What it Takes

My mind is blown.  After years of trying and saving and desperate pleas to God I am at last standing here with a GIANT box that is filled with the makings of my future baby/ies.

THIS is what it takes for me to have a child...  I don't know whether to laugh or cry. I know this isn't my first cycle, but really, this is the first "REAL" cycle. This is the first time I got to meet the Fedex guy carrying my giant box of meds instead of hanging around the RE's office waiting for labs to determine if I get to return home with the next batch of drugs.  My last cycle was really only Lupron, Gonal F, Ovidrel and Crinone (aside from antibiotics, valium and that blasted enema). We won't order our Lupron until closer to start, so that isn't pictured here.

 

Here's what is in each pic:

Crinone x 2 boxes
Follistim Cartridges x 4

Menopur Mixing vials

Doxycycline
Prednisone
Diazepam
Estradiol
(And peeking in at top left, my needles)

 

Here we have:

Meopur vials again

Follistim pen and handy carrying case (boxed)

Syringes
Q caps

And lastly:
- Novarel
- Syringes
- Q caps again
-Alcohol wipes
- Biohazard container

Awesome... making a baby (for me) requires the use of a biohazard container.

Honestly though... This box mostly makes me so ridiculously, incredibly happy!  I didn't think I would EVER make it this far.  We were so sure that we'd never be able to do another cycle if the trial didn't work and yet by the grace of God here I stand with a box full of medication standing on the doorstep of another cycle. We are blessed!  I am grateful.

T minus 11 days till CD1 (hopefully)

Pull the Trigger

Final stim shot last night. Last Lupron this morning. My u/s revealed no newcomers to the follie party so we're going to retrieval with 3 follies. I'm disappointed, but you know... 3 will do. It's better than none.

Trigger is Ovidrel and I take it at 8pm. Tomorrow is a "free" day according to my calendar... Though I dunno how you can call taking the pre-retrieval enema downtime. Lol (P.S. Why has no one else mentioned a pre-retrieval enema on other blogs?)

I don't feel like this is going to be it. I am already planning IVF #2. But if nothing else, this will be a great learning experience for when we get to an out of pocket paid cycle where we can deviate from the plan determined by trial sponsors.


We're also wondering... Since this trial allows a max transfer of 2 3d embryos, what we should do if we have a third... IF we have a third. Do we freeze at 3days or push and see if it makes it to blast before freezing? Anyone have suggestions?

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.]

CD1

Well, wouldn't you know it... right on cue my body kicked out a cycle day one!!  I went in for my baseline testing and to check lining to see if we're ready to start the stims yet.  We aren't. :(
Lining was at 6.1mm and he needs it to be 5mm or lower.  So I will go back to check again on Wed.

As far as follies:

Left side is showing 7 with biggest being 6.1mm and the others not far behind.
Right side has 5 with biggest at 5.5mm
So a total of 12.

I had blood drawn and will find out the numbers tomorrow I guess?  Not sure how long the turnaround is on those.

I also asked about what I should be taking to work on my MTHFR since I know that this is a study, so I have limited access to the doctor overseeing the trial and no access to my own RE since he is not involved with this -- even though it's being run out of my own clinic.  I just want to make sure we don't get this far and then lose the baby because of the MTHFR so I had to make sure that base was covered.  They said that as long as I am taking Prenatals and Calcium there is nothing else I can do... I don't fully trust that.  Any other ladies dealing with MTHFR have any suggestions for me as far as supplementation?

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

Snowpocalypse 2014

 My HSG yesterday had to be rescheduled due to EVERYTHING in our area being closed for a possible snow day -- which turned out to be nothing in the end.

So already the schedule has changed as follows:

2/3 - HSG and Test Transfer  (Previously scheduled for 1/31, then 1/28)
2/4 - Start Lupron
2/7 - Last day of BCP
2/10 - If my body cooperates and gives me a CD1 then U/S E2, LH & FSH
        -  Start assigned study drug (either Gonal F, or Afolia)
2/15 - Labs & u/s
2/17 - Labs & u/s
2/18 - U/s and E2 (am) -- Possible Trigger Day (Ovidrel)
2/20 - Possible retrieval, start Doxycycline
2/23 - Possible transfer day
3/10 - Possible first Beta

But this is really a good thing... I think... I have started bleeding. [TMI AHEAD] On Sunday it was a light spotting, Monday it was more than what I would call spotting, but still not as bad as my regular period, Tuesday it was bad enough to require multiple tampon changes every couple of hours, and today - while dark brown in color - I am still bleeding pretty regularly.  There has also been some mild cramps, similar to the cramps I used to get with my period when I was younger - pre-endometriosis.  All this time I have been dutifully taking my BCP at the same time.  I haven't missed a single one.

