Waiting and hoping and peeing on a stick ...

I have been testing daily since Saturday.  I knew it was early, but I couldn't help myself.  And of course every time I see that absence of a line I am heartbroken.  But I kept telling myself that it wasn't over till it was over.  This morning I ran out of the FRER's I had been using, so I went to the store to buy more.  And when I was at the store, I remembered that last time I didn't get a BFP on the FRER until after my pregnancy had already been confirmed at the doctor's office.  So instead I bought EPT and Clear Blue Digital tests. Both of which I had success with in the past.

Of course I couldn't wait to test until I got home from work. Instead, I tested at the end of my lunch break.  The EPT looked positive, but then it sort of didn't.  I just couldn't be sure.  I took a picture at the 2 minute mark and it looked sort of positive (faintly) but the second picture I took a few seconds later looked less positive.  10 minutes later, the positive was gone.

I posted the pics to one of my online forums and most of the girls said it looked like a positive to them.  So I decided it was time to pull out the digital test. And guess what ....

At 8 days post 3 day transfer it appears that I might be pregnant again!! Now I just have to wait for my beta in 2 days to confirm and then hopefully a repeat 2 days after that to make sure my numbers are doubling.  I am really nervous and hoping that this is the real thing for us this time. Please say a few prayers that we have a sticky bean (or two).

Frozen Embryos

As of Sunday when we did our 3 day transfer, we still had two additional embryos hanging out in the lab.  We were praying and hoping that they would make it to day 6 and be able to freeze.  Our clinic is very strict about the embryos that they will freeze and they will not freeze anything that isn't really good quality.

I have been worrying about them for a few days now, but I figured that if they weren't doing well the clinic would have called and let me know that they hadn't made it.  Then I decided that at least 1 of them must be doing well for the same reason, they would have called if not.  I was following the old "no news is good news" adage, or at least trying to anyways.

Well, I just got the call about them.  Both of the embryos made it to freezing!! I am so excited.  Especially because these two embryos were not as good quality as the two that we transferred on day 3.  I am hoping that means great things for the embryos we transferred.  I can't wait to find out if we are pregnant!!

IVF 2.8 - Embryo Transfer

This morning we did a 3 day transfer of two 8 cell embryos.  We still had all four embryos going strong this morning.  They were as follows: 8 cell graded at A-, 6 cell graded at B+, 8 cell graded at B, and 8 cell graded at B.  The last 8B embryo was only a 2 cell yesterday, so it's development caught up to the rest of the embryos.  We transferred the A- and one of the B's back today.

And the doctor was very hopeful. She seemed to think things look great and that we have a really good chance of this working for us.  She is also hopeful that the other two embryos will make it to freezing, but time will tell with them.  Hopefully things work out and she said that she feels better having the embryos back inside me now than waiting and letting them be in the lab any longer than necessary. 

We are hopeful, but even if it works and we get pregnant, I don't think I will be comfortable until we get to the first ultrasound.  Then I might actually believe it might work out. For now I am just trying to stay positive and have belief that this will work.

IVF 2.7 - Fertilization Report

Today I was on pins and needles all morning.  I was anxious to hear the results on how our eggs fertilized.  Finally a little after noon the nurse called.  Of the 10 eggs that were retrieved they were able to do the ICSI on 9 of them.  Of those 9 ICSI'd eggs, 4 of them fertilized.  So currently we have four embryos chillin in the lab.

I am a little disappointed about this number.  Last time we had seven embryos starting out and by the time we got to day 5 we only had 1 really great embryo and 2 lesser quality that never made it to freezing on day 6.  I am worried that these 4 embryos are not going to make it. And I don't know what we will do if that happens.  I am also starting to realize that the problem must be me and my body.  I am starting to fear I just don't make very good eggs.

Tomorrow we should hear from the nurse again to find out when our embryo transfer will be.  The nurse said today that it will either be Sunday (a 3 day transfer) or Tuesday (a 5 day transfer). At this point I am thinking that we might be doing a 3 day transfer because it might be better for the embryos to be inside me than taking the risk of going to a 5 day transfer. Guess time will tell.

Right now I am just trying to stay positive.  I realize that 4 embryos are better than none and I keep telling myself that the goal this time is quality, not quantity and with any luck these four embryos are going to be the best quality possible.  I just hope it's true.

