Preparing to transfer our one miracle embryo...

Following the epic failure of our IVF cycle that resulted in having only one embryo to freeze, we had a sit-down with Dr. N. She said she and everyone in the office was so upset about what had happened. She also agreed that it made the most sense to move on to the transfer of the embryo next month, especially since the plan was to only transfer one embryo anyway. (In some cases, 2 embryos are transferred to increase the likelihood of success – in which case it would have made sense to go right into another IVF cycle to try to get more.)

Another thing we of course had to come to terms with is that the embryo could possibly not survive the thawing process. She informed us that the success rate for thawing is 95%. So there is a 5% chance that we will go through all of the prep work for the transfer and our embryo won’t make it. Hard to swallow.

The doc reassured us that the requirements for freezing at RMA are very stringent (even more so than where she worked before) and that our embryo had to be super quality. (As an aside, although this was meant to be comforting, and it was, I can’t help but wonder if we would have had more embryos if we had gone forward with a fresh transfer and the quality requirements hadn’t needed to be so tough. But I try not to dwell on this now since there is really no point in looking back.)

I also asked more about why the cycle had gone so poorly and what the scoop was on the egg quality issue. At this point, it could be one of two things: (1) It was just a bad group of eggs; or (2) My eggs are all of poor quality, which hurts our overall odds of success. If we go on to another round of IVF, we will likely get our answer. She also commented that next time she would probably reduce my meds, even if the cycle takes longer, in hopes of perhaps getting better quality eggs even if there are fewer of them.

She reassured us that the preparation for a frozen embryo transfer was much easier than a fresh IVF – just pills and patches to build up the lining of my uterus. I felt very relieved. However, upon scheduling my baseline scan and going through the discussion about getting my meds ordered, of course another bomb was dropped on us. Three terrifying words: Intramuscular progesterone injections. Yep – the doc had failed to mention that I would have to do these for 2 weeks. I have read horror stories about these shots – that they leave your behind sore and bruised and lumpy. Needless to say, I was pretty pissed. Plus, the nurse seemed to think it was pretty funny to joke with me about how long and huge the needle is. And to top it off, because they are done in the butt muscle, Jared would have to do them!

When my box of meds arrived and I saw the size of the needle, I freaked. I emailed Dr. N right away to see if there were any other options. I was already completely overwhelmed and frustrated. In my head, I was thinking that if I had known about the IM progesterone shots I might not have chosen to allow them to freeze the embryo! She replied that I could certainly opt to just use the Crinone (progesterone) cream instead and that she would just have to get it okayed by the rest of the docs. I felt instantly like a weight had been lifted.

When I arrived at the office for my scan, the nurse was on me right away. She said she saw the docs email and that the rest of the practice wanted to make sure I was aware that studies show better pregnancy rates when the injections are used instead of the cream. UGG. I was so upset and didn’t know what to do. I allowed the nurse to go through the injection teaching with us but had still not made up my mind. I wanted to talk to Dr. N to get her opinion (she was out of the office that day).

Also, at this appointment, we got the official calendar for our cycle. It was 2 weeks of estrogen pills, with a scan and blood work once a week (patches were no longer being used). In the third week, progesterone gets added (thankfully I had some time to make my decision on the shots). Our transfer was to be December 8 and our pregnancy test on the 17^th. I was so happy that everything would be done and we would know by Christmas, and even before the slew of Christmas gatherings began.

Later than day, Dr. N called. She confirmed that the success rates are better with the shots. She suggested that I at least try them and if it’s too awful, we can switch. So, in the end, I decided to buck up and deal. When I told Jared, he was less than enthusiastic. I think he was really liking the idea of not having to give me these shots. But once he realized like I did how much regret we would feel if it didn’t work and we hadn’t done everything we could possible do, he got on board. That night when I got all my meds out on the counter with the calendar and dosages (I have to check off every time I take a dose – I am too afraid I won’t remember if I took something or not!), I got one of the progesterone needles out, unwrapped it, and let it lay there on the counter. I felt that if I could stare it down – look at it every day – that I would be less fearful.

All looked good at my first scan after starting the estrogen – lining was thickening and levels were good. I got the okay to up my dose for the next week. My next appointment was supposed to be when my shots would begin.

An issue that I have been dealing with throughout this whole process, that I felt was getting worse, was my weight. I HATE putting on weight. At this point, I can probably wear about half, if that, of the pants I own and most of the other half is uncomfortably tight. I just felt like a big blob every day and it was wearing on me. Once my ovaries were shrinking back to normal size after the IVF cycle, I began to run again. And as time passed, I began to work on getting back my endurance, gradually increasing the length and speed of my runs. And I hate to say it, but the worse I felt about the extra pounds, the harder I was pushing myself on the treadmill. During my 2^nd week on estrogen, I was finally almost back to my normal running routine. I felt that it wouldn’t matter if I was running harder since my ovaries weren’t being stimulated this time.

At my week 3 appointment, Jared and I were geared up to start the injections and to hopefully (if the embryo survived the thaw) have the transfer that weekend. Why can’t I learn that nothing is a guarantee? My scan showed no growth in my uterine lining – in fact, I lost a little bit of it. Blood showed that my estrogen had actually DROPPED, despite the fact that I had been taking an increased dose for a week.  Due to this setback, we wouldn’t be starting the progesterone and the transfer would be delayed. I was instructed to stay on my current level of estrogen and I also had to start wearing an estrogen patch. These little boogers are pretty annoying – they go on the lower abdomen and get changed every 3 days. I spent the first few days worried the thing was going to fall off (although after I experienced the pain of removing the first one, I realized that sucker wasn’t going anywhere!). Plus, by the end of the 3^rd day, the edges are pretty nasty. I was to come back for another scan at the beginning of the next week.

Even though it doesn’t seem like a big deal, I was completely devastated by this turn of events.  Why doesn’t my body ever work like it’s supposed to?!  And, again, I felt like it was an obstacle at every turn – like we were being warned that we were doing the wrong thing or going in the wrong direction. I also felt completely fed up with putting my life on hold for these treatments.  This delay pushed us further and further into the Christmas season, which I just didn’t want to be ruined by being in the middle of treatment.

The next day, (as I always do) I did some internet research on exercise while trying to conceive. The consensus seemed to be that light to moderate exercise is deemed beneficial for conception but strenuous or excessive exercise is detrimental. What I was having a hard time pinpointing was what exactly is “moderate” exercise or “strenuous” exercise? If I weighed 250 pounds, walking might be strenuous, whereas if I ran marathons, a 4 mile run might be moderate. I found it all to be rather ambiguous. In the end, I decided that it was better to just err on the side of caution and cut back my running (speed and distance).

Finally, it was back to the office to see if my lining/estrogen levels were any better. At this point, I was less and less stressed about the progesterone shots – I just wanted to get moving forward! The doc said my lining was a really good type – “sticky” was the term she used. I could tell she was less than overjoyed by the thickness (just shy of 8 mm – I believe the goal is 7-9) but it was better than the previous week so she gave us the go-ahead to move forward (pending lab results). We had our nurse draw 2 big circles on my hiney with a sharpie so Jared wouldn’t have to worry about finding the right spot for the injections, which would begin that night. She also reviewed the whole process with us and I feel that we left the office feeling okay about it. I would also start Medrol that night, a steroid that suppresses the immune system so my body doesn’t fight against the embryo.

