IVF process is critical and the cycle can be cancelled at any step along the way.

What's interesting, is I knew this with my IUI cycles. I was always anticipating my IUI cycles being cancelled at each monitoring appointment. Why that anticipation didn't carry-over to this IVF cycle, I'm not really sure. I suppose since I've been at trying to conceive for so long, without any major delays (cysts, non-response, etc), the possibility of the IVF cycle being cancelled just didn't register.

How I imagined this IVF cycle to go: stim and have 10-15 follicles at egg retrieval, have at least 5 make it to a blastocyst, with a fresh cycle transfer on day 5, and with some to freeze. Then the real hope of all hopes: that I would get a Christmas BFP with Baby C arriving in September 2016.

So much dreaming, imagining, and hoping for a cycle to finally work and to realize a beautiful dream of having a birth child.

All of it got smashed when the cycle finally cancelled.

Looking back at it now, I'm actually glad the cycle got cancelled when it did. If I went through Egg Retrieval and had no eggs make it to day 3 or day 5... that would have been even more devastating. Not to mention the Egg Retrieval being a serious thing (the one part I was scared most about). I would've hated going through all that and then not have any viable eggs. So, I'm grateful the cycle got cancelled early enough to avoid that. In all honesty, I think that possible scenario would have been 10x's more devastating.

Everything happens for a reason, that I know for sure. I have no clue how this is all going to end. One year into TTC and there's not much to show for it besides a big hole in my pocket book. Hoping 2016 will be the year TTC will lead to a BFP... fingers crossed.

I haven't decided what I'm going to do next yet. I'm actually predicting that the way the cycles work with my RE's office, I'm probably looking at a February or March IVF cycle. Which seems so very far away. I do know that I want to move forward, I just don't know when that's going to be or what it looks like right now. I'm not giving up yet. I have at least one more IVF cycle in me. Hoping the protocol is good and I actually respond to it this time.

Next Steps: 

• 12/16/15 @ 9:15 am: IVF #1 Post Mortem Discussion and Next Steps 

For more details on my IVF #1 process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Cycle Cancelled

I had my monitoring appointment this morning. Things didn't go well, this IVF Cycle is cancelled. They didn't see any growth in my follicles, most were under 10 mm. Only 1 in my right ovary, but was still small. Then 2 in my left ovary, which were also small. The largest one was in my left ovary and hadn't grown since Sunday.

Originally, I thought I'd be able to convert the IVF to an IUI. But the RE said there were no viable follicles to do that. With the largest one not growing, it probably does not have an egg in it and the others are so small. So, no IUI.

Of course, after Sunday I knew the cycle could be cancelled. But I thought that I'd be able to convert to an IUI. So, I was really bummed from that. I cried again, but this time was able to hold it until the end. The nurse gave me a hug and the entire staff looked so sad for me. They have all been rooting for me over the last year. I really like the staff there.

But here I am... a cancelled IVF cycle. So crazy. I didn't think of this as a possibility when I started this whole thing. I was entirely too optimistic. Almost like with my IUI's, I was sure that I would get pregnant within 6 cycles. This journey has had so many bumps in the road for me. Who knew it would be so difficult and hard and long to have a baby :(

I think I processed the possibility of the cycle being cancelled on Sunday and was prepared for a bad outcome for today. I've been so busy with other things that I haven't had a quiet moment to really process this loss. Now, I'm faced with new choices:

1) Take a break from TTC or
2) Move forward with another IVF cycle under a different protocol.

I guess technically there's a third:

3) Stop TTC all together.

For now, that's not an option... I just can't stop right now.

I have a consult with my RE next Wednesday and will see what he says/suggests.

I feel a little numb about the entire thing. On Sunday it was devastating news. Today, it felt inevitable and numbing. Ugh. Not to mention that things get so much more complicated after this, as I will be back to work next month - can I make the monitoring appointments? Will I need to use vacation time? What if this happens again? When do I stop trying? How much more can I put my body through? <sigh>

I've decided to wait until my discussion with the RE to decide anything. Right now I'm thinking going forward with another IVF cycle is what I want to do. Have to look at the timing and everything... Let's see what is to come.

Next Steps: 

• 12/16/15 @ 9:15 am: IVF #1 Post Mortem Discussion and Next Steps 

For more details on my IVF #1 process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Stims Days 6-8, Possibility of Canceling IVF Cycle

Here's how Stims days 6-8 went down... not good news for this IVF Cycle. For the other stim days see:

Stims Days 1-4
Stims Day 5

Stims Day 6 (12/4)

Brought my son to a kid museum. There were so many pregnant ladies with either 3 kids including a newborn or 2 kids and pregnant. It was definitely a little overload for me! My Little Guy seemed to enjoy it for the most part. It's funny, he's so independent. Some other kids his age were very dependent on their moms. But seeing so many pregnant women and so many newborns in one place... And being on all these medications! Ugh. Was a bit much. 

Not having coffee is really getting to me! It's not like I used to drink a lot. Just 1-2 cups a day. But going without it in the morning feels like something is missing. Oh how I long for my cup of coffee... Coffee... Coffee... <sigh>  

Stims Day 7 (12/5)

A very emotional day. Darn meds. I'm also really-really tired. Normal activities tire me out quickly. Still getting the perpetual headaches and feel like I need to nap, but then can't! Ugh. A few hot flashes as well. Joy-joy. Also, the injection sites keep bleeding. Thinking I'm just hitting bad spots maybe? More annoying than anything. 