IVF 2.6 - Egg Retrieval

Egg retrieval was this morning at 8 am.  I wasn't nearly as nervous this time as I had been the last time.  I think it's because I was able to anticipate what was going to happen.  I was still nervous, but mostly just because I am a worrier by nature and I can't help but worry about all of the "what ifs".  Plus I worry about silly things like, will I talk when under anesthesia and what will I say, will I snore, or will my body do something embarrassing? And as many times as I try to tell myself that they have probably seen it all, I still can't help but worry.

Steve and I were up early to shower and get ready and drove the hour to the clinic. Once there Steve went to the lab to produce his specimen and I went to the waiting room.  Eventually the nurse came to get me and took me back to the procedure area. She hooked me up to an IV, took my blood pressure and started getting me ready to go.  The doctor came to see me and said she anticipated at least 10 eggs and possibly a few more if they had grown since Tuesday morning. The procedure went really well.  The doctor was able to retrieve 10 eggs and she said everything looks great.

I am feeling pretty good after everything. I came straight home and went to sleep for about 3 hours. I have just a little bit of cramping but nothing overwhelming. I am anxious to hear the fertilization report tomorrow.  Then I will find out on Saturday if we are doing a 3 day or 5 day transfer. We are also hoping to transfer 2 embryos back.

IVF 2.5 - Follie Check 4 & 5

Monday was our fourth follie check.  Everything looked good and in the words of the nurse we were "so close".  So they scheduled another follow up for this morning and had me double my repronex last night and keep my normal dose of bravelle this morning. 

Follie check number 5 today went pretty well. According to the nurse my estrogen level is at 2559 and my lining is 11. On the right ovary I have 2 measuring at 21, 2 measuring at 18, 1 at 17, 1 at 16, and a bunch of 14 and 13's.  On the left ovary I have 1 measuring at 16, 3 measuring at 15, and 1 at 13.  She said it looks like I will have 7 eggs at retrieval, maybe 10 if a few of the smaller ones grow over the next few days, but they don't want to keep me going for another day or two because they don't want to lose the larger follicles. The nurse told me that anything 16 and over is considered mature. She said we could end up with less eggs if any of my follicles don't have an egg, but at my age she said it isn't very likely to have happen. Basically - I am a late bloomer and we are in great shape.  I feel so much better than I did this weekend and now I'm really excited.

This also means that Egg Retrieval is scheduled for Thursday morning at 8 am! Transfer will be either Sunday (3 day transfer) or Tuesday (5 day transfer). For trying so hard not to get too attached or too involved in this cycle, I am really excited to be doing the retrieval. I hope that this works for us, that we are able to transfer back two really great quality embryos, and possibly have a few embryos left over to freeze. 

Wish us luck!!!

IVF 2.4 - Follie Check #2 and 3

It is very late and I cannot sleep because of a late nap I took on the living room couch this evening. I figured that this is the perfect time to update on the progress of IVF #2. 

Last Thursday, the 19th, I had my second bloodwork and ultrasound check.  The nurse called that afternoon and left a message letting me know that things looked "good", but didn't give specifics about the number of follicles. She did say that the doctor wanted me to take a second shot of Bravelle for that day along with my normal lupron and repronex doses in the evening.  She also wanted me to increase my Bravelle in the morning from 150 units to 225 and come back on Saturday for repeat bloodwork and ultrasound.

This morning (Saturday the 21st) I had my third bloodwork and ultrasound appointment.  This time the nurse, who is not my normal nurse, gave me all kinds of information when she called.  She let me know that again things looked "good".  My estrogen was 937 and my lining was 10.  Follies are as follows, on the right: 2 at 15, 1 at 13, 1 at 12, and 3 at 11, on the left: 1 at 12. She said to continue my current doses of medication and to return on Monday morning for another bloodwork and ultrasound check.

Needless to say, I am a little disappointed.  With the follistim last cycle I was doing the egg retrieval on Tuesday.  At this point the earliest the retrieval will be is Wednesday.  And I am concerned about the sizes of the follicles.  None of them are particularly big and only 2 are at 15.  I can't remember what they want them to be, but I don't think any of them are anywhere near where they should be.  I know that the reason we are doing different meds this time is to try to get better quality eggs, but it seems I am not responding as well to these new meds.  And maybe that's the point.  More quality and less quantity.