We were both nervous about the first progesterone injection. I just kept telling myself that thousands of couples go through this and are fine – we could do it too.  Jared did an amazing job – it didn’t hurt at all. He even knew just what to do to comfort me – counting to 3 before starting, singing while the liquid is going in, telling me when it’s almost over.  My butt did feel a little sore that evening and the next day but it was not anywhere near what I thought it would be. Since then, we have settled into an evening routine of the shots, and even though I still get a little nervous every time, I am thankful that it’s not so bad and that I have such an amazing husband who turned out to be a stellar shot-giver!

So where are we now? We are in a state of prayer. Praying that our little miracle embryo survives the thaw on Saturday morning. Praying that she hatches out of her shell and attaches to my uterine lining. Praying that she grows and grows and that in 9 months we are blessed with a beautiful, healthy Baby Graybill!

I think over the past year or more, because of all the treatments we have been through, I have allowed the science of baby making to take over my brain. It’s been all about medicine and scans and timing and numbers. I need to allow faith to take over and to refocus on the miracle of God that a child is. I have to just pray and believe that God will answer my prayers. Last evening, the pastor from my family’s church visited us and spoke to us about what we’ve been going through. He prayed with us and anointed me. I felt overwhelmed – and for once it wasn’t with anxiety or sadness, it was with peace. I feel at peace knowing that it’s all in God’s hands.

 

Will this be our last Christmas as a family of 3?

The Graybills 2013

Jared, Kristen, & Peanut Butter

 

A heartbreaking week...

Egg retrieval

Friday night before my egg retrieval surgery Jared and I headed down to King of Prussia…we had an amazing meal at The Cheesecake Factory and then headed back to our hotel to veg out (and eat cheesecake and try not to freak out about what was happening tomorrow!).

Yummy!

 

Bright and early on Saturday we were up and we headed over to the office (literally almost across the street) at 7:00. Almost immediately I was whisked away by a nurse. In retrospect, I wish I would have kissed or hugged Jared goodbye at this point – I didn’t know I wasn’t going to be seeing him again until after! The nurse had me change into a hospital gown, silly grippy standard issue blue socks, and the glamorous surgery hair net thing. I was so nervous - I peed twice even though I hadn’t had anything to eat or drink since about 10:00 the night before! She asked me some questions and checked my vitals. Then the doc stopped in to say hello, presumably having just finished the procedure before me. I had met him before – he had done a scan or 2 for me before Dr. Nguyen came to Mechanicsburg and he was actually the doc that did my last IUI. He asked if I was nervous…I told him yes but that I was trying not to think about it and so far I was just doing what each person was telling me to do! The best thing about this wait is that they cover you with a blanket that has been kept in this amazing blanket hot box device (note to self: must research getting one of these for the house). If I was going to be scared out of my mind, at least I was warm and cozy!

I was then moved to the next room where I met with the anesthesiologist. He asked me a litany of questions and checked my vitals again. As he was trying to jam a needle into my hand, he was trying to “distract” me by asking me about where I was from and all that. I had no interest, haha…I was trying so hard to be sociably but IT HURT! Apparently things did not go as expected because soon he was after the vein in my arm. That one hurt, but not nearly as bad as the hand. At this point, I started to panic. As I sat there, in pain, with a needle in my arm, with surgical garb on, surrounded by strangers in a fluorescent lit room at 7:15 in the morning, I just had a flash of a friend who had announced on Facebook the previous day that she was pregnant…AGAIN. In one overwhelming moment, I was just angry and sad and scared. Of course, the anesthesiologist thought I was having a panic attack and just tried to get me to breathe. Soon he was pumping me with fluids and I sat there…just trying to breathe in and out.

Before I knew it, it was time to go and they walked me into the operating room – it was huge and in the center was a chair-like thing with padded stirrups that held almost your whole leg. As I sat down I looked up and saw one of those big round surgical lights with the handle in the middle and I remember thinking that it was just like on Grey’s Anatomy. I literally said to the nurse and anesthesiologist, “wow, this just got real.” In a flutter of activity, they were moving me and strapping me, and hooking me up to stuff – terrifying. One of the last things I remember is getting an oxygen tube stuck up my nose and telling them I could feel something in the back of my throat…then I felt the meds kick in and it was lights out.

Of course, the first thing I said when I woke up was, “Is it over?” I was so happy with that fact alone. The first few minutes are fuzzy but I remember them wheeling me into recovery and hearing the most amazing words – “33 eggs”. Let me clarify that the average IVF egg retrieval results in 8-15 eggs. We knew there were going to be a lot but WOW. I immediately asked for Jared and was so relieved when I saw him. I cried when I told him the egg number. At this point, I was definitely in some pain but it was really not bad at all considered that they had just poked holes in my ovaries. It felt like period cramps but not even like the worst period cramps I’ve ever had. We sat there and hung out for about an hour. Jared was texting friends and family that all went well and they were periodically checking my vitals and going over what meds I was to start taking and other post-op instructions. When I was ready they gave me some orange juice and graham crackers – yum! When I was cleared to go, I just changed and it was off to Mifflintown for a day of R&R!

Hanging out in recovery - so happy it's over!

 The remainder of the day I was pretty narcoleptic and just laid around. The pain was a little persistent but manageable with Tylenol. I was thankful to not be feeling worse and also fearful that hyperstimulation symptoms were going to show up. I was definitely bloated but felt it wasn’t anything out of the norm. I started to feel worse in the evening so by 8:30 I decided to hang it up and went up to bed – I slept for almost 12 hours!

Embryos week

The next morning I felt much better – a little pain/tenderness and a little bloating. As we were eating breakfast in the kitchen, the embryologist called – 26 of the 33 eggs had fertilized! I cried. I think at each step I had been prepared for something crazy and rare to come along…the follicles would be empty…the eggs would reject the sperm and not fertilize... The average fertilization rate is 50-70% so we were officially above average. Jared and I just didn’t know what to do with all this good news. Looking back on those 2 days – it was like everything was going perfect. Too perfect.

Monday morning the embryologist called again. Right away I panicked because I could sense a tone in her voice – like someone preparing to deliver bad news. She said that 10 of the embryos failed to “cleave” (i.e. cells didn’t divide) which she thought was odd. She commented that this might even be the cause of my infertility. (I am thinking – “oh great, just add it to the list!) Of the 16 remaining, she said she was happy with the morphology (or quality) of about half. Then she said she would call early Tuesday in the event they decided I need to come in for a day 3 transfer. (Day 3 transfers occur when the embryos are not doing well vs. a transfer on day 5 which is the goal.) I was shocked! Plus, there was the idea of having to stop everything and drive to KOP the next day (the embryologist was quite shocked when I told her we were 3 hours away…I was thinking  ”guess what, lady – we don’t all live in Philadelphia!”) Everything seemed so hasty and uncertain. I felt upset and confused after the call. I waited all day hoping my doc or nurse would call to talk about the potential for a day 3 transfer. Finally after Jared called them, I got a call from my nurse. She said according to the notes, there were 16 ongoing embryos and even from as many eggs as we had, this was normal. (I really felt that if the same info had been delivered in a more positive way, I would not have been so upset.) She was very surprised to hear they mentioned a day 3 transfer and she didn’t know anything about it. She told me Dr. N was going to call to touch base with me.

