Strength in Numbers

Many people have been asking me if I'm excited about this process. My standard answer has been that it is hard to get excited about this when we've been through all that we have. I think today I would change my answer.

We had our first ultrasound today since starting the medication last Thursday evening. Everything is looking good! From now on when the ultrasounds are done we are looking at numbers and size of the follicles. Today we had 6 good size follicles on the right side and 8 on the left side. We want a total of at least 10 follicles; We have 14!  The follicles on the right side measure from 9-11 and the ones on the left measure from 8-10. We are looking for a measurement of 14.  

From here we are continuing the current medications for Monday and Tuesday night. I am still on Follistim 225 and 1 vial of Menopur at night. Wednesday morning we go back into the office and have another ultrasound. When the follicles reach the right measurement we will start the Ganirelix to prevent the follicles from ovulating. Hopefully this will start Wednesday. We are thinking that the retrieval should be either Monday or Tuesday next week.

So yes, after the ultrasound today I gave Nick a high five. I am getting excited! I just hope that we don't take anymore steps backward!

Shoot me up!

Well today is the day. We get to start the injections today to start the process of growing the eggs needed to do the IVF. I thought I would share a picture of all the medications that are needed for one cycle of IVF. Most of the medication came in a big brown box to our door. Some of the medication needs to be refrigerated and some doesn't.

If you look closely at the picture you can see the Follistim, the pen that is used to give the Follistim, Menopur, Ganirelix, Progesterone, HCG, aspirin, prenatal vitamins, Foltx, 2 prescriptions for Z-pak, and assorted syringes and needles. Yes, this is a ton of stuff! All along I have been taking the prenatal vitamins and Foltx. Foltx is just additional folic acid since the prenatal vitamin doesn't have enough in it. 

Tonight I start taking the Follistim and the Menopur. Nick and I both start taking our Z-paks tonight as well. We have to take these to treat for ureaplasma/mycoplasma. Instead of testing for these bacteria, they just treat for them. I also start taking aspirin 81 mg daily. According to the literature I was given the aspirin is believed to help thicken up the lining of your uterus and help prevent certain antibodies that contribute to miscarriage and pregnancy loss. 

So for the first four evenings I am giving myself Follistim 225 units and 1 vial of Menopur. If you recall the highest Follistim I was on for the IUI was 150 Units. I am on so much more medication because we want to produce many more eggs for the IVF. Menopur contains LH and FSH. Both of which help to produce eggs and aid in ovulation. I take both of these medications between 6pm and 8pm each night. The picture below is all of the stuff I need for medications tonight. This doesn't include the prenatal vitamin and foltx. I'll take those when I go to bed. 

One of the other big things that happens today includes not having to park at the bottom of the hill at work anymore. Since we are producing more eggs, my ovaries are going to be getting bigger and strenuous excercise would not be a good thing. I get to park in the garage! YEAH!!! 

Where do we go from here? Well, I shoot myself up every night for the next four nights. Then we have an ultrasound Monday April 29th at 8am. This ultrasound will measure how big the follicles (eggs) are getting and how many we have. The doctors will decide if and how much more medicine I will need, how much longer to take them and when the next ultrasound will be. That day they will also decide if I need to start taking the Ganirelix to prevent premature ovulation. 

I thought I might mention at this point that we put an offer on a house in Green, OH yesterday. It's a short sale so we aren't expecting this to be a "short" process at all!  I'll keep everyone updated :) I'm also going to mention that at some point there will be a "guest" post. Nick is going to do a couple of posts about his feelings and thoughts about this whole process. I thought it would be neat to get a guys perspective! 

And we're off....

Yesterday was my follow up ultrasound. I've been on the birth control now for 12 more days. This time my blood was drawn first for the estrogen level and then I went into the exam room for my ultrasound. Nick wasn't able to make this appointment since he had to work, so I was on my own. I couldn't see the ultrasound screen this time. I forgot to mention that all of these ultrasounds are intravaginal. It's a lot like having a rod stuck up there and moved around in different directions. Since I've been bleeding the entire time I've been on the birth control this movement hurt and would make me bleed more. So here I lay on the table with the wand in place and moving. All of a sudden Dr. Moretuzzo says "Ok, we are good to go."  YEAH!!! No more cyst!

Where do we go from here? Well, Saturday was what I'm hoping is the last day for a while that I will be taking birth control. Thursday April 25th starts the next step. Thursday will be considered cycle day #3. I will start giving myself shots that evening. I have to take them at the same time every day. Then Monday, April 29th I go in for another ultrasound to see how the eggs are growing in my ovaries. I will post more details about the medications on Thursday. Don't want to get too far ahead :)

Infertility Etiquette

Today's blog focuses on feelings more than the process right now since we don't have anything coming up until Saturday. I am sure this is not something that people want to hear, but it is something that I feel needs to be written.

