8w0d: Looking Good

What a difference a week makes. As soon as they showed up on the screen it was really obvious they had grown. We really loved that Dr. NFB had us in frequently to monitor the babies and my hormone levels. Both babies came through with flying colors at this appointment.

Baby A - 1.6cm with heart rate of 166bpm
Baby B - 1.5cm with heart rate of 159bpm

Quick note on fetal measurements prior to 20 weeks: lengths are crown-to-rump (CRL). Because their little limbs are forming and not proportional, it is inaccurate to include them in the length of the embryo/fetus. Therefore, the convention is to measure the top of their heads to the bottom of their butts.

The babies have little stubby limbs! This is Baby A.

Baby B's heartbeat. The inconsistency in the middle is me breathing and causing the monitor to move.

Progesterone-In-Oil Injections

Beginning on the night of the retrieval, Chris had to give me daily 2cc progesterone-in-oil injections. These are intramuscular using a 22 gauge, 1.5 inch needle. I still had my sharpie circles drawn on my upper butt/lower back from the trigger, so we just kept retracing them. I thought they would hurt worse than the prior shots, but they really didn't. Chris is awesome with injections. The downside is 2cc of oil is a lot of fluid sitting in a muscle. We had 36 of these total before switching to a different progesterone supplement.

Here is what I did to minimize the discomfort: iced my skin for about 45 seconds beforehand and then cleaned with an alcohol wipe. While that was drying, I eliminated the extra air from the needle and handed it to Chris. He injected it, checked for blood in the syringe, and then pushed the fluid (this part took a while - probably 60 seconds). Immediately after he pulled the needle, I put pressure on it with a gauze pad while we heated a facecloth in the microwave. That served as a hot compress for a few minutes and then I sat on a heating pad for about 15 minutes. This actually did a pretty good job at minimizing sore muscles, although some days were better than others.

Unfortunately, we either hit a nerve or got too much fluid built up around a nerve. My left hip, farther down my leg, hurt to walk for about a week, and is still numb/tingly/itchy. We left that side alone for several days and only injected into it occasionally after that. The last time we even touched that side, I felt the injection all the way down my leg to my foot so I knew we had re-irritated that nerve. Ah well. I had a positive pregnancy test to focus on making everything worth it.

Chris did such a great job. If you ever need an injection in your butt, Chris is a pro. Here is his diagram where he injected each needle so he knew where to put the next one. I love him.

7w0d: Two Heartbeats!

Dr. NFB had us come in one week after our first ultrasound to check growth and to make sure Baby B had a heartbeat. I was nervous, but I had a feeling that everything was going to be fine. Sure enough - both babies had heartbeats! Baby A was 116bpm and Baby B was 120bpm. They also tripled in size. A was 7.5mm and B was 6.8mm.

Here is the downside of the internet. I had researched before the appointment and knew that these heart rates were a little on the low side. I asked Dr. NFB if they were ok and all she said was, "They are fine." Not great, not excellent, not perfect - just fine. More worrying, but at least fine was better than marginal.

At this point, we had told our immediate family about the positive pregnancy test, but not that we had had an ultrasound. We wanted to see a heartbeat first and because Baby B didn't have one at the prior ultrasound, we continued to keep quiet. My parents were in town for Christmas and we were so excited to show them the picture when we walked in the door. They knew right away they were looking at two of something!

Dr. NFB had another blood draw ordered to recheck my P4 and E2 levels. The nurse called later in the day to say my P4 had gone up to 157 despite dropping the progesterone-in-oil dose in half. In other words, the babies were doing a great job producing it on their own. They had me stop the PIO injections and switch to Crinone. No more daily needles!!

The babies are the gummy bear looking objects.
The round circle visible near Baby B is the yolk sac. Both babies have them. They
provide nutrients until the placenta grows big enough to take over.

6w0d: First Ultrasound

The wait between the beta and the first ultrasound was the longest two week wait we've ever had. I was so worried that something had gone wrong. I even had Chris call the nurse as I had no symptoms. I figured I should have been nauseous by 5 or so weeks. She was really sweet and offered to have me come in for another beta draw. When it came down to it, I declined. I decided it would just give me something else to obsess over and it wasn't going to change anything.

Finally ultrasound day arrived. Dr. NFB came in and asked how I was doing. I said fine but I was really worried something had gone wrong and there wouldn't be anything in my uterus. She said nothing, the image showed up on the screen and then she said, "hmm...how about two somethings?!" REALLY? We were so excited.

She found Baby A first and saw a heartbeat. I couldn't see it, but Chris said he saw a pixel flickering. She measured it at 103bpm, so it had just started beating.

Amazingly, she was also able to see Baby B's fetal pole. It measured a day behind with no heartbeat yet. Dr. NFB said that was totally fine. They have about a 50/50 chance of seeing heartbeats this early.

Dr. NFB ordered a blood draw to check my progesterone (P4) and estradiol (E2) levels. The nurse called in the afternoon to say that my P4 was 138 - high enough to drop my PIO dose down to 1cc from 2cc. E2 was still really high at 2800 so she said to stop taking the Estrace completely.

Here are our tiny babies (both are a little over 2mm; yes, millimeters):

It is REALLY hard to see the fetal poles. Thankfully, Dr. NFB is excellent at reading
ultrasounds. What is easily seen are the gestational sacs (black areas) and
yolk sacs (round circles inside the gestational sacs).  Baby B on left, A on right.

4 weeks 2 days

There really are two pink lines on those pregnancy tests!

Originally, I planned to not take a home pregnancy test until the morning of my beta, scheduled for 11dp3dt (11 days past 3 day transfer). However, I lost my will power at 6dp3dt. A very very faint line showed up. Hmm...I assumed it was still the hCG trigger shot leaving my system. I tested again the next day and the line got darker. Same thing next morning. Ok, so there is something there making enough hormones to turn a test positive.

Finally on 11dp3dt I went in for my first beta. They drew at 8:00am and said they'd call around 2:00pm with the results. The six hours in between were torture. I finally called Chris at 11:00 to see if he could escape for lunch because I needed out of the office for a bit. That helped.

At 1:30 the nurse called. First words out of her mouth were, "Congratulations! You're pregnant!" Beta: 310. She said she hoped for 100, so 310 was awesome. Now more waiting - the individual draw isn't as important as the rate at which the beta increases. In early pregnancy, it's supposed to double every 48-72 hours. Two more days to wait to see if this pregnancy was progressing.

At 13dp3dt or 4 weeks 2 days, I went in for the second draw. Dr. NFB called with the results that afternoon. Beta: 624. Doubled perfectly! The first ultrasound is scheduled for 6 weeks 0 days.

Embryos are Home

The transfer is done. It was a very easy procedure compared to everything I/we have gone through the past two months. I took a valium which made me really loopy. I felt like I couldn't see or speak clearly. Anyway, the embryologist met us in the lobby at 12:15 and brought us back to the same recovery room we were in for the retrieval. First, he told us that our embryos look great. On day 3, he wants 6-8 cell embryos and we have one 10-cell and one 8-cell!!

They are very careful about keeping a clean and sterile environment around embryos so I had to change into a gown and put on a hair cover. Chris had to get into a jump suit, cover his shoes, his hair and wear a mask. Dr. NFB and the embryologist did the same.