Another question that was raised by all this was whether we were going to be doing a transfer at all. Last we knew, it was very probable that we would be freezing everything due to my hyperstim risk. However, except for a pretty severe case of constipation, I had been feeling pretty good. I was consistently the same weight every morning and my bloating and soreness seemed reasonable to me. I began to hope that we would be able to do a day 5 transfer after all.

Tuesday morning, Dr. N called. She started the report with “ok, are you ready?” I really felt she was going to tell us there was nothing left or that what was left was not good enough quality to be transferred. What she did say was that of the 16 embryos remaining, 7 had stopped developing or were not healthy. That left us with 9 embryos. In terms of quality, unfortunately, we had no A+s, a few As, and mostly Bs. UGG. However, the embryologist feels that there are a few that are healthy enough to make it to day 5. YES. But, because of my soaring estrogen levels and risk for hyperstimulating, they wanted to freeze everything that’s left at day 5 and delay the transfer until next month. UGG.

What a roller coaster of emotions. In 2 days, how did we go from 26 embryos to 9?! She said we might end up with only 2! The thought of this seriously concerned me because there is not a 100% survival rate when it comes to thawing embryos. Our fear was that if we freeze 2, we could end up with nothing. However, she made sure to make it known that if we would do the fresh transfer and I would get pregnant (and hyperstimulate), I would be very sick for a long time. We left it that she would discuss our concerns with the other doctors and go from there. However, the more I thought about it, the more I realized that fighting the doctors was one of the things that was making us stressed – it was feeling that we had to make decisions. Jared and I talked about it and later I emailed the doc and told her that we would concede to do whatever the team thought was best.

We spoke to her briefly on Wednesday and all the embryos were still growing but they aren’t graded on day 4 so we really got no new information. Although we did get the official decision to freeze and I got the go-ahead to stop my progesterone (used to prep my uterus for implantation and pregnancy) and Medrol (a steroid given to suppress the immune system so it doesn’t attack the embryo at transfer) since there would be no transfer this month. I should expect my period in a week or 2 and then they would start prepping me for next month. From my understanding it will just be oral meds and estrogen patches (no injections, I was assured!).

Thursday morning Dr. N called with what I thought was going to be the final pre-freezing report. She informed me that 4 embryos were continuing to grow. Somehow I was not surprised by this number and was even a little relieved –  I felt like so scared that none of them would make it. All 4 were in the very early “blastocyst” stage – the blastocyst is the developmental goal for a day 5 transfer embryo. She stated that because they were so early in this stage, the lab will wait to make the final decision on what to freeze and do the actual freeze on Friday. I didn’t ask any questions about the grading of the 4 – I think, at least for the moment, I preferred ignorant bliss to the risk of getting more negative news.

In addition to all this bad news, my body was suffering from what I believe to be the effects of mild ovarian hyperstimulation and/or the excessive hormones. My belly was still bloated and my ovaries were very sore. I was nauseous every day and had terrible heartburn. I had aversions to foods I normally love and became obsessed with certain foods (I think the week was officially dubbed “Tuna melt Week”!!). I was just a mess.

Friday was all about waiting…waiting waiting waiting…for the final call. In my head, I think I was allowing myself to hope that since the 4 embryos were all early blastocysts that they would all make it to freezing. I missed the call while Jared and I were at his grandfather’s viewing. We stepped out quickly before the service to return the call. After being on hold for what seemed like forever, Dr. N got on the line and delivered the blow. Only 1 embryo had been frozen. It felt like someone stabbed me in the gut. I didn’t even know what to say. 33 eggs and we got ONE embryo.  14 injection days, all the running to Harrisburg, a trip to KOP, anesthesia, surgery, plus the exhausting effect the hyperstimulation had on my body and not to mention thousands of dollars stripped from our insurance funding – and we got ONE embryo. I was sick.

She then proceeded to tell me that we have 2 options from here – proceed with the transfer of the single embryo next month or do a whole new round of IVF to try to get more embryos. I managed to ask her if she knew why things had gone so poorly. Her answer still rings in my ears: “It’s an egg quality issue.” She went on to tell me other things about the eggs and how they develop but it was all gobbledeegook at that point. All could hear in my head was – not only can you not ovulate, your eggs are defective.

To say that the events of this week sent me into a tailspin is definitely an understatement. Walking away from our first IVF cycle with only one embryo is heartbreaking – in addition to learning about my egg quality issue. I think that after we got so many eggs and so many fertilized, I allowed a little hope to creep in. But as I have learned over and over and over again, nothing is a guarantee. And now, I think more than ever before, I feel the need to mentally prepare for the distinct possibility that Jared and I will never have children.

We have a sit-down scheduled with Dr. N tomorrow to go over everything. I am hoping to get some more detailed answers about the egg quality problem and how severely this impacts our overall chances of ever having a baby.  At this point, unless she has some amazing pitch prepared for going right into another round of IVF, we are probably going to transfer our one embryo next month and pray for a miracle.

I feel very torn in this moment in time between "beating this horse til it's dead" - i.e. doing everything in our physical and financial power to have a child, OR taking to heart "If God shuts a door, stop banging on it. Trust that what's behind it is not for you." I've said it a thousand times - should it be this hard? We just seem to be met with obstacles at every turn. Every time we begin to have an ounce of hope, our hearts get shattered all over again. I met with a counselor for the first time yesterday. It really hit me hard when she said that, other than the loss of an infant or a small child, what we are going through is as bad as it gets. We are grieving the loss of the children we will never have.

IVF Days...

I was journaling most days while I was doing injections - I really wanted to keep track of everything that was happening...

IVF Days 1-3

On Friday (10/18), I got the official okay to start “stimming” (aka ovulation stimulation, aka doing my injections to make my follicles/eggs grow). As a bonus, Dr. N explained to me how to mix the Follistim with the Menopur so I only have to do one shot! I just have to push the Follistim (from the pen) into one of the vials of Menopur and mix it and then add a little bit of saline to get enough liquid…love her!

The starting dosage is 150iu of Follistim and 2 vials (150iu) of Menopur. I do this for 3 days and go back Monday for another scan and blood work. I was a little nervous doing my first one on Friday (it’s been a month since my last injection plus the first one for IVF felt like a lot of pressure) but it was so easy – once I got through the Follistim part (I haven’t used Follistim since April so I had to get reacclimated with putting in the cartridge and putting on the needle) it was just like mixing Menopur which I have done so many times. I am so happy to finally be starting!