Stims Day 8 (12/6)

Much anticipated monitoring appointment today, ultrasound and bloodwork. I have to admit... I was worried! These were the questions I was considering:

Would my egg retrieval get finalized? 
Would I get my trigger day/time? 
Would I need more monitoring appointments?

So many questions that I hoped would be answered by this day. Instead, we discussed the possibility of canceling the IVF cycle... My follicles are not developing as quickly as they'd like. It's weird too because through all my IUI's, I stimulated really well to a low dose of injectables. Now, I'm on such a high dosage of meds and I'm stimulating about the same as I did for my IUI's.

I wasn't prepared for the discussion of canceling the IVF cycle. I knew in my head that it could happen. I knew that if I didn't stimulate well, that there's no point in going through with the egg retrieval. I just wasn't ready to hear it. Wasn't prepared to hear it. I was ready to discuss trigger times and finalizing the egg retrieval day/time. Not ready to hear that all of this could be for nothing.

I go into my appointment and the vaginal ultrasound is the most painful/uncomfortable than it's ever been. The RE was trying so hard to find the follicles... I knew it was bad before he even said anything. I know what a developing follicle looks like and they weren't showing on the ultrasound. Basically, I have 1 lead follicle in my right ovary and 4 small ones. The left has 2 large ones and maybe a few small ones. So, a total of 3. Three. That's it. Just like my IUI's.

After the ultrasound was completed, he told me that there was a possibility of canceling the cycle. They want 4 or more follicles to do IVF. He talked about the possibility of converting it to an IUI instead. I couldn't help myself, I cried. I'm so overly emotional on these meds. I knew it was coming and couldn't stop it, the tears came and came. Ugh. First time I cried in the RE's office in front of the RE and the nurse. I'm sure I'm not the first one to cry... But it was still embarrassing to be so vulnerable in front of them. I even warned them before it came because I couldn't stop it from happening.

I'm pretty upset about the entire thing. After all this IVF stuff-- this is what happens. It's just heartbreaking. To think, I didn't even really want to do IVF. It took a lot of thinking and considering before I decided to move forward. Now I'm here and it's not going well.

I have one more monitoring appointment on Tuesday where the decision will be made on what happens next. What I need to decide is:

If there are <4 follicles - do I have an IUI done instead?
If there are >5 follicles - do I still go through with the IVF cycle?
Do I do nothing and cancel the cycle and not do an IUI?

I hate these choices. My head is spinning. I know statistically that IUI success rate is so low after 6 IUI's. However, here I am with follicles -- do I try this month or let the follicles go to waste? It all just sucks. I'm so upset about this. This process is so crazy and so emotional and so heartbreaking. It would be great for it just to work.

Not to mention that it feels like I'm never going to be able to have a baby. It just seems like the odds are stacked against me and nothing is working. It makes me so sad. I've tried to remain positive through all of this, all the IUI's, all the appointments, all the medication, all the BFN's. It's just so hard sometimes. Right now it feels like it's just too much.

Not to mention, if this cycle doesn't work (whether I convert it to IUI or do an egg retrieval) -- the thought of doing another IVF cycle is hard to think about. I don't know if I can make all the monitoring appointments when I'm working... not to mention having to meet my insurance deductible and out of pocket expenses again. Ugh. This process is a time suck and a money suck. It's like an endless pit of suckage.

I used to tell myself that it would be all worth it in the end when I had my Baby C in my arms. But now, who knows if there will be a Baby C at all... :(

Hoping for better news on Tuesday. Let's see... 

Next Steps: 

• 12/8/15 @ 8:45 a.m. - Ultrasound and Blood Work. 10:00 a.m. Acupuncture. 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Stims Day 5

Had my first monitoring appointment today for IVF. I also had my acupuncture appointment.

Ultrasound

The ultrasound went really quickly, but the results weren't where I wanted them to be. The results:

• Right Ovary: 4-5 follicles 
• Left Ovary: 2 follicles and a cyst! 
• Uterine Lining: 11.56

The RE didn't seem worried about the cyst... Said some women get a cyst during stims, that they're just going to ignore it. Ugh. Not sure how I feel about it and scared to check Google-verse. So maybe I won't...

So potentially 7 follicles developing right now. I was hoping for over 10... I had about 15 at the baseline ultrasound. 

I'm a little worried. But, can't really let myself worry about it - just have to see things through and see what happens. 

My fears are that I won't have many mature follicles and that I won't have any embryos to transfer and/or freeze. It's a true fear and a possibility, which is scary... Because the % goes down. Not all eggs are mature, not all mature eggs will fertilize, not all fertilized eggs will divide to a 5 day blastocysts. I wanted to start off with enough so that I would have a few left at the end of the entire process.

To go through all this IVF stuff, you really hope and pray for good results. It's so much to put your body through. 

Anyways. I'm trying to stay positive. Some days are more difficult than others, especially when the results aren't what you wanted or expected. 

Forgot to mention, I'm HIGHLY emotional - I'm assuming due to the medication. Since I started Stims, I am so easy to cry! 

Christmas card shopping = cry fest. 

Sad news stories = cry fest. 

Happy news stories = cry fest. 

You get the point. My emotions are all over the place. Darn meds mess with your balance. 

Just praying that this process will get me Baby C at the end of all this. Praying - wishing - hoping.

Blood Work 

Results for E2 = 280.5

Acupuncture Session #4 

I had my acupuncture session today. We focused on my headaches. The sessions are becoming more and more relaxing as I continue to go. Felt light again afterwards. Wish that feeling stuck all day long!