The trial nurse seems annoyed by it, but not concerned at all.  "The Googles" show that this is not uncommon in women who have been off birth control for a while -- in my case I took my last Depo shot in 2003.  Hopefully this all stops by Monday so I can do my test transfer, HSG and pap without any problems and start my Lupron on Tuesday.

The Doxycycline is making both of us SO sick.  If I don't eat enough food before I take it I am sick to my stomach and Mr. R finds that if he has any food in his belly when he takes his HE feels sick to his stomach.  But we're sucking it up and taking it dutifully every day. 

Things are moving forward.  SO EXCITING!!

(Some) Results Are In

I just got the call.  SOME of the blood work is back.  Well, the ones I was most concerned about are back anyway....

First a trip down CD3 test memory lane:

DEC, 2012:
AMH: <0.16
FSH: 19.8
E2: 17

MAY, 2013:
AMH: 0.28
FSH: 10
E2: 23

"NORMAL":
AMH: 1-3
FSH: 3-10
E2: 25-75



*drumroll*




JAN, 2014
AMH: <not tested>
FSH: 8.9
E2:  50.1

HO-LEE-CRAP! My FSH and my E2 are now what they would consider to be "normal"!?!  My December 2012 readings were such that my RE opened the conversation with a recommendation of donor eggs.  "No point wasting money trying with your own.  These numbers do not bode well for you."

AHHHHH!!!!  I want to run around this office nekkid yelling at the top of my lungs!

Still Prolactin and Thyroid results to come, but I've never had any concerns around these two, so not super concerned... Of course now I've said that THIS is where the problem will be.  Erg. Infertility man. 

New Year. New Us. New Home. Oh... and the trial has started...

Yep!!!  We called last week to check in and make sure that the trial was still going to happen as we hadn't heard anything in a LONG time.

Nurse: "Oh yeah, the trial has started."

Mr. R (with me listening in): "Ummm... so... ummmm..."  *Looks at me expecting a full-scale meltdown of tears and drama.*

Nurse:  When can y'all come in to sign consents?

Mr. R: "So we're still IN???" Then to me, "WE'RE STILL IN!!!!"

I started my period late Sunday night and called on Monday to schedule CD3 testing for the next day.

So here's what I know so far:

1)  The trial is comparing a new antagonist with Gonal-F.  I will either be part of the control group using Gonal-F, or part of the test group using the new product -- name escapes me, and I don't have paperwork with me at the office.   

Some of you may balk at my lack of knowledge around this drug that I am allowing them to pump me full of... but those of you in a similar can't-pay-for-even-one-IVF-cycle-on-our-own boat will understand... "You want to inject me directly with urine from some post menopausal nuns but I get a cycle of IVF for free?  Sure. Where do I sign?"

2)  The trial required that I have more than 10, but fewer than 20 on my AFC.  I passed this phase with flying colors.  (Huzzah!  My repro system did SOMETHING right for once!!) Mr. R was the only one conscious enough to pay attention to numbers... I was just so deliriously excited to be in there with the dildo-cam that I didn't hear a word out of the nurse's mouth.  (Yes, I said deliriously excited and dildo-cam in same sentence.) Per Mr. R's memory my AFC was 8 on Rt and 9 on left so 17 total.  Phew!

3)  I also had a blood draw and we're waiting on the results of that to see if I squeak in and can participate.  They need my FSH to be no higher than 10 [Edit: correction 15].  As you can see from my two previous tests my FSH numbers can vary greatly.  19.8 back in Dec of 2012 and 10 in May 2013.  So we have all kinds of prayers, fertility dances, candles, etc lit that my body plays along again and shows them a number they will accept.

4)  I also have to have an updated HSG and I am ashamed to admit that while my lady parts have been incessantly poked and prodded over the last year, I am overdue for a pap, so that needs to happen as well.

Now for the good news... I am actually as we speak taking the first of the drugs I will be required to take to start this cycle.  Okay, so it's only birth control... but it's seriously the furthest I have been so far in this journey and I was so excited to take that little pill this morning I could have cried.  I feel like I am actively doing SOMETHING!!!

Of course on Friday my results could come back with an FSH reading of 20 and I could be out of the trial in one swift second... but for today I am enjoying this TEENY TINY thing.  It's a step forward and I have GOT to celebrate this.

Suppdate

Like what I did there?

Well, here we are a few months in to my supplements.  As I mentioned, I did skip a few days here and there back when I went through my gloom and doom phase, but I picked them all back up the day I found out about the study... and here we are exactly two weeks later and I am noticing some stuff that I want to mention and see if anyone else has had similar experiences.