As I am beginning this process, I am also mentally preparing for physical changes that will come along with it. I am cutting my running WAY back and will probably stop altogether at some point next week when my ovaries really start to get enlarged. I plan to just walk for exercise. I also need to focus on, particularly during the week, eating more (and eating healthy). I know that this combination will lead to me gaining weight. I just keep telling myself that I have to make a safe and happy home for my baby. I know most people wouldn’t care about gaining weight since I will if I get pregnant but, since we have been at this for such a long time, I have always tried not to pack on the pounds.  I am also anticipating feeling bloating and uncomfortable as my ovaries fill up with follicles in the coming days. But I am totally ready - flowing shirts and yoga pants will be my wardrobe staples!

IVF Days 4-6

Monday morning I had my first scan since starting my meds – not much to see but that’s pretty much what I expected. She said I have a good number of follicles on both sides. After my blood work came back, Dr. N upped my Follistim to 225 iu and kept the Menopur at 2 vials. It was back for another scan Wednesday morning – I could start to see the follicles on the screen but they still weren’t measurable in size. She reassured me that things were going great so far and that they are just going “slow and steady” – too much medicine at once and I could get overstimulated. Wednesday my estradiol level increased from 59 (Monday’s) to 233. She decided to keep me on the 225 Follistim/2 Menopur. So we just keep putting along.

I haven’t really noticed feeling any different this week – I’m not bloating yet, which is nice. I actually think I feel better being off the birth control pills! For now, it’s back for another scan and blood work on Friday. The NP gave me a heads up that I may be starting a new drug - Cetrotide - this weekend to keep me from ovulating prematurely. I am hoping they can give me instructions on how to mix it with my other meds so I still only have to do one shot.

IVF Days 7-9

At Friday’s scan, things seemed to be moving along. I had 16 follicles on the right side and 18 on the left, although she said some of them are really small and probably won’t develop.  Most of them were about 8 or 9 mm (17-21 is the goal for mature follicles). My estradiol rose to 560 so I had to add the Cetrotide to the drug regimen.  She also had me increase the Menopur to 3 vials (225 iu) and keep the Follistim at 225iu.

I was able to mix all the meds together and keep it at one injection, which is great. Adding the Cetrotide to the routine took some getting used to but I was able to get a new rhythm down. Saturday night I started to feel some abdominal bloating and maybe even some slight cramping/twinges – it definitely feels like something is happening in there!

 

My nightly drug regimen!

 

IVF Days 10-12

Sunday morning it was off to Harrisburg Hospital for a scan and blood work (we have to go to the hospital for monitoring on the weekends). The tech told us she measured 10 follicles on each side measuring 9 or higher! The biggest one,  I believe, was about 12. That afternoon I got the call from the office that my estradiol was up to 1,207! The instructions were to keep the Menopur at 3 vials but to reduce Follistim to 150iu. I was also to continue with the Cetrotide. They wanted to see me again Monday morning. I was beginning to feel like we were getting close J

Monday’s scan was great – the docs seem really happy with the progress and it was great seeing all my big follicles on the screen! She measured and measured and measured – 12 on the left and 19 on the right! Most of them seem to be in the 11-13 range. There were a few bigger ones – 15 and 16 – but I think she said she was going to “let them go” (meaning wait to trigger) in order to get the other group at the right size. Her best guess was that my egg retrieval procedure would be Friday. They will likely want to see me every day now. This is a bummer for my time and my veins (they are so sore already!) but it’s all about 100% effort this cycle. This one’s for all the marbles!

On a sad note, I found out after my appointment that my grandfather had passed away. It makes me sad that I never got to have a child while he was around. But I am happy that he at least got to be at my wedding and that I got to see him one last time last week before he died.

Monday afternoon I was informed that my estradiol was up over 2,200 and I was to keep the same drug regimen that night. Nothing really new at Tuesday’s scan. Jared came along and got to see all my crazy follicles on the screen. There didn’t seem to be a whole lot of growth – she said she was thinking more like a trigger Thursday and retrieval Saturday now. Of course, as Penn State season ticket holders, we were bummed at the thought of missing a home game…yet another sacrifice…Instructions were to keep Menopur at 3 as well as the Cetrotide but to up the Follistim to 200. Estradiol at 3,018! Closer! Closer!

At this point, I am feeling nervous about several things.

1 – That the follicles will poop out. I think after being used to scans every other day and seeing consistent growth, the piddly pace of every day scans makes me anxious, especially since she pushed back her estimate on the trigger/egg retrieval date.  Also, the fact that my follicles have pooped out before makes that a real thought in the back of my mind.

2- Hyperstimulation (Ovarian Hyperstimulation Syndrome – when, as a result of fertility meds, the ovaries become swollen and painful and the abdomen gets bloated and fills with fluid). The doc seemed very nervous about this and they are explicitly asking me how I am feeling each day.

3- Egg retrieval – as the possible day approaches, my nervousness grows. I even broke down and googled about it (as I always do – I am so weak!) and read some pretty scary things, especially about pain. Jared tried to calm me by telling me that only those with bad experiences write about it on the internet. He even ratted my googling out to the docs, haha – they were both, “Don’t do that! No internet!” They knew it would get me worked up.

IVF Days 13-15

Wednesday was an early, early scan -7 am! - so we could head out to Johnstown for my Grandpa’s funeral. Things really didn’t look much different but she insisted we were progressing. It was looking like Saturday would be the day, or maybe even Sunday. I got the call that afternoon that my estradiol was 4,200 and that things were coming along. Meds were to remain the same.

As an aside, I am almost completely bloated out of every pair of pants I own (I could probably get them buttoned but it would not be comfortable!) I have been doing my best to wear stretchy pants, skirts, and some of the larger items in my wardrobe. My belly looks like I just ate Thanksgiving dinner...twice...for about 3 days in a row, haha. Deep down I know that this is part of the process and I just have to deal with it. Maybe I will get pregnant and I can roll right into maternity pants!

Thursday I had my scan with a nurse from the Philly offices – she was there covering for my docs. She was great and really helpful in explaining things. I felt like I could really see a lot of growth in the follicles, particularly on the right side. I had a lot that were above 17 – it was looking good! She said she felt pretty certain I would be triggering that night for retrieval on Saturday. She reviewed with me all my pre-op procedures and meds. I think it was really starting to sink in that this was really a “real surgery” which made me a bit increasingly nervous. She was to call me in the afternoon (as always) for the official word and, if it was time, the dosage for my HCG trigger shot (which is the last step – it’s done 36 hours EXACTLY before the procedure and gets the eggs ready to be harvested).

The call was a rough one. My estrogen had skyrocketed above 8,000 which is not good. This puts me at an even greater risk of hyperstimulation.  I was definitely going to trigger that night but the doc wanted me to use “Ovidrel” (a name brand and lesser dose) instead of the generic HCG. HCG is one of the things that triggers hyperstim so the idea is to cut that to reduce the risk – however, less HCG can result in fewer mature eggs. The doc also wanted to me to start medicine – Dostinex – to reduce my chances of hyperstimulating. (Of course, trying to find a pharmacy that carried it in the middle of nowhere like Juniata County proved to be a drama in and of itself – thankfully Walmart had it!) And then the news that felt like a real blow – there is a decent likelihood that if I do hyperstim, the doc will want to freeze ALL the embryos and not do a fresh cycle at all. We would delay the embryo transfer until next month.  I was so upset and scared. Not to mention my hormones – I am really not a person of sound mind at this point! I just remember feeling defeated and overwhelmed…again. The words that have haunted me over and over – should it really be this hard?

