I'm in a mood today!  I almost didn't start this post today because of it, but I'm sitting on the couch unable to do very much.  I don't know why, but I've been in a mood all week.  Anxious and stressed, grumpy, you name it!  To start, the weather this month has been very crappy, and most of you know I'm a fair weather girl!  My mood really needs sunshine and warmth, not windy, grey and cold like it's been.  May is one of the most beautiful, warm months in our area, which also annoys me because we're halfway through the month and it's freezing!  By the way, I'm totally acclimated to California, so when I say freezing, I'm talking low to mid 60's and windy.

This morning started with fasting for blood work, so instead of getting up at 6:30am to have a cup of coffee, I stayed in bed and tried to get more sleep.  I was moving slow without the caffeine, so I left a little late for the lab.  Google maps kept telling me "you have arrived at your destination" in a neighborhood, so I arrived twenty minutes after the lab opened…. to a packed waiting room!  I was told the wait was about 50 minutes.  I waited over an hour, in a very dimly lit, noisy, crowded waiting room.  I had a slight headache when I got there (something that has graced itself back into my life several times this week) and by the time I was called back it was bordering on migraine.  I'm sure the phlebotomist thought I was going to pass out because I kept putting my hands over my eyes when she was doing the draw.  The fasting part was for normal blood work ordered by my PCP over 6 months ago (clearly I don't like to fast!) and I had to do blood work for Dr. R's office, which is mandatory in California for IVF.

Lee and I both have to do tests to prove we don't have HIV or any other STD's before we bring a baby into this world.  Okay, I get it, but where are these tests for people who get pregnant on their own??  I can't imagine anyone paying the crazy amount it costs for IVF knowing they have a STD they could pass on to their child.  Call me crazy!  I was told these tests are covered by insurance, yet the lab states the tests are almost $1,000 and my portion "may be" $200 so they had to put my credit card on file and the payment will be run once it goes through the insurance, which isn't a fast process.  Once I left there I was so nauseous that I drove home with a bag on my lap.  I managed to make it home, took someone Advil, but five minutes later it all came up with a vengeance.

I laid in bed, crying over my pounding head, trying to get the dogs off of me and away from me.  They are still pretty young and don't quite understand when Mommy doesn't feel good.  I was able to go back to sleep for a bit, then finally was able to eat dry Cheerios around 11:30.  Every time I get up to do something, my headache worsens, so it's been a couch day, which I really, really don't enjoy.  I managed to muster up a little energy to take the dogs on a walk, which my head didn't like.  Tomorrow is church, plus a dog festival in Santa Cruz (we took Banjo last year), and I hope to visit my friend's newborn, born on Monday, so hopefully tomorrow is much better!

Okay, enough complaining… Lee and I met with the IVF coordinator last week and got all the basic info we need, plus our calendar.  I started birth control yesterday, but otherwise I won't be on any hormonal medication until the beginning of July.  Hooray!!  We have to get the blood work I talked about, plus do a recessive genetic test, which requires spitting into a vial and mailing it off through FedEx.  There are two tests options, so we need to research and decide which one to do (they vary by a couple hundred dollars).  The main test of the basic option determines if we are carriers for the cystic fibrosis gene.  It's not a required test, but one we definitely want to do.  That's an awful disease with a short life expectancy and we wouldn't want to bring a child into this world, knowing we are both carriers.

I schedule my hysteroscopy, pelvic ultrasound and mock embryo transfer with Dr. R; one is at the end May, one is the beginning of June, and the mock transfer is mid June.  I tried to at least get the hysteroscopy done by my gynecologist, but her MA said it has to be done in a surgery center under general anesthesia.  I freaked out a little about that, and the MA kept asking "are you sure it's a hysteroscopy you need?"  I can't understand why Dr. R would do it in his office, under no anesthesia and tell me it's a quick procedure, while my gynecologist wants to put me out!  Her MA said the anesthesia is negotiable, but I would need some sort of anesthesia.  In the end, she can't fit me in until the middle of June, which is too late.  I wish the financial coordinator hadn't even mentioned that option or gone into a little more detail instead of telling me I just need to "find a doctor that has the scope in their office."  I guess she didn't understand it's way more involved with gynecologists.

