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. 

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.

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

In the Beginning...

In the beginning I wanted a cricket team.  As many babies as I could have, I'd love and rejoice in each one. Time marched on.  Travel opportunities came up.  Backpacking in Europe for 3 years I was transient and penniless - laying over in hostels for just long enough to save enough money to move on to the next place. I LOVED EVERY MINUTE!

In 2005 while in Holland I met my husband online.  He was American, and I a South African in Europe.  We married and I moved to the States in 2006.  We dropped all birth control and figured we'd let the wind carry us where it wished.  We were happy in the beginning... but then I started to see an unfamiliar side of him... a side I didn't like very much.  By 2011, tired of hanging in there, childless, disillusioned and tired of trying to make it work I called it quits.

Like some miracle it wasn't long before my true prince walked into my life.  My one love.  My other half.  The person I honestly believe I was brought to this country to meet... for the purposes of this blog we'll call him Mr. R.

These days Mr. R and I live a peaceful, simple, happy life just outside of a quiet, quaint country village on the Texas Gulf Coast with our Dog - Freija, cats Brutus, Diesel and Chloe and a tank full of fish.  What's that?  Ahh yes, Freija Chloe?  That's not my name... I WISH I could be more open about that on this blog, but we work in law enforcement and there are limits to what I am willing to put out there online.  Just call me R...

Where was I? Oh yes... so Mr. R and I (R) are happier than we have ever been down here on the coast.  We live simply, but lack for nothing of real importance.  We have love, we have family, we have great weather and access to quiet beaches. ;) What more could we possibly want?

I never did forget my dream of that cricket team.  The dream has morphed and modified over the years as I grew older.  Mr. R has two children from previous relationships.  A DD - K, 17 and a DS - J, 15.  Neither live with us and we have very little contact with J after an ugly divorce.  This bridge will mend in time.  Initially I was so excited at the thought of being a step mother.... well no, that's not entirely true... I was scared witless because of the awful one I had... but I was determined to be the kind of stepmother I'd always hear about from my friends.  Cool, fun, loving, and really really good to their father.  I am sad that I only came into their lives so late, and in one case after a bitter divorce and the poison tongue of one parent had driven a deep wedge into the relationship between Mr. R and his son.

I still longed for just one of my own.  JUST ONE! I'd give anything for just one healthy baby.

Mr. R, already unhappy in his marriage at the birth of J had a vasectomy to ensure that there would be no more.  He stuck it out and tried to make things work for the sake of his son.  He put in 14 years trying before he gave up and left.

"No problem," I thought, "we'll just get the doctor to reverse the vasectomy and give it a bash."  There had been obvious signs that there might be something wrong with me, but my marriage had been almost celibate and my ex husband smoked a LOT of pot which I believed caused him to have slow swimmers.  The problem definitely wasn't mine. "So let's get the thing reversed and get to trying!"

December, 2012

"Um, so that's not actually possible with so much time elapsed," informed my stone faced RE at our first meeting.  "15 year old vasectomys are pretty much a done deal.  Your only option is IVF."  My heart sunk...  "But your odds are pretty good - in the 60% range!  You're only 34, it's not bad!  Let's do a few standard blood tests to make sure you're all good and genetically a good match and we'll get that train moving."

60%?  AWESOME!