Portal Message: Medication Changes 

I received the portal message and here's what it said:

Based on your lab results your medication dosages have changed. Please follow the new dosing starting with your next scheduled dose.  

TONIGHT: 12/3
Gonal-F 300 iu
Menopur 150 iu
Lupron 5 iu  

FRIDAY NIGHT: 12/4
Gonal-F 300 iu
Menopur 150 iu
Lupron 5 iu  

SATURDAY NIGHT: 12/5
Gonal-F 300 iu
Menopur 150 iu
Lupron 5 iu 

The only real change is the Gonal-F is going up to 300 iu (was at 225 iu). I have to think that they weren't happy with my response thus far then. Hoping the change in dosage will help push more follicles to develop. Fingers crossed.

Next Steps in IVF-Land:

• 12/6/15 @ 9:30am: Ultrasound and bloodwork. 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Stims Days 1-4

I'm supposed to stim for 8-10 days. So technically, I'm about half-way through stims right now. Which is crazy to think that Egg Retrieval is NEXT week!!! It's getting so close to being here. Here's how Stims Days 1-4 went for me.

Stims Day 1 (11/29): 

After Stims Day 1, I started getting this horrible headache. Normally, when I go to sleep with a headache it's gone by the time I wake up. Nope, not this time. When I woke up the next day, the headache stayed ALL day long. It was so bad. Which made it worse is, I had my annual eye exam that morning and had my eyes dilated :(  I ended up going home and having to sleep until my eyes got back to normal, it was just too much. 

Stims Day 2 (11/30):  

Not surprisingly, I was able to mix the medications without reading the instructions! Guess I've been at this for awhile now, almost feels intuitive and natural mixing and injecting medication. Odd. 

Stims Day 3 (12/1): 

I had my Acupuncture Session #3 this day. Since I was getting the headaches on the medication, she put the needles in places to help with the headaches. I felt so good, I fell asleep a few times! Afterwards, I felt extremely "light". Not sure how to explain it.

Doing Stims this night, I made a mistake with the Gonal F pen! I dialed it up to 225, then put the needle on. Well, when I was twisting the needle on I accidentally pushed down and some meds got squirted out!! I was like "NOOOO!" Luckily I only pushed out 25 iu. But still, meds are expensive! Felt like such a waste.

Strange, but I also bled a lot when I took the needle out after doing the injection. I don't normally bleed at all. If I do, it's just a little bubble. This time, I had to put pressure on it to make it stop bleeding. Not sure what the difference was? Maybe just that one spot was sensitive or something. Who knows. I also got a headache again this night and into the next day. 

Stims Day 4 (12/2): 

I had my Blood Work this morning. I was going to the zoo with my son, so I brought him along. I was a little worried what he would do while I was getting my blood drawn. But surprisingly the staff just took him and entertained him while I got my blood taken. Have I mentioned how much I love my RE's office? I just love the staff there.

The blood work today was to test my Estrogen (aka Estradial, E2) level. The result = 197. I'm not sure if that's good or bad... I'll need to ask tomorrow when I go in for my Ultrasound and more Blood Work. This is the time where they might start changing my dosage of medication (increase or decrease).

Today, I'm also supposed to start checking the Portal Messages. The portal message today said: No Medication Changes. So, I'm guessing they were happy with the blood results. Let's see what happens tomorrow. Hoping for good news that a lot of follicles are developing! Fingers Crossed. 

Next Steps in IVF-Land:

• 12/3/15 @ 8am: Ultrasound and Blood Work. @ 10am Acupuncture Session #4. 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Stims Day 1

It's that time... The time I've been waiting for --> IVF Ovarian Stimulation. This is where the big stuff for IVF starts happening. I'll stim for 8-10 days. Depending on how I react to it and how well I stimulate - will impact when my Egg Retrieval is. Here's how it works:

1. I start stims (11/29). 
2. I will go in on Day #4 of Stims and get blood work (12/2). 
3. I'll have an ultrasound and more blood work done on Day #5 of Stims (12/3). 
4. Depending on how these appointments look, I'll get additionally monitoring appointments scheduled (every 1-2 days) and might have to adjust my medication dosage (higher or lower). 
5. I'll need to start checking the online portal every day starting on Day #4 for any direction changes on my medication dosage. 
6. Then, they'll tell me when to do the trigger shot. 
7. They'll schedule the Egg Retrieval (tentatively scheduled for 12/10). 

I enjoyed my last morning cup of coffee yesterday. I have to admit, I was sad to drink my last cup :( Nothing like morning coffee.

Here are the directions on my IVF calendar:

• No Caffeine, Alcohol, Tobacco. Limit exercise to walking only and avoid heavy lifting. 
• No Advil, Ibuprofen, Aleve, or Motrin
• Use Protected intercourse only.

Lupron Update 

I thought I didn't have many side-effects to the Lupron at first. But as I continued to take it, I experienced: Dry skin, acne, short tempered, and some headaches. No fun :( 

Stims: Day #1 

Today begins the IVF cycle. Injectable medication being taken:

Gonal F: 225 iu

Menopur: 150 iu

Lupron: 5 iu

Mixing the meds wasn't too bad. You mixed all three into the Menopur vial and then have only one needle injection: 

I went really slow with the mixing. This is my first time with the Gonal-F pen and combining medications together. Going slowly helped, I think I'll get the hang of it pretty quickly though. 

