Today's appointment went well... I think. Determined not to forget any questions or things I wanted to cover I prepared a 4 page handout for discussion. Don't laugh. Okay laugh. It's ridiculous. (It even had a page titled "Notes" at the back. I smiled from ear to ear when Dr. S turned to it and started scribbling furiously. Take that Mr. R! Ohhhh how he laughed at me for that page).
Anyway, I didn't want to waste this time dwelling on the "what went wrong" portion of the program, so I jumped right over that and talked about my insurance cover, what we have left, how we've met all our deductibles for this year and what our next plans are. I explained my reasons for each step and Dr. S seemed very supportive.
So in order here's what we covered:
1) Vasectomy reversal.
Dr. S says that based on the low motility we're seeing in the TESE samples he's not expecting miracles to occur here, but he agrees with me that there is no reason for that door to remain shut. You never know what might happen and also... for future attempts - depending on SA results post-reversal - we'll probably be able to avoid TESE either way since we'll only really need fewer than 8 for ICSI, but it does open the door for wildcard IUI tries in the future since we still have cover for this. He says to go for it, but do it ASAP.
He has ordered an endocrine panel for Mr. R on Saturday. We have our consult with urologist on Wed next week and we're HOPING to have surgery the week after.
2) Laparoscopy.
My reasons for wanting this are threefold. Firstly, I have mild endo and my last lap was 3 years ago. I want to know that it's gone and won't be a problem for next transfer, for SURE. Also, I have dysmenorrhea (ridiculously painful periods with hideously heavy flow) and the last 6 months we've gotten to the point where I literally cannot get out of bed for CD 1 and 2, and I only make it through the day hopped up on 4-600mg of Ibuprofen every 2 hours and by assuming labor positions on my knees and arching my back up and down while sobbing hysterically and rushing to the bathroom every hour. Yes, I know that's a LOT of ibuprofen, but its better than what my OB prescribed -- hydrocodone, which incidentally doesn't work at all! I cannot go on like this much longer and it definitely got better for a short while after last lap. And lastly, I figure a lap may double as an endometrial scratch of sorts. Dr. S doesn't give much weight to endometrial scratching as being beneficial, but it can't hurt so he has agreed to do a lap for me.
They're scheduling me for lap surgery next week. Will hear tomorrow what day. This is too far out from transfer cycle to be beneficial as a "scratch" replacement I think. Oh well.
3) PGS Cycles
So here's where it gets pretty up in the air. We discussed briefly how we feel about outcomes of the Micro Flare protocol. We both agree that 6 retrieved, 5 mature is pretty close to the top end of what I can expect in any cycle, it's a pity about the fertilization - though to be fair (standing up for my eggs) 3 fertilized out of 5 mature is not abysmal by any stretch of the imagination. If only they'd all keep growing from there!
I've been reading up on the Agonist/Antagonist Conversion protocol (thanks to an amazing friend on TWW forum) designed by the famous Dr. Scher of Las Vegas. I added a note about it in my handout - didn't mention the good Dr. Scher at all, just the possibility of considering a protocol that focused on keeping the LH low throughout and giving a max dose of FSH on day 1 & 2 of stims, before exposure to LH. Dr. S read about this and said, "Ah yes, the Scher Protocol. We've used this in the past and had moderate success with it, but we haven't used it in a while. It might work here." I felt REALLY good about him in that moment. I am SO glad I switched REs in this clinic. My last RE had a tendency to pooh-pooh any suggestion I made without even considering it. Dr. S is going to discuss it with his partners (including my other RE) but he feels that given our time constraints, remember everything has to be done by Dec 31 to avoid extra costs, this might be too long for our time line.
He does believe there is still some wiggle room in my max dose of Follistim. I cycled on 450 last time, and he says he has gone as high as 600 before. We're probably going to up me this time.
He mentioned a protocol that they've already been discussing for me called Lupron Overlap -- I've never heard of this before, so anyone with experience on this protocol please let me know. He wants to give this some more thought.
In order to run with our desired timeline two months spent languishing on BCPs is not going to work, so for the second retrieval cycle he is thinking about letting me start right after AF shows up post retrieval #1 without a break BCP cycle.
I start BCPs for first cycle tonight. He drew an updated AMH today to see if I have continued to improve (see sidebar). Fingers crossed!
4) Donor Cycle
Now here's where it gets tricky/confusing/tough to plan and honestly we didn't go into this part in too much detail as we'd already gone 45 minutes over my 30 minute appointment.
Two retrievals will already land us somewhere in mid November before we have PGS results -- and this is of course barring any delays, cysts, needing to delay trigger to allow stragglers to catch up, etc. I haven't had a troublesome cyst yet, I know I am due one. And last cycle we delayed trigger by 3 days waiting for my slow-pokes to catch up.
If we get to November and find that we have no viable embryos for transfer we're going to have to rush into selecting a donor, paperwork, etc. Nevermind stimming the donor, retrieval, etc. It doesn't seem likely that we'll be able to transfer before the end of the year.
We're hoping that my insurance will be agreeable to starting the donor process before we get results of PGS. I am a realist, and I know that of the 2-3 embryos we're sending for testing the odds of even one of them coming back normal is very, very low. If by some miracle we do get one of the expected three back, I am still hesitant to transfer a singleton. I know everyone has their preferences, mine is a twin transfer every time. We are fully prepared for twins, we would welcome a twin pregnancy with incredible joy - we would be equally ecstatic if twin transfer became singleton pregnancy.
So the hope is that we'll be able to select, sign ,and start a donor in November, for ER in December. This way, IF we have one normal genetic embryo we can still put two back. One genetic and one donor and freeze the rest of donor embryos for future FETs at a much more affordable price.
What may end up happening is that we end up doing a transfer in the new year. We're hoping not to have to do this, but transfer only is a much more affordable price tag. I am pretty sure though, that a cycle started in 2014 will count towards 2014 benefits, even if it is completed in 2015? I have no idea how that will work...