I also didn't realize how emotionally invested in this cycle I am.  I have been trying to keep my distance from it all so that I don't stress myself out or become super attached to anything.  I have to do this for my own sanity. Otherwise I would be so scared and a total basket case.  But somehow, without realizing it, I have become invested.  And who was I kidding? How could I be anything but invested in this? It's my body and you can't inject yourself full of hormones and go through all of this without being invested.  I think it's one of the biggest investments you can make.

So .. for now it's a wait and see.  In general I am not feeling super optimistic, but I also know that it's not over till it's over.  All we need is one or two really great embryos ...

IVF 2.3 - Follie Check

Today was my first follicle check since I started the stim meds last Friday.  Currently I am taking 150 units of Bravelle in the morning, 5 units of lupron in the evening, and 75 units of Repronex in the evening.  Three shots a day are starting to take a toll on my poor belly.  I feel like I am starting to resemble a well used pin cushion.  I think I am having a reaction to the Repronex because the area around the injection site is red and hurts to touch, but goes away after a few days. 

So, back to the follie check.  Things are looking good so far.  The ultrasound tech told me that I have 2 on my right ovary measuring about an 11 and several on my left ovary that are just under 11.  The IVF nurse told me that my estrogen level is good, the lining looks great, and follicles are growing.  I am to continue my same dosage of meds and go back in on Thursday morning for repeat bloodwork and ultrasound.

I am a little excited now that things are started and coming along.  However, I think I am also trying not to get too emotionally involved in all of this because I know what can happen when things go wrong.  A part of me wants this so bad, but another part is afraid that it will work. I suppose that's how everyone feels. I just keep praying that things work out for us this time around.

IVF 2.2 - I hate insurance companies!!!

Like the title says .. I Hate Insurance Companies!!! Why you might ask? Well let me tell you. Steve and I payed full out of pocket costs for our IVF cycle in July.  We didn't have insurance coverage so that was that.  If we had done the IVF in November as planned we would also have payed cash for that cycle too.

Then in November we had open enrollment for our insurance and in the "changes for 2012" page of the booklet I noticed that it said the more expensive PPO would now be covering infertility treatments at 50% and included GIFT/ZIFT/IVF.  So I elected the more expensive plan and figured we were good. 

That was until I got a call from the IVF clinic the week between Christmas and New Years and was told that it doesn't appear I had coverage for IVF in 2012.  Although the information about the deductible and copays was also incorrect.  The billing lady figured that the insurance company hadn't updated its information yet because it was not the beginning of the year.  So she told me she would call again after the first and verify the benefits.  But it really made me nervous!

So being the obsessive compulsive and gotta have everything together person that I am, I of course called the insurance company first thing January 3rd (because of course they were closed on the 2nd in observance of the holiday). And lo and behold, I do not actually have coverage for IVF. What??!! So I fire off an email to the Admin person on campus and asked them why I was being told I had no coverage when I had 2 documents showing I did.  I of course scanned those documents in the email and hoped for the best.

The next day I get an email back from our corporate office telling me that the insurance company would call me directly to discuss the coverage.  I check my voicemail and there is a voicemail from someone at the insurance company, her name was Jacinda.  I call them first thing and Jacinda was not available so the lady on the line said she could help me.  Long story short, we spent about 2 hours on the phone over multiple phone calls trying to figure out what IVR was because this was covered while IVF was excluded. This went on until about noon when the lady, Donna, told me she would have to talk to her supervisor and call me back once she got everything straightened out.

At 12:51 pm I got a call from the insurance company.  It was the girl I talked to the day before, the first time I called the insurance company. She told me that she had made a mistake the day before and that the IVF was in fact covered.  Apparently there was a second page to the benefits and she hadn't realized it. WTH?? I walk away from my cubicle to talk to a coworker for a moment, walk back and see that I have a voicemail. It's the IVF clinic, they wanted to let me know they had also called the insurance company and was told that there was no coverage.