In retrospect, freezing everything is not the worst thing in the world. The reality is if I would hyperstim, do the transfer, and then get pregnant, the HCG produced by the pregnancy would make the OHSS way worse and it would last longer. I have a friend who went through this and it put her in the hospital with severe OHSS. I am still VERY scared about hyperstimulating. From what I have read (yes, I was at it again), I could just be uncomfortable for a while (painful, swollen ovaries) or, if the fluid builds up in my abdomen, I might have to go into the hospital to have it drained out – uck! I am following orders – eating protein and fresh fruit and veggies, staying hydrated, making sure I am peeing enough, and , as of this morning, weighing myself every morning. But if I do get OHSS it probably won’t rear its ugly head until after the retrieval.

So last night (Thursday) I did my Ovidrel trigger. It is a pre-filled syringe so there was no mixing. It was so quick and easy it almost felt anticlimactic – there was so much anticipation about the “trigger” and in 2 seconds it was done! I had a final appointment for blood work this morning (Friday) – they want to ensure that the HCG is in my system. My mom came along, which was nice – to be able to show her where I’ve been going. She also got to meet Dr. N. I didn’t have an appointment to see her but I really wanted to talk to her because I knew she’d calm me down and she totally did. She still feels that everything is going to go great although the other doctors are a bit concerned about my estrogen level. But she said we will just wait to see how I feel to determine whether we will do a fresh transfer.

Jared and I are headed to King of Prussia later today for my egg retrieval tomorrow. We decided to stay over since my surgery is at 7:45 a.m. I am hoping to relax, have a good meal, and get a good night’s sleep. In reality, I am completely scared about the egg retrieval. I am trying not to think about it so that I don’t get worked up. I just have to focus on the fact that by this time tomorrow we might have fertilized embryos!

 

 

Beginning our IVF journey...

The consult

So the IVF consult with Dr. N went mostly as I had expected. My primary concerns going in were (1) having to do multiple injections a day…which she stated would not be the case, and (2) having to do progesterone shots after the embryo transfer (I had read about these bad boys on the internet – long needle, in the butt, and painful!)…she said they only use the Crinone (vaginal cream) for progesterone – no shots! Whew! (Progesterone is produced naturally by the body but they like you to have any extra boost to help with implantation.)

We also found out that they had FINALLY received my records from Danville. Based on what she saw there and everything that’s happened so far with RMA, the diagnosis is “Hypothalamic amenorrhea”. Here is the best description that I found on the web, thanks to shadygrovefertility.com:

The hypothalamus in the center of the brain controls reproduction. It produces the hormone, gonadotropin releasing hormone (GnRH). GnRH signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle stimulating hormone (FSH) and after ovulation, progesterone luteinizing hormone (LH). In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and, along with progesterone, prepares the uterus for a fertilized egg. Sometimes the hypothalamus stops producing GnRH, which in turn, will reduce the amount of other hormones produced (FSH, LH, and estrogen). Ovulation and menstruation stop, resulting in infertility.

So after 2 years, it sounds like I don’t ovulate because my brain in damaged. OUCH. But we are happy to at least have some answers at last.

After doing some research on HA, it’s looking more like this could have been caused by my diet and exercise habits as well as anxiety/stress.  As one website put it, Hypothalamic Amenorrhea is the fancy way of saying “stress-induced loss of menstruation.” Other interesting points – “The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children. “Safe” means both physiologically and psychologically. Mental stress can hurt your fertility just as much as physical stress. Unfortunately, these two stressors commonly occur in women today.  Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating. Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating. It’s no wonder that so many women struggle with this.” (http://www.paleoforwomen.com/overcoming-hypothalamic-amenorrhea/)

Five years ago, I started counting calories and took up running. I lost about 20 pounds and my eating and exercising has never been the same. I also tend to get stressed out really easily. (Not to mention over the past 5 years I had a job in politics – hated it…went back to school – hated it…and then started a whole new career!)  I think all of these factors have been enough stress on my body that it may have caused my infertility. In the end, I am trying not to dwell too much on the cause and rather focus on solving the problem.

The other problem with me, we learned, is I have a super duper storage of eggs.  The doc said there is a hormone called AMH (antimullerian hormone) that is measured to estimateAMH, or antimullerian hormoneAMH, or antimullerian hormone how many eggs you have – typically for someone my age, a 2 or 3 would be normal. I am a 5. This makes sense for the problems we’ve been having…my body will do next to nothing as far as making follicles/eggs on its own but then once the docs added the meds everything would explode (ie. lots of follicles that all wanted to grow together). This is actually perfect for IVF because the goal is to grow as many eggs as possible.

After explaining more about what is happening with me, she reviewed the whole IVF process.  Most of it was not new – I had already read A LOT. But basically it’s approximately 10-12 days of injections (she said I can expect to get pretty uncomfortable and bloated-feeling toward the end due to my ovaries being so enlarged).  Then, if all goes well, it’s off to King of Prussia for the egg retrieval (where I will be asleep).  The eggs go to the lab where they are fertilized with Jared’s sperm and they wait in the lab to see how many fertilize and how they grow and depending on that I come back to KOP in 3-5 days for the embryos to be transferred into my uterus.  As a bonus, the wait to find out if it worked in IVF is only 10 days instead of a full 2 weeks like with IUIs! The doc said if we do a 3 day transfer (meaning 3 days after the fertilization - less than ideal, they do this if the embryos aren’t thriving, they might do better in me) we will put 2 in, if we make it to day 5, she only wants to put 1 in. (As an aside, I am not sure how I feel about this. I feel like 2 should go in regardless…but twins are still a big health risk and I read that it is possible for an embryo to split, which could lead to more than twins. I am still holding off on this decision until we get to that point.)

The other awesome thing we found out is that we can freeze any embryos that are good but that we don’t end up using. Then if this cycle doesn’t work, I don’t have to go through all the injections and egg retrieval again – they just thaw 1 or 2 of them out and do the transfer. And if it does work, we can even store the frozen ones and come back in a few years to try for #2! Pretty crazy!

At the end of the meeting, we just had to talk to the financial office to get squared away and then we could get started. Oddly enough, I have to be on birth control pills for at least 2 weeks before I start injections in order to regulate my hormones. Seems counterintuitive I know. But we definitely left the office that day feeling good – not overwhelmed at all, just ready to start this new chance at a Graybill baby!

Beginning the IVF process…

The next week Jared spoke to the financial office and, as we expected, almost everything is covered. (Can you say “AMAZING”!) The only thing we have to pay for is to freeze any remaining embryos and a yearly fee to store them. Overall, we couldn’t ask for anything better.

I scheduled my “baseline scan” (to make sure everything looks good for me to start the birth control pills) and nursing consult (where the NP goes over all the consent forms and meds instructions). Luckily, I have already done injectable medication so there wasn’t really too much for me to learn. I can’t imagine women that have to learn all that in one sitting – that would be totally overwhelming!