One rookie mistake I made. I was recapping a needle and the needle pierced the outside of the cap and got my finger! Ugh. This is the FIRST time I've had a mistake with the needle before. Hurt like hell. Thankfully, this happened after I was done with the injections - was just getting ready to put it in the sharps container. 

The injection hurt going in, some burning sensations. Then the site of the injection was a bit tender afterwards. 

Start Medications: 

I had to start a few oral pills as well. 

• Baby Aspirin: 81 mg
• Zithromax: 1 pill, 500 mg - for 3 days

Continue: 

• Prenatal Vitamins
• Metformin: 2x's a day, 500 mg

One other thing I'm going to give a shot is using a heating pad on my tummy for 20 minutes a day. My acupuncturist said it'll help and I've read on a few boards that it helps the follicles develop. It can't hurt to give it a try! Also, drink plenty of water. My acupuncturist told me to drink the water at room temperature, not cold. 

How do I feel?

I feel a little disconnected from the IVF process today. It was a long holiday weekend being home full time with the boys. I'm just tired. I have a busy week ahead of me. I wish I knew how all of this is going to turn out. I'm trying not to jump and worry about the end result, as each step in the process is so critical. I also am so worried I'm going to screw up the medication somehow. Hopefully I'll get the hang of things and I'll stimulate well to the meds. 

Next Steps in IVF-Land:

• 12/1/15: Acupuncture Session #3
• 12/2/15: Blood work
• 12/3/15: First Monitoring Appointment (Ultrasound and Blood Work), Acupuncture Session #4

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Quick Update + Acupuncture Session #2

IVF Update

Haven't written an IVF update in a few days. Not much to report. I stopped Birth Control pills after 23 days of being on it. Just a note - I got really bad headaches in the birth control. At first, I didn't make the connection - but after I stopped, the headaches stopped! 

I am continuing on with Lupron (10 iu). The injections were going extremely well. Then the last two days the needle kind of hurt going in. Not sure why... I'm not doing anything different. Psychological maybe? Who knows. I am starting to feel like a pin cushion though. Injections in your belly every day is not a fun task.

I did start my period, which is not my "normal" type of period. They told me I might start it and that it might not be like my normal period, so I wasn't surprised. But it's still annoying because it's lasting longer than my normal cycle and it's a different consistency... Sorry if that's TMI. 

Although things have seemed slow, it's about to get busy-busy with IVF updates, as I start stims on Sunday and monitoring appointments next week.

Acupuncture Session #2 

I don't know if I'll ever get used to acupuncture! It's such a different way of thinking. I really do need to read more into it, so that it can be more effective.  Only if I had more time! LOL. My acupuncturist looked at the color of my tongue when I go in and I guess that tells her stuff about my balance. This time needles were in the following places: calves, feet, by my knees, inside of my elbows, lower tummy, and forehead. None of them really hurt going in. 

The difference this go around is, I was actually able to relax! I even almost fell asleep a few times. Maybe next time, I'll be able to relax even more and fall asleep. I felt great afterwards. Wish I could've taken a nap though, I was tired for the drive home.  

Next Week in IVF-Land: 

• 11/29/15: Start Stims! Menopur, Gonal-F, and continue Lupron
• 12/1/15: Acupuncture Session #3
• 12/2/15: Blood Work 
• 12/3/15: Ultrasound and Blood Work, Acupuncture Session #4

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Acupuncture, Session #1

At my IVF Consult, my RE provided a referral to two acupuncturist. I was on the fence about really going for it... fear of needles and all. Also, the additional $ that goes along with it. I've already spent so darn much on this process... I didn't feel comfortable dishing out more money on a concept that might not really "up the odds". There are so many contrary opinions out there: it works, it doesn't work, can't hurt. Well, I figure -- It can't hurt.

I heard acupuncture really relaxes you. I'm so tense lately, I can definitely use some relaxation.

I called one of the acupuncturists my RE referred. She was really nice and had some good information on her website. It says that you really should start acupuncture 3 months prior to IVF. Well, obviously I'm behind the ball on that one! I didn't think I'd get here and didn't foresee having to take these extra steps towards having Baby C. But here I am: IVF-land and now acupuncture-land.

Here's the plan:

1. Initial Consult / 1st Session: go over medical information, provide any test results from RE and PCP. $150 
2. Ongoing Sessions: have 1-2 regular sessions a week prior to egg transfer. $85 per session 
3. Day of Transfer: have treatment before Egg Transfer and treatment after. $325 

Session #1 

This was my first acupuncture session, ever. So, I wasn't really sure what to expect. I provided my blood work and lab results, we discussed my medical history, we discussed IVF and infertility. Then after the paperwork and initial discussion was complete, I had my first real acupuncture session.

Let me say, it was a little surreal. I have a big fear of needles. Knowing this, I kept my eyes shut while she started sticking me. Some spots it hurt. Others, I didn't feel it. Places that hurt: my right wrist, my right foot, and my forehead. After awhile, it didn't hurt. The right wrist was uncomfortable if I moved it wrong.

After she stuck me with the needles, she put a heating lamp over my stomach. I guess to help "warm up my uterus." Then, I laid there for 20-25 minutes. I couldn't really relax. I did open my eyes to check out the needles. They look scarier than they felt.

Afterwards, we discussed my next steps in regards to: IVF prep, supplements, diet, exercise, and meditations. She's recommending 1-2x per week prior to IVF, day of transfer (before/after), and 3-5 days post transfer to help with implantation.

