We Trigger on Monday

What a week it has been! As you know, we started with 12 follies.  Well after a week of stims, we are down to 3 over 10mm in size, and they upped my Gonal F dosage from 225 iu to 450 iu on Friday.  I went in this morning for a follow up and the three have increased from 11mm (the largest) went to 20mm.  The other two are now 14mm and 15 mm respectively.  I have given up hope that another friend may join us at the party.  It looks like we're going to just have these three, and I am at peace with that.

I am on another shot of 450iu Gonal F tonight, and then tomorrow morning I go in for my last blood draw and date with the dildo cam.  We will most likely trigger tomorrow night and retrieval is going to be on Wednesday transfer on Saturday. 

Mr. R has started looking at YouTube videos of the TESE procedure and he is not looking forward to this at all!  I feel bad for him, but I am excited to see that it is possible to collect and save multiple vials of sperm for future attempts. I didn't realize that was possible, but after seeing how extensive this procedure is I am glad that it's an option.

I still can't quite get my head around the thought that this is it.  I am IN an IVF cycle... This week there will exist on this planet little beings that are made of half me and half Mr. R.  They may not live long, they may not make it to birth... but for a short while they will be here on this earth with us.

I am wrestling with positivity... I want so much to believe that this is it.  I have a strong, VERY strong feeling that this is not the end for us... that this is just a step on the road. 

My forum February cycle group are dropping BFPs like it's going out of fashion.  Only one BFN.  The last two are me and one other lady.  She had her transfer today.  Then it's my turn.  What if our luck has run out?? ARGH!!

Long Overdue Update

Last I posted we were on CD1 and my lining was still too thick to start stims, so we went back on Wed, and it was perfect, 4.40mm however my Estradiol was still too high.  They wanted it under 21.0 and it had gone up from 25.4 on CD1 to 37.4 on CD3.  Argh!  Nurse T thought it was stress related and advised me to take a couple days off if I could, and relax, and to come back on Friday.  I really REALLY don't have any time to take off at work since I just started this job in December, but I did it because this is more important than anything.  Friday morning I went in... Lining still perfection and under 5mm, but Estradiol has not dropped down enough... it's 23.1.  Saturday morning I went in again... Lining = perfect, Estradiol is now slightly up again 23.7 (though they count that as unchanged since the rise was so insignificant).  They told me to come again on Monday, but I really cannot take more time off work at this point. I asked if they would consider letting me come in on Sunday, my mother would be leaving town and I would (hopefully) be calmer and less stressed.  Sunday morning... BINGO!  Finally, lining under 5mm, Estradiol 20.0, still 12 follies:  7 left, 5 right.

So I started my stims on Sunday.  The nurses there are SO behind us.  They called and were SO excited when they told me to come back and get my stims.  They know that this is our only chance. I walked in and saw the Gonal F box sitting on the chair.  So I am in the control group of this study, not the trial group testing out Afolia.  I had decided I was cool either way.  Gonal F is tried and true, but Afolia might be amazingly new and good.  Either way I would be happy, and I am.

So yes folks... I have the most photographed uterus and ovaries in all of Texas, but I am moving on to stimming.  Today is Stim day 4.  I have a little log book to track everything in.  I also received a cute water bottle and cooler for my meds.

Mr. R has started his Clomid for the TESE.  He's not experiencing any issues with it so far, but last time (while we thought the trial would start in October) he had some tingling and sensitivities with "the fellas" but so far so good.

So far zero side effects from the Gonal F, but man is the Lupron hitting me hard.  I pretty much walk around every day with a headache and last Thursday it turned into a migraine.  I don't mean "ouch my head really hurts I have a migraine," I am talking about the full-on cannot stand, whole body shaking, throwing up violently migraine.  Prior to this headaches would come and go and vary in intensity, but since Thursday I pretty much live with  a constant headache.  It's mild enough that I can ignore it most of the time, but every now and then I am forced to take a Tylenol to numb it down a little.  I had hoped that since my Lupron dose has halved it would stop, but that hasn't changed anything so far.

What's next?  Well this Friday I go in for first post-stim follie check.  And I think I go in again on Monday for a final evaluation when we decide to trigger or not.  Tentative trigger date is 2/24, Retrieval is 2/26 and Transfer is 3/1.  Mr R will have his TESE performed at the same time as my ER so we're going to be in separate rooms for that procedure, and for the ET he isn't sure he is going to be able to make it because of work... We could be in different counties while I am getting pregnant.  :(  This whole thing is SO not my childhood dream.  And even WITHIN treatment, the tiny cracks, the dream is still shattered.... *sigh* It doesn't matter as long as we have a good end result.