1)  Spotting.  I have a little spotting almost every single day of my cycle, regardless of when I ovulate.  It's really minimal and (TMI) only when I wipe, but it's there.  It's not a problem other than it really puts a damper on any possible non-baby-making sex... :/

2)  I was due to start my period this week.  Don't ask me the exact date, but it was this week sometime.  (Note:  Due to the vasectomy there really is no point in temping and tracking my cycles since there is 0% chance of falling pregnant without assistance.  That, and the fact that charting is a BIG pain in the ass, plus the fact that I did it for 6 years during my previous marriage without success means that I just don't care to chart at the moment).  Anyway, I have all the period start signs: aching, swollen breasts; some cramping; some spotting (again this has been going on all month); some lower back pain... It's been like this for about 5 days now, but still no period and today is Saturday. 

3)  (TMI) Those Chinese herbs have seriously kick-started my digestive system.  I have never been as regular as they say.  I'm told you should "go" twice a day to be considered regular.  My whole life I have been an every other day kinda girl.  Not any more... Since starting the herbs (8 pills with every meal) I am going at least 4, sometimes 5 times a day.  Everything appears normal, but I am just going a LOT!  Did anyone else find this?  I mean, my acupuncturist said they would remove blockages but DAMN!

4)  I started the DHEA slowly this time, for the first few days I took just one pill a day with my nighttime supps, then I raised it to 2 pills, one at lunch and one at night.  This week I am up to the recommended dose of 3 per day and I am not noticing the same adverse effects I noticed the last time.  No DHEA rage at all!

5) Melatonin dreams.  Oh man, I sleep like a rock, but I have some crazy-ass, vivid dreams on this stuff.  And because I also drink so much water (1 gallon a day) I get up to pee 2-3 times a night, but the dreams continue when I get back into bed seamlessly.  I do find it harder to get out of bed when I take them, but I know that the sleep I am getting is better, more restful sleep so I just go to bed a little earlier than normal and set my alarm a little earlier too.  (I wake up at 4am for work, so the new 3:30am alarm isn't my favorite part of this!)

Other than that everything is going along swimmingly.  I am moving to two acupuncture appointments starting next week.  Still no official start date for the trial, but I am going to be all good on the acupuncture whenever it starts.  Nothing for us to do now but continue taking our supps and wait... Mr R took his first Clomid last night, will be back with an update on what/if he notices any effects.

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. 

First Acupuncture

 Friday was my first ever acupuncture appointment.  It's on everyone's fertility to-do list, and has been on mine, but the cost is just too much for me to cover in addition to all the saving we have to do to pay for our own IVF.  I called the clinic on Friday morning as I still hadn't heard anything more about the trial.  We have a urologist appointment today (Monday) and I wanted to make sure I knew what we needed to tell the Urologist about the trial... Okay, being honest I totally just used the urologist as a reason to call so that I could hear someone say again that I was for sure in the trial...

I left a voicemail and heard back from them just before the acupuncture appointment time saying that yes, I am still in the study and that there is nothing special I need to tell the urologist about it.  Hmmm.... She also went on to say, "Oh!  I do have more firm dates for the trial."  Me: "Really? AWESOME!" Her: "Yes, we're looking at October."  Me: "Yes, last I heard we were looking at first or second week of October.  No firm start date yet then?"  Her:  "No, that's all we have for now."  Honestly, how is the month of October a firm date?  Is it just me?  I dunno. I wish they were more decisive and firm about this... this airy-fairy, up-in-the-air attitude makes me panic!  I just need to remember that this is going to cost us 10% of a full pay cycle and suck it up. Ohhhmmmmmmm Ohhhhhmmmm

So anyway, back to the acupuncture... I decided to get started with this since we are essentially about 2-3 weeks out from start of the trial and it needs time to work properly. I had no idea what to expect barring what I heard from other IF bloggers who have done this treatment.  Let's start off by saying that I didn't feel super confident in his abilities on walking into his tiny office.  Firstly, he was late. Secondly, the office was decorated with cheap Chinese tchotchkes and smelled like massage oils. Thirdly, my heart kind of sank when a 6ft tall blonde man walked into the room and introduced himself to me as Dr. H. Am I wrong for wanting a Chinese person practicing acupuncture?

He glanced over the 12 pages of history I had meticulously filled out and then said, "So you want to get pregnant eh?" Understatement. Of. The. Year.  He then walked me through to the treatment room. Oh my!  Bordello red walls.  Giant Chinese fan. And my favorite part... leopard print silk sheets... cos nothing says "China" quite like the print of an animal found in Africa....

He started with the needles and I was pleasantly surprised by how painless they were.  I won't say that you don't feel them at all, because you do, they feel like a tiny scratch and then it's over.  I had them all over my face, legs and feet.  A couple of them did hurt though.  There was one just below my left knee that felt like he had pressed down on a bruise.  I yelped and he said, "Yes, that is your spleen.  That's the source of your blockages." Another on my other leg was also quite tender and he said that was my stomach, also where he believed I had some blockages.  The only other painful one was under my skull on the right where I have a swollen gland, and have had as far back as I can remember. He inserted the needle right into the gland and it HURT. He had to remove it and go at that spot from a different angle.  He also pinched down on my stiff shoulders and said that I was clearly very stressed as he inserted a needle there.  Note to self:  Tie up your hair for your next appointment! Aside from the needles he said were in my ovaries (didn't hurt at all) that's about all of them. He then lowered the lights and left the room for 30 minutes telling me to relax and sleep if I felt so inclined.