I need to redouble my efforts to seek out a donor who matches a reasonable set of requirements and is based in or around the Houston, TX area.
I also need to spend an hour with an insurance rep to go into these details.
So there you have it... This post is pretty much verbal diarrhea I am afraid. I just have to get it all down on paper before I forget it - especially the donor part of the plan. Dr. S and I didn't discuss it in much detail because we spent much too long talking about protocol options. This is what I understood from our conversation, but I am hoping to hear from his nurse tomorrow with a schedule and more clarity on the specifics - as far as we can see them from here.
Wednesday, July 30, 2014
Tuesday, July 29, 2014
The (Tentative) Plan
We had a chance to sit and talk last night. Talk about the cover we are so blessed to have, and discuss how we're going to use this to our best advantage before the year is through and we have to start meeting all our deductibles again. What helped actually was that we had a call from my mother who had just read my text about the insurance coverage and our options. She had some advice... she always has some advice and it's rarely the same as what I am thinking... Her advice to us is to forget about trying again with my own eggs. She feels strongly that my desire for a biological child is "ridiculous" and "frivolous". Yep... she used those words. The fact that they will cover a donor cycle means that they're willing to lay out twice as much as what we're asking for the PGS cycle, and we have a MUCH higher chance of success. She feels that the money would be better spent on a cycle with better odds. What helped was that while I was explaining our options to her in minute detail so that she could fully understand what our coverage meant -- I am not originally from this country, and our insurance back home is very different. Mr. R was standing by as I explained each step, and what the cover meant, and how I felt about our options. I was not able to make my mother see my position on this, but Mr. R heard me loud and clear. When I hung up he said, "Baby, we're not giving up on your eggs yet. Let's give it one more try."
We went over his questions about the two options. We discussed our cover and he reminded me that while we will most likely need 3-4 retrieval cycles for sufficient blasts to PGS, we only have 4 total IVF cycles paid in full -- including our donor cycle. We've used 1 already. (Our first cycle was a drug trial). And if we want to try donor eggs we will need to have at least one IVF saved for that. There is no way on this earth that we will be able to afford the estimated $26,000 it would cost us out of pocket for a donor cycle. No way. Ever. That will be our last try.
We came up with a plan... now of course, this will most likely be thrown around/tossed out after our appointment with Dr. S tomorrow, but I wanted to document it all so I can refer to it if needed.
1) Vasectomy reversal. This is our top priority.
2) Retrieval #1, day 5, biopsy, freeze blast/s and freeze biopsy material.
3) Laparoscopy for my endo (rest cycle)
4) Retrieval #2, day 5, biopsy, freeze blast/s and send both biopsy's for testing.
5) IF any normal embryos, transfer frosty/ies - if not, plan B.
6) Donor cycle. Plan B.
7) If donor cycle fails we're HOPING that the vasectomy reversal will prove a success and that we will have the option of IUI which we have unlimited cover for. But there's a chance that post-reversal SA will come back with very poor, unusable results. This is officially Plan C.
8) If all else fails there's the tiny, teeny, weeny, itsy, bitsy glimmer of a chance for a miracle unassisted pregnancy created the old fashioned way. Percentage odds are ridiculously low, but you never know what the future will hold and we're going to move forward holding this hope in our hearts. Plan D.
9) While we're hoping for the miracle to end all miracles, we may be able to start saving for an out of pocket donor cycle -- maybe in Europe where donor cycles are slightly more affordable, still... I don't imagine that they're cheap -- so we will need a few years to save for this one. Plan E.
The reality is that we probably will not have any genetically normal embryos. Heck, we may not even have enough blasts to send for testing after just two retrieval cycles. In both my past cycles we only had one embryo that appeared to possibly be able to make it to day 5. Having just 2 to test does not offer great odds, but it's our only and last chance. I know that I need this to be able to move on with peace in my heart that I gave me eggs every opportunity.
The reality with Plan B is that even with 22 year old eggs one donor cycle may not be enough for a successful pregnancy, but it's all we can afford to do. (Unless we win the lottery, in which case we'll keep trying and trying until we're successful).
Plan C's sober reality is that after almost 16 years his tubes are probably all gunked up and what comes out will be a mess. But we've done some reading and we've heard that this can improve over time. (Mr. R has promised to be vigilant about clearing the tubes out often. lol) (No, we don't seriously know if that helps, but he's committed to trying.) And yes, I realize that if IVF didn't work, our odds of success with IUI are very low, but I can't help but hope that we might "catch" a genetically normal egg one month.
We know that Plan D is our "Unicorn" plan. But since we're not willing to give up on a child completely, this will always remain on my list.
Plan E will mean extending our life of "poverty" to quote my mother as we save furiously for the chance at trying another donor cycle somewhere more affordable. We will see how tired I am when we get to this point. Honestly, this extreme penny-pinching lifestyle is really starting to grow old after just 2 years and I don't know how much longer Mr. R will be on board for PB on toast 2 nights a week. We'll see.
So there you have it folks! My game plan for the rest of this year and beyond. We'll see how much it changes after appointment with Dr. S tomorrow.
We went over his questions about the two options. We discussed our cover and he reminded me that while we will most likely need 3-4 retrieval cycles for sufficient blasts to PGS, we only have 4 total IVF cycles paid in full -- including our donor cycle. We've used 1 already. (Our first cycle was a drug trial). And if we want to try donor eggs we will need to have at least one IVF saved for that. There is no way on this earth that we will be able to afford the estimated $26,000 it would cost us out of pocket for a donor cycle. No way. Ever. That will be our last try.
We came up with a plan... now of course, this will most likely be thrown around/tossed out after our appointment with Dr. S tomorrow, but I wanted to document it all so I can refer to it if needed.
1) Vasectomy reversal. This is our top priority.
2) Retrieval #1, day 5, biopsy, freeze blast/s and freeze biopsy material.
3) Laparoscopy for my endo (rest cycle)
4) Retrieval #2, day 5, biopsy, freeze blast/s and send both biopsy's for testing.