I belong to the TwoWeekWait forum, and in our cycle group, out of 7 of us 4 already have BFPs, 1 negative, and 2 have yet to transfer.  It looks like I'll be the last one transferring out of all of us.  Hopefully they don't use up all of our BFP luck before I can get there!  [I just realized how insane that sounds... how superstitious does all of this make us??? Meh.]

Ch-Ch-Ch-Changes

The more things change... Haha

So on Wed I get a call from RE Nurse... (Nurse T).  She says that she has just realized that we will need to come BACK to the clinic on 2/4 to get my first Lupron, as the first one needs to be administered in the office and it HAS to be on the 4th.  Since I live 2 hours away this is not going to be convenient... driving all the way there on Mon for Hysterosono and TT and then again the following day for the shot, so instead she is going to move the hysterosono and TT to the Tuesday.  (Now the 4th date we've scheduled for these).

Then, while entering the info into the calendar she realizes that I am still needing an updated pap.  And that an updated (clear) pap is required before we can start the Lupron.  Results take 2 days, so she asks me to get in with my PCP or local OB to have that done on Thur... cos, you know, I live in a small town so a next day appointment with either of these docs is a piece of cake, right? Wrong.  So our only option was for me to take another morning off work, drive out to the RE office just for the pap.  I am still bleeding and I believe they don't like to do pap tests while you're on your period, but since this is very unlikely to be an actual period and the bleed is quite slow now, Dr. S just went ahead and did it anyway.  Now we just pray that their lab can get the results back in time and that they aren't skewed by the bleeding.

On Tues, I have to be there at 7am which will require leaving my house at 5am.  First we will sign consents, then we do the Hysterosono (I've been calling it an HSG as this is what I had before.  I am told that this is a Hysterosono which is slightly different and less invasive.  Who knew?) And after that we will do the Test Transfer.  If all looks good, and my pap result comes back clear then we will do the first Lupron.  Mr R will take his shot-giving lessons and I will be done with the long drives until the 10th when I hopefully start CD1 and can get my updates baseline testing done and start with the study drug.

On Wed my mother arrives from Canada and will be staying with us for 2 weeks.  Worst. Decision. Ever.  But I will suck it up and deal.  Mother is helping us pay for part of the $5,000 out of pocket expense of this cycle so I CANNOT complain.  Actually, I've not really discussed the costs involved with this trial here on the blog.

Here's what has come up so far:

$175 - Hysterono
$1,500 - IVF Test Cycle Fee
$1,750 - Clinic & Facility  charges for TESE (sperm aspiration as Mr. R has a vasectomy)
$1,000 - Urologists fee for TESE
$800 - Storage for sperm and any possible embies for one year

So if we weren't dealing with a Vasectomy we'd be getting a cycle for under $3,000 which is unreal considering we HAD been looking at $15,000!!

That's all I have for today. xx

The Urologist

As a reminder, not only do I have DOR (Diminished Ovarian Reserve) but Mr. R has a 14 year old vasectomy that is beyond the recommended cut off age for effective reversal.  We were referred to this Urologist by our RE.  Their offices are in the same building, and they work together often.  We'll call him Dr. B.  Dr. B studied at Harvard and Duke University and specializes in male fertility so I figured he was well qualified to handle my man's nuts ;).  He is a large, soft spoken, African American man - think Mike Tyson.  Mr. R was not amused... "Really?  No pressure or anything!" haha

 We met him at a location closer to our home, he sees patients there every Monday in a shared office set-up that is common around here. (i.e. today it's a Urologist, tomorrow a Foot and Ankle doctor and on Wed it's an Ear, Nose, Throat doctor.)  The place was not exactly super sparkly clean- note the yellowed seat of the examination bench BLEURGH!- , and we were greeted by the receptionist with "Sign in here." No time wasted on pleasantries at all! We were finally ushered through to the back a full 30 minutes after our scheduled appointment, and waited there an additional 30 minutes before Dr. B breezed into the room dragging his laptop table behind him.  Mr. R was grumpy, I mean REALLY grumpy! He grumbled several times that this was ridiculous and that he already didn't like this doctor, and he wasn't sure he wanted him anywhere near his "bits".  By the time Dr. B walked in I was sure Mr. R was ready to walk out. But 2 minutes after meeting the good doctor Mr. R softened and joked, and relaxed and all was well again.  I had all my questions answered.  He was not at all condescending (as some of the doctors we've met on our journey have been).  He really put my mind at ease and I am very happy we are working with him.