We got paperwork to look over before that appointment because they require you to decide in writing what you want done with your frozen embryos in certain situations (ie. if one or both of us would die or if we would get divorced). It was kind of stressful because you start to think about whether or not you would consider these embryos as “babies”.  One of the options is disposal in accordance with proper procedures. You can also donate to an infertile couple. It was a lot of discussion about these embryos that we don’t even have yet!

Everything with the baseline scan looked fine and I got my script for BCPs. Two bombs did get dropped on us at the nursing consult. First, I would definitely being doing at least 2 shots per day during the egg stimulation. The 2 meds I will be taking – Follistim and Menopur – I have already done by themselves. However, Follistim is delivered in a reusable injection pen that takes a cartridge of meds whereas the Menopur is a powder that has to be reconstituted and delivered via a syringe. Thus, they can’t be mixed and taken together. Bummer! Plus, there is another medicine – Cetrotide – that I may have to take toward the end to keep me from ovulating prematurely, which will make 3 shots a day. In the end, though, it’s definitely one of those “Crap! Oh well…” situations.

SIS and mock transfer

The other bomb was that I needed to come in for 2 procedures before I can start stimulation meds. The first is a “mock transfer”, which is exactly what it sounds like – a “practice round” of the embryo transfer so they can figure out how best to navigate their way in. The other is a “Saline Infusion Sonohystogram” (SIS) where they fill my uterus with saline and look at it in a scan to ensure it looks healthy and that there are no polyps.  I was told these would be easy-peasy….

Doing what I always do, I googled about these procedures before the day of my appointment. As soon as read that someone thought the SIS was similar to the HSG, I began to worry. (The HSG was a procedure I had done in our early months at Danville – they inflate a balloon in the uterus and then shoot dye into it to see if the fallopian tubes are blocked at all. If the dye comes out the other end, the tubes are open. My HSG was easily the worst pain I have ever felt. I screamed and screamed. In the end, my tubes were totally fine. But I knew I couldn’t go through that kind of pain again (unless I got a baby out of it, of course!))

For the mock transfer (and the actual embryo transfer as well), you are told to arrive with an uncomfortably full bladder. Not fun. (The full bladder is needed to help them see things better.) By the time they took us back to the room, I was very miserable – I just wanted to get it over with so I could pee! They use a belly scan to look at the catheter as it’s going into the uterus, which was actually pretty cool. This procedure was uncomfortable, but certainly not terrible – pretty much like an IUI while having to pee.

After they let me use the restroom, it was time for the SIS. It was not as bad as the HSG but it was a close second. I moaned and bawled but did not out rightly scream (thankfully). I felt kind of bad for the doc and NP – they looked terrified, haha. The doc questioned me about the results of my HSG – she said that normally an HSG or an SIS will only cause that much pain if there is tube blockage. My opinion is I am just a sissy!

Here we go!

So that pretty much brings things up to date…I had a scan and bloodwork yesterday and got the okay to stop taking the BCPs. If all looks okay at my scan on Friday, I will start stim meds that night!

All the supplies/medication I will need for my first cycle of IVF 

Right now, I am feeling excited and nervous. Excited about starting something new – a new chance. Nervous about the injections and changes in my body.  But I know I just have to focus on how badly we want a child and how it will all be worth it if it works!

Here is a prayer that I have been praying:

The Fertility Blessing

You know my deep desire for a child - a little one to love and to hold, to care for, to cherish. Grant that my body may conceive and give birth to a beautiful, healthy baby in Your Holy image. Guide me in all my choices so that this conception, my pregnancy, and my baby’s birth are in line with Your will. Heavenly Father and Holy Mother, hear this prayer of my heart, mind, and spirit. Amen.

 

"There's obviously something broken..."

"There's obviously something broken..." Those were the words of the doctor who did my last scan last week. And yes, they hit like a ton of bricks. I mean, clearly, we knew that something was not right. But hearing it so matter-of-factly was a bit startling. But let’s back up…

When last I wrote, I was pretty much in a panic that the cycle was failing. I found out that the doctor had decided to kick back my meds because my follicles were all growing together (2 many mature follicles = risk of too many babies) and my estrogen was increasing very quickly. My understanding is that he thought scaling back my dosage would stop some of the small ones from progressing. Well, what happened was that the dosage ended up being too low and it basically shut everything down. By Sunday’s scan, I had no growth and my estrogen levels had dropped off. Plus, I lost my uterine lining thanks to the lack of estrogen (can you say spontaneous period!?). Dr. Freedman called and explained all this to me on the phone, which was nice. He felt badly that this had happened. He kept saying “I don’t want to overcook ya.” – Nothing like feeling like a Thanksgiving turkey – ugg. He didn’t cancel the cycle but just decided that I would basically be at baseline and starting over. I was 2 weeks into injections and not pleased…

...

Pic of the inside of my sharps container! Lots of needles...

 

...

 

I went back for scans the next week and there was minimal growth and my estrogen was SLOWLY creeping up. On Friday, the doctor came in…

As an aside – let me explain the situation with the doctors. When we switched to RMA, there were 4 doctors from the Philly practice that rotated days in Mechanicsburg. Dr. Freedman was there the day of our consult so he became our doctor. We would see whichever doctor was in the office for scans, but Dr. Freedman was handling our care decisions. However, when we were in our first cycle, the Mechanicsburg office got a full time doctor – Dr. Nguyen – and the Philly doctors would no longer be coming to Mechanicsburg. They offered us the option of switching over to the new doctor but we decided at the time to stick with Dr. Freedman because we had talked to him so much and felt so impressed by him. But since August, Dr. Nguyen is who I have been seeing at my scan appointments.

...

 Site of our new fertility dr - RMA of Central PA

...

So Dr. Nguyen came in and asked me if I was frustrated. She said she had looked over my cycle and even she felt frustrated for me. I told her that we have been at this for so long that we don’t even notice the frustration anymore. She began to talk about IVF and asked if we had thought about it. (She had dropped an IVF comment on me before so I wasn’t overly shocked this time.)

Another aside – IVF is in-vitro fertilization – basically they used injectable meds to grow a whole bunch of eggs, then the eggs are retrieved in a “minor” surgical procedure, they are fertilized with the sperm in a lab, and then the embryo(s) are transplanted back into the uterus to hopefully implant. It’s invasive, time consuming, and expensive (think out-of-pocket without insurance - $10,000-$15,000ish) but offers success rates that are leaps and bounds higher than any other treatments.

I told her that we were pretty resigned to the fact that that is probably where we are headed. I also told her about our stellar insurance coverage…her response: “Oh you should do IVF!” She seemed pretty certain that was the best option based on what she was seeing. I told her that we were okay with moving on to that and we were both just ready for it to be over – baby or no baby. She told me not to think of IVF as the end of the line – that some patients are just better suited for it and she feels that way about me. She said that it’s not like I failed at everything else so now it’s on to IVF. In my head I am thinking – I am pretty sure that’s exactly what it is like!