I went ahead and scheduled our medication training, which will be July 1st.  I will have my medications at that time and will be given a calendar that has all my doses in detail.  The coordinator will also train Lee on how to give injections subcutaneously.  Once my embryos have been transferred, Lee will be trained on how to give intramuscular injections, which I think I have to do for about 8-10 weeks if pregnant.  Basically the beginning of July I will become pincushion!

The official start of my IVF cycle is July 7th.  That day I'll do a baseline estradiol test, ultrasound, and start my medications.  I'll list the date ranges below for what follows:

July 10th:  blood draw only
July 14th:  blood draw plus ultrasound
July 15th-18th:  Possible blood draw plus ultrasound
July 15th-18th:  Possible Trigger Day
July 17th-20th:  Possible Egg Retrieval
July 20th-25th:  Possible Embryo Transfer
July 29, 31, Aug. 2, 4, 6th:  Possible pregnancy test

They schedule about 20 couples each IVF cycle, though I'm not sure the range of people that actually make it through.  If they find something on my hysteroscopy and/or ultrasound that would be prevent IVF from working then my cycle will be canceled and the money will be refunded, minus $500.  Each person reacts differently to the medications, but Dr. R will make us all fall into these date ranges.  I will be monitored and told when to stop my birth control, if/when to adjust my dosage of medications, and precisely when to do my trigger injection.  The trigger shot assists in final maturation of the follicles and sets ovulate in motion.  Once I'm given my time, I have to be within minutes of it, and the retrieval will happen 36 hours later.  After the retrieval, which is under conscious sedation, Dr. R will decide on a Day 3 or Day 5 transfer after monitoring the embryo daily.  There are risks/benefits with both so we'll just have to trust that he knows best.  We will decide at that time, after consulting with him, how many to transfer.  The embryo transfer is a quick procedure under no sedation.  I'm required to rest and take it easy 3 days after, but I'm going to take a week off work and just pray some of those days will fall on a weekend for financial reasons!  At first I declined the week-off doctor note, but after the stressful week I had at work, I decided I'm not going to return to a stressful job immediately after the transfer and risk miscarrying.  Post-transfer is the most important time in conception and I have to treat it as such.  I'm really going to have to find a way to de-stress as much as possible when I do return to work.

Post-transfer I can't lift anything over 10 lbs, which means I have to figure out how I'm going to get my dogs in the car in the morning.  If my pregnancy test is positive, I will be restricted from lifting anything over 20 lbs.  It's going to be really difficult making lifestyle changes, and I already told myself after vomiting this morning that I need to buck up!  I may be going through months of vomiting!  I've drastically cut down on my wine intake, which surprisingly wasn't as difficult as I thought.  I was going to completely cut it out now, but I figured I may have 9 months soon of no vino, so I might as well enjoy it while I can.  I'm wondering if my headache this morning was triggered by no caffeine, and I have a feeling that will be more difficult to give up.  I'm going to have to start alternating decaf in my daily routine!  I really hope my headaches exit soon because Advil is my drug of choice, and I know I have to avoid that when I'm pregnant.

I definitely felt overwhelmed this week, plus add in a menstrual cycle and I was a bundle of joy!  I have to keep reminding myself of the outcome!  Dr. R's office recommended acupuncture to de-stress, which sounds so nice, but it's another cost we can't afford.  I'm going to try to find a good yoga DVD I can do at home.  Like my mother said, stress is my middle name and I really need to change that!

The quote at the top of my post is my new favorite quote.  It's all over my fertility office and it spoke to me after the first time I saw it in his office two years ago.

I'm already in a better mood after writing (very therapeutic!) and the sun came out (though it's still freezing!).  I'll update after Memorial weekend, once my pelvic ultrasound results are in!  Thank you all for the kind words and emails.  Please don't take it personal if I don't respond right away.  Life has been pretty busy and hectic.