5) IF any normal embryos, transfer frosty/ies - if not, plan B.
6) Donor cycle. Plan B.
7) If donor cycle fails we're HOPING that the vasectomy reversal will prove a success and that we will have the option of IUI which we have unlimited cover for. But there's a chance that post-reversal SA will come back with very poor, unusable results. This is officially Plan C.
8) If all else fails there's the tiny, teeny, weeny, itsy, bitsy glimmer of a chance for a miracle unassisted pregnancy created the old fashioned way. Percentage odds are ridiculously low, but you never know what the future will hold and we're going to move forward holding this hope in our hearts. Plan D.
9) While we're hoping for the miracle to end all miracles, we may be able to start saving for an out of pocket donor cycle -- maybe in Europe where donor cycles are slightly more affordable, still... I don't imagine that they're cheap -- so we will need a few years to save for this one. Plan E.
The reality is that we probably will not have any genetically normal embryos. Heck, we may not even have enough blasts to send for testing after just two retrieval cycles. In both my past cycles we only had one embryo that appeared to possibly be able to make it to day 5. Having just 2 to test does not offer great odds, but it's our only and last chance. I know that I need this to be able to move on with peace in my heart that I gave me eggs every opportunity.
The reality with Plan B is that even with 22 year old eggs one donor cycle may not be enough for a successful pregnancy, but it's all we can afford to do. (Unless we win the lottery, in which case we'll keep trying and trying until we're successful).
Plan C's sober reality is that after almost 16 years his tubes are probably all gunked up and what comes out will be a mess. But we've done some reading and we've heard that this can improve over time. (Mr. R has promised to be vigilant about clearing the tubes out often. lol) (No, we don't seriously know if that helps, but he's committed to trying.) And yes, I realize that if IVF didn't work, our odds of success with IUI are very low, but I can't help but hope that we might "catch" a genetically normal egg one month.
We know that Plan D is our "Unicorn" plan. But since we're not willing to give up on a child completely, this will always remain on my list.
Plan E will mean extending our life of "poverty" to quote my mother as we save furiously for the chance at trying another donor cycle somewhere more affordable. We will see how tired I am when we get to this point. Honestly, this extreme penny-pinching lifestyle is really starting to grow old after just 2 years and I don't know how much longer Mr. R will be on board for PB on toast 2 nights a week. We'll see.
So there you have it folks! My game plan for the rest of this year and beyond. We'll see how much it changes after appointment with Dr. S tomorrow.
Monday, July 28, 2014
Vasectomy Reversal & An Update
We received awesome news last week! Mr. R called the urologist and asked them to check our insurance to make sure that they do not cover vasectomy reversals. The kind nurse who has done a lot of digging through our insurance for us to discover that TESE was covered said, "We don't ever check with insurance companies for reversals, none of them cover them. The cost is $5,000 and the best you can hope for is that they MIGHT cover the hospital portion for the surgery. You will need to call them for this part."
Mr. R dutifully called our insurance and the woman he spoke with said, "Oh no, we definitely don't cover vasectomy reversals, but let me check on the hospital portion..." She kept him on hold for what felt to him like an eternity before coming back on the line... "Um... so I looked into it and it seems that we WILL cover infertility reversal surgery 100% and since you've met your deductible that's $0 out of pocket."
Infertility reversal??
Mr. R checked with her several times and asked her to double check with a colleague to make certain that this meant vasectomy reversal. She came back and confirmed that yes, vasectomy reversal is considered "infertility reversal" and yes, we are 100% covered.
Okay, so I am still well aware that the chance of a "natural" pregnancy -- I hate that term... (what's a better way to refer to an unassisted pregnancy? I guess unassisted pregnancy sounds better already!) We know that the chance of an unassisted pregnancy is very very low... like tiny, miniscule chance, but at least it opens that door for us every month so we're doing it. Urologist consult is next week.
AF showed up yesterday at last. I stopped progesterone and estrogen supplements on 11dp3dt. I called it in to the triage line yesterday and this morning received a call from my cycle nurse who said, "Okay, so you stopped progesterone 9dp5dt"... uhmmm... we didn't do a 5dt, we did 3dt? "Oh you did? Okay then..." HOW does my cycle nurse not know this? Does anyone else ever feel like their cycle planning is all just a prefabricated sheet that they pull out of a filing cabinet under a tab that has your diagnosis? Like "Over 35, DOR" and out comes a sheet with a basic plan for micro flare lupron. Ugh... Well we're moving into uncharted territory now... or rather, we're moving into territory rarely charted by this clinic... so my hope is that now I will have to have an even more customized cycle plan.
She didn't sound enthused at the idea of a reversal and thought it was unnecessary, but advised me to discuss with my doctor. That's fine. I know what they're all going to say, but we're doing this anyway.
She advised me that my RE can do a laparoscopy for me and that there is no need for me to go through my OB GYN for this. Probably a better idea so that he can time it to match my cycling.But their surgery facilities are out of network and so we will have to pay for that out of pocket -- whereas my OBGYN surgery is IN network and would be free. (ALWAYS money isn't it...) Strike this, see below... just had a call from our finance rep and we're pretty sure that we've met our out of network deductible too at this point, so there won't be any difference cost-wise. Better then to do the lap with my RE so we can time it in with my cycling.
She says that I will need 6-8 weeks post laparoscopy for my lining to repair enough for transfer... but I mentioned that with banking embryos this was a non-issue, at least for 2-3 retrieval cycles.
She also said that we cannot do back-to-back retrievals as the risk for cysts is increased with the constant stimming. I would need to do a stim cycle, rest cycle, stim cycle, rest cycle, stim & transfer cycle -- if we have any to transfer. So we're looking at transferring in or around January 2016... maybe.. depending on how much of the PGS stuff is out of pocket and how my 100% insurance coverage for IVF will work with stim-only cycling. Back to money again... *Sigh*
So that's where we stand right now... will know more after WTF appointment on Wed about how we're going to proceed. Mr. R has run out of sick/vacation/personal days at work and so he will be taking an early lunch to join us by phone for the consult... it sucks that he can't be there, but it's the best we can do without jeopardizing his crappy job that comes with awesome insurance.