Some notable notes from this consult:

-  We will not freeze any sperm and will do the aspiration on the morning of my egg retrieval.  This unfortunately means that they will most likely be wheeling Mr. R out of the room and wheeling me in.  No hand holding.  No calming talks while all the "science" part of this is going on.  Cold sterile rooms, on our own, separately.  I was bummed about this, but I trust that Dr. B knows  his stuff when he says they have MUCH better success with fresh over frozen.  Dr. B is therefore ready to go at a moment's notice whenever I am ready for retrieval -- which I thought was really quite remarkable!  Down side is that we will have to have a fresh extraction with every IVF attempt.  Upside is we cannot afford more than one IVF attempt (aside from the trial) and because they are able to work from same room at same time per Dr. B the cost of doing a fresh extraction every time is very, very reasonable... around $1,000.  Anyone else had experience with this sort of procedure and can chime in on costs?

-  He will not be doing an extraction through the vas, but will rather take a section of the testes and extract sperm from there.  Strangely Mr. R finds the idea of him cutting away a piece of his testes less painful sounding than them threading a tube through there and sucking up some swimmers.  Men!  Go figure.  He described the pain relief, anesthesia which Mr. R found to be agreeable.  This was the area he was most concerned with.  He will have a valium cocktail before entering the surgery, he will then receive shots in his lower abdomen and only then will they move to the more area-specific anesthetic.

-  Dr. B thinks Mr. R is perfectly fertile and doesn't suspect any issues with count or quality of his sperm. He ran through a number of questions designed to "guesstimate" Mr. Rs fertility.  I like to call it the Man Test.  The questions were as you'd expect:  How often do you have intercourse, do you have other children, etc.  My favorite part was when he asked, "How often do you shave?" and Mr. R who is meticulous about his grooming replied, "You mean my face?" I nearly fainted. Anyway, based on his answers and the physical examination Mr. R is guessed to be perfectly fertile behind the vasectomy, but we won't really know until the day of, which of course is going to drive me crazy with worry.  For now Dr. B has prescribed clomid.  (I know right? Wierded me out too, but apparently it boosts testosterone production and will create what Dr. B describes as "super sperm" and while we're not too concerned about sperm count or quality, we need all the help we can get).

Lastly... We have been talking about our plan C.  Our final attempt, our last hope.  We are not going to be able to afford to keep trying with IVF and donor eggs and other measures.  Adoption is also out of our price range.  After the trial we have one IVF cycle and then ??  Mr. R has a 14 year old vasectomy and doctors we have spoken to advise against a reversal saying it's a complete waste of time, with million-to-one odds.  I have read enough on these blogs and forums to know that any shot is better than none.  Right now, every cycle goes by with a zero percent chance.  I am so happy for, (but secretly quite envious of), those of you with DOR and no male factor issues because the supplement cocktail has been working all kinds of miracles in the IF blogosphere... but no amount of wonder supps will ever help me as long as we have the vasectomy to deal with.  I asked Dr. B to be honest about his feelings about a reversal being our last ditch effort.  He was supportive!  He said he has seen people overcome amazing odds and he sees nothing wrong with a reversal up to 15 years.  After that there really is no hope because of the "sludge" that accumulates in the tubes.  So IF we fail at these two cycles, that is what we're going to do.  The cost is about half of a full IVF cycle, which is still a LOT of money, but it's an amount which secures us multiple months of possibilities instead of one single shot at success.  Mr. R has some concerns about our age.  He is 41 and doesn't really want to be successful for too much longer.  He has issues with the idea of being an "older parent" and we're talking about this... bottom line is, with me being pre-menopausal already at 35 we really won't have too much longer anyway!

So that in a nutshell is our visit to the Urologist.  Now we pick up the clomid script and get him going on those in addition to the Fertility Blend supps for men and I continue with my fitness, supps, acupuncture and TCM and we wait to hear back from the Dr. C about the start date for the trial.