I've been wrestling with the whole "think positive!" thing... I hear it from everyone.  I am sure you do to? I have found in my life that if I think positively about something I really want my heart takes over and runs with it and before I know it I've planned out and pictured every single moment related to that thing.  I go through positive images so much in my head it's as though I've lived them.  And 9 times out of 10 it falls through.  Positive thought doesn't work for me.  But what if I NEED to think positively for the IVF to work? All I know is, if I open my heart and dare to picture myself with a baby at the end of all of this and it doesn't happen my heart will break into a million pieces and I don't think I will ever, EVER get over it.  But I feel like it's important to try it.

So I've decided that I am going to try a little moderation.  During my acupuncture sessions and ONLY during these sessions, in the 30 minute  relaxation time I am going to picture the blockages being freed, my eggs coming back to life and my ovaries becoming bountiful.  I will picture the whole process from start to finish, step-by-step, ending with me holding my child in my arms. As he turned the lights down I was excited to try it.  Excited to allow myself for the first time to think about a positive ending to all of this. And guess what?? I couldn't do it.  I got all the way through to the IVF process in my head several times, but when it came time to see the sac in my first ultrasound I stalled.  No matter how many times I brought myself to that point I just couldn't bring up that image in my head.  It's like my body is acting in self preservation mode. 

There are two ways I could look at this: 1)  I am about to spend a LOT of money on a no-hope project. 2) I couldn't picture myself driving when I tried it before I got my license and that worked! Maybe this will be the same... I dunno... I guess I will keep at it during my next appointment. 

I was also interested in the traditional Chinese herbs everyone has been talking about, but it seems my guy (who I should add is the ONLY acupuncturist within a 45 minute drive from my house) dispenses little pills in decorative bottles covered in Chinese text.  I am to take 8 of one and 8 of another with meals.  He doesn't seem to have any dried herbs, or anything like what everyone else has described and I had to ask him for these... he didn't recommend them to me.  One is labeled in English as "Relaxx Extract" and the other "Six Noble Combination".  I can tell you that these taste AWFUL and have to be taken with a liquid that has flavor.  Water is not going to cut it with these little suckers -- which resemble rabbit droppings.

Waiting... Waiting... Waiting...

Well, it's Monday.  Officially 9 days since I last spoke with the clinic about the trial and I still have nothing in my hands that says I am in.  No email, no follow up paperwork, nada!  It's still super early, but I am really REALLY hoping to hear from them today with "next steps".  I just need something tangible to bank on.

My crazy infertile brain is already playing the fate game.  "Don't be too confident that you're in, then something will come up."  "If you pretend to yourself that you aren't in, then you WILL be in."  Make plans, LOTS of plans for the first week of October.  Make plans that require deposits.  If you already have good plans, then you will be in the trial.  Guaranteed!" 

Meh.

I'm in a STUDY!!!

We recently took a road trip and managed to tune into a radio station that Mr. R loves, but we can't get in our area of Texas.  It's a local station, but for some reason won't play for us out in the sticks.

I just got off work that morning and was dead tired and napping all the way to our 4 hour destination, but Mr. R heard an ad for an IVF trial for women over 35 years old and woke me up at the tail end.  I heard the name of a clinic which sounded something like mine.   You know how they are all named Fertility Treatment Center of, Texas Fertility Associates, Texas Center for Reproduction, etc. I wasn't totally sure... besides... if it was MY clinic, surely they would have let me know about a study, right?
We went about our camping weekend and I didn't give it another thought until Monday when we returned.  Mr. R reminded me to call the clinic and find out...

Guess WHAT?!?!?  It IS my clinic holding the trial and I DO qualify!!!!  (Why they didn't call me and tell me about it is beyond me since I am glaringly perfect for the trial since it's for DOR/POF over 35!) Anywhoo... I spoke with the nurse who gave their list of requirements and only two things are an issue... 1)  I have to have an FSH under 12... now my most recent reading was at a 10, but the one before that was at 19.... so who knows where it will be when the trial starts.  and 2)  There cannot be any male factor issues... we don't know about that. Mr. R as you know has two healthy children already, but he has a 15 year old vasectomy that may pose a problem.  We're meeting with the urologist on the 23rd to see about that, but luckily the fact that we will need to do a sperm aspiration for our trial does not disqualify us, but that portion will be out of our own pocket.  At $2,000  that's a DEAL!  The trial is also not completely free, it's going to cost me $1,500 but that is just 10% of the required amount for a self-pay so I am stoked!  We currently still only have about $8,000 saved because of various car troubles that have set our savings back, so when she said this I cried!  She was all freaked out -- really?  You deal with desperate infertiles every day and my crying freaked you out?  Wow!