It's all very interesting and now that I'm doing acupuncture, I need to really research it a little more. She recommended I read two books: 1) The Infertility Cure and 2) Feed your Fertility. I need to check if these are available at the library.

All in all: an interesting experience! I've never really looked at fertility/infertility in this type of way before. I guess I haven't really had time to think about it as things get so busy when you're cycling for fertility treatments. I've been more focused on the medications, the injections, and not missing a step. I haven't really thought about all these other things, like Chinese Medicine.

I can't say I "enjoyed" it. But I feel good that I'm doing it! Here's to hoping it turns out well.

Next Week in IVF Land:

• 11/24: Acupuncture Session #2  
• Lupron: Continue 10 iu until 11/29
• 11/29: Start Stims - Day #1 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Starting Lupron Injections

Today was my first day of Lupron (10 iu). At the Injections Class yesterday, we went over the injection. But for some reason, I just couldn't *remember* if I needed to insert air into the vial! So, I watched some YouTube instructional videos before my injection.

The actual injection went relatively quickly. Probably because I've been giving myself injections for months now. Mixing was quick and the actual injection was quick. Hopefully the rest of the injections (especially when I start stims on 11/29) will go as smoothly.

The rest of the week: 

• 11/20/15 @ 11am: First Acupuncture session. 
• 11/21/15 @ 1pm: Our ADOPTION!!! 
• Lupron: Continue 10 iu until 11/29. 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Injection Training + IVF Payment

Yesterday, I received all of my medications. I'm glad I didn't receive them sooner because it was a bit overwhelming seeing all of it. Luckily, my injection training class was today and it made it seem a little more "doable".

Here are the instructions that I received for today's appointment:

1) Appointment for Injection Training, Signing of consent forms, and payment in full.
2) May also have an ultrasound today if indicated.
3) Bring ALL medications and consents (IVF packet) to this appointment.
4) Prior to this appointment, you must view injection training video on website.
**Possible Urine and Blood Sample Today

I ended up not needing the ultrasound, urine, or blood sample.

Injections Training

For injections training, the nurse went over every single medication that I was taking. Showed me how to inject each one of them and explained what they were for. I had read through all of the consent forms and also watched the video on their website, so nothing was "new" or unexpected. She also verified that I received everything. I am missing a few items that were on the prescription request, so I need to call the pharmacy back and get those to arrive. Luckily, that's for medication I won't be taking until mid-December.

Then, the nurse started going over additional "packet" information: pre- and post- egg retrieval and egg transfer. We even went over what happens when I get pregnant. Which was a bit crazy, because I know IVF isn't a for-sure thing... but I sure feel very optimistic that it'll lead to pregnancy. It was nice hearing the positivity from the nurse as well!

Fingers crossed!!

IVF Payment

IVF Payment was due in full today. Luckily the price went down significantly since I was so close to meeting my out-of-pocket fees. Not too bad, considering. Here's what it came down to:

Line Item	Estimated Price	Actual Price	NOTE
Estimated Co-Payments or Co-Insurance	$1,600.00	$329.00	Will go down when I meet Out of Pocket Maximum.
Estimated Deductible	$0.00	$0.00	Already Met
Professional Fees	$0.00	$0.00	Billed to Insurance
Laboratory Fees	$0.00	$0.00	Billed to Insurance
Anesthesia Fees	$0.00	$0.00	Billed to Insurance
ICSI	$1,525.00	$1,525.00	Not covered by insurance.
Embryo Cryopreservation	$500.00	$0.00	Insurnace covers first year.
HCG Pregnancy Test	$35.00	$35.00	Collected at time of service.
Total Amount Due to RE Office	$3,660.00	$1,889.00
Credit Card Charge		$111.24	Charge for using CC vs Cash
Medication - 1st Round	$4,000.00	$245.00	Approximately, pending costs
Medication - 2nd Round			TBD - need to order PIO
Donor Sperm	$530.00	$530.00	Donor#4
Acupunture	$730.00	$730.00	$150 initial, $85 after, $325 day of transfer. Will Change, depending on how many treatements I receive.
Total Out of Pocket Costs	$8,920.00	$3,505.24

I'm feeling very optimistic about this process right now! I keep thinking that there's a possibility I'll have actual embryos in just a few weeks. Originally, this process felt like it was dragging. Now, it almost feels rushed - like I'm jumping right in.

What was also nice to note is, my RE's office is open on the weekends for IVF. I didn't know this previously, because they are not open on the weekend for IUI's. Which I thought was very interesting...! But this is GREAT news because I was worried with the "what if" things fall on the weekend thing.

Moving forward and moving along this IVF-world. Hoping and praying my Baby C is at the end of all this.

The rest of the week: 

• 11/19/15: first Lupron injection! 
• 11/20/15 @ 11am: First Acupuncture session. 
• 11/21/15 @ 1pm: Our ADOPTION!!! 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Medication Ordering Debacle

IVF is about to get r-e-a-l! I start my first IVF medications in a few days.

The problem: I didn't received a call from my pharmacy to place my order.

Why meds are needed now: 

1. My injections class is on Wed, 11/18. I need to bring all medication with me. Mostly so they can verify that you have everything for your IVF cycle (no last minute freak outs if something is missing). 
2. My first injections start on Thurs, 11/19! First Lupron shots. 