For a long while I have wanted to be a mom, to be pregnant, and to experience everything that goes all with it.  When I was younger and not in a place for this to happen I cherished hearing about other people's children, what they are up to, what stupid things they do and so on. I also didn't mind hearing about women's pregnancies; how they were going, the appointments, the pain, the fatigue, and all the other issues that come with being pregnant. As I have grown up, gotten married, and become in the position to hopefully become a mom I enjoyed all of this as well. Now that we are going through all the problems that we are going through I find myself in a different frame of mind.

When you see what seems like everyone around you get pregnant it gets depressing. I want to be one of them. Every time I have to listen to people complain about their back hurting, being tired or complain about anything all I can think is I would kill for that opportunity. People do not seem to understand how their words and actions effect other people. It gets to me when I listen to mothers complain about being up all night with their children. If you didn't want that, why did you get pregnant? Most people know whats coming. I get tired of hearing all the complaints. There are times when I don't want to listen to the cute things your child did last night or last week. I don't want to see your latest pictures. All it does is remind me of what I don't have.

Comments aimed at what people think is helping the situation don't. I don't want to hear "quit trying, it'll happen when you least expect it." I don't want to hear " if you just loose some weight, you'll get pregnant." These are ignorant comments. If you knew my story, you wouldn't be telling me these things. The other day I had someone who didn't know my story say to me, "Those IVF moms are psychotic." At first, I turned to her and said " We aren't all psychotic." Then I got to thinking, while I can't answer to that for other people, I have to say that yes, I will probably be psychotic. I have a reason. I have been trying for a long time to have a baby, to realize this dream and by god I am going to protect that dream at any cost.

I am posting a link to another blog that talks about Infertility Etiquette. Please take the time to read it and think about it. http://www.resolve.org/support-and-services/for-family--friends/infertility-etiquette.html

We have our next ultrasound on Saturday April, 20th to see if the cyst is gone and we can continue on the journey.

Bitter Disappointment

On Thursday, April 4th we signed the consents to start IVF. Signing consents wasn't just here's the papers and here's where you sign. No, it was more in depth than that. There were three separate consents that we had to go over.

First, we talked about the fact that giving my body excess hormones can make it go into overdrive. Don't get me wrong, this is want we want to happen, but controlled. Sometimes the hormones can make you go into ovarian hyperstimulation syndrome (OHSS). This syndrome consists of cyst formation which in turn can rupture requiring surgery. Another thing that can come from this syndrome is fluid shifts. The high levels of estrogen can pull fluid to the abdomen or around the lungs. Sometimes this can require hospitalization as well. Multiple pregnancy and ovarian cancer are also risks with superovulation therapy.

The second consent was actually for the IVF retrieval and embryo transfer. This was an 11 page document that went into detail about the process. It talked about how my body was going to be prepared, the fact that there is no guarantee that the process was going to work, the fact that we need to do ICSI ( see April 7th post), selective assisted hatching, and watch to do with excess embryos. Selective assisted hatching is a process that helps the embryo to implant in the uterine wall. This is done when you've had a failed IVF cycle in the past or you are of advanced maternal age. Hopefully we won't need this!

Third, we talked about specifically what to do with the excess embryos that may be produced through the superovulation therapy. We chose to have them cryopreserved. When we are ready to have more children we can thaw the embryos and use those to try to get pregnant. Because things happen in life, we had to decide what to do with the embryos in case we both were to die, get a divorce, the IVF lab were to not be in business anymore and they couldn't get a hold of us, or we don't want the embryos any more. In all of the cases we chose to donate the eggs. I know what I've been though so far to have a baby and I couldn't imagine destroying them when someone else could use them.

The next step of our visit that day was to talk about what to do next. I was told to stop taking my birth control that day and that I would come into the office for a baseline ultrasound and estrogen level on April 8th (today).  Then we would start the injections the next night (tomorrow). I would take the injections for 4 nights and then go for another ultrasound on Saturday and Monday.  Well, things didn't go as planned today. I went in for my ultrasound and they found that I have a cyst on my right ovary. Dr. Moretuzzo told  me that they get better results when there aren't any cysts. So, I would have to go back on the birth control. The only question was for how long. They drew an estrogen level to determine that. Mine came back at 36, which is on the low end. They think that the cyst is going away since its not secreting too much estrogen.