We went into the same procedure room as the retrieval only all of the machines were turned off and instead of ski-boot looking things for my legs there were standard stirrups. Dr. NFB did a mock transfer with an empty tube. When she was satisfied with everything, the embryologist went into an adjacent room to retrieve our embryos. There was a TV in our room connected to a camera in the embryo room where we watched him show us the petri dish with my name on it and two little dots inside. He loaded them into the tube and brought them back into the room. He held the abdominal ultrasound wand while Dr. NFB transfered the embryos. We were able to see the whole thing on the ultrasound monitor. It was actually really cool. As a final check, the embryologist took the tube back to the microscope to make sure the embryos were out. They were and that's it!

While we were there, I asked Dr. NFB about my response to this and how I was surprised that things just didn't go as I had hoped. I was so relieved to hear her say that she completely agreed. Just like us, she had expected a higher response (more follicles), more mature eggs, and a much higher fertilization rate. She said she has some thoughts on what happened, but for now has confidence in the two embryos we transferred. If we have to come back, we'll definitely talk about a different protocol. There is no way to predict exactly how someone will respond to all these very potent medications, so this is definitely a learning process. I am so grateful for the care and attention Dr. NFB, the IVF nurse coordinator, and the embryologist provide.

I am on three days of "couch potato" rest. I can get up to shower, eat, and make a simple meal, but that's about it. I'm taking full advantage of this - Netflix, my Kindle, and a snuggled-up kitten are my good friends. For now, we just have the daily progesterone injections and lots of prayers for our little ones.

Everyone, meet the Brown Embryos:

9 Cells and Counting

The embryologist called this morning with an update. At this stage, he is looking for 2, 3, or 4 cell embryos. We have one 5-cell and one 4-cell! He graded them as high quality. We are thrilled with this report!!

We know this is SO early, but in a process where every day brings either good news or bad news, we are happy to have good news today. We are praying that our little fighters continue to grow.

Transfer is scheduled for tomorrow at 12:30. No sedation, no needles, just valium. Speaking of valium, I really wish they would have prescribed me an entire bottle, not just one pill.

Oh, we actually had one more fertilize yesterday, but he said it is measuring 24 hours behind and is very unlikely to continue to grow. However, he will incubate it today and see how it is doing tomorrow morning.

Well.....update

We spoke to the embryologist yesterday afternoon and he said that of the eight retrieved, six were close to being mature. They all had tightly packed cells around the outside which indicated they are not fully mature. He decided to remove this layer of cells and do ICSI.

He called this morning with an update and said that despite the ICSI procedure going well, only two fertilized.

This is way below all of our expectations (ours, Dr. NFB, and the embryologist). All we can do now is hope that the two that fertilized are perfect. We need to distract ourselves today because it is very easy to be frustrated with the fact that in 26 hours we've gone from thinking we have ~11+ to work with down to two. We will focus on the two that are still hanging on. I'd like to leave the house for a while, but I can't stand up straight yet, so there better be some good football on today.

Retrieval

Disclaimer: This is written under the influence of propofol, versed, zofran, and vicodin.

The retrieval is done. I'm back home. We showed up at 7:00 and they started getting me prepped. I changed into a gown, socks and a hair cover. The nurse anesthetist then took me into the procedure room and hooked me up to an oxygen mask and blood pressure, pulse, and heart rate monitors. She started an IV and at 7:25 pushed the cocktail of drugs. That's it - that's all I remember until they woke me up to bring me into the recovery room.

The embyrologist came in to the recovery room to tell me that they retrieved eight eggs. He doesn't yet know how many of those are mature. I'm really discouraged and there may have been tears when he said that. I expected all 11 of the largest follicles to have eggs and maybe one or two bonus eggs from the smaller follicles. After we got in the car I made Chris go back in to ask the nurse how that happened. Did I really have 3+ empty follicles? Did I start to ovulate on my own in the past 24 hours? The nurse was busy so we are waiting for a phone call back.

We stopped at Starbucks on the way home (I sat in the car) so I could get my turkey bacon and egg white sandwich. My reward. :-) I've taken vicodin for the pain and will just take it easy for the rest of the day. Maybe Lucy will snuggle up with me soon.

Trigger is Done

Chris did an excellent job. His face was white when I turned around afterward, but he didn't pass out. The nurse drew circles on my backside with a Sharpie this morning so Chris knew exactly where to inject the hCG trigger and the upcoming progesterone-in-oil. I iced it for about 30 seconds, cleaned with an alcohol swab, and Chris injected the needle with no hesitation. This was an intramuscular injection so the needle was a bit bigger than what I had been using for my stomach (25 gauge, 1.5" vs. 27 or 28 gauge, 0.5"). I barely felt the poke and didn't feel the fluid plunge at all. Besides the fact that this will leave a knot in my muscle, it hurt less than the stims - I nicknamed them Follistim Fire and Pur Burn.

Triggering Tonight

Dr. NFB walked into our 5th monitoring appointment this morning and said we are triggering tonight. My E2 levels are too high to keep taking the stims. I asked her what the concern was with the E2 levels and she said if they get too high they start worrying about ovarian hyperstimulation syndrome. I'm not at a high risk because they will only aspirate 11-15 follicles (over 20 is higher risk), but still something to watch.

She will also prescribe Estrace to prevent an estrogen crash. Everyone around me is thankful for that. The Lupron took it down to non-existant (5 pg/ml at baseline vs. the 2809 pg/ml I had as of yesterday). We called it Rage in a Vial or Tears in a Vial depending on what irrational reaction I had to something benign.

Chris: What do you want for dinner tonight?
Me: You want ME to decide what we are having for dinner??? I have to stick myself with needles, I have a headache from them, and just want a nap on the couch. And you have to go and ask me what I want for dinner.
Chris: You're right, the medicine sucks. I just thought I'd see what sounds good to you. How about pancakes? And here is a hug and there is the couch.
Chris's head: Really? That pissed her off?? I think it would be better for everyone if she just parks it on the couch and says nothing for the rest of the evening.
My head: Yikes, I'm bitchy. Injecting rage every morning is not good for interpersonal relationships.

Thankfully that went away as soon as I started stims.

Dr. NFB measured 11 follicles this morning. She didn't bother measuring the others even though they are still there. She said they will probably not mature in time for the retrieval on Friday. We inject the hCG trigger tonight at 8:30pm!

Still Going

I had my fourth monitoring appointment this morning. Dr. NFB measured 15 follicles again, same distribution as last time: six in my right ovary, nine in my left. We could immediately tell the follicles had grown when they showed up on the ultrasound screen. They are starting to squish together. However, they are not collectively big enough yet to trigger. More stim injections tonight and back to the office tomorrow morning for another check.

The nurse called this afternoon with my E2 results. It is doubling every 48 hours. 11/11: 710, 11/13: 1400; 11/15: 2809. This led Dr. NFB to drop my Follistim dose to 100iu tonight. The nurse said this means we will probably trigger tomorrow night and retrieve on Friday. But Dr. NFB will make the final decision after the scan and blood work tomorrow.

I'm really pulling for Friday - I'm ready to get the show on the road and I have sick leave I'd like to use up. My abdomen is done being stuck; the skin is bruised, tender to touch, and it hurts to have anything pushing on it including my pants, which were unbuttoned and covered by a long baggy shirt today. Also, Dr. NFB isn't working this weekend so if we retrieve on Saturday, it will be with a different doctor. I know they are all very competent, I just want my own doctor.