That's another thing... Mr. R accepted this job as he transitioned out of law enforcement and completed studies for a new career. The work is menial, the hourly wage is deplorably low, his colleagues are (mostly) insufferable... but as we've discovered the insurance kicks butt! He will need to tough it out a bit longer until we can figure this out.
Just had a call back from my clinic's financial services:
PGS
IVF: We've now met in network deductible so this is free
Facility Fees: We've met our out of network deductible (though it's not yet reflecting) so this SHOULD be free, but worst case $1,500 for each of us for retrieval and TESE
(PGS requires a medical review and approval on a case by case basis.)
Biopsy: My clinic fees for biopsy - $2,750
3rd Party Lab: $3,000-5,000 (Shady Grove Testing in Maryland)
My clinic will require $2,750 biopsy fee paid up front. I deal directly with 3rd party lab on their costs.
Donor Eggs
IVF Me: 100% cover
Facility: Most likely free, but possibly $1,500
Donor Services (everything including meds): Verbal confirmation that this is covered 100%. My clinic requires confirmation in writing. IF they don't get written confirmation this portion ALONE is $16,000 but it looks like everything for me and Mr. R is covered at this point. We can expect written confirmation or denial in 2-3 weeks. Our financial rep is submitting the written request today.
Money. Money. Money. Money.
Mr. R dutifully called our insurance and the woman he spoke with said, "Oh no, we definitely don't cover vasectomy reversals, but let me check on the hospital portion..." She kept him on hold for what felt to him like an eternity before coming back on the line... "Um... so I looked into it and it seems that we WILL cover infertility reversal surgery 100% and since you've met your deductible that's $0 out of pocket."
Infertility reversal??
Mr. R checked with her several times and asked her to double check with a colleague to make certain that this meant vasectomy reversal. She came back and confirmed that yes, vasectomy reversal is considered "infertility reversal" and yes, we are 100% covered.
Okay, so I am still well aware that the chance of a "natural" pregnancy -- I hate that term... (what's a better way to refer to an unassisted pregnancy? I guess unassisted pregnancy sounds better already!) We know that the chance of an unassisted pregnancy is very very low... like tiny, miniscule chance, but at least it opens that door for us every month so we're doing it. Urologist consult is next week.
AF showed up yesterday at last. I stopped progesterone and estrogen supplements on 11dp3dt. I called it in to the triage line yesterday and this morning received a call from my cycle nurse who said, "Okay, so you stopped progesterone 9dp5dt"... uhmmm... we didn't do a 5dt, we did 3dt? "Oh you did? Okay then..." HOW does my cycle nurse not know this? Does anyone else ever feel like their cycle planning is all just a prefabricated sheet that they pull out of a filing cabinet under a tab that has your diagnosis? Like "Over 35, DOR" and out comes a sheet with a basic plan for micro flare lupron. Ugh... Well we're moving into uncharted territory now... or rather, we're moving into territory rarely charted by this clinic... so my hope is that now I will have to have an even more customized cycle plan.
She didn't sound enthused at the idea of a reversal and thought it was unnecessary, but advised me to discuss with my doctor. That's fine. I know what they're all going to say, but we're doing this anyway.
She advised me that my RE can do a laparoscopy for me and that there is no need for me to go through my OB GYN for this. Probably a better idea so that he can time it to match my cycling.
She says that I will need 6-8 weeks post laparoscopy for my lining to repair enough for transfer... but I mentioned that with banking embryos this was a non-issue, at least for 2-3 retrieval cycles.
She also said that we cannot do back-to-back retrievals as the risk for cysts is increased with the constant stimming. I would need to do a stim cycle, rest cycle, stim cycle, rest cycle, stim & transfer cycle -- if we have any to transfer. So we're looking at transferring in or around January 2016... maybe.. depending on how much of the PGS stuff is out of pocket and how my 100% insurance coverage for IVF will work with stim-only cycling. Back to money again... *Sigh*
So that's where we stand right now... will know more after WTF appointment on Wed about how we're going to proceed. Mr. R has run out of sick/vacation/personal days at work and so he will be taking an early lunch to join us by phone for the consult... it sucks that he can't be there, but it's the best we can do without jeopardizing his crappy job that comes with awesome insurance.
That's another thing... Mr. R accepted this job as he transitioned out of law enforcement and completed studies for a new career. The work is menial, the hourly wage is deplorably low, his colleagues are (mostly) insufferable... but as we've discovered the insurance kicks butt! He will need to tough it out a bit longer until we can figure this out.
Just had a call back from my clinic's financial services:
PGS
IVF: We've now met in network deductible so this is free
Facility Fees: We've met our out of network deductible (though it's not yet reflecting) so this SHOULD be free, but worst case $1,500 for each of us for retrieval and TESE
(PGS requires a medical review and approval on a case by case basis.)
Biopsy: My clinic fees for biopsy - $2,750
3rd Party Lab: $3,000-5,000 (Shady Grove Testing in Maryland)
My clinic will require $2,750 biopsy fee paid up front. I deal directly with 3rd party lab on their costs.
Donor Eggs
IVF Me: 100% cover
Facility: Most likely free, but possibly $1,500
Donor Services (everything including meds): Verbal confirmation that this is covered 100%. My clinic requires confirmation in writing. IF they don't get written confirmation this portion ALONE is $16,000 but it looks like everything for me and Mr. R is covered at this point. We can expect written confirmation or denial in 2-3 weeks. Our financial rep is submitting the written request today.
Money. Money. Money. Money.
Wednesday, July 23, 2014
Have You Seen This Girl?
It's freaky because even Mr R said "look! We need HER eggs! She looks just like you." I must admit the resemblance to my 20yr old self is quite uncanny... Give her blue eyes and slightly curlier hair and add about 10lbs and that's me at 20! Same face shape. Same mouth. Same nose. Same puffy eyelids and eye shape. Same dimples even! (Things that weren't on my list!)