I start the birth control again tonight. I will be on the birth control until April 20th when I go in for another ultrasound to see if the cyst is gone. If it is, we can continue on course.  How did I feel about this today? THIS SUCKS!! It seems that my body can't get anything right even when its told what to do. Nothing goes according to plan. If it did, I'd already have a one year old on my hands. I'm a little bitter today, but I want to do this right so that we get the best chance.

This Is Gonna Hurt

When we decided to proceed with the IVF process we were given a checklist of things that needed to happen before we could go on. One of those things was to have more blood drawn. We both had to have tests for infectious diseases. Those included HIV, Syphilis, Hepatitis B, and Hepatitis C. I also had to have blood drawn to check for Rubella immunity. All of these things can cause problems with pregnancy and affect the baby as well. Since we haven't been told that anything is wrong with these tests, we think we are in the clear.

Another thing we had to have done was a sonohysterogram and trial transfer. Part of the process of IVF is to transfer the embryos back into the uterus after they are fertilized. Doing the trial transfer ensures that they can transfer the embryos in the right place. This is critical to the success of IVF. When they do the transfer they simulate the process with saline. They insert a catheter through the cervix and then insert an ultrasound probe. While they transfer the saline they do a 3D ultrasound to see where the saline lands. The transfer of the saline hurts like a (B****)  the worst cramps I've ever felt. It's a good thing Nick was standing right next to me so I could squeeze the shit out of his hand. I'm pretty sure his hand was cramping after the procedure. Did I mention that I thought I was going to have to pee in a cup when we got to the office so I drank a ton of tea to make sure that I had a full bladder? Oh yeah and then I didn't have to pee in the cup so I felt like I was going to float away. It's a good thing that they let me pee before the transfer or I would have made a very big mess :) Everything went well with the transfer and we got moved on to the next thing on the list.

As soon as we walked out of the room from the transfer, we were whisked into another office to talk about medications. As opposed to the IUI cycles, there are a lot of medications for IVF. For the rounds of IUI I was only on one medication, Follistim. There's a lot more to this one. I'll go into detail with those later. The medications for IUI cost us around $900 a cycle. This time we were getting a ton more medication. One would think that it was going to cost us more money than the IUI. We got lucky. My job comes with a perk; insurance with infertility coverage including medications! All of our medications for this round of IVF were only $320. All of the medications had to be preapproved and then shipped to the house. This process took about a week. In the meantime, in order for me not to ovulate and have a period I was put on birth control. This also bought us time until the medications could be delivered. We had to have the medications in hand before we could sign the consents for IVF.  

The last thing to check off the list was another semen analysis for Nick since he hadn't had one done at the new office. He'd been off the clomid since we moved and got put back on about two months ago. We wanted to see if it's been working. We were impressed!  The sperm count was higher and the morphology was better. We still need to do ICSI (intra-cytoplasmic sperm injection) which means that they will manually insert the sperm into the egg. Since the little dudes aren't shaped right they can't penetrate the egg like they are supposed to. Doing the ICSI gives us a better chance of having an egg fertilized. Signing consents was a story in itself which I'll talk about in another post. For now it's time to go to bed and get up in the morning for more prodding...

Scientific Discovery

This post is a little challenging for me. While I may be a neonatal nurse practitioner, the field of genetics has always been a mystery to me. As part of the pre-IVF blood testing I had blood drawn to test for three different and significant genetic conditions that could be passed on to our little dream. Those genetic conditions are SMA (Spinal Muscular Atrophy), CF (Cystic Fibrosis), and Fragile-X.  All three of these conditions can be screened for prior to pregnancy and in our case, the embryos can be tested prior to being reintroduced into the uterus.

Two weeks after I had blood drawn we got a phone call. I am a carrier for SMA. First let me explain what SMA is. SMA is a disease that is autosomal recessive, meaning the both parents have to have the gene and pass them on to the child. http://en.wikipedia.org/wiki/Spinal_muscular_atrophy In SMA, you want to have 2 copies of the gene. I only have 1 which makes me a carrier. If both parents are carriers there is a 25% chance that our child would have SMA.  So the next step to this process was to have Nick tested. Which we did. About 2 weeks after his blood was drawn we met with the doctor. Nick is not a carrier!  He has 2 copies of the SMA gene! Since only one of us is a carrier we now have a 50% chance that our child will be a carrier. So all in all we have a 1/2,592 chance that our baby will have SMA. Pretty good odds that we are in the clear if you ask me. :)

The second test that we had done was for Cystic Fibrosis. See more information here: http://en.wikipedia.org/wiki/Cystic_fibrosis  This one came out much better. I was tested for 147 different cystic fibrosis mutations. I'm negative!  This means that we have a 1/40,100 chance of having a baby with CF.