I call the IVF clinic back and tell her everything that has transpired over the past few days and she tells me that unfortunately she needs to hear from the insurance company that we have coverage and not from me.  So back on the phone I go with the insurance company to find out what the heck is going on.  This time I ask for Jacinda and luckily she was available.  She verified the benefits again explaining that the system needed an update that would show the coverage. I asked her to call the clinic and let them know, so she put me on hold, called the clinic.  Then while I am still on hold I get a call from the clinic letting me know everything is fine. So yay!! Hang up with the clinic and wait for the insurance company to come back on the line.  She comes back and then gives me all the information I need so that if anything gets denied I can get it taken care of.  Huge sigh of relief, everything is going to be OK!!

Or so I thought ... because an hour later I get a phone call from the clinic again.  Apparently she called the insurance company again to find out if the embryo cryopreservation would be covered and talked to Donna.  Apparently Donna was still attempted to find out what IVR meant and what was covered under that. So the clinic didn't want to accept the 50% coverage quote they received until they heard it from another person at the insurance company.  Once again I called the insurance company to find out what the heck was going on.  I talked to Jacinda again and she was really upset that Donna had talked to the clinic again. She tells me that she will have her supervisor call the clinic the next day (because they were already gone for the day by this time) and let them know that everything is fine.  I voiced my concern that if we were having such a difficult time obtaining verbal confirmation of benefits, what was going to happen when the clinic began submitting bills for the cycle.  Jacinda told me she had the same concern so her boss was going to put a flag on the account letting the billing people know they needed to read the notes and would see that the services would be covered.  But of course things could slip through the cracks and if there were any problems I should call them immediately and they would get it taken care of.

So It's official, we have 50% coverage for our IVF cycle.  YAY!!!

On a side note - have been on the lupron for 5 days now and things are going well.  Stopped my birth control pills last night so I am expecting my period in the next few days. Thursday is my baseline ultrasound and bloodwork and Friday I start the stim medications.  It's hard to believe that in 3 weeks we will hopefully be transfering our babies back into my uterus!!  It's so exciting!!!!

IVF Journey

In May 2011 we finally decided that we were tired of waiting to get pregnant and tired of fertility treatments.  The Clomid medication was making me feel like a crazy person and with my 30th birthday and Steve's 35th looming on the horizon, we decided that it was now or never to do the IVF.  Luckily we had some money saved and decided to take a loan from each of our 401k plans to cover the cost of the IVF.

IVF, In Vitro Fertilization, is a very complex process.  Every doctor and every clinic do things just a little bit differently. The process my clinic uses is starting your cycle on birth control pills.  One option is to add a medication call Lupron, which is a suppressor, to the time you are on the pills.  Once you stop the birth control pills you continue the lupron and start an FSH hormone.  The objective of the FSH medication is to stimulate the ovaries and allow multiple follicles to emerge.  During this time you are monitored through blood work and ultrasound every couple of days.  Sometimes another medication, LH is added to the mix.  LH is lutenizing hormone that helps improve the quality of the eggs that are being produced.  At some point the lupron is stopped and when bloodwork and ultrasound confirm it, it's time to ovulate and have the eggs retrieved for fertilization.  About 48 hours prior to egg retrieval you discontinue all medications and at 36 hours prior give yourself a trigger shot (usually a medication called Ovidrel).  This medication causes ovulation so that egg retrieval can be done.  Egg retrieval is the process of being sedated and the doctor, using ultrasound guidance, aspirates each of the mature follicles.  From there the eggs are fertilized, either naturally or with a procedure called ICSI (this is the process of injecting each egg with an individual sperm).  The eggs are then checked for fertilization and then for embryo development.  Clinics generally do an embryo transfer at either 3 days or 5 days post fertilization.  The theory on a 3 days transfer (at least at my clinic) is if the embryos do not appear to be developing well, that they are better off inside the body than out.  A 5 day transfer is preferred because it provides the best of the best embryos and often gives the embryos an opportunity to show survival of the fittest.  Finally, a blood test, or beta, is given anywhere from 13 to 16 days after egg retrieval.  (This is of course by no means a scientific or complete explanation of the IVF process, it is just the best explanation that I can provide based on the information and experience I have had with the IVF process).