Here is a histogram of today's scan (I also redid the scale on the one from 11/13 so its easier to see the progression):

Artist Rendering

I don't have a lot of extra skin on my abdomen to grab so my injection sites are limited to two quarter-size spots on either side of my bellybutton, further reduced by bruises as the nurse told me not to inject into them. The area is tender to touch, but only a couple days left of these injections!

MBA Lesson Put to Use

We had the third follicle check this morning. I was a bit anxious to see what was going on because I haven't felt many physical side effects yet and I thought I should by now. Also, medicine leaked back out of the injection sites a couple nights ago. The nurse showed us into the exam room and the ultrasound readout from the last patient was still up on the screen (no patient info, just measurements). She had 20 follicles. Ugh! Dr. NFB walked in and Chris informed her that we have follicle envy of whoever was there before us. She laughed and said that she thought we would have a good update today.

A few more follicles decided to join in the fun - she measured 15 (six in my right ovary, nine in my left)! A couple are on the small side, so they may not mature in time, but we have several that look great. They took more blood to check E2 levels. Dr. NFB didn't call this afternoon, so I'm continuing with the same doses. I don't know the E2 result, but it must have been fine. We go back on Tuesday. She said I may be ready to trigger Tuesday night, so ER is back to being up-in-the-air between Thursday and Friday.

My MBA and Excel skills came in handy today - I made a histogram of my follicles:

11/11/81 to 11/11/11

It was about 15 years ago that I realized my 30th birthday would fall on one of the coolest dates of the century. How do you celebrate a big birthday on an awesome day? Throw a big bash ran out of desire to plan a huge party years ago; escape to the Caribbean with my husband vacation was moved to the end of November and then canceled; spend the day hanging out with my husband, talk on the phone with my family, go out to dinner with our great friends - winner!

I started off my 30s by waking up to an alarm so I could stick myself in the stomach for the 45th time and then get to our second monitoring appointment. It went fine. I guess I was holding out hope for a miracle of lots of follicles, but I'm still just chugging along with 11. I guess 11 really is my lucky number. She measured four in my right ovary and seven in my left, most between 8mm and 10mm. Dr. NFB repeated that I am responding a little slowly. We mentioned that we are disappointed with that and she said she'd much rather have it be a bit slow than too fast. Also, she said my follicle count is right in the normal range.

It's looking like my retrieval will be next Friday, one day later than originally planned. They did a blood draw to check estradiol levels and will call this afternoon with the results. Dr. NFB said she will probably up my stim dosages. As soon as the nurse calls with the next steps, I need to call the specialty pharmacy and get more drugs shipped asap (and a new sharps container, more alcohol pads, and more syringes).

Chris and I grabbed Starbucks afterward and are enjoying a relaxing day at home. This evening we are heading out to dinner with our dear friends and then back here for dessert so I can get the stim injections done on-time. No alcoholic or caffeinated beverages during stims, so I'll cheers to a great 30 years with something hydrating. :-)

P.S. As I stuck my keys in the ignition this morning, I realized I've been driver for half of my life today. Crazy!

Update 3:00pm: the nurse called and said my E2 levels were great at 710. I'm not really sure how to interpret that, so I'm going with what the nurse said - they are great! Based on that, Dr. NFB decided to leave my doses the same. I called the specialty pharmacy and they are shipping out more drugs overnight. I told Chris I thought it was awesome that they do overnight Saturday delivery in a cooler and he reminded me that even though we don't pay out of pocket for it, it probably goes against my insurance maximum. Oh...well, fingers crossed it doesn't matter.

Lucky 11

I have this thing where I have a hard time accepting anything other than above-average. I've always been this way. Sixth grade we were exempt from weekly spelling tests if we got a 100% on every spelling related assignment during the week. Guess who rarely had to take that test? In high school if there was an AP class available, guess who took it? In college, I made it into the Honors Program. Grad school - finished 2nd in my class.

However, I can't mind-control my ovaries. I really wish I could because then those things would blow the doctors out of the water. After I left the office they would be making comments to each other like, "Have you ever seen such beautifully responding ovaries? Perfect follicles all growing at exactly the same rate. Wouldn't it be wonderful if every patient responded so well!"

As you have probably guessed by now, I didn't receive such a glowing report. The nurses aren't standing around admiring pictures of my ovaries. Chris says everything is great and that I'm working myself up. He's right. I just can't get over that Dr. NFB casually uttered the words, "you are a little behind." Daggers to the heart of a competitive stubborn girl! Of course nothing else she said seems to matter.

She measured five follicles in my right ovary and six in my left. All were between 4mm and 7mm.

Positives: I have 11 growing follicles all around the same size. Dr. NFB really didn't seem concerned; she said I might have to stim for an extra day or two. I consulted Dr. Google and it seems long Lupron may cause a slower response to stims. I'm on super extended bonus track Lupron. And, I found anecdotes where people only measured 10 or so follicles at the initial scans, but ended up with 15-20 at retrieval.

Negatives: I want to know where the other nine antral follicles are. This one is not a huge deal, but I'm probably going to need to order more meds.

I had blood drawn to check estradiol (E2). Dr. NFB said she'd make a decision on dosages after she saw my blood work. No phone call meant to continue with what I have been doing. I never heard from them, so I'll keep the same dose for three more days. The always-more-positive Chris says that's a good sign - the follicles are doing well enough that they left the dose the same. The normal obsessive part of me wants to know what that E2 level was, but it really doesn't matter. I have no idea what it means and it will just give me more crap to google when I should be doing something else.

So - that's it until we have another look on Friday!

Suppression #3: All is Quiet

Now that my ovaries have made their point that they will do whatever they damn well please, they have quieted down. Or maybe they just wanted to let everyone know that they work just fine on their own, thankyouverymuch.

I had my THIRD suppression check this morning. No cyst! The nurse called with my blood work results this afternoon and I pretty much have no estrogen in my system. I may have heard incorrectly, but I thought she said 5.4 (recall last two weeks were 124 and 137). They want under 30. Check! I think this also explains the headaches I keep getting.

I start stims on Saturday! I'll get the calendar updated soon.

Dr. NFB also did an antral follicle count. Each month in normal functioning ovaries many follicles start to develop and pretty quickly in the process, one emerges as the dominant follicle and releases hormones to suppress the rest. The other follicles and the immature oocytes (eggs) inside just die off. If the ovaries are observed early enough in a cycle, the doctor can count how many tiny fluid filled antral follicles are hanging out waiting for FSH (follicle stimulating hormone) to start competing for development. Too few is a sign of diminished ovarian reserve and too many is a sign of polycystic ovarian syndrome.

Dr. NFB counted nine in my right ovary and 11 in my left. These are excellent numbers. The Lupron is preventing my pituitary gland from releasing FSH and LH so without the stims, my ovaries will just keep hanging out at this stage. With controlled hyperstimulation we are going to try to get as many of those follicles to develop mature oocytes as possible. We hope to prevent a dominant follicle as it will shut down growth in the rest. Also, I will continue to take Lupron to prevent my body from ovulating on it's own. If it does that, they can't retrieve the eggs and therefore, no IVF.

In theory, if every one of my antral follicles respond to the stims, they would retrieve ~20 eggs. But, not all may respond or some may not contain an oocyte. I would be thrilled with 12-15 follicles at retrieval containing 10-12 mature oocytes. However, let's not count our chickens before they hatch. I'm just excited that I'm finally properly suppressed and have a great antral follicle count. Next appointment is Tuesday, 11/8 to see how I'm responding to the stims and adjust the dosages accordingly.