Fragile-X is a little more complicated than the rest. http://en.wikipedia.org/wiki/Fragile_X_syndrome I have what's called a premutation. On the X chromosome we have repeats of chunks of DNA. The gene that they look at typically has 5 and 40 repeats. To have Fragile-X you typically have more than 200 repeats. People that have between 40 and 200 have a premutation. I have 57 of those repeats. When the X chromosome gets passed on those repeats multiply. So  in theory it's not our children that we need to be afraid for, but for our children's children.

After finding out this information we went to see a genetic counselor. She was wonderful. She explained all of our chances for having a baby with each of these diseases and calmed our fears. We had the option of doing the preimplantation genetic testing, however it is really expensive and with our chances being so low we decided not to have the testing done.

So, one decision down.... way too many to go....

Well, I'd like to see your uterus...

Well, I'd like to see your uterus....

Not really the words that you're expecting to hear when you go to the doctors office.  Not that this was the first time I've had a doctor want to do an ultrasound. It was just a new way to get there. Our story starts when Nick and I met in February 2009. We met at Lutheran Hospital. I was working as a nurse in the Neonatal Intensive Care Unit and Nick was working as an EMT on the transport service for the hospital. Long story short we started dating and got married August 13, 2011. 

Well, now that I think about it our story starts before that. When I was a teenager my periods were never regular. Not that that is a problem when you're a teenager. I didn't think too much about it and it never bothered me. Until college that is. In college I was finally diagnosed with Polycystic Ovarian Syndrome (PCOS). http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome 

Basically PCOS is a syndrome that causes you not to ovulate and have irregular periods. There were times when I would go months without having a period. In college I was put on birth control to make my periods regular. So when Nick and I were planning on getting married and having children we made the decision to stop the birth control before the wedding so that I could get it out of my system. So I took my last birth control in March 2011.  We were prepared for the fact that there was a possibility that I could get pregnant prior to the wedding. I didn't want to wait because I knew that I was going to turn 30 this year and that the older I got, the slimmer our chances were of not only getting pregnant but a greater chance of having complications. When my periods we not regular after coming off the birth control, I knew that we were going to have problems. After we got back from the honeymoon I bought an ovulation kit. When the first one didn't show that I ovulated and I hadn't had my period, I bought another one. I continued to wish and hope that we would be able to do this naturally, but I think deep down in my soul I knew that we wouldn't. Once the second kit failed to show that I ovulated, I made an appointment with my OB/GYN. We met and talked. We decided to do another baseline ultrasound to see if I really had cysts on my ovaries and some blood work. On a whim, she had Nick get a sperm count done. We didn't think there was going to be anything wrong since he had Dakota. My ultrasound showed some small cysts on both ovaries consistent with the PCOS and my blood work was fine. Nick's sperm count on the other hand was not good. His swimmers didn't swim and his guys were funny shaped. In our follow-up appointment we were told we needed to see a fertility specialist. Nick also needed to go and see a urologist. 

December 12th, 2011 we saw Dr. Bopp, the fertility specialist, for the first time. Since I hadn't had a period since October 20 he gave me medication to start one. That sucked! When it started I had to go and have a bunch of labs drawn. Then I had to have an ultrasound done with dye to make sure all of my parts were in working order. Did I mention that insurance doesn't cover any of this? Nick had another sperm analysis done and this time the results were better. We went to see Dr. Thomas, the urologist, and he suggested that Nick have some labs drawn. His testosterone came back low so he put Nick on a medication called Clomid. It's the same medication that some women use to ovulate to get pregnant. This is an off label use. In the meantime all of my labs and ultrasound came back good. Dr. Bopp thought that we would have a good chance at conceiving with a technique called IUI (Intrauterine insemination). I was going to use the clomid to start my ovulation and then when the ovulation kit said I was going to ovulate we would go in and do the insemination. The insemination was supposed to help Nick's sperm get passed the cervical mucus and give us a better chance. With the sperm being funny shaped they would have a hard time getting though the mucus. When they start clomid, they start you at 50 mg. I took it from day 5-10 of my cycle. I never got a smiley face on the ovulation kit telling me that I had ovulated. When this happens they draw blood to check a progesterone level. This level can tell you if you ovulated. Mine this time was 1. Nope, didn't ovulate.