DAY #1 (11/12)

Call #1: The Pharmacy. My IVF calendar advises that if I don't receive a call from the pharmacy by one week of starting meds, to give them a call. As of this morning (11/12), I haven't received a phone call. Therefore, I call the pharmacy. They said they haven't received the prescription request from my RE's office. The pharmacy confirmed their fax #, just in case and said to have my doctor's office send in the prescription request. 

Call #2: The RE's Office. I call my RE's office to let them know that the pharmacy hasn't received the prescription request. The nurse has a fax confirmation that says it was submitted and received on 11/9. We confirmed the fax # was correct and she said she will re-fax this morning. She advised me to call the pharmacy back this afternoon if I don't hear from them before then -- that way the nurse can re-fax (if needed) and so that I don't get too far behind schedule. 

Side Note: This isn't the first time a pharmacy has "lost" a prescription fax request. It happened for a few of my IUI cycles. The difference was, I was dealing with a local speciality pharmacy and it's quicker to get the medication. This time around, I'm dealing with my insurance pharmacy (now that IVF is a covered service) and I think they'll be shipping it to me (instead of a personal delivery to my front door). 

Call #3: The Pharmacy. Waited and waited, but no call from the pharmacy. When afternoon rolled around, I gave them a call back. "Amazingly" the rep was able to find my info that was sent on Monday (when the earlier rep was not). However, I was in the wrong department - I needed to go the "Specialty Pharmacy".

Transfer #1 to: the Specialty Pharmacy. They've received the prescription, everything is OK with it. However, my benefits haven't been confirmed. So, they transferred me to the "Benefits Team."

Transfer #2 to: the Pharmacy Benefits Team. Rep said that they just received the request earlier today. Rep said she has to work on it and will give me a call back by the end of the day. That even if things weren't approved, she would call me back just to give me a status update. There may be additional paperwork that needs to be completed by my RE's office and/or Insurance.

Side Note: Never received a call back on this day (as promised) from the Benefits Team.

DAY #2 (11/13)

Call #4: the Pharmacy Benefits Team. The Rep called me the next morning to give me an update. It turns out that there are "prior authorization" forms that need to be completed by my RE's office. So, the Benefits Rep contacted my RE's office and faxed them the forms. Now, the Pharmacy Benefits Team is waiting to receive the completed authorization forms from my RE's office... all before I can order. The Rep said she would call me back once she received the authorization forms.

All I could think is: tick-tock-tick-tock. Time's a-wasting! And, how much is this going to cost me?? 

Side Note: No call back...  

DAY #3 & #4 - Closed! The Weekend :( 

Tried not to freak out all weekend waiting and wondering if I would get this all sorted out on time.

Thoughts: Injections class is Wednesday and I start my first shots on Thursday. Will this get resolved on time? Ugh. 

DAY #5 (11/16)

Call #5: the Pharmacy Benefits Team. I called and left a message for the benefits rep. 

Call #6: the Pharmacy Benefits Team. Received a call from the benefits rep, letting me know everything has been approved and I can order. She transferred me to the scheduling team. 

Transfer: to Scheduling. Of course they call while I was at the RE's office for my appointment for my Saline U/S and Trial Transfer. So I told them I'd have to call them back. 

Call #7: Scheduling. After my appointment, I called them back and was FINALLY able to place my order. The only hitch, they said that the Progesterone In Oil (PIO) was only good for 30 days. I'm not scheduled to start PIO until after Egg Retrieval (ER) on about 12/10... So the PIO can go bad before then. So, I opted to not order PIO right now and will order it closer to ER. 

Final Verdict: medications arriving on 11/17/15. 

Never thought it would be so difficult to order my medication! During my IUI's I had no problems from the local pharmacies, they were quick and efficient. But now that my insurance has finally kicked in, it's like running around in circles. <sigh>  Hopefully I won't have to go through this again and this IVF cycle will be a success. This was just so frustrating.

DAY #6 (11/17)

Medications Finally Arrived!

Ok, I have to admit -- I was expecting a box of meds. I received two boxes of meds. I wasn't really intimidated with all the injections that I have to do during IVF... not until I received all these medications! It's a bit intimating seeing it all there. I quickly refrigerated the appropriate medications and went through the boxes. Honestly, I'm not really sure how to "verify" all the meds! But luckily tomorrow, at injections class, I'll get everything verified and get a better handle on all of these meds.

IVF is about to become a real thing now... I keep thinking about it and wondering how it's all going to turn out. One step at a time...

The rest of the week: 

• 11/18/15 @ 9am: Injections Class
• 11/19/15: first Lupron injection! 
• 11/20/15 @ 11am: First Acupuncture session. 
• 11/21/15 @ 1pm: Our ADOPTION!!! 

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Sonohysterogram and Trial Transfer

In January, I did Sonohysterogram as part of my pre-screening. They found a uterine defect and I had to have a hysteroscopy surgery in February to have it removed. It turned out it was a polyp. My RE said he wanted to repeat the Sonohysterogram (uses ultrasound to look at the inside of your uterus - a  salt, saline, solution is put in the uterus for a clearer image) to make sure that a new polyp or fibroid hasn't developed. Apparently about 20% of polyps grow back! Having the surgery delayed my first IUI procedure by two months.

At my IVF consult, my RE said if we found something I may need to have another hysteroscopy... which would delay my IVF cycle. He said, "I'm not trying to get you through an IVF cycle, I'm trying to get you pregnant." I liked that he said that and appreciate his honesty. So, going into the Sonohysterogram I was a bit nervous they would find something again.

When I arrived at the RE's office, they wanted to do another urine sample. Not sure what they're testing for this go-around. I really should ask next time. I just blindly go through tests without asking. I guess I trust my RE's office a little too much!