After my scan she said that things could go on in the cycle to work out but to think about IVF for next time. The nurse also mentioned to me again about switching doctors and I left considering if that would be best (I hate making decisions!). Luckily, the decision was soon made for me. That afternoon the office called – Dr. Freedman was cancelling my current cycle and recommending that I set up an IVF consult with Dr. Nguyen. It was a tough message – it’s like I knew it was coming but to have it actually be right there in front of me was painful. I also felt a little relieved that the doctor switching decision was made and that we were finally moving on to the final level in this long battle.

Our consult is tomorrow. I am anxious to get the scoop on the whole thing. I have read enough – and talked enough to a fellow IVFer – to feel a bit afraid but I am trying to hold out on any true fear or judgment until I get the whole story. We are armed with a list of questions and will see how it goes.

Ironically, I realized that my first treatment cycle – a diddly 50 mg of Chlomid – was in September 2012…one year ago. IVF will be my TENTH round of treatment. We started trying to get pregnant in August 2011…TWO YEARS AGO. The time that has passed blows my mind. In that time I have had friends get pregnant, have their babies, and celebrate their babies’ 1^st birthdays. I just pray that in a year from now we are in a different place in our lives and off this path of sadness and waiting.

 

Let's get caught up!

End of July 2013 –

Well a lot has happened since I last wrote…I finished my Prometrium pills and after a few days – still no period. So Jared and I geared up to go to the beach for a week with my family and figured we’d deal with everything when we got back. A week before we would have left for vacation, Aunt Flow showed up! I was shocked. (I also forgot how painful these dang periods are – I am so out of practice!) So it was back to the doctor for a baseline scan and to see what the game plan was. Scan was perfect – thin lining, no cysts. The NP even said I have “perfect anatomy” – I am thinking, “yeah, so perfect I can’t get pregnant!”

After reviewing my blood work, the doc decided to do Menopur.  We were of course excited to be starting another round. But we were also bummed – because I’d have to be in for scans and blood work every couple days, we would likely miss the beach. Sacrifices!

He initially wanted to start me on 75 units (1 vial) per day but later I emailed him and asked him to reconsider. The doc at Danville had seemed to think that my previous cycle didn’t work because they had started my dosage too low. The last thing I wanted to do was repeat the last cycle (especially if I was going to miss vacation!). He was very understanding and opted to start me at 2 vials (150 units) and that he would back it down to 1 if things started to progress too quickly. After a few days, my hormone levels hadn’t budged so he upped me to 3 vials (225 units). – As an aside, I find it interesting that the new doc looks at all my hormones, whereas Danville only looked at one (Estradiol).

After a week of scans and blood work every other day (it was a crazy week! We managed to drive to the beach between my Mon morning and Wed morning scans!), things slowly progressed. We were at Hershey Park (since the cycle busted our plans to spend the whole week at the beach, we opted for mini day trips instead) when I got the call that I had one follicle at 17 and to take my trigger shot that night and come in for IUI on Sunday. The Good – the HCG trigger they use is a pre-filled syringe (no mixing vials!) and they do IUIs on the weekend to get optimal timing…the Bad – they only do weekend IUIs at the King of Prussia office.  As if we hadn’t done enough driving that week, it was off to Philly!

The IUI itself was easy-peasy – I felt that it was way quicker and less painful than at Danville. I love the sense of calm and happy after an IUI – it’s like everything has been done that can be done. It’s the day or 2 after the IUI that the crazy begins to creep in, haha…if I didn’t get my period before, I was to come in in 2 weeks for a blood test.

Jared & I after the IUI

 

Another new aspect with the new doctor – an awful invention called “Crinone”…this is a progesterone vaginal cream that they recommend you use once a day after IUI. It’s intended to, as it was described to me, “make your uterus nice and sticky”! Really it’s to help thicken the lining in hopes that an embryo will implant. Well, as if using a vaginal cream isn’t in and of itself annoying, it also made me feel excessively tired. I felt like a zombie for days!

Two week wait was murderous as always. I chose not to drink at all which is not fun. Plus, I read the Crinone can delay your period so I didn’t know whether to expect period symptoms or not.  Although it was 2 days later than it would normally arrive, Aunt Flow came knocking the night before I was to go in for my blood test. (As an added bonus, once I stopped the Crinone, I had “withdrawal” symptoms – a headache for 2 days and the inability to stop crying. The fun really doesn’t end.)

End of August 2013 –

So it was back to the doctor for baseline. Jared and I had talked about getting a sit-down with the doctor to try to get an idea of what is happening and where we go from here. But we were trying to be patient too – although this was our 8^th failed cycle, it was only our 1^st with the new doctor. At the baseline, I asked the doctor doing the scan about her thoughts.  Her response still rings in my ears – “At your age, with this many cycles, you should be pregnant by now.” It was haunting – I could just hear Zoma back in February – “You have been with us for such a long time.” I felt hopeless. It was looking more and more like we were on a crash course with IVF. And once that starts, the insurance money is going to run out really quickly – and then it’s the end of the road.

I ended up emailing Dr. Freedman and he called that evening and we got to talk about the cycle. Basically, it was not an ideal cycle. They decided to trigger me because I did have a technically “mature” follicle but it was only 17. He likes to have 19 or 20. But they were concerned that if they let me go any longer, some of the other follicles would catch up and I’d end up with too many mature (ie. too big a risk for multiples).  He didn’t make me feel much better about the likelihood that IVF isn’t the answer, but I felt okay about trying another round of Menopur and IUI.

So that brings us to the present – September 2013. I am on injection day #9. I started out alternating 3 vials, then 2 vials, then back to 3, etc. Two days ago my scan showed 1 follicle with a small lead – a 12 – and then 3 others that were closely behind. He kicked me back to 2 vials. This morning there was minimal growth – if anything the smaller ones are starting to catch up – not good. He is kicking me back to 1 vial. I don’t feel good about this at all. It is my understanding that I should have 1 or 2 follicles that take the lead but all of mine seem to want to grow together. I go back in 2 days and am praying for a miracle.

A new beginning…

After my Menopur cycle was cancelled, the doc said to wait 2 weeks and to call when my period comes (which it should, so he says…). Well, after 1 week I started spotting but he said it was too early for it to be my period.  But even after the 2 weeks, it never came. I was not the least surprised but I wasn’t really worked up about it because I knew I could start a Menopur cycle without a period just as I did before. But you know how I have said before that the second we think we know what’s coming everything gets turned on its head…

When I called the clinic I was informed that my doctor was out of the office for 3 weeks! And the nurse casually tells me that the doctor covering his patients is in Wilkes-Barre (another 45 minutes up the road)!! I knew that driving to Danville every other day was one thing, but going to Wilkes-Barre was just not an option. Plus, the nurse wasn’t even sure this other doctor would start me on a new cycle of Menopur without a period so it was looking more and more like I was in for the 31-day cycle of pills. She was going to talk to the doctor and get back to me on Monday. I was beyond frustrated and I told Jared I really want to quit if it doesn’t happen by the end of the year. I felt very reminded of a quote I had seen on Pinterest: “If God shuts a door, stop banging on it! Trust that whatever is behind it is not meant for you.”