P.S. The nurse handed me a zip lock bag full of syringes because I've been on Lupron WAY longer than planned. I will be very close to running out of the vial by the end of this. Amazing how fast things change - I didn't find it odd to carry a stash of syringes in my purse the rest of the day.

Bathroom Remodel

Watched ovaries apparently don't suppress, so we finished up the jack 'n jill bathroom remodel instead. Last spring we replaced the black formica countertop with tile and mosaic backsplash and the white linoleum floor with large 20x20 tile. The only thing left was the tub surround. It was previously tiled and we had hoped to pop the tiles off and somehow save the underlying drywall. It didn't work at all, so we ripped it down to the studs and hung cement backer board before re-tiling and painting.

Almost a "before" shot.
We started demo before we realized we hadn't snapped a pic.

Down to the studs.

All done! Grouted, caulked, sealed, painted.

The mosaic border in the shower matches the backsplash around the counter.
We also replaced the lights and the towel bar & toilet paper holder.

Suppression #2 is a Bust

We had a second suppression check this morning. We saw one of the other doctors in the practice because Dr. NFB was out, which we knew in advance. Dr. LoFB earned his nickname within 10 seconds of walking into the exam room. That's Dr. Lots of Funny Business. He asked me if I always went against what I was told, in reference to the fact that I had ovulated. Chris and I both agreed that I can't help but be a bit stubborn and defiant. Dr. LoFB confirmed that I had a healing "collapsed cyst." It was smaller than last week, but still present. Our next steps would depend on my blood test.

The IVF nurse called later in the afternoon with my results. My estrodiol was 137 (higher than last week) indicating that the cyst was still very much active. She told me to stop the birth control pills to see if that helps. I'm to continue with 10 units of Lupron every morning and come back for a re-check next Tuesday. She said that they were trying to take over my body and it clearly wants to do its own thing. Maybe the third time is a charm!

Breaking a Taboo

Infertility seems to be one of those things that nobody openly discusses. It makes going through it very lonely. It really should not be this way. 12% of couples will encounter infertility at some point which means there are a lot of people out there struggling with this. I bet there are people I know who are currently silently undergoing infertility treatments. If we don't talk about it, then we miss out on shared information, advice, and support.

However, as infertility is a medical condition, the details and treatments are a private matter. Only the person going through it can chose with whom she/he shares and what information is disclosed.

Redbook just launched The Truth About Trying campain in partnership with Resolve. I am so excited to see this effort at bringing more awareness to infertility. I wish that every infertile couple had the information they needed to make the best decisions for themselves and the support to know they are not alone. I wish everybody else had enough understanding to know how to be compassionate and supportive. I don't expect everyone to just know what it's like to go through infertility, but it would be wonderful if the physical and emotional demands of infertility were more widely known. If you know someone who is going through it, your presence and empathy will make their journey easier to travel. I promise.

I can't speak for anyone else on why infertility is kept a secret. All I can tell you are my thoughts on it and how they have evolved over the past year:

Problem: I wanted to maintain the element of surprise when announcing our pregnancy after the customary first trimester. I think people look at you differently when they find out you are in the "baby stage." I didn't want people's judgements before it was all said and done. Also, if people know that we are trying, then they generally would expect to know of a success before 12 weeks. For me, it is scary to spread the news before the end of that critical first trimester.
Solution: I came to terms with the loss of going about this the "normal way" and just decided that I can't both tell people about infertility and then expect that they don't want updates. This is one of the reasons I decided to write a blog. I will provide more frequent updates, but only when I am feeling ok with it. I think that seems fair. People will know we are pregnant before the end of the first trimester, but that is just the way it is. More people to pray for a sticky, healthy baby.

Problem: I took infertility personally. I felt like I was failing at something I was designed to do and something I had just expected to have ever since I was a little girl. This is the first time in my life I haven't had the power to change my situation by myself. This challenged how I have defined myself my entire life: strong, independent, capable. I thought that talking about it would mean that I was admitting defeat, that I might fail, and that perhaps, I'm not who I thought I was.
Solution: Clear thinking made me come to my senses. No one's body is perfect. We don't know if this is a problem with me or with Chris, but something in one or both of us isn't working quite right. Pretty sure there is something slightly broken in everyone. This just happens to be ours. I also decided that rather than feeling powerless, I should feel like I've grabbed the bull by the horns. We finally sought out the right doctor and are doing everything we can to beat infertility's sorry ass. Besides, weak people can't do infertility. We have had to face something really shitty and decide that no matter what happens, we have each other. We have had to talk about topics that many couples never do. I've had to take medications that chew up and spit out my hormones and deal with failed cycle after failed cycle and still try to be a good wife, daughter, sister, friend, and employee. And you know what? Most days I do it! One last thing - the needles. I can give myself injections now!

Problem: I don't want pity. I can't control how others respond, but feeling sorry for us isn't what I want. Trust me, we feel sorry enough for ourselves for everyone.
Solution: I can't control how others feel, so fugetaboutit.

Problem: I thought that people would not understand. I had NO IDEA what it was like to be "infertile" before this. I was afraid of poor reactions and rude comments/advice.
Solution: Once again, I can't control how others feel nor what they say. If they say something totally wrong or insensitive then I can use it as an opportunity to educate them.

Problem: I was worried that if we ended up with twins, I would have to answer totally inappropriate questions like, "are they natural?" (actually overheard one day in the grocery store)
Solution: First off, what the hell does that mean? Natural? No, I gave birth to robots, but their temper tantrums and shit are very realistic. Second, it really is none of people's business how our children were conceived. So perhaps I should just ask something equally as inappropriate in return, "how many times a week do you and your partner have sex?" or "what's your favorite position?"

Problem: People have moral objections to assisted reproductive technologies, including the Catholic church.
Solution: I'm really not interested in getting into a religious debate. I don't understand why most religions support something like cancer treatment (preventing death), but can't support ART (starting life). We are doing what is right for us and whatever happens as result is between us and God, not anyone else.

Problem: Let's face it: talking about infertility often involves talking about the reproductive system and hormones. Also it's closely related to sex. Topics which make most Americans uncomfortable.
Solution: Why is that? Why are you uncomfortable with it? They are just parts of the body. Just like poop, everybody has them. And I hope everyone has sex too. So I suggest that you just start getting used to the vocabulary. SPERM! UTERUS! OVARY! See, that's not so hard. Try using them in a sentence.

Suppression: FAIL

Our suppression check appointment didn't start or end as expected. First, Dr. NFB started measuring a couple really tiny follicles, which confused me, because I'm not supposed to have any. I asked her if that was normal and she said I was behind schedule, but that more follicles would probably pop up. Wait, what?? Chris was super confused, too. Uh...Dr. NFB? I'm supposed to be suppressed. You do know that I'm on birth control pills and Lupron now, right?

Apparently there was some mix up between the nurse, what was written in my chart, and what Dr. NFB read. Whatever, she got it straightened out and re-evaluated my ovaries for suppression. And found a damn cyst. She said the blood work would tell us what that cyst was up to.

The nurse called with my results this afternoon. Sure enough, my super awesome ovaries function so well that I ovulated even though I'm on birth control pills and Lupron. The cyst was just a normal post-ovulation wound (happens to every woman for every follicle that ovulates - it's actually what releases progesterone to support an early pregnancy). My estrodiol level was 124; it should have been under 30. My progesterone was 5.4 and should have been less than 3. LAME!!!