I hope everyone is having a good weekend!

XOXO,
Chelle

I have received so many kind words about this blog, and just want to thank each of you for taking the time to read it!  Many of you have struggled with infertility (and endometriosis) and know exactly what we are going through.  It means so much to us that baby Stewart has so many people praying for them, even when they are just a thought and not yet real.  We even have someone who wrote our prayer on a piece of paper and placed it in a crack of the Wailing Wall in Israel!!!  If baby Stewart is successfully conceived, he or she will be the luckiest person in the world, because they will be surrounded by so many loving family members and friends!

Not too much has gone on since my first post, but I'll give you a little update.  I met with the financial coordinator and made the first hefty down payment.  She went over the fee schedule, the range of cost for medications and additional testing I'll need, plus the schedule of my cycle.  There are a few test I can do elsewhere, possibly covered by insurance, which will save an enormous amount of money and time!!  I'm frantically trying to find a doctor to do a hysteroscopy and pelvic ultrasound (these are done to make sure my uterus looks good and there's nothing that will prevent IVF from working).  I may have to do one of both tests with Dr. R because both tests have to be done within a certain time.  My gynecologist (who I've seen once and absolutely LOVE) is so booked up that I had to see a P.A. for my PAP smear last year, because the physician was booking out 8 months for routine appointments!  I asked Dr C, who I work closely with, who he recommended (and who to avoid).  He talked with an anesthesiologist friend who gave me some recommendations.  I was given two names of doctors to absolutely avoid, which is convenient since my PCP recommended one of them.  Just another plus of working in the medical field!  I'll need to find another OB-Gyn regardless, because the one I love doesn't do obstetrics anymore.

I bought a large planner book yesterday (it was on clearance and pink… a sign?) to keep everything organized, because I feel like my brain is already starting to get overloaded.  Apparently soon I'll be given a printed calendar of everything from Dr. R (when to take my meds, etc), but even with the few things I have to remember within my personal life plus IVF, my brain is saying "whoa!"  The financial advisor did tell me the projected dates of my retrieval, which will be July 17, 18, 19, or 20th.  I asked "but what if my cycle doesn't fall then?"  Her response was "oh, he'll make sure your cycle happens then!"  It's amazing how much they can manipulate your hormones to make you ovulate at a specific time!  Those dates happen to fall on the weekend, and if I'm ready for retrieval on a Saturday or Sunday, the office opens for me.  I told my projected dates to my direct manager and told her I'll make my appointments as best as I can around my work schedule.  She said she really appreciates that, but told me this is important.  Basically in her eyes, this comes first and I shouldn't worry about work being understaffed; they'll handle it.  It was soooo nice to hear her say that!  There's certainly been MANY times we've been understaffed and I've had to work overtime or even harder (or picked up the slack for the lazy ones) and it's good to know she sees that.

It occurred to me after I wrote my first post that not everyone knows the basics of IVF.  I've had people ask "will you be able to breast feed?" and several people offer me their eggs (most were joking, but I've had a few serious people!).  IVF (in-vitro fertilization) is the process of removing eggs from the ovaries and mixing with sperm in a lab culture dish.  In-vitro means taking place in a test tub, culture dish or elsewhere outside a living organism.  Originally referred to a "test tube babies," the first child born through IVF was in England in 1978.  Coincidentally, I was given "fertility" as the subject of my project in my medical assisting class.  Here is a video I made 2.5 years ago:

https://www.youtube.com/watch?v=IqeWY4r5m6s&feature=em-share_video_user

I realized after I finished the video, which took me 8 hours to do because I couldn't figure out how to edit parts of my speech and had to repeatedly do over and over again, that my research was incorrect and the number of babies born through IVF was much higher than 3.5 million.  That's an overall video of IVF, but here's what we know in more detail...