So, we decided to do our egg retrieval the week of July 24th.  Because of a world wide shortage of lupron, my RE decided that instead of doing the lupron, we would instead use Ganirelix.  The difference between these two drugs is the timing of when you start taking the shots.  Instead of taking the Ganirelix prior to starting the FSH drugs, we would start the Ganirelix a few days after starting the FSH, which we used Follistim.  Eventually the doctor also added Luveris, an LH med, to improve the quality of my eggs. Everything went well with our medication and follicle development and on Tuesday July 26 we had our egg retrieval.  Steve was out of town for work, so luckily we had a frozen sample in storage that we were able to use because he couldn't provide a fresh sample.  We had 10 eggs retrieved and 7 of those fertilized.  The doctors decided to do a 5 day transfer on Sunday July 31st.  Of the 7 embryos, we had 1 that was at a blastocyst stage, 2 that had degenerated, and 4 that were still in morula stage.  Because we had one really good embryo, we only implanted that one.  We were told that we would receive a call the next day letting us know if any of the remaining 4 embryos were able to freeze.  We were hoping to have frozen embryos as a back up plan in case the IVF didn't work or to have for a second child in the future if it did work.  But alas, none of our embryos made it to freezing so all of our hopes and dreams were pinned on the one embryo we put back. Our first beta was scheduled for Monday August 8th.

Sunday August 7th I took a home pregnancy test and got what appeared to be a very faint positive.  The test was an EPT and after getting several opinions I decided I needed to take another test to be sure.  I had several pregnancy tests in my bathroom drawer left from previous purchases of ovulation predictor kits (it's cute that they give you a free pregnancy test with the purchase of the OPK's, it makes me think that even the company is rooting for your success). Luckily, the tests I had in the drawer were digital tests.  I was thrilled because this would give me a definite answer,  the result would literally say "pregnant" or "not pregnant".  I took the test and the result was "pregnant"!!! I was thrilled and immediately started spreading the news to our friends and family.  I knew there was no way around sharing because everyone knew we were doing the IVF and would be anxious to hear the results.  The next morning I went for blood work and the pregnancy was confirmed.  My beta was a 40.  This number is a little low, but I was only 8 days post a 5 day transfer and at this point, anything over a 5 is considered pregnant.  A repeat beta was scheduled for Weds Aug 10.  The reason they check your levels again so soon is because your HCG levels should at least double every 48 to 72 hours.  The second beta came back at 60.  This was definitely concerning because the numbers hadn't doubled, but they had risen, so there was hope.  The doctor decided that we needed to wait 6 days before repeating the blood test again.  After researching, I found that the most likely reason for this was if we had a chemical pregnancy, the numbers would be back to less than 5 by then end of the 6 days.  But when I went back for the blood work on Tuesday August 16, my beta was 985.  The nurse and doctor were thrilled and they scheduled our first ultrasound from Monday August 22. 

At this point I was having some pregnancy symptoms. I was queasy a lot, pretty much all day and was mostly eating bland, soft foods - yogurt, bananas, mashed potatoes.  I was also finding myself craving chicken.  I am normally a person who eats chicken and red meat pretty evenly.  But for some reason, all I wanted to eat was chicken.  I could eat it for breakfast, lunch and/or dinner.  It sort of shocked me that I could have cravings so early.  I was also really nervous about the queasiness.  I figured if I was already experiencing it, the chances were pretty good that I would experience some pretty heavy morning sickness as the pregnancy progressed.  I was also pretty nervous about the pregnancy itself.  I felt like I would feel better once we saw a heartbeat and was anxiously counting the days to that particular goal.

Friday August 19th, at 5 weeks and 3 days, I was at work and felt this weird gush sensation.  I sat down, put my hand between my legs on the outside of my pants and had blood on my fingers.  I ran to the bathroom and had a lot of blood in the toilet.  I immediately went home, calling my husband on the way to let him know what was going on. I figured that we would be going to the ER because I was having a miscarriage.  I also called the RE's office to see what they thought I should do.  While I was waiting for them to call me back, I arrived home and noticed that the bleeding had significantly slowed down.  I was still having bleeding and some clotting and mild cramping, but no more gushing.  The RE's office said it sounded like a subchorionic hemorrhage, a complication that is common in early pregnancy and is caused by implantation.  Basically what happens is that there is a hematoma that develops in the uterus, but outside of the gestational sac.  The nurse told me that as long as I wasn't having severe pain or filling a pad in an hours time, that I should be ok.  But if it was worse or I felt that there was something wrong, I could call them or go immediately to the ER.  Because the bleeding slowed down every hour as did the cramping, we decided that things must be ok.  By morning the bleeding had completely stopped.