I am really frustrated. I had a feeling this was going to happen. Not sure if it was because they overlapped the antibiotic too early in the pill part or if my ovaries are really just that stubborn. I would not doubt the latter at all. It also renewed my frustration that we are going through all of this even though my body appears to function exactly as it is designed.

The plan is to continue the pill and Lupron injections until next Tuesday when they'll recheck for suppression. That cyst should heal up all on its own in the meantime. My ER and ET have been pushed out at least a week. The nurse told me to not make any travel plans for Thanksgiving.

Icing on the cake: right as my call with the nurse was ending she said, "Oh, hey. When you come in next Tuesday, you need to pick up more syringes because you'll run out of your current supply." FML!!

Accomplishments All Around

This weekend was eventful for our family:

Huge congratulations to my Mum who finished office time at her job last week. She will be on vacation for the next two months and will officially retire in mid-December. 

Happy Birthday on Saturday to Dad and Ally! I have always loved that you two share a birthday. 

Also on Saturday, Ally and Travis ran in a 10k race and totally rocked it. They finished in 46:54. Ally placed 4th out of 77 in her division. I am very impressed!!

On Sunday, Chris ran his second half marathon and knocked a little more than 2 minutes off his previous time. He finished in 1:55 and said he felt great the whole way. I am so proud of him! It would have been fun to run with him, but it was also fun to stand near the finish line and watch people complete 13.1 miles with my warm americano in my hand. Sidenote: the race colors were blue and orange. There were blue and orange balloons and flags lining the last 0.2 miles and the finish chute. I felt right at home. 

And finally, I had my first out-of-house injection. I'm supposed to give the Lupron shots at 7:00 am every day, but we had to leave the house at 5:45 and start walking toward the start line for Chris's 1/2 marathon by 6:45. I prepped a syringe at home and brought an ice pack, alcohol pads, and gauze with us. Traffic was terrible and we pulled into the parking lot at 6:40; just enough time for me to get that shot done without hesitation. I did it! And had my first bleeder. The nurse warned us that I would occasionally hit a capillary or small blood vessel and it would bleed. Guess that was one of those times.

Taking the Plunge

Let me get this straight - the girl who can't pick out her own splinters is supposed to give herself injections. Without fainting. I have not watched a needle pierce my skin in 20 years. Whose bright idea was this?

This morning was my first Lupron injection. I preceded this event with a terrible dream where I forgot I'm not supposed to inject the entire vial and after a dozen injections realized I had overdosed on it. Not comforting. While I dried my hair I decided that I can totally do this. The needle is small and I have many of these, so best to just jump right in and get it done.

I got the syringe prepped with 10 units of Lupron and right as I turned the needle toward my stomach, Chris reminded me that I forgot to ice the injection site to numb it. Oh. Good idea. As I was icing, Chris announced that watching me put in earrings gives him goosebumps and this was way worse, so he would be walking away now. Chris - you have less than 3 weeks to get over it because you have to give me the intramuscular injections. And you better keep your eyes open!

Ok - iced, cleaned with alcohol, skin pinched, syringe in hand. Just stick it in. Go. Do it. Now. I had the same feeling I had when I was little and standing at the top of the high diving board staring at the pool below. I was so confident as I climbed the ladder and walked across the board and then right before I jumped, dread and fear took over and rendered me motionless.

Hearing Chris make breakfast downstairs brought me back to the situation at hand. I love breakfast and was starving. So, I pushed the needle in, depressed the plunger, and pulled it back out. DONE! I DID IT!

It stung more than I had expected. Rookie mistakes or were my expectations too high? Probably both, but I survived and get to do it again tomorrow.

Meds Arrived Today

The Caremark specialty pharmacy turned out to be very easy to work with. The IVF nurse had extra paperwork to complete for pre-approval, but once that was done everything went very smoothly. They called last Friday to confirm the list of medications, it shipped yesterday, and arrived today. It was shipped overnight in a cooler because the Follistim needs refrigerated. The most amazing, totally surprising part of this whole thing is that my insurance covered A TON of the cost. We paid out of pocket just under $300 for everything. I also picked up the last of the local pharmacy prescriptions today. Here is a tour:

Love the picture of the penguin - complete with a bow tie!

IVF Central - we set up a med/injection table in our room.

Lupron - one tiny tiny half-full vial (it will last for all 20+ injections) & insulin needles.
I start these tomorrow.

Follistim cartridge (in middle) with needles in surrounding packets

Follistim Pen - insert cartridge, attach needle, dial the dose  (yellow tip) and inject.
The cartridges can be used for multiple injections, just need to use a new needle.
Also, it came in this fancy carrying case. 

Menopur - powder in the bottom vials, liquid in the top vials.
Use the Qcaps (far right) to transfer the liquid into the powder vial, dissolve.
Syringes (far left) and small needles (middle).

hCG trigger
This one is so important that we bring it into the office, they mix it and send us home
with a full syringe and a very specific time to inject it. They will also draw a target circle
(aka bullseye) on me. This is an intramuscular injection and the first one Chris has to give me.

Progesterone in sesame oil and big needles (1.5", 22 gauge).
Ugh. I'm told these leave painful knots. We were given instructions to massage
the injection site for a few minutes followed by a very hot compress.
My butt (or "target area" as the nurse calls it) will be sore.  :-(

Sharps container for the needles.

More meds! In no particular order: aspirin, prenatal vitamins, Kryptonite,
doxycycline, valium, vicodin, medrol, & folbic.

My reward jar for surviving each injection; dark chocolate and caramel
Hershey kisses. I also raided the Halloween candy for the Starbursts.
Something tells me Chris will end up sneaking most of these. 

Lucy was too cute to pass up. This is where she sat while we unpacked all the meds.
Then she hopped down, got her stuffed mouse, and got back up. She loves that little thing!
And we love her. 

Head First

I received an unexpected call from the IVF nurse on Wednesday morning. She had the results from the blood draws we had last weekend. Good news: we are both free of infectious diseases! Bad news: one of my hormone levels was elevated. Boo.

This particular hormone was borderline when I had my first diagnostic blood draw in May, albeit still within the normal range. Dr. NFB prescribed the Kryptonite anyway. The problem with my most recent blood draw: she was giving me medication to make it go down and it went up. Dr. NFB doesn't like to be crossed.

She decided that she needed to look at my pituitary gland before proceeding with IVF. Unfortunately, you don't just open wide and say, "aaahhhh" to look at your pituitary gland; MRI required. Thankfully they were able to schedule it for Thursday morning. MRIs actually aren't bad. I might even consider them relaxing - warm blankets, headphones with music, not at work! Just ignore the room size machine that's pinging magnetic waves at your brain. Also ignore the fact that you are there because a doctor suspects there could be something wrong with your insides.

Honestly, I wasn't that worried about the results. Yes, my levels did go up, but they really weren't that far out of the normal range.

We received the results Friday morning - everything is fine. We are proceeding with our current schedule.

The worst part of this little hiccup: she doubled my Kryptonite intake. I was taking it every other night; now I have to take it every night. People, there is a reason we call it Kryptonite. If I do the following then it's not bad: eat a snack, go straight upstairs and swallow the pill, get into bed, fall asleep within 30 minutes, stay asleep for at least five hours, six is better. I should add that I brush my teeth before getting in bed, but I don't think that has anything to do with avoiding the side effects.