As far as we know, my eggs are fine and hopefully still plentiful!  My rate for conception starts dropping drastically at age 36, 37 (I'll be 36 in October), so we are racing against time!  Lee's recent spermanalysis showed his boys are appropriately numbered, alert and ready for their marching orders!  I'll be put back on birth control probably next week (thank HEAVENS!!!  Oh, how I've missed that little daily pill!) to regulate my cycle, even though it's regular, but mostly to prevent any cysts from developing that would delay my IVF cycle.  I'll need to be on birth control for at least a month, then I will begin the hormones.  I don't know all the medications I'll be taking or the schedule, but I think I take Lupron first, followed by a cocktail of injectable hormones.  Lupron will basically make me feel like I'm going through menopause.  Awesome!

My cycle ends with a trigger shot, which depends on the quantity size of my follicles, plus my estrogen level. Follicles are what hold the eggs in place and the goal size is 18mm, because they likely contain mature eggs.  My trigger shot can happen at any time (as in 2am), and once done (I heard it's very painful), the retrieval will happen within 36 hours.  I don't yet know when Lee will be asked to donate his sperm, but I'm guessing it'll be the same time as my retrieval.  The goal for retrieval is 10-12 eggs, but I've read some women can have up to 30 retrieved.  Some of the eggs will not be as mature as anticipated, and some will die off naturally, so the number dwindles down quickly.  They take Lee's strongest boys and inject them directly into my best gals, through the process of ICSI, which stands for intracytoplasmic sperm injection (intra = into, cyto = cell, plasmic = plasma).  Layman's terms?  The sperm is injected directly into the egg.  ICSI has only been around for 10-12 years and greatly increases the chance of fertilization (instead of letting the sperm and the egg hang out in a petri dish and hope they fertilize on their own).  My doctor said he's doing ICSI more and more, and will fertilize each egg of mine through this process.

Once ICSI is performed, the eggs are kept in the lab while they develop into embryos.  The transfer usually happens around day 3-5, however my doctor said he's been doing more 5 day transfers lately.  The transfer is very quick, because prior to my cycle he will do a mock transfer, which is basically like laying out a map of my uterus so he knows exactly where to go and can do the procedure quickly.  A catheter will be place into my uterus and the embryo(s) will be placed directly there.  I've already read the procedure has to be done on a full bladder (ouch!), then you have to continue to hold your bladder while they look at the catheter under the microscope to make sure the embryo isn't stuck in it.  Another fun fact I've read?  Apparently I'll look like I'm three months pregnant come time for the transfer because of "the bloat," as some women call it.  Fortunately it's a quick procedure and I will be under no sedation!

Once the transfer happens, you begin the ultimate test of patience.  We have to wait two weeks before I can do a blood test to know if it worked.  Any viable embryo left can be frozen and stored for a smallish fee and, assuming I get pregnant, I can opt down the road to have them transferred into me for a little cost of $3,000 vs … (I'm not going to give the exact amount of in-vitro, but let's just say it's comparable to a college education!).

I have an appointment on Wednesday to get all my prescriptions and instructions from the nurse.  Dr. R said I can shop around, if I want, for medications (some people get their meds from Canada and Mexico for a significantly reduced price); he doesn't have a pharmacy he can recommend in Canada, but he definitely doesn't recommend Mexico for the medications.  I think I'm going to stick to the US.  If these were medications I'd be using for years I may try to find a reliable pharmacy in Canada, but I don't want to leave an room for error in this process.  If any couples have medication left over from the cycle this month, the office will evenly distribute to the couples doing their cycle in July.  My friend has a box of syringes left over from her cycle a couple years ago, so that will save us money as well.

Thank you again for taking the time to read my ramblings!  I'll update again after my appointment!  I hope everyone has a wonderful Mother's Day, and like I told my Mom, I hope this will be my last Mother's Day without a child of my own!  Until then I'll hug my fur babies tight, and be thankful for what I have!  Wishing all you lucky moms a very happy and special Mother's Day!

XOXO,
Chelle