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
estimate 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.
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