However, if that process breaks down I can kiss a good night sleep and a decent morning goodbye. I usually fall asleep fine, but I tend to wake up a couple hours later. The Kryptonite stuffs up my sinuses so I can't breath through my nose. It also confuses the heck out of my temperature sensors. My insides are hot, but my skin is cold. Covers on = too hot, covers off = too cold. Then there is the inevitable, "dang it, I should get up and go to the bathroom while I'm awake." The second I ponder whether my bladder will let me go back to sleep or not, that's all I can think about. It's not worth the energy to decide; just go. 

The Kryptonite must lower my already low blood pressure because I'm pretty dizzy when I first stand up. And then the nausea hits. This continues until about 8:30 or 9:00 in the morning and in the meantime left me tossing and turning the rest of the night and made it unpleasant to get ready for work. I can't wait to be done with this medication. But, I'm thankful everything is fine and we are on schedule with IVF. 

IVF Schedule

Just in case you didn't notice, there is a new tab at the top of the page. I put an image of our tentative IVF schedule in that tab.

I Didn't Faint!

Because you already know more about me than you ever thought you would, I will just add that I faint easily. Chris comes home with a scraped arm, I end up lying on the floor. Dermatologist removes a few spots, I end up with my head between my legs while sipping a juice box. I owe my wonderful father for all that he has given me. However, this one counts as a demerit.

When were at the IVF consultation, Dr. NFB listed off the items for which she wanted a blood test. Then she added the required infectious diseases and we opted to add the cystic fibrosis and spinal muscular atrophy genetic panels. You know what her response was to the list? "Well, that will be a lot of blood at that draw." Ummm...1) a doctor thought that would be a lot of blood, 2) Doctor NO FUNNY BUSINESS thought that would be a lot of blood.

You can imagine all the nightmare scenarios I created for myself over the past two weeks. I told Chris that if I pass out to please just tell them to shake me awake and not overreact. I actually considered carrying an index card that read, "I faint easily. If I'm out, just finish taking my blood and wake me up." It took me an hour to fall asleep last night.

We arrived at the office this morning and I was taken, as usual, right on time. The lab tech stuck in the needle (didn't hurt) and we sat there. I don't know what was going on because my eyes were closed and I was singing songs in my head. Then she breaks the silence."Sorry this is taking so long. These vials are pretty big." "Oh, that's fine. How many have I filled?" "About half of the first one. You have four of these and then a smaller one." "Oh." In my head: SHIT!!! I need more songs!

Lots of time passed. I filled all the vials and then actually had the guts to look at my accomplishment. I was impressed with myself. I proudly walked back into the waiting room and one of the nurses, whom I chat with whenever we are there, walks over and says, "Hey, I just opened your chart and see that Chris has a blood work order too. Can we do that today?" YES! STICK HIM!

He only had to give one vial, but he got The Tape! The Tape that is so sticky it hurts far worse than any needle. I shaved my arms last night in preparation for The Tape. Chris did not. :-)

We rewarded ourselves and the start of this incredible process with post-appointment coffee, diet cokes with lunch, and wine with dinner. I will resume my good habits later.

Well, Here We Go...

Why hello birth control pills. I haven't seen you in several years. Never thought I'd take something that prevents pregnancy as part of a process to get pregnant. Then again, I never thought we'd be doing IVF. If I understand things correctly, it is to give my ovaries a break so they will respond better to all the stimulants next month. Also, it allows the doctor to start controlling the entire process. I believe they can even alter the schedule a bit by adjusting the number of days the BCPs are taken. We have no need to rush things so I anticipate taking all 21 of the active pills and overlapping the Lupron injections the last seven days or so.

Embryology 101

Today we went in for a no funny business session about ART - that's assisted reproductive technology for the uninitiated. As luck would it, Dr. NFB led the session with the embryologist and the IVF nurse. She got right down to business and explained the general process (stimulation, retrieval, transfer). We already had our consultation with her so this information was not new. Then the embryologist walked through what he does from egg retrieval to embryo transfer. Fascinating. 

He showed pictures of each step from egg (oocyte) to blastocyst and explained what he looks for at each point. Here is what he said (I think - I wrote quickly): 

• Day 0 - The doctor aspirates the follicles first thing in the morning, which includes the egg and follicular fluid. He then finds all of the mature eggs (it is possible to have empty follicles and immature eggs) by looking for a "polar body".
• Day 0 -He incubates the eggs for a few hours and adds the sperm in the early afternoon. If doing IVF, sperm are added to the petri dishes with the eggs and nature takes it course overnight. If doing ICSI, he injects a sperm directly into each egg.
• Day 1 - Checks for fertilization in the morning; late on day 1 cell division begins.
• Day 2 - Hopes to see 4 cell embryos, but 2 and 3 cells are ok. Based on how they are developing he and the doctor decide if we are going to do a 3dt or 5dt. 
• Day 3 - 6, 7, or 8 cell embryos
• Day 4 - He can't count the individual cells anymore so it is referred to as a morula 
• Day 5 - The embryo divides into the cells that will become the baby and the cells that will become the placenta. This stage is called a blastocyst. 
• After day 5 the embryo will start to hatch - this has to occur for implantation and needs to occur in the uterus

It is truly amazing that all of this has to go correctly and then continue to go correctly for months to create a human. How in the world does anyone reproduce?!

There were eight other couples there besides us. They were soooo quiet before the session got started it was making me laugh. Same thing used to happen to me at church. Allison and I spent many a mass stifling our giggles. 

I asked the embryologist who babysits the embryos when he has a day off. He said he grew up as a dairy farmer where there were no days off and so he will be there if there are embryos in his lab. Someone else I know (DAD!) grew up on a dairy farm and now I have every confidence that this guy has his lab in perfect order and is very protective over it. Our embryos will be in excellent hands. 

I tried to add some levity at the end. Some guy asked who gives "all those shots" and the nurse said she would teach both of them how to administer the shots. I then asked if the guys could learn to do it by sticking themselves. The girls laughed, the guys looked scared. 

Our Stress Relief

Lucy. She loves kibbles, tuna, her stuffed mouse, packing paper, and fleece blankets. Oh, and she has asthma, but you would never know that because she talks to us VERY LOUDLY.

Family & Friends

Infertility is hard to understand, hard to explain, and hard to grasp. There is a lot to learn and come to terms with whether you are an infertile couple or close family or friends of an infertile couple. Part of my intentions with this blog is to try to provide one window into this seemingly secret world. I will eventually (probably) change this blog from being invite-only to public. I have a list of reasons why I think so many treat infertility as taboo, but that is for a different post on a different day. And, truthfully, while I have started to open up to you, I’m not ready to extend that to anyone and everyone. I’m not the best example of breaking that taboo, but I promise to try.

One of the biggest steps to breaking down the infertility stigma is awareness and education. There is a great organization out there called RESOLVE which is working on that very topic. Their website has helpful information and I have put the link in the sidebar. My Mom came across a portion of their site this morning which I had not yet seen. It is all about friends and family. It really was very helpful and I encourage everyone to read through it (click here or link in the sidebar).

It opened my eyes to the fact that infertility doesn’t just affect the couple, it affects the entire family. Now that I think about it, of course it does. I’m sure it sucks just as much for our parents or siblings to be surrounded by their friends bragging about their grandchildren / nieces / nephews (or worse – complaining about them) as it does for us. There is so much uncertainty in infertility and I can’t tell you how or when this will end for us. But it will end someday.