One thing that struck me is that when she said, "There is a small cost involved." I replied, "I have $8,000 saved so far, what's the cost?" She said, "Oh no, with $8,000 you can do a few trial cycles..."  I was so shocked I didn't think to ask her what she meant by that... Ladies who have trial experience, can you tell me if these trials usually have multiple cycles?  Or is it a one time deal?  I don't want to be the squeaky wheel who keeps calling with questions so I don't want to call and ask.  Also... once you're accepted for a trial... don't you need to receive some paperwork or something?  I guess since they already have all my information since it's actually with MY RE they don't need much from me.  But all I have that says I am in the trial is her word (which I checked multiple times, "So I am in?  You're sure I am in?  I qualify for the trial right?  Okay, so for sure... unless my FSH is too high, I am in??") over the phone.  It's only been a week, and trial isn't due to start until first/second week of October... (they're waiting for their current trial to finish). Eeekk!!!  I feel like I want something written.  I want to have a to-do list.  I need something physical to make this feel more real!

So the plan... I have lost a bunch m ore weight since I last posted.  I am down to 188lbs which is 10lbs away from an official "Healthy" BMI.  I am proud of that.  But here's truth time... I did pick up a few cigarettes in the last few months.  I am not proud of it, but the stress got to me!  I am back on the quitting wagon now though and will be smoke-free again before the trial starts.  I also started slacking on all my supplements.  The harder it became to save money, the more despondent I became.  Honestly I had almost given  up hope when this trial option came up.  Now I am all about it again.  I will (HOPEFULLY) get one shot in this year.  And can continue saving for a second shot in the new year... unless of course this trial involves multiple cycles.  SQUEEEEEEE!!!

Okay, that's enough out of me.  Time to go check in on some other blogs now that I am feeling a little less sorry for myself. I am not proud, but at least I am honest, right?  xx

Taking a DHEA Break

Urg... I was going to save the next supplement update for 2 weeks time and give you a full month feedback but this change came with such a dramatic hormonal performance I feel like I should add this in right now so everyone is aware of this potential side effect.

I mentioned in another post how I started feeling a little more emotional than normal, but I figured it might just be DHEA, a little PMS mixed in with an emotional day (Father's Day) and lack of sleep.

Last week I was bouncing off the walls with emotions.  Literally up one second and down the next and then crying, then angry and then outrageously happy or excited.  By Saturday I was a mess.  I was having panic attacks, crying -- I mean SOBBING -- at the drop of a hat and one minute I felt like I wanted to slap Mr. R and the next I wanted to hug him and just cry.  Bless him he was so patient in dealing with me and it gives me hope for how he will be when it comes time to hit the hormones for treatment, but really  this was NOT fun.

I am convinced that it is related to the DHEA and so I stopped taking it on Saturday.  Yesterday (Sunday) I felt a bit better, not as emotional and today (Monday) I feel better still.  More in control of myself.  I plan to give myself a week long DHEA break and then maybe bring it back at a lower dose, and go for a week on, and then a week off, and repeat like that until we stim.  Dr. C has already told me no DHEA after we get started.  He's not a big fan of the stuff.

Anyway, if anyone out there is following along with the supps I am taking, I would advise you to keep a close eye on the DHEA because WOWZA did it ever cause a reaction in me!

Discount IVF Meds

Woohoo!  A little good news today from EMD Serono (remember the Compassionate Care application I submitted for up to 75% discount on my Gonal F and Cetrotide).  I faxed the application paperwork to them on Tuesday evening, and received my card and number, etc today by email.  What a relief! (and such amazingly fast turnaround time.) 

I realize that's just a discount on 2 of the 6 meds I will be needing, but as has been my motto through most of this planning stage, every little bit helps. 

I have discovered that there are two other programs that may offer reduced rates on meds that I need.  Heart + and Design Rx.  However, these two programs are pharmacy specific I am told by my finance rep at the RE.  In other words, only certain pharmacies will accept the discounts, and the pharmacy that my RE prefers (read: is pushing me) to use is not one of them. 

Heart +
This program is, again, not going to save thousands of dollars.  The website states, up to $500 though only one of the meds on my list - Novarel - is covered by this plan, and I have no idea what that costs, so I am quite sure that the full $500 savings won't apply here. Heart + offers eligible patients savings on prescriptions for Bravelle, Menopur, Endometrin and Novarel.