So next month they increased it to 100mg. I took it from day 5-10 again. We never got a smiley face.  So we had my progesterone drawn. Guess what? It was 9.8. I did ovulate and the kit missed it. I was furious. It was a missed opportunity. Each time we start a cycle we have to pay up front. One round of IUI is $1,650. If we don't do the IUI we can continue to use the money that we paid for the next stuff. 

Every time I start a cycle I have to go in for an ultrasound before they would give me the clomid. So the third month they increased the clomid to 150mg. This time it worked like it was supposed to. I got a smiley face and we went in to have the IUI done. Nick had to "make a deposit" in a cup and then they spin it down and give them a bath to make them swim better. To do the IUI they insert a small catheter with the syringe of Nick's sperm attached to it through my cervix. Then they push the syringe. I had to lay flat for 10 min. That's it. That's all there is to it. A week after the procedure I went back in to have a progesterone level drawn. It was 17! This was great. It means that my body was preparing to be pregnant. That was a Friday. The next Wednesday I started spotting. I was hoping it was just implantation bleeding. Boy was I wrong. Aunt Flo came in full force on Thursday. Did I mention that Nick was gone in Arizona this whole week prior to Aunt Flo starting? His Uncle had been hit by a drunk driver and died. I was supposed to check a pregnancy test that Friday May 18th. I didn't need to. I already knew. I wasn't pregnant. I was devastated. Nick wasn't here to comfort me. I called Dr. Bopp's office and we had decided to go ahead and try it again. I had an appointment for the next Tuesday (May 22). 

When we got to the office we decided that we wanted to try something that would give us more of a chance. We were lucky that Dr. Bopp was in the office. He is only here in town on Tuesdays. His other office is in Indianapolis. He suggested that we try doing injectable medication. This would give us a 4 times better chance of conceiving. It also doubles our chances of getting twins. So that night I started shooting up ;) It's a medication called Follistim. I stimulates your follicles or eggs to grow. They started me on 75IU. I did this for 5 days. Sunday we drove to Indianapolis (the Ft. Wayne office isn't open on Sunday) for an ultrasound a blood work. The ultrasound checks to see how many follicles you have growing and how big they are. I had 4 on my left and 5 on my right. They all measured around 7mm. The blood work they draw is an estrogen level. As your eggs grow they secrete estrogen. The bigger they are the more estrogen they secrete. My estrogen
level was 89. This is ok. They just want it to go up as the follicles get bigger. So, they increased the Follistim to 125IU. I did this Sunday, Monday, and Tuesday nights. I went back this morning to be checked. This time she only measured the biggest one on each side. Both of them were measuring at 10mm. They want them to be around 18-20 to be considered mature. My estrogen level was 189. So we increased the Follistim to 150IU and went back Friday to be checked again.  This time I had a 12mm and 14mm on one side and an 11mm on the other. We kept the medications at 150IU and went back on Monday June 4^th. When the follicles were big enough, I gave myself another shot, this time  called ovidril. This stimulates the egg to release. 36 hours after that we went back to the office and had the IUI done again. Then the 2 week wait began. One week after the IUI, I went in for a progesterone level which was fine.  Only two days after the progesterone level was drawn I started bleeding. That when we knew that the IUI hadn't worked. 

We did one more round of the IUI with the injectable medication (Follistim). This round we started at 125IU. The follicles got big like they are supposed to and we triggered the ovulation. We went in and had another round of IUI done. Again my progesterone level was great. Again I started to to bleed a couple of days after the progesterone level was drawn. Another failed round of IUI.  

One of the reasons I started this blog was to put my emotions down on paper, well computer. During our rounds of IUI we found out that Nick's 17 year old niece was pregnant. Talk about a gut shot. How is it that an unwed, irresponsible teenager could get pregnant and I couldn't?! I was married, had a good job, wanted a baby.   Why is it that people who don't need to be having children can get pregnant so easily and I, who is married, has a job can't? Why is it that I have to pay out of pocket for infertility expenses and she gets government assistance? I have never felt so angry and betrayed. Eventually, I decided that that I was better than that. Better than her, better than them. I decided that I was just going to not be around them. 

So far it has been ok. It helped that we moved to Akron, OH for my new job as a Neonatal Nurse Practitioner August 2012. We decided to take a break at this point. We were going to have to switch infertility offices and with starting a new job in a new place we thought it would be better to not have the added stress.   

Now that we are settled in Akron, we have decided that its time to try again. We have started in a new office Reproductive Gynecology, Inc. http://www.reproductivegynecologyinc.com/  Today we go in to sign the consents to start IVF. We have our appointment in an hour.