A couple of additional points stuck out to me (well, the whole thing did, but you can read it all there).  One, infertility is a medical condition. We aren’t dealing with this because we are stressed out, or because we don’t know how to make a baby, or because God is punishing us. I don’t believe in a vindictive God. Two, the pain of loss and uncertainty is very real. I have tried to tell my self that things in my life could be worse. I’m sure they could. But that isn’t for anyone else to decide or judge. Also, I’m not sure how thoroughly some people have really thought about what if they weren’t able to have biological children when there is apparently nothing wrong. We hold out hope every single month that this will be our turn and we have had to cope with a lost opportunity every single month. As time goes on, it raises more questions about whether this will ever work. Sometimes it really sucks; sometimes we cope by focusing on plans for the next round.

The RESOLVE website mentions that family and friends should ask how they can be supportive. I’ll just tell you rather than making you ask. Trust me when I say that just the fact that you care means a ton. Positive thoughts and/or prayers are much appreciated. Letting us talk to you about it, whether through this blog or over the phone, is a huge gift. Know that we care about and want to hear about what is going on in your life too. Don’t avoid us or avoid telling us news about friends or family. We’ll deal with it. Your support of our treatment decisions is also important to us. I know there is controversy regarding infertility treatments; if you disagree, just don’t tell us. We are trying to create a family here, not conjure up the devil.

Finally, Chris and I have had almost a year to process infertility. We are doing so much better with it, but everyone needs their own time and own ways of processing it. Please let us know if you have any questions about what we have learned or how we have handled something. As for news on successes or failures – assume no news is bad news and we won’t hold out for very long on any successes.

Thank you for your love and encouragement. We’ll get through this.

We're in This Together

A couple months ago I came across an article on CNN about infertility from the husband’s perspective. At first I was thrilled! Not only was someone willing to discuss infertility, it was a DUDE! But as I got further along in the article, the author used phrases like, “when she has a failed cycle” or “when she has a canceled IVF due to poor response.” STOP! Since when is infertility her problem?

Chris and I have never considered this process to be mine or his alone. We want children together and therefore, whatever path it takes us to get there is also done together. Yes, I bear the brunt of the treatments and side effects and it has seemed to take a greater emotional toll on me. But not once has Chris ever considered this my problem. Failed cycles involve both of us. If in the end, we find out the primary problem is male factor infertility, I will not consider this his fault or his problem either. Marriage and parenting are partnerships where each person has to give 100%. Infertility treatments should be no different.

Chris is every bit as involved as I am except for the actual procedures. He comes to every appointment, he researches, he asks questions. The RE office doesn’t just talk to me. If he answers the phone when they call, they'll talk to him. He always comes back to the exam room and is equally addressed by the nurses and doctors. In fact, we see more couples in the waiting room than women alone.

Further, Chris is very thoughtful and protective. He has jumped out of bed 45 minutes early to make me breakfast because the Kryptonite has made me feel queasy. He surprised me with fancy ginger ale (made with actual ginger, not “natural flavorings”) because I am not drinking beer any more. He cooks dinner while I nap from not sleeping the night before after having hot flashes and bad dreams thanks to the Kryptonite / Clomid cocktail. So while Chris can’t pop the meds, he certainly makes it as easy on me as possible.

I can’t imagine feeling like I was going at this alone. And I’m sure Chris can’t imagine not being every bit as involved as he is. We are in this together, after all this is for OUR family.

There's That Sign Again

I returned from vacation to find the following email sitting in my inbox. This came from a very nice coworker who has no idea about our situation. She was still pregnant with #1 when we started trying and is now 2 weeks from her due date with #2. I'm pretty sure she also thinks that everyone gets pregnant on the first try. Ugh.

I hit delete as I grabbed my purse and left for our IVF consultation.

Subject: pretty happy today!!!
Text: I just found this parking space in front of the building!!!!! I love the NJ office! I'm a dork and excited to come to work tomorrow to use it.
Attachment:

$$$$

We are required to have a “financial obligation discussion” with the practice’s IVF financial advisor before they will begin any procedures. I figured we would call them sometime next week, but in typical exceeding all of our expectations fashion, the lady called Chris this morning. It is SO NICE to go to a practice where they all talk to each other, they all read the charts, and they are very prompt. In fact, they order my hCG trigger shots from a pharmacy in Cleveland and that pharmacy always calls within an hour of us leaving the appointment to confirm our credit card and mailing address.

She went over all of the insurance and financial aspects with Chris:

• Office visits: considered in-network, my insurance will cover 100% after my $30 per visit co-pay.  Estimate out of pocket without insurance is ~$2,500.
• Lab and embryologist: considered out-of-network. My insurance will cover 70% after a $750 out-of-network deductible. We have to make a deposit of $4,000 before any procedures and then be reimbursed by the insurance company for whatever they will cover (at their rates, of course). 
• Medications: not covered by health plan, but are covered by a prescription plan. No word yet on our OOP cost. We already told the IVF nurse that we have to order from CVS Caremark to receive any drug coverage. They will order from wherever is the least expensive for us, but apparently CVS is terrible to work with. Great. If no insurance, I think the meds are $3,000-$5,000.
• ICSI if added at the retrieval is an additional $1,500. They will submit to insurance, but not sure it is covered.
• Assisted hatching if added before transfer is an additional $500. They will submit to insurance, but not sure it is covered.
• Cryopreservation (aka freezing) of any embryos is $675 for the first year and $306 each additional year. Not covered by any insurance, 100% OOP.
• Chris's insurance company will not cover any infertility treatments so everything related to him will be OOP. Unfortunately only a few states require insurance to cover infertility. 

At least my insurance will cover most of this. And the good news is that if for some reason this doesn’t work the first time, it looks like we will have insurance money left over for another round. My lifetime maximum infertility coverage is $10,000 for medications and $20,000 for services.

IVF Consultation

We had our initial IVF consultation with Dr. NFB today. She is by far the best medical provider we have ever worked with.

Anyway, IVF is a lot of work. And expensive. And there are many needles. Worse, I have to give them to myself or trust Chris to do it. This makes me feel faint thinking about it. I wonder if she’ll give me a box of smelling salts to go along with this. Below are the notes we took and answers to the questions we asked. Of course all of this doesn't matter if we are lucky enough to be pregnant this cycle.