Mock/Trial Transfer 

The mock/trial transfer wasn't too bad. Although I don't think I'll ever get used to that darn speculum!! The actual catheter they inserted wasn't bad, just tickled. RE said that it went in smoothly and that my cervix is within the normal range, 7.5mm, I think he said. So there shouldn't be an issue with Egg Transfer. 

Sonohysterogram 

Went well, wasn't as crampy as I remember the first go-around. The best news ever: NO uterine defects and NO cysts. Woohoo! Good news. It's ok to move forward with the cycle. 

It's a little crazy with IVF because at any monitoring appointment, the cycle can get cancelled. Just going from one step to another. I swear I was holding my breath until he said everything looked good. 

Medications 

Medications FINALLY got ordered!!! I'll write a seperate post on that drama. But good news, medications arrive tomorrow. 

Donor #4 Arrived 

Received confirmation that the donor sperm arrived at the RE's office... All set to go. 

Other Stuff 

I'm on vacation this week from work and go on adoption leave starting next week. Which means, I'm not working again until the New Year! Yay :) 

This week is busy-busy prepping for the adoption. 5 more days!!! We took our family pictures yesterday and they turned out pretty good. 

I found time today to get a massage -- which was desperately needed! 

Week Overview: 

• 11/17/15: medications being delivered 
• 11/18/15 @ 9am: Injections Class
• 11/19/15: first Lupron injection! 
• 11/20/15 @ 12pm: First Acupuncture session. 
• 11/21/15 @ 1pm: Our ADOPTION!!! 

For more details on my IVF process, see IVF Calendar/Timeline.

Edited to Add: the urine test was a pregnancy test. Needed to be done prior to the Saline U/S. 

Cycle #7, IVF #1: Choosing Donor #4

Here I am again, choosing a new sperm donor - this time for my first IVF Cycle. IVF, still hard for me to believe I'm here doing this.

Discussion with Embryologist 

Before I ordered, I called the Embryologist at my RE's office. I haven't worked with her before, since I've only done IUI's. Surprisingly, she called back QUICK and she's really-really nice! I liked her immediately. My questions were around: # of vials needed and type of vial needed. She said I can order an ART vial, which is amazing because it's HALF the price of IUI vials! YES, half the price! I am thrilled about this. ART vials have less sperm vs. IUI vials. For IVF, you don't need as many sperm - especially since I am doing ICSI.

This was the BEST news ever. Saving a little money feels really good.

Choosing Donor #4 

Technically, I can use 2 out of my 3 previous donors, as they have ART vials available.

Donor #1: Used for IUI's 1-4. Not available / no vials
Donor #2: Used for IUI 5. Available
Donor #3: Used for IUI 6. Available

I've decided to go with a new donor -- Donor #4.  I took a look at my previous donors and it's not that I didn't *like* them - I totally did! I just decided to take a new look at different possibilities.

What's interesting and different about doing IVF is that I'm doing ICSI, so the chances of my eggs getting fertilized are higher than a normal IUI where you don't even know if sperm met egg. There's a lot of pressure on Donor #4 because he most likely will be "the one" to help me have Baby C.

Some things stayed the same in my search criteria:

• Height - Over 6 feet tall. 
• Eyes - blue (preferred - not mandatory) 
• No Jewish Ancestry
• Has available ART Vials 
• No Diabetes 
• No major allergies 
• Proven Donor 

What's new: 

• Extended Testing - not all the donors at the sperm bank I've chosen have had extended testing. I didn't really look into that previously. Now, with doing IVF and ICSI - it kind of matters a little more to me. 

Once I inputted that criteria, the number of potential donors shrank. None of my previous donors were included in the Extended Testing. 

There was one donor who popped out to me, his profile caught my eye right away. He met my original search criteria + the extended testing. I liked his profile too. I emailed the sperm bank and received additional photos. The donor's baby pictures are adorable! 

Making the Purchase

The actual purchase was straight forward, since I've purchased from them for my previous donors. I stuck with the same sperm bank since I've had amazing customer service from them. Now, I have downloaded all the information off the website for this donor. My 3 month subscription to donor profiles will be expiring at the end of this month. Hopefully I won't have to order donor sperm ever again!! Will see how it goes...! I only ordered 1 ART vial. Believe it or not, Donor #4 only had 1 ART vial available for purchase. Glad I was able to snatch it up.

Next Step: Donor Sperm to arrive by 11/16.

For more details on my IVF process, see my IVF Calendar/Timeline.

Cycle #7, IVF #1: Costs, Meds, and Consent Forms

At my IVF Consult yesterday, I was given a packet of "consent forms" and a list of costs. Reading through the consent forms... there's so much to it. You have to initial every single page. It's very detailed and makes me feel like I'm signing my life away... just like when I bought my house (just not as much paperwork).

I read through all the documents thoroughly and there were no "surprises" in there. The only thing I really had to consider is IF I have frozen embryos, what do I do with them after I am finished building my family. Options: 1) discard, 2) donate to science, 3) put them up for "adoption" to another family. I don't think I could live with myself to discard them or donate to science. So, for now - I've opted for choice #3.

Costs

The costs are a "tricky" thing. My insurance is currently covering 80/20 of all costs (since I met my deductible). However, I have about $442 left to reach my out-of-pocket maximum for the year. So, the RE's office can't provide me with the "exact" estimate until I reach that out-of-pocket maximum. I should hit it after my medications get ordered. Some costs are covered and some are not (like ICSI). I've decided not to do PGS testing for now.