We then proceeded to scope out every strawberry-blonde, curly headed woman we passed for possible similarities. We're calling this game Egg Stalking. Mr R is resolved - should we ever see a good match - to ask her if she has ever considered egg donation. Not sure how I feel about this... Is it even legal to approach people on the street for the purposes of soliciting their eggs?
Those of you who are reviewing donor banks frequently - please let me know if you see anyone who looks like this. Especially if she's Texas based!
DE is still our Plan B moving forward, but Mr R is growing more comfortable with the idea every day and since I don't have much hope for even one genetically normal blast to come out of our PGS journey I plan to actively continue researching donors.
Tuesday, July 22, 2014
9dp3dt & Next Steps
Here we are again, 9dp3dt and while this time AF hasn't shown up I am still cramping and still BFN on tests so I am calling it.
Plans...
We spent last night discussing DE and all that entails. We even perused one database to check out the options and see how hard it would be to find a lookalike. This is going to sound vain I think... I have really, REALLY curly hair and it's kind of my trademark, people know me for it and I have always dreamed of little ones with heads covered in ringlet curls as mine was. I am also very tall at 6' and it's important to me that my future children have at least a chance of being tall too. (Mr R is 5'10") in one database we managed to find two possible donors with curly hair - though not quite as curly, both were over 5'9. That put my mind at ease. Is it ridiculous that I want to find someone that closely matched? I feel ridiculous being so specific. What do other recipients look for in a "match"? We talked about it at length but Mr R is adamant that we give my own eggs one last try and because I am not completely sold on DE myself yet I agreed.
So what does that mean for us? Clearly we have a quality issue when it comes to our embryos. Three grade A, zero fragmentation went in but none came out. We've been reading about PGS. I emailed my embryologist last night to get his take on it and it seems he's already brought this up to my doctor. Our only concern is that because of the low number of eggs I produce, and even lower number making it to day 3, we may never have any to test given that our clinic only does Day 5 genetic testing. And an even stronger possibility is that we send my one day 5 embryo for testing only to find out he's genetically abnormal. I've heard about banking embryos - multiple retrieval cycles, freeze all day 5s and send them for testing. The cost, as you can imagine, is going to be exorbitant and most insurance companies will not pay for PGS so this is going to be out of pocket - to the tune of between $2,500-4,000 per the internets. Then we also have the issue of Mr R needing a fresh TESE with each retrieval and our embryologist saying we'll need 2-4 retrievals to have enough embryos to test. My mind is spinning. We are not rich people. We live a very modest life. I don't know if we can afford this and it makes me incredibly angry that the only thing standing between me and a possible genetic child is money! We would gladly do 10 retrievals if we could afford it. Our insurance coverage when it comes to banking is questionable and I have my clinics finance people looking into that today. But even with the cover we have each cycle is a minimum of $4,000 out of pocket and at this point we've sold everything we have to sell - we're sharing my old beater car and sitting on camping chairs in our living room. My mother says I am ridiculous to even consider this because financially it will ruin us. It infuriates her that we've spent as much as we have already and says we're living in poverty! I don't feel that we're quite that bad, but I do see her point. When is enough enough?
We're also discussing a wild card option. Mr R wants a vasectomy reversal. It's now almost 16 years old. We've been told that a reversal at this stage is worthless and that any semen would be unusable. Of course every man likes to think that theirs is the best and strongest and that they will beat the odds. I'm not sure about that, but what I am sure about is at least wanting to have a teeny tiny chance at a miracle. The slightest possibility that one day one perfect sperm cell will meet a genetically normal egg and create a perfect miracle baby. The internet is full of success stories like that - even in cases with DOR. Once the vasectomy reversal is paid for we have unlimited monthly free tries, on top of our embryo banking and genetic testing.
And so... Our decision? Well, we're going to talk about it some more today - Mr R is coming home early to console me and we're going to formulate a plan to take with us to our WTF next Wed. But at this point we think our future looks like this:
1) vasectomy reversal
2) 3 bank retrievals (insurance has 3 cycles left)
3) PGS any day 5 embryos we have
4) laparoscopy for my endo (not necessary but we hear it can help with implantation)
5) transfer normal embryo (2 if we have that many)
And if all of that fails then we can move in to DE with a clear head.
I'd love to find some bloggers who are dealing with old vasectomy reversals and banking for PGS. If you currently follow anyone like this please let me know their URLs. I've learned so much from you all and I know there's a lot I need to learn about these two things.
Sunday, July 20, 2014
Friday, July 18, 2014
Sunday, July 13, 2014
Transfer
We're SO glad we pushed for day 3! This morning our embies were one 8A and one 6A and one remained 2A and they're pretty sure he arrested over night but gave us the option to transfer anyway - they would normally leave him another day to see if he does anything before discarding. So as of right now I have three embies on board but chance of triplets just went WAY down. You know what is weird? I don't make many eggs, and they don't all mature or fertilize but dammit they are all perfect, zero fragmentation embryos every time.
Bed has been set up. Snacks are ready and I have been a DVRing fool this week. I only slept like 2 hours last night so I am ready for bed!
Saturday, July 12, 2014
Division Report
We had a call from the embryologist this morning - later than usual which had us a little nervous. He told us that we have 3 embryos. One is 4 cells, and two are 2 cells. He said we're pushing to day 5.
Wait... What??
We were surprised because the embryologist we spoke with yesterday was very keen to go with day 3.
He explained that since we now have 3 "for sure" embryos he'd be more comfortable with waiting to see which of the 3 make it.
We explained that we've spent the better part of 24 hours discussing putting 3 back with family and given our specific set of circumstances and our past experience we're ready to go with the 3 we have for a day 3 transfer.
He said that he understands our wanting to tackle this aggressively, but he would advise day 5. His partner - whom we spoke with yesterday - was pushing for day 3. We asked for a little time to discuss further and hung up.