• My IVF protocol (exact schedule TBD)
• Attend an IVF class next week (9/29)
• Call CD1 and the IVF nurse will schedule some appointments:
• Blood draw for me: testing thyroid, prolactin levels, rubella immunity, blood type and, as required by the great State of Ohio, infectious diseases (HIV, syphilis, Hepatitis-B and Hepatitis-C). We have also elected to see if I am a carrier for cystic fibrosis and a muscular skeletal disease that I didn’t write down fast enough.
• Sonohysterogram: inject saline into the uterus and observe with an ultrasound. Checking for polyps, fibroids, or anything else that could cause problems with implantation. Easier to pronounce and MUCH less involved than the HSG which was done in a hospital with contrast iodine and continuous x-ray.
• Trial transfer: Dr. NFB performs a transfer but with no embryo. It is to make sure the needle will work and that she knows exactly where to put the embryo(s) when the time comes.
• More tests for Chris – no details yet, but will probably include an antibody test. Stop reading this bullet if you don’t like details. Basically, the body can launch an attack on itself. Semen can actually damage or kill its own sperm. The lab adds a substance to a sample of sperm and checks to see if it binds to the sperm (binding = bad).
• Blood draw for Chris: apparently the State of Ohio also requires the male to be tested for infectious diseases (HIV, syphilis, Hep-B and Hep-C). If my test results come back as a carrier for cystic fibrosis or the other disease then Chris will also be tested.
• IVF nurse draws up detailed medication schedule
• Start birth control pills on CD3, take for 3 weeks
• Start Lupron subcutaneous injections – will overlap with BCPs and injected daily until egg retrieval
• Stop BCPs, continue Lupron alone for 4 days
• Suppression check: ultrasound to make sure that my ovaries look ok and are quiet. Blood test for something (I think estradiol levels)
• If all looks ok, start stims: Follistim and Menopur subcutaneous injections until retrieval (still doing Lupron injections. Daily injection count = 3)
• During stims, appointments every 2-3 days to monitor follicle growth via ultrasound and to check estradiol levels via blood draw
• Once follicles reach ~20mm each, hCG intramuscular injection. I have had these before, but never had to do it myself!! It has to be done 36 hours before retrieval, so that will be ~8:00-10:00 PM. The office is not open at that time to stab my ass for me.
• Egg retrieval (ER) and 1 day of bed rest
• Start progesterone-in-oil injections (PIO) on day of retrieval. TEARS! Daily intramuscular injections based in oil, not water. These will continue for 2 weeks. If I’m pregnant, then they continue for 2-4 more weeks depending on how fast the placenta starts producing it on its own. I’m not going to be able to sit. I’ve already volunteered Chris to give these to me. Good thing he has played darts before.
• Embryo transfer (ET) on either day 3 or day 5 post-retrieval. Abbreviated 3dt or 5dt. If we have several good quality embryos, they will let them continue to grow in the lab for the extra days so they can isolate the best of the bunch for transfer. If we only have a couple good embryos then they do a 3dt. She thinks because of my age we will have a 5dt. Three days of bed rest. 
• Two weeks later: beta check
• I seemed to stop responding well to Clomid – does that cause any concerns for my response to Follistim?
• No, completely different drug
• Will we work primarily with you throughout the whole process?
• Yes, the IVF nurse will do her best to schedule everything so that we see her for most checks and for the ER and ET
• Any reason we should take a cycle break before starting IVF?
• No, there is no difference in the pregnancy rates so it is totally up to us
• Given we are ‘unexplained’, any concerns about my uterine lining or anything that might cause implantation problems?
• No, even with the Clomid, which can cause thickness problems, I produced a thick enough lining and from the looks of the all the ultrasounds I don’t appear to have any polyps or fibroids. Will take a closer look with the sonohysterogram.
• Will I be awake during the egg retrieval? (what I really wanted to know is if the sedative is a truth serum – not that I have anything to confess, but I would like to just not say anything while Dr. NFB and the nurses have needles where sharp objects should never be stuck)
• No, while it is not a general anesthetic, it is a heavy sedative and will cause me to sleep. I might be able to respond to direct commands, but that’s about it. Plus the sedative contains an amnesiac. This sounds like what they gave me when I had my wisdom teeth extracted. My poor Mum. “How long was I in there, because I swear it was only like 2 minutes? Wait, how long did you say it took? Did I cry? No, oh, but how long was I in the room? And did I cry?” NO!
• Do you recommend ICSI (intracytoplasmic sperm injection)? This is where they fertilize the eggs directly.
• No, she doesn’t see any reason to recommend it. But, we will authorize the embryologist to make a game time decision if he doesn't think the eggs and/or sperm look like they will work well on their own
• How often will we hear about the progress from retrieval to transfer:
• They can tell us how many follicles they aspirated at the retrieval. Later that day the embryologist will call with how many eggs are mature. At the end of day +1 he will call with a fertilization report. On average, about 75% of mature eggs will fertilize. End of day +2 will call with whether we are doing a 3dt or 5dt. End of day +5 will tell me how many they will freeze (we are hoping for at least a couple).
• Do you recommend acupuncture?
• Whatever I want to do to relax is fine, but if I want to do acupuncture I need to start now because all those needles can cause more anxiety for some people. She does not want my first acupuncture treatment around when I start stims.
• Can I stop taking bromocriptine (aka Kryptonite)? It's a hangover without the party.
• No, not until I get pregnant. Damn.

I like to understand everything that is going on, so I tend to research things on my own. Here is what I found out about the medications:

• Birth control pills – nothing anyone doesn’t already know. The point in an IVF cycle is to start suppressing ovulation as the doctor wants to control that process
•  Lupron – stronger ovulation suppression drug. It acts as an agonist at the pituitary gland receptors and causes a reduction in estradiol and testosterone levels. Also noteworthy: it is used to treat the symptoms of prostate cancer. At least my prostate will be in good order...
• Follistim - synthetic FSH (follicle stimulating hormone) stimulates the ovaries to produce more follicles. Dr. NFB prefers this brand over Gonal-F because it is easier to self administer
• Menopur - equal parts FSH and LH (luteinizing hormone) to stimulate the ovaries to produce and mature more follicles. Dr. NFB wants to use this in conjunction with Follistim because she believes it helps with egg quality
• hCG - chorionic gonadotropin to trigger the final stages of egg maturity, will cause ovulation which is why it is important to time this injection exactly as directed so they can retrieve the eggs before ovulation
• Progesterone-in-oil - prepares the uterus for implantation and decreases the maternal immune response to the embryo. Need injections because the cells that naturally produce progesterone are aspirated during the egg retrieval. 

Infertility is Not Fair

Nobody deserves to go through infertility. Some could have a greater appreciation and understanding of the miracle it takes to conceive a baby, but this process isn't something I wish upon anyone.

I have recently been able to let most of the feelings of injustice go. 

I spent a lot of energy over the past year wondering what I did wrong in my life to deserve this. As if this is payback - karma. Despite all of my thinking I couldn't come up with anything. I feel so happy and grateful to be married to Chris. I am a trustworthy friend. I take decent care of my body, eat relatively well, exercise off and on, never experimented with any drugs. I truly love my family and friends. I am educated, have a good job and a comfortable home. Further, there are PLENTY of people out there who don't seem to deserve to conceive easily, but they do. Why would God choose to punish me while he lets someone addicted to cocaine or someone who is going to neglect their child have a baby? 

Blaming myself is clearly not rational. It is not my fault. There isn't anything I did or didn't do to bring on infertility. Like many of the unfair things in life, it just happened.

There is another element of unfairness in infertility. The vast majority of the fertility treatments fall on the female. Sometimes with male factor infertility the guy has to have surgery to correct something. Other than that, all of the treatments are the female's responsibility. The medications and their side effects, the ultrasounds, the blood draws, the procedures. If we end up doing IVF, I am the one who will have to give myself injections, go in for monitoring appointments every other day, and undergo an egg retrieval. The female also has the constant physical reminders of the process: failed cycles, cramps, medication side effects, injection site pain, ultrasounds, and then the tortuous two week wait where every twinge and itch could be a pregnancy symptom. That said, Chris does everything he possibly can - comes to all the appointments, helps me stay positive, researches with me, listens.

One day I had a revelation and decided that the female burden of infertility is entirely fair. At the end of this process, I plan to be pregnant. I get to grow a baby and give birth. I will happily endure any medication or procedure to experience that gift. All side by side with the most wonderful and supportive husband who would gladly take some of these procedures off my hands if he could. He's even offered to give himself practice injections so he knows how to help me do mine.