DesignRX
From their website:  DesignRx partners with pharmaceutical manufacturers through its elite network of specialty pharmacies to offer unique programs to help patients with little or no drug coverage. The DesignRx pharmacies are carefully chosen to participate in the network based on their distribution volumes, geographical locations, experience within a given disease state, and overall patient customer service.
I seem to have registered for this one, but really it's all not very clear.  I need to do a bit more digging to try and figure out what it is that I signed up for, as there seems to be some type of membership forum attached to the site as well.  At any rate, they discount Crinone 4 which is on my meds list.

Here's where I could use some help/advice/opinions...

1) Have you ever used either of these programs (Heart + or Design Rx)?  Were they worthwhile?

2)  What pharmacies do you recommend?  My RE likes Freedom Pharmacy but they really push them a lot and I get the feeling that theirs is a mutually beneficial relationship - which usually does not bode well for patient prices.  I don't mind going through multiple pharmacies, I just need to keep the costs as low as possible and I would at least like to have something to compare Freedom to, to make sure that I am getting the best deal.

Any advice from those of you who have walked this road before me would be GREATLY appreciated!!

Goals: # 4 Research Different Protocols for DOR

If you're just joining us now, this is the list of my personal goals as I work towards raising enough money and preparing my body for IVF treatment in Sep, 2013.  Here is a list of the previous posts in this series if you would like to look back.

GOALS:

1)  Financing.
2)  Improve AMH
3)  Egg Quality
4)  Research protocols for DOR IVF

IVF PROTOCOLS FOR PATIENTS WITH DIMINISHED OVARIAN RESERVE

Okay, I won't lie.  I am WAY over my head on this one.  I've read... maybe 50 articles on PubMed discussing various protocols for DOR patients.  Some say Add GnRH AND Micro HCG.  Others say adding HCG can lower the clinical pregnancy rates.  I know for a fact that my protocol, chosen by Dr. C will include Micro-HCG so I am specifically looking into studies that include it.  *Sigh*  I am WAY over my head. 

All the information I have on my protocol is a list of the drugs I will be needing.  Part of me wants to know exactly what he's planning so I can get opinions and reviews from those who have gone before me.  Another part of me wants to just let the man do his job and not stress over the intricacies of the protocol he has come up with. I am torn between the two.

So if you want to drive yourself batty I recommend that you mosey on over to PubMed and go hog-wild.  As for me... I think I am going to sit on this one a little longer.

Goals: #3 Improving Egg Quality

Let's take a quick peek at where we've been before we look at Goal #3.

GOALS:

1)  Financing.
2)  Improve AMH
3)  Egg Quality
4)  Research protocols for DOR

IMPROVING EGG QUALITY

In my situation, and according to Dr. C, my egg quality is not a concern however I have read enough sad stories of ladies with DOR who only got 4 eggs and they were all of poor quality - despite their young age.  At 34 I know I am no longer in my baby-making prime, but according to the good doctor I am not quite yet a shriveled old hag, in spite of what my empty ovaries would have you believe.  This middle ground is one of the things that concerns me in all of this.  If I was 25 they'd say "You're young!  They'll be perfect!" If I was 45 they'd say, "You're older and so we're not expecting beautiful eggs." At 34 opinions vary from doctor to doctor. Being the OCD perfectionist that I am, I'm going to take precautionary measures just in case.

Look, as I've previously mentioned we're killing ourselves to come up with money for this one cycle.  Dr. C provides unlimited FET, but I do not anticipate having any spares for freezing. Those of us for whom IVF is a luxury well beyond our budget ALL say, "I have this one shot." But those of us on a shoestring budget AND who have DOR really may only have ONE shot.  There will be no extra eggs for FET, one single try.  You're in, or you're out.  (And really... the interwebs, have shown me that I might not even get the one try I am hoping for.  If I only get three eggs, and none of them are good, or don't develop properly, that's it.  I am out before I even get started.)

But, I digress... egg quality.  We want them plump and healthy and ready to get to work.  We want them perfect.  P-E-R-F-E-C-T! But how?  I'll collate all the tips I have learned in one place, but first I want to give the sources a moment in the sun... (Speaking of sun... how are you doing on that Vit D for increasing AMH?)

Ready for some linkage?  Here it comes.

One in Ten Million - Blog
So here's (in my opinion) the creme de la creme of resources for those of us with DOR, or POF. Cole Jeanette is one tenacious lady and she has, in 4 short months, taken her body from a 1 in 10 million chance of falling pregnant to pregnant with twins.  *Gasp!* I know!!!  She lists EVERYTHING she took and alternative therapies she tried on her blog and gives clear, easy-to-follow instructions on anything that you will need to "MacGuyver" at home for yourself. This is my number one recommendation.  If you read nothing else I post, definitely go and read just this ONE blog.  You'll learn a lot! (and you'll notice how many of her suggestions are in my list below)

Natural Fertility Info
I know, here I go with the "touchy feely" sites again, but despite the name this site is very explanatory.  I thought I knew all there was to know about my ovaries and the eggs therein from Bio class in school.  Boy was I wrong.  Lot's of interesting information here and great clear diagrams.  Also some hints and tips on how to naturally  improve your egg quality in 90 days.