We frantically called parents and asked for opinions. They were all in agreement... Day 3. We called the embryologist back and we're set. Tomorrow at 0700 we will have all 3 of our embryos returned to me and then the waiting begins. Thanks to HCG booster shots I won't be able to drive myself crazy with POAS. This is a big gamble, but we're ready whatever the outcome. Realistically we know that while we have one strong front runner, the other two are slower and possibly weaker and may not make it. Chances are we could make it to the other side with one or none. Last cycle we had one perfect 8A zero fragmentation embryo and he didn't take. Who knows. We're giving it our all.
Friday, July 11, 2014
Fertilization Report
Had our call at 0730 this morning from the embryologist. Right now, of the 5 mature eggs that were ICSI'd we have one that has for sure fertilized and is starting to divide. Two more they're almost positive are fertilized. Last two aren't showing any signs of fertilization yet, but they'll leave them overnight and check again tomorrow. He says that with testicular biopsy sperm is hard to see polarization (?) I was half asleep for this call so my memory isn't perfect... But that's the issue with the two he THINKS fertilized.
Then he asked how many we plan to put back. Actually it went like this: "How many are you putting back? I mean with your age, previous failed cycle and diagnosis?" In other words, "Surely more than one right?" I replied that we're for sure returning two, and depending on quality we're considering 3. He sounded pleased with this and said that if that is the case, and we only have three that have fertilized then there is no sense in waiting till day 5 as we would only do that to help select the strongest ones. If we plan to put back all that we have then we may aswell go with day 3.
I dunno why but I have this day 5 thing in my head as a goal. I know that success rates are pretty similar between day 3 and day 5 but I just want to put back a blast and KNOW we're in good shape.
I know that my decision to return 3 may be controversial. We live on land with my in laws and we're surrounded by close family within 2 minutes from our front door I work from home and don't have to work for us to survive. We're equipped for 3 should all 3 take - but we know that's highly unlikely. So now we're seriously considering 3 on day 3. Does anyone have any thoughts on this? Should I push them to day 5? And why?
Thursday, July 10, 2014
FIVE mature!!
Just had call from embryologist. FIVE of the six were mature and we're ICSI'd. FIVE!!! Oh I hope they all fertilize!!!
SIX!!!!
Thats right folks... With 5 follies I somehow managed 6 eggs! Hoping at least 4 of these are mature. Birthday Fert report tomorrow. Seems there's something to this whole "shoot for the stars" thing!
Wednesday, July 9, 2014
T Minus 8 Hours
Well we're at the starting line. Enema done. I cannot believe that I've had to subject my husband to a second round of this. Erg!!! Anyway, as I said... It's done so the doc should have a nice clear view of my follies.
We're off to bed in a few minutes. Our check in time is 6:30am and there's that 1.5hr drive to contend with so we're leaving home at 5am.
Please send us your happy thoughts and vibes for 4 mature eggs. (hey, "shoot for the stars", right?)
Tuesday, July 8, 2014
Monitoring #5
Went in for our last blood draw this morning.
Results:
E2: 797
LH: (not posted yet)
P4: (not posted yet)
So it's confirmed... tonight we trigger. I talked a little yesterday about how this delay has me feeling. Mostly I am scared that we may have lost our big follie (round here we're now referring to the follies in size order by letters of the alphabet A through E. "Number 21" sounds so impersonal, so 21mm = A, or Allen, or Alice or any name beginning with A, 17mm = B, or Bob or Betty, etc). I WISH I knew how they were looking today, but I think it's probably best that I don't know.
The last few days I've spent a lot of time talking to them, and singing to them, and eating really well to make them strong - loads of protein shakes, willing them to grow and willing A to quit growing. This part freaks me out because after Thur there is nothing more I can do. After Thur it's all on them. They will mature or not mature. They will fertilize or not fertilize. They will divide and grow or not. And if any make it to transfer, they will either implant or not implant. From here on out it's all up to them and it scares the hell out of me!! I am really praying for some miraculous great news and a shock of 4 strong embryos on morning of transfer, but I will be satisfied with 2. I just want to do better than last cycle.
Was advised by the nurse that we're not the only couple in surgery this time. There will be one other couple who are ALSO doing TESE and retrieval. I never see anyone on the blogs talking about TESE, so I guess it will be nice to see another couple who are dealing with the same thing. Of course she's probably going to be ridiculously normally fertile and like 22 years old with a bumper crop of 20 eggs.... Hey, at least Mr. R all hopped up on Valium might try and behave himself instead of running around flashing his naked butt at the nurses like last time. Seriously... can't take him anywhere!
Results:
E2: 797
LH: (not posted yet)
P4: (not posted yet)
So it's confirmed... tonight we trigger. I talked a little yesterday about how this delay has me feeling. Mostly I am scared that we may have lost our big follie (round here we're now referring to the follies in size order by letters of the alphabet A through E. "Number 21" sounds so impersonal, so 21mm = A, or Allen, or Alice or any name beginning with A, 17mm = B, or Bob or Betty, etc). I WISH I knew how they were looking today, but I think it's probably best that I don't know.
The last few days I've spent a lot of time talking to them, and singing to them, and eating really well to make them strong - loads of protein shakes, willing them to grow and willing A to quit growing. This part freaks me out because after Thur there is nothing more I can do. After Thur it's all on them. They will mature or not mature. They will fertilize or not fertilize. They will divide and grow or not. And if any make it to transfer, they will either implant or not implant. From here on out it's all up to them and it scares the hell out of me!! I am really praying for some miraculous great news and a shock of 4 strong embryos on morning of transfer, but I will be satisfied with 2. I just want to do better than last cycle.
Was advised by the nurse that we're not the only couple in surgery this time. There will be one other couple who are ALSO doing TESE and retrieval. I never see anyone on the blogs talking about TESE, so I guess it will be nice to see another couple who are dealing with the same thing. Of course she's probably going to be ridiculously normally fertile and like 22 years old with a bumper crop of 20 eggs.... Hey, at least Mr. R all hopped up on Valium might try and behave himself instead of running around flashing his naked butt at the nurses like last time. Seriously... can't take him anywhere!