As an aside – starting a few months ago, ads for a new fertility center in Mechanicsburg had run in our local paper and billboards went up on the highway en route to Harrisburg. I honestly hadn’t given much thought to switching doctors because I felt so invested in our path in Danville. Plus, we didn’t want to go backwards – we were afraid a new doctor would want us to start all over from the beginning of the process (diagnostics, clomid, the horrifically painful HSG, etc).

The weekend after I talked to the clinic I googled the office I had seen advertised – Reproductive Medicine Associates of Central PA. There are 4 doctors in the practice and they are out of Philadelphia and have a satellite office in Mechanicsburg. Something just came over me and I decided it was time to talk to someone new. I called Monday to set up a consult. I have to say – just the friendly demeanor of the person who took my call was refreshing. Plus, I was expecting a wait for an appointment (it took us over a month to get in to Danville) – nope! They could get us in that week!

Jared and I went into that appointment still on the fence about whether we wanted to switch. Needless to say, they had us sold before we even left the office. It’s crazy that we did not know how badly we were being treated until we got to experience being treated well!  We had a long discussion with the doctor about each of our and our families’ medical histories as well as everything we had been through so far (so thankful for being a type A nut and having kept an excel spreadsheet of all my treatments and dosages!). He asked so many questions and really seemed stumped as to what is going on. He really didn’t seem to understand the 31-day cycle of pills business. However, I was really won over during my ultrasound. I have had what seems like a million of these done…and I can’t believe I didn’t realize how the doctor and nurses at Danville were never talking TO us but rather just AROUND us. It was amazing to have someone explain what we were looking at. My uterine lining was very thick (which is odd for me) – even Jared commented on it right away, haha. He’s now an expert on what my uterus and ovaries look like on a computer screen!  I was very relieved to hear the doctor say that everything looked totally fine – uterus and ovaries.

Next we sat down with 1 of the 2 front desk nurses to go over our insurance. (I love that there are only 2 nurses…each time at Danville I had 1 of 5 or 6 who rarely remembered me).  We were blown away to learn that we have used only $250 of our $20,000 fertility maximum. Of course, the insurance lady at Danville had never pulled this information for us. Another awesome feature is that you can elect to communicate via email! No more phone tag!

They sent me for the litany of blood work-11 vials! (I just found out today that all came back normal.) We did one final sit-down with our NEW doctor – Dr. Freedman – and were very happy to hear him say that he didn’t want to make us go backwards. He said we will probably be doing Menopur but first he wants to try something new to bring on my period (new to us, not new in existence) – Prometrium, which I will take for 7 days. Of course, I am VERY skeptical that this will make me get a period. If it works, I will be very conflicted …happy – yay! A period in 7 days of meds! …and MAD – at all those wasted 31-day rounds they made me do before.

Right now, Jared and I are feeling so excited and rejuvenated by this fresh start. There are all of these positives that I have mentioned and, of course, a big big one is the location as well. My drive will now be less than 1 hour, it’s close to Jared’s work so he can come to appointments without having to take off the whole day, and there is so much more to do in the Harrisburg area (shopping, lunch with friends, yoga classes) versus Danville.

As we were leaving the office, I found myself looking around, taking everything in, and wondering – “will this be a place for happy?” Even when I was getting my ultrasound, I found myself imagining what it would be like to get happy news in that room. Danville had become a sad place for us and I feel so glad that we decided to make the leap and let it go.

An unexpected surprise…and an unexpected disappointment

After the upsetting news about my ovarian cysts, Jared and I settled into the idea that we were done with treatments until July. So when I called the clinic to get my “period pills” when my period didn’t come at the end of May, I was surprised that they wanted to me to come in for a scan. The nurse said the doc wanted to check the cysts and “maybe try something new.” I was intrigued but didn’t give it much thought. In all honestly, I was actually expecting the cysts to still be there.

 

After another hiatus, it was back to Danville:

The entrance to the clinic @ Geisinger:

 
Well, the scan revealed NO CYSTS! I was happy about that alone. Then the doctor said he wanted to start me on a new drug – Menopur – and that I didn’t need to wait for my period so we could start right away! We were elated. It was so unexpected…I had packed June full of fun activities to make the time go faster and now we didn’t have to wait. I should have known – if we have learned anything in this fertility game it’s that the second you think you know what’s going to happen, things get turned on their head.

 

So the new drug is much like the Follistim – one injection per day. However, unlike the handy Follistim injection pen, Menopur has to be reconstituted which means mixing vials and dealing with syringes. I had had some practice at this for my HCG shot so I wasn’t too concerned. After a messy ordeal with getting the meds ordered (the clinic faxed the order to the wrong company…at 5:00 on a Friday!), we got everything straightened out  - thankfully we weren’t on a clock to start because I had not had a cycle (normally you would have to start on a certain day after day 1 of your period). The reconstitution process was more complicated than I expected but after a few days I got the hang of it. The shot hurt more than the Follistim – it burned when going in but it really wasn’t terrible. And my stomach didn’t bruise like it did before.

The new drug - Menopur:

 

All the supplies to do my injection every evening:

After a few days on the meds, it was marathon running to Danville for blood work and scans...Thursday, Friday, Monday, Wednesday, Friday…it got old pretty quick. Work is already crazy busy so losing big chunks of my days was really stressing me out.  My first scan showed that my uterine lining was thickening (good news!) and that I already had a follicle developing (more good news!). The doctor seemed happy that the meds were working. Subsequent scans showed more follicles and a little growth. By Wednesday, I had 4 follicles but they were all still pretty small. I was starting to worry a little bit because by this time on the Follistim my follicles were almost mature (big enough for me to trigger ovulation and get my IUI). After my Wednesday appointment, the doctor ordered me to increase my dosage so I was hopeful that by Friday the follicles would be close to mature and maybe I would be ready for IUI on Monday.

One of my little follicles being measured on the screen:

Friday’s scan showed almost no growth. The doctor seemed stumped. They keep a “log” of my scans and he just stared at that paper for what seemed like forever. And then, and I could tell with reluctance, he said he thought we should cancel the cycle. He said the follicles just weren’t growing and that we shouldn’t just keep pumping me full of meds. As you can imagine, I was heartbroken.  I was sad that we weren’t going to get to try at all this cycle and that I had done 11 injection days for nothing. But I also felt afraid that the meds hadn’t worked – that whatever is wrong with my body might not be able to be fixed…

So the doc says I SHOULD get my period in 2 weeks because my uterine lining did get thick on the Menopur (which it does not do on its own). But I am not getting my hopes up. Even if I do get my period, I am thinking I will probably have a bunch of cysts again like I did after the Follistim. But when I do come back in, he wants me to do the Menopur again but starting at the higher dosage. I asked if we should go back to the Follistim (duh, since that like, you know, worked!) but he said Menopur is actually a better drug, whatever that means.

In this moment, which may or may not last, I feel completely discouraged. I feel like we are putting our life on hold waiting for something that may never happen.  And as is always the case when we get bad news, I get weak in my thoughts and feel angry and sad that we have to go through all of this, especially when so many can have children so easily. But this thinking is like tears -- it really serves no purpose and doesn’t change a darn thing…

In the end, as close as I am to my breaking point, I’m not there yet. So, as always, we shall press on…