News Medical
This isn't a pretty, easy to use site and they don't focus on fertility specifically, it's more general medical.  But I found this article on the use of Melatonin to improve egg quality to be very interesting and I wanted to include it.

The Magic List

At this point you may wish to grab yourself a cup of coffee and a note pad, oh and a full pen... I am talking brand new, fully stocked with ink.  The list is long.

SUPPLEMENTS

I'll start off with the ones I am taking.  Note that some of these are dual-purpose and were mentioned in my previous post about increasing AMH.

CoQ10 - 800mg/day
DHEA - 75mg/day
Royal Jelly - 456mg (concentrate) / day. If you have the jelly itself you need 1500mg/day
Fish, Flax, Borage, Omega 3,6,9 - 2 caps/ day
Melatonin - 3mg/day
Prenatal Vitamin - 1/day
L-Arginine - 1 cap 3x/day
Black Cohosh 3 caps/day
Ginseng - 1 cap/day
Thai Ginger- 1 cap/day
Vit D3 - 1000mg / day
Baby Aspirin 1/day
Red Raspberry Tea - 1cup/day


Here's how 1 full day's intake looks (Actually, I have added some stuff since these were taken):

Some others (slightly more difficult to find if you live out in the country like me, but I have ordered them and am waiting on delivery.)

Wheatgrass
Chaste Tree (AKA Vitex)
Maca
Myomin
Pregnitude (easy to find this one, online only, but too pricy for me right now, and I am concerned about taking this WITH my existing prenatal before I speak with Dr. C again)

THERAPIES

Fertility acupuncture
Fertility Yoga
Fertility Massage
Mayan Fertility Massage (Difficult to find a qualified practitioner on this one)
Castor Oil packs

Goals: #2 Improve AMH?

Today I'm going to get into Step 2 of my Goals list.  As a reminder, here's the list again:

GOALS:

1)  Financing.
2)  Improve AMH. NEED MORE EGGS
3)  Egg Quality.
4)  Research protocols for DOR

So, yeah, improving AMH levels... Impossible right?  I was told as much by Dr. C however I proved him wrong in 4 short months by losing weight, eating clean, drinking 1gal of water per day and adding Fish, Flax, Borage, Omega 3,6,9 oil supplements.  I increased my AMH from <0.16 to 0.28 -- now I realize that those of you who don't have DOR will look at that and laugh at the "improvement" but my DOR girls will know what a big deal ANY improvement on that number is.  It IS possible.  I've already done it once.  I WILL do it again. Mark. My. Words.

There are few good sources of info on improving this online.  I will link to what I consider to be the best below.  (Actually, I think for convenience I will add a link list to my sidebar which will include ALL helpful links that I post about.)

The one I've seen posted about most frequently is Dr. Malpani and I think it's because he gives the clearest list of supplements/steps to take.

Here's what Dr. Malpani recommends:

1. Yoga
2. Acupuncture
3. ** DHEA, 25mg thrice a day. (tee-hee I love a man who uses "thrice")
4. Wheat germ daily
5. CoQ 10, 100 mg daily
6. Vit D3 ( Calcirol), 60000 IU, once a week for 10 weeks

In this article on FertileHeart.com the writer doesn't give much weight at all to AMH levels calling them unreliable.  She goes on to state that weight loss can improve these numbers.  I am inclined to agree with her on this part.  I've proven it myself, 40lbs down = an improvement of at least 0.12 points. Okay, so I've not solved the puzzle completely but given that "ideal" is 1-2, I'd say that's a pretty good leap, no?   In a more recent article she recommends a Vitamin D supplement and calls Vit D deficiency a "virtual epidemic".  Living in one of the sunniest states in the nation I have never been concerned with a lack of Vit D, but if it's being recommended by at least two sources I am going to give it a go.  Can't hurt, right?  I can also say that at first CD3 test in December, 2012 I was pretty much indoors all the time and seeing as how I have worked nights for two years I don't really spend a lot of time in the sun.  At time of second test in May, 2013 I was walking outdoors on a track in the sun almost daily in the afternoon for a minimum of 1 hour.  More sun = more Vit D = improved numbers.  It might be a bit of a stretch, but I can see that.  Be advised the FertileHeart site is very "new agey" and "touchy feely" in nature, but they do have some very interesting articles and I value and agree with their opinion on this.

Natural Fertility Info is another great resource site with natural supplements you can add to your regimen to support your body's natural functions and nourishing the edocrine system.  They make no claims that their suggestions will miraculously cure your low AMH. That being said, a number of the suggestions on their list are recommended above, and in tomorrows post on improving egg quality, so I am happy to throw them in with the pile of supps I am already taking.