Monday August 22nd we went to our ultrasound appointment as scheduled.  The tech gave us a due date of April 17th and said we should be 5 weeks and 6 days along.  She told me that usually they cannot see a baby until at least 6 week, but since we were so close we might see the baby.  However, she said we were looking for a gestational sac and yolk sac.  She asked us to give her a few minutes to look around and then she would show us what she saw.  After several minutes she turned the screen towards us and showed us where the cervix was and where the top of the uterus was and explained that there was nothing there.  She said that we most likely lost the baby during the bleeding that happened on Friday.  She said she needed to check my tubes to make sure there wasn't an ectopic pregnancy and that after that we would see the doctor. 

After blood work and a meeting with the doctor, we had to wait an hour for the results of the blood work. They were again checking my hcg and the results of that would determine our options.  Luckily, my beta was 221 which made the doctor feel pretty confident we had had a natural miscarriage and would not need to have a d&c or take medication to eliminate an ectopic pregnancy.  I had to go back to the clinic the following week to have my blood taken again, beta was 8.5, so had to go back again the following Monday.  Finally on Labor Day, Monday September 5, my beta was less than 2.5 so they determined that the miscarriage was complete and I was cleared from having to have any additional follow up care. And sadly, our very much wanted pregnancy was completely over.

It only seems fitting that the next post will be titled "Miscarriage sucks".  So stay tuned.

Infertility Sucks!

Like the title says, Infertility sucks.  One of the worst things in this world is to feel like your body has betrayed you.  As a woman, I know that my body has the ability to create, carry, and deliver a baby. As a woman, it's my right and privilege to bear children, yet my body has decided to boycott.  It's gone on strike and refuses to be a party to my wants.  I know that I have as little control over this as I do over the temperature outside, but for someone like me who is a perfectionist and tries to be great or succeed at every endeavor that I undertake, the idea of not being able to have a baby is somewhat devastating.

Steve and I have tried to have a baby for over eight years and it's been a fruitless endeavor.  When we were told by the clinic at Magee's that IVF was pretty much our only option, we knew then that we would have to put our dreams of a family on hold for awhile.  We simply lacked the financial ability to put make our dreams a reality.  But after a year or more of waiting, we decided that we needed to have a second opinion.  Right around the time we decided we wanted a second opinion, the doctor who pioneered the technology for IVF, Robert Edwards, was being given the Nobel Prize.  As a result of the Nobel prize, the local paper did an article about the clinics in the area.  They focused on the success rates of three of the area clinics.  This article is what lead us to choose our new clinic, Reproductive Health Specialists in Penn Hills, PA. 

There are several reasons I was drawn to RHS.  One, the drive to the clinic was much shorter than the one I had been driving to Magee's.  When I was going to the clinic at Magee's, I would have to get up between 4:30 and 5:00 am in the morning to be in Pittsburgh for a 6:30 appointment.  I needed to leave the house no later than 5:40 am in order to avoid rush hour traffic going into the city.  I would be at my appointment for up to half an hour (an appointment usually consisted of blood work and then an ultrasound).  I would leave the city around 7:00 am and make it to work by 8:00 am.  I would work my normal shift of 8:00 am to 5:00 pm, make the half hour drive home and usually get up the next morning or the day after that and do it all again.  It's an exhausting process.  So the fact that I could avoid rush hour traffic and shorten my drive time was a major positive.  The second reason I was excited about our change in clinics is that the doctors in the office were female.  I just feel that much more of a connection with a female doctor than a male doctor.  And as it turns out, the only male who appears to work there is the embryologist.  Or at least that's the only male I've ever come in contact with at the clinic.  And the third reason was their success rates.  In 2007 RHS's IVF success rate was around 60% compared to 45-50% for the clinic at Magee's.

We went for our initial consult with RHS in October 2010. We were pleasantly surprised to find out that the doctor didn't want us to jump into IVF right away.  She felt that because we had never been monitored on the Clomid previously, that we should try a few cycles of Clomid and IUI.  The first 3 cycles we weren't able to do the IUI's because of Steve's work schedule, but I was able to visit him and we tried on our own.  In Febuary and March we were able to do the Clomid and IUI, but both cycles were unsuccessful. Finally we decided that IVF was the way to go and in May 2011 we began our IVF journey.