Monday, July 7, 2014
Monitoring # 4
Monday morning and here I sit in the doc's lobby waiting for my u/s. I'm bloated to the point that I am running out of pants to wear comfortably... And I am gassy as all hell which pairs wonderfully with the other fab side effect of all this estrogen... Ridiculously high sex drive. This weekend I could barely keep my hands off Mr R! I think it helps to know that after trigger we're going to have to go 3 weeks without. I am a master of the lean-sit, push your hips to the front of the seat and lean back I to the chair back so your lower stomach is almost straightened out. It's super fun when you consider that I am just under 6feet tall and most of that height is legs so I look ridiculous but I don't care. I am super uncomfortable. How? HOW? Do those of you with normal ovaries and 12 large follicles deal with this?? These 4 are too much for me!
Today I plan on noting the sizes as she calls them out. Yesterday when measuring my right side the nurse gave me a measurement of one of the follies around 10, but when I logged in to my portal for the exact measurements it showed nothing on the right. In fact all of yesterday's measurements were "off" so today I am taking notes.
I still have such a positive feeling about this cycle. I find myself driving along and singing to my ovaries and talking to my eggs - willing them to grow. I'm starting to have flashes of images in my head of how my life will look with a baby - something I've never been able to do before. I hope that all this positivity doesn't burn me in the end. But I'm going to go with it. Last cycle I could not have been more negative and look how it played out...
Phew! This post is already super long... Can you tell I was WAY early for my appointment and no one has blogged this morning so I have nothing to read.
Back from u/s and waiting to hear... My 20 is now a 21, my 17 is still 17, and my 14s are also pretty much unchanged. And I confirmed... on the right, we're still sitting at just under 11mm... so he's no longer a contender. We MIGHT delay trigger another day, all depends on my blood work. I am completely okay with whatever decision the doctor makes at this point. Mr R would prefer to trigger tomorrow, retrieval on Thursday because then he'd get Thu and Fri off (recovery from TESE) before the long weekend. I just want to trigger whenever we're likely to get the best return on investment. I was really hoping that my right and the 5th on my left would show up, but now that that seems unlikely and we're looking at 4, with 2 of them probably being immature at retrieval... argh... I dunno....
Portal is not yet updated and I haven't received my instruction call, so I will close this out and add when I know more.
Back from u/s and waiting to hear... My 20 is now a 21, my 17 is still 17, and my 14s are also pretty much unchanged. And I confirmed... on the right, we're still sitting at just under 11mm... so he's no longer a contender. We MIGHT delay trigger another day, all depends on my blood work. I am completely okay with whatever decision the doctor makes at this point. Mr R would prefer to trigger tomorrow, retrieval on Thursday because then he'd get Thu and Fri off (recovery from TESE) before the long weekend. I just want to trigger whenever we're likely to get the best return on investment. I was really hoping that my right and the 5th on my left would show up, but now that that seems unlikely and we're looking at 4, with 2 of them probably being immature at retrieval... argh... I dunno....
Portal is not yet updated and I haven't received my instruction call, so I will close this out and add when I know more.
EDIT TO ADD:
FINALLY had the call now. We trigger tomorrow night. My E2 is up in the 600s now and my LH is rising so we're out of time.
Follie Measurements: LT: 21.51, 17.81, 14.84, 14.32 RT: 10.88
Endo Thickness: 10.5mm
Bloods:
E2: 623
LH: 2.1
P4: 0.55
Retrieval is now set for Thursday morning. Oh PLEASE let those 14s do something amazing tonight!! (And please don't let the big guy go too far). I talked earlier today about how positive I was feeling about this cycle. Suddenly I am freaking out... I feel like we're going to wait too long on the 21mm and lose it, and the 14s will continue to stay put leaving us with just the 17mm in the lab. One fert, one transfer, BFN.
Sunday, July 6, 2014
Monitoring #3
We aren't triggering today. Let me back up...
It seems that measurements yesterday (or today) were off... On my right today they don't see any over 10mm, whereas yesterday they saw 2 at 9 and 10.
On my left it seems the big 20.33mm one from yesterday is now 20.47mm, not much growth over night. The others are: 17.69, 14.59, 14.26 - so some have shrunk? Or measured differently? I don't know. At any rate our doctor feels -- and I agree -- that it's worth waiting for those 14s to catch up a bit so while I could have triggered today, we're going to wait another day and see what we can do with the little'uns.
So we're looking at 4 mature eggs in a best case, but possibly will have to sacrifice the one (I am told that anything over 23 is probably "over-ripe"). I want those 14s over 16mm for best chance at maturity.
Bloods:
E2 414
LH 0.21
P4 0.45
Back for more monitoring tomorrow.
It seems that measurements yesterday (or today) were off... On my right today they don't see any over 10mm, whereas yesterday they saw 2 at 9 and 10.
On my left it seems the big 20.33mm one from yesterday is now 20.47mm, not much growth over night. The others are: 17.69, 14.59, 14.26 - so some have shrunk? Or measured differently? I don't know. At any rate our doctor feels -- and I agree -- that it's worth waiting for those 14s to catch up a bit so while I could have triggered today, we're going to wait another day and see what we can do with the little'uns.
So we're looking at 4 mature eggs in a best case, but possibly will have to sacrifice the one (I am told that anything over 23 is probably "over-ripe"). I want those 14s over 16mm for best chance at maturity.
Bloods:
E2 414
LH 0.21
P4 0.45
Back for more monitoring tomorrow.
Saturday, July 5, 2014
Monitoring #2
Looks like we've got a couple of new friends from the right ovary showing up to play... Maybe... Two more! Okay so they're still pretty small with one hovering around 10mm, but they're there.
On the left our forerunner is already at 20 (growing about 6mm in two days) with the other 3 following a little behind at 15 and under and 1 more still less than 10mm.