I will update this when I have a more accurate idea, but here's what it looks like right now:

Line Item	Price	Price - Estimated after meeting Out of Pocket Max	NOTE
Estimated Co-Payments or Co-Insurance	$1,600.00	$0.00	Will go down when I meet Out of Pocket Maximum.
Estimated Deductible	$0.00	$0.00	Already Met
Professional Fees	$0.00	$0.00	Billed to Insurance
Laboratory Fees	$0.00	$0.00	Billed to Insurance
Anesthesia Fees	$0.00	$0.00	Billed to Insurance
ICSI	$1,525.00	$1,525.00	Not covered by insurance.
Embryo Cryopreservation	$500.00	$500.00	Up to 5 embryos. Need to verify if this is covered by Insurance.
HCG Pregnancy Test	$35.00	$35.00	Collected at time of service.
Total Amount Due to RE Office	$3,660.00	$2,060.00
Medication - TBD	$4,000.00	$442.31	Approximately, pending costs
Total Out of Pocket	$7,660.00	$2,502.31
Donor Sperm	$530.00	$530.00	Donor#4
	$8,190.00	$3,032.31
Out of Pocket Remaining	$442.31		A/O: 11/10/15

IVF Protocol: Luteal Lupron (OCP) Protocol (Day 5 Transfer) 

Medications: Here is a list and explanation of all the medications that I'm going to be taking.  I'm hoping my side-effects are limited on these drugs... we shall see. 

GnRH-agonists (leuprolide acetate): Lurpon. This medication is taken by injection. There are two forms of the medication: a short acting mediation requiring daily injections and a long-acting preparation lasting 1-3 months. The primary role of this medication is to prevent a premature LH surge, which could result in the release of eggs before they are ready to be retrieved. Since GnRH-agonists initially cause a release of FSH and LH from the pituitary, they can also be used to start the growth of the follicles or initiate the final stages of egg maturation. Though leuprolide acetate is an FDA approved medication, it has not been approved for use in IVF, although it has routinely been used in this way for more than 20 years. Potential side effects usually experienced with long-term use include, but not limited to: hot flashes, vaginal dryness, bone loss, nausea, vomiting, skin reactions at the injection site, fluid retention, muscle aches, headaches, and depression. No long term or serious side effects are known. 

Gonadotropins, or injectable "fertility drugs": Gonal-F and Menopur. These natural hormones stimulate the ovary in hopes of inducing the simultaneous growth of several oocytes (eggs) over the span of 8 or more days. All injectable fertility drugs have FSH (follicle stimulating hormone), a hormone that will stimulate the growth of your ovarian follicles (which contain the eggs). Some of them also contain LH (luteinizing hormone) or LH-like activity LH is a hormone that may work with FSH to increase the production of estrogen and growth of the follicles. Low-dose hCG (human chorionic gonadotropin) can be used in lieu of LH. These medications are given by subcutaneous or intramuscular injection. Proper dosage of these drugs and the timing of egg recovery require monitoring of the ovarian response, usually by way of blood tests and ultrasound examinations during the ovarian stimulation. As with all injectable medications, bruising, redness, swelling, or discomfort can occur at the injection site. Rarely, there can be an allergic reaction to these drugs. Many women experience some bloating and minor discomfort as the follicles grow and the ovaries become temporarily enlarged. The risks and side effects include fatigue, headaches, weight gain, mood swings, nausea, and clots in blood vessels. 

Human chorionic gonadotropin (hCG): Novarel, Pregnyl, Ovidrel. hCG is a natural hormone used in IVF to induce the eggs to become mature and fertilizable. the timing of this medication is critical to retrieve mature eggs. Potential side effects include: breast tenderness, bloating, and pelvic discomfort. 

Progesterone or estradiol: Progesterone and estradiol are hormones normally produced by the ovaries after ovulation. After egg retrieval in some women, the ovaries will not produce adequate amounts of these hormones for long enough to fully support a pregnancy. Accordingly, supplemental progesterone, and in some cases estradiol, are given to ensure adequate hormonal support of the uterine lining. Progesterone is usually given by injection or by the vaginal route after egg retrieval. Progesterone is often continued for some weeks after a pregnancy has been confirmed. progesterone has not been associate with an increase in fetal abnormalities. Side effects include depression, sleepiness, allergic reaction, and if given by intra-muscular injection, includes the additional risk of infection or pain at the injection site. 

Oral Contraceptive Pills: some treatment protocols include oral contraceptive pills to be taken for 2 to 4 weeks before gonadotropin injections are started in order to suppress hormone production or to schedule a cycle. Side effects include unscheduled bleeding, headache, breast tenderness, nausea, swelling and the risk of blood clots or, very rarely, stroke. 

Zithromax Tri-Pak: AZITHROMYCIN (az ith roe MYE sin) is a macrolide antibiotic. It is used to treat or prevent certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections.

Baby Aspirin (81 mg): helps with uterine lining. 

Medrol: A steroid which is sometimes given to transiently suppress immune function during the interval following retrieval and transfer up to the time of implantation.

Estrogen Patches: Estrogen may be administered late in the IVF cycle, usually by skin patches, in order to support the development of the embryo and stabilize the uterine lining.

Next Step: 11/16/15 @ 10am, Sonohysterogram and Mock Transfer. 

For more details on my IVF process, see IVF Calendar/Timeline.