And I am afraid that's it. I've scoured countless blogs and forums for the miracle AMH increase trick but aside from the above nothing of any real value comes back and I haven't been able to find any published studies that support either of the above two options either.  So when it comes to improving AMH we're kind of on our own.  None of the above would hurt though, right? (** There are warnings associated with DHEA so definitely research that one some more before you take it).  But what can it hurt to increase Vit D intake?  To add a little wheatgrass to your regimen?  Top that up with some CoQ10?  (One of these days I'll post a pic of my daily supplement intake that will have you in stitches I am sure!)

There you have it. Improving AMH is, in my opinion, not impossible, but not going to be quick, easy, or certain.  I feel that the changes required are not drastic and so I will continue working on the above in the hopes that by the time we get to trigger I have a bountiful crop of lovely, strong follies and many, many eggs! Now, please excuse me while I meditate on that... "Ohm... bountiful eggs, Ohmmm"

UPDATE:  In January 2014, after 6 months on this regime I have improved my numbers further.  Unfortunately AMH was not tested this round. But the other numbers look GREAT!  

UPDATE: In April 2014, my AMH has risen again, almost double what it was in May 2013 at 0.53.  Look, it's still not a normal 1, but I am halfway there! 

Improving Odds

With the second round of CD3 testing concluded, we found ourselves back in Dr. C's lobby waiting for our appointment.  Other patients who arrived later were seen first... we waited some more... Having read other blogs, I know this doesn't make for good news... I had worked a 12 hour night shift, as had Mr. R.  We got home, showered and headed straight to Dr. C... a 1.5 hour drive. I was tired, and starting to freak out... I cried.  My best friend B, in town from South Africa on a visit, tried to console me to no avail.  Dr. C had something bad to tell me, I could feel it.

Finally the nurse ushered us into the waiting room.  Took my weight and BP and complimented me on my weight loss.  She seated us in a consulting room and we waited... and waited... in fact I dozed off and on in my chair.  Finally, growing restless Mr. R checked with the nurse who sent in Dr. C's assistant who explained that the doctor was held over in surgery that had gone longer than expected.  *sigh of relief followed by sadness for that poor woman who, it seemed, may be in a worse place than me right now* I agreed to wait a little longer and fell back asleep.  It was now 1.5 hours beyond our appointment time and 2 hours since our arrival.  Assistant came back in to say that we were welcome to go on home and she would have the doctor Skype us, since we live so far away.  She asked for our phone number and we headed out.

We live in the COUNTRY and have no access to Starbucks so I wanted to stop and get a drink.  (yes, yes, I know caffeine is like the devil when it comes to fertility.  Don't judge me!)  We just pulled into the parking lot when the phone rang, it was Dr. C and he said he had some good news... well, better than last time, but let's be real here, it's not hard to beat that news!

MAY, 2013 RESULTS:

AMH:  0.28
FSH:  10
E2:  23

(I think I am going to pop my test results, as well as what are considered "normal" readings in the side bar for quick reference.  Check there if you want to know how far below "normal" I am).

He was happy about the improvements, surprised to see even that little improvement on the AMH and said it was looking more promising than last time.  He is now willing to give us odds of about 25% but also said that this is based around our possibly not getting any useable eggs.  He has no concerns about my egg quality given my age -- if you've read any blogs or forums you will know, like I do, that your physical age means nothing when it comes to egg quality! -- but he is more concerned about how many we might get, and how many will fertilize so he is being conservative with that figure.  However, if we get 2-3 decent eggs fertilized for transfer, he is comfortable giving us back the 60% odds of conception.  WOOHOO!!

"There is some bad news though..." *deep breath in* "... I am concerned about how much time has passed and given your numbers I want to stress to you that you do not have time to waste here.  The estimates I have given you are based on taking action by Aug/Sep at the latest.  How far are you with finances?  Have you spoken with our finance department?  There are excellent IVF lending programs out there."

Oh, the finances... They've bothered me from day 1. Honestly, for a person who is not at all concerned with the trappings of wealth, finances sure do trip me up a lot!  We've both gone through divorces recently enough that our credit is still ruined.  We both endured foreclosures on our homes and were left with sky-high credit card debt.  Being the "leaver" comes at a high cost it seems! No bank in their right mind would loan us a penny right now.  No,  if this was going to happen it was going to be from the sweat of our brows and the kindness of family donations.

We sat for a moment and let the conversation sink in.  Mr. R knows me well enough to know that I can be a tenacious b*tch when I have to be.  He has witnessed it all through my weight loss.  If I have a goal I immerse myself in it.  I research it.  I live it. I breathe it like air.  He knew in that moment that I now had a goal, a cut-off date.  And I think he knew right there that the next 60-90 days were going to be hell for him.