They want me back tomorrow to take another look. The question is... Do we trigger tomorrow and waste all the little ones, or do we sacrifice the big one and trigger on Monday so we can reap the rest in their prime? We'll find out in the morning I guess. :/
Edited to add specific measurements:
Left: 20.33, 15.81, 15.20, 11.67
Right: 10.16
Thursday, July 3, 2014
Numbers
Finally, 30 minutes before Doctors office closes for the weekend, I get my results...
E2 158
LH 2.9
P4 0.34
Per my (stand-in) nurse my (stand-in) doctor says that these levels are consistent with the number of follies we're seeing and also look like we're going to have some time to stim a bit longer and try to get another straggler or two to catch up with my top 4 follies.
At this point it really is sounding like we won't trigger until Monday, but I won't really know for sure until Sat monitoring appointment.
Meds will remain unchanged.
OH PLEASE! OH PLEASE! OH PLEASE! Let one or two more catch up!!!
E2 158
LH 2.9
P4 0.34
Per my (stand-in) nurse my (stand-in) doctor says that these levels are consistent with the number of follies we're seeing and also look like we're going to have some time to stim a bit longer and try to get another straggler or two to catch up with my top 4 follies.
At this point it really is sounding like we won't trigger until Monday, but I won't really know for sure until Sat monitoring appointment.
Meds will remain unchanged.
OH PLEASE! OH PLEASE! OH PLEASE! Let one or two more catch up!!!
Clearly I'm a Nutjob
Four. That's all I have.
My right ovary decided to go on vacation. I had 6 antrals on that side, but not 1 decided to join the party. Left side had a better response with 4 out of 5 growing, but still... of 11 possibles all I have are 4 at this point.
Sizes: 13, 11, 10 and 9. The 5th is hanging around 6 and COULD still show up for me, but it will be a ways behind the others and probably not mature. On the right side all 6 are between 4 and 5 and highly unlikely to show up.
Game plan for this weekend is to work on my stress levels, do my fertility yoga for blood flow, guzzle protein shakes and Mr R's big plan is to focus all the shots on my right side... I've explained that this won't make a difference, but I will let him focus on what he thinks will help at this point.
Next monitoring appointment is Saturday, possible trigger on Sunday night, but she says it's likely that we'll wait till Monday to trigger and push the retrieval back a day to Wed 7/9.
Okay, so let's focus on the positives? Last cycle I had 3 follies, 2 on the right which measured 20.52 and 14.87 at retrieval and 1 on the left measuring 14.07 at retrieval. Only one was mature (obvs the 20.52) and while the other two matured over night, they failed to fertilize and arrested on Day 2. This cycle they are closer in size and it's likely that I will have more than 1 over 18mm at retrieval which means a higher likelihood of 4 MATURE eggs and hopefully then 4 fertilized eggs.
Premature question of the day?
IF we have 4 embryos,
1) Do we risk going to day 5 and losing some?
2) And if we have 4 do we still put 3 back? Or do we transfer 2 and save 2?
I need to quit thinking about this.... Meh.
My right ovary decided to go on vacation. I had 6 antrals on that side, but not 1 decided to join the party. Left side had a better response with 4 out of 5 growing, but still... of 11 possibles all I have are 4 at this point.
Sizes: 13, 11, 10 and 9. The 5th is hanging around 6 and COULD still show up for me, but it will be a ways behind the others and probably not mature. On the right side all 6 are between 4 and 5 and highly unlikely to show up.
Game plan for this weekend is to work on my stress levels, do my fertility yoga for blood flow, guzzle protein shakes and Mr R's big plan is to focus all the shots on my right side... I've explained that this won't make a difference, but I will let him focus on what he thinks will help at this point.
Next monitoring appointment is Saturday, possible trigger on Sunday night, but she says it's likely that we'll wait till Monday to trigger and push the retrieval back a day to Wed 7/9.
Okay, so let's focus on the positives? Last cycle I had 3 follies, 2 on the right which measured 20.52 and 14.87 at retrieval and 1 on the left measuring 14.07 at retrieval. Only one was mature (obvs the 20.52) and while the other two matured over night, they failed to fertilize and arrested on Day 2. This cycle they are closer in size and it's likely that I will have more than 1 over 18mm at retrieval which means a higher likelihood of 4 MATURE eggs and hopefully then 4 fertilized eggs.
Premature question of the day?
IF we have 4 embryos,
1) Do we risk going to day 5 and losing some?
2) And if we have 4 do we still put 3 back? Or do we transfer 2 and save 2?
I need to quit thinking about this.... Meh.
Wednesday, July 2, 2014
Am I Insane?
Last cycle I was largely unaffected by the stims - aside from the daily headaches and one awful migrine, but we think this was the Lupron. Other than that, and a little bloating, nothing. And of the 17 follies I started with, I had only 3 develop, with one of those being a giant leap ahead of the others.
This time is different. Different meds, different protocol and totally different reaction. But I am a little concerned that this might all be in my head. I'm still getting the daily Lupron headaches. But I swear I am feeling bubbling and twinging in my lower abdomen. I am also...well here it is folks... I am super gassy, peeing constantly and super bloated, but continuously thirsty. Today my hips are hurting, like a LOT. It's killing me not knowing what's going on in there. I only had 11 antrals, which really isn't much compared with these ladies who have like 20-40 follies growing, so it's weird to me that I would have this strong of a reaction. I am sure that this must be in my head. My E2 reading gives nothing away.
CAN'T WAIT TILL TOMORROW! I need to see them. I need to know what's going on in there.
This time is different. Different meds, different protocol and totally different reaction. But I am a little concerned that this might all be in my head. I'm still getting the daily Lupron headaches. But I swear I am feeling bubbling and twinging in my lower abdomen. I am also...well here it is folks... I am super gassy, peeing constantly and super bloated, but continuously thirsty. Today my hips are hurting, like a LOT. It's killing me not knowing what's going on in there. I only had 11 antrals, which really isn't much compared with these ladies who have like 20-40 follies growing, so it's weird to me that I would have this strong of a reaction. I am sure that this must be in my head. My E2 reading gives nothing away.
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