All Aboard

Here we go again - about to hop on the train as it leaves the station.  Tomorrow is my baseline appointment.  This is the appointment where they'll check that everything looks good to go before I start my stims for this final (I make no promises, but I really think I mean it) egg retrieval.

This is also the appointment where we must pay for the full cost of this IVF cycle.  For those who wonder really really how much it costs to go through a full IVF cycle, I'll lay it out for you.

On Tuesday we'll be paying, out of pocket:

• $11,906 - this covers the full IVF (ICSI, Assisted Hatching, Fresh Transfer, Ultrasounds etc) and is with a self-pay discount
• $763 -  anesthesia 

For this cycle we have already paid, out of pocket:

• $3164.52 - for my meds
• $7.93 - for Ian's meds
• We saved just under $900 because of leftover meds from a previous cycle. We could end up spending more if we need refills on anything.

This does not include the costs of any of the testing we did between last cycle and this.  This also does not include the cost for freezing any leftover embryos.  Of course if this cycle does not succeed, and we do have leftover embryos, each of those following transfers will cost $3099 as well as the cost of medications.  We won't even talk about how much more we'll have to come up with if none of this works and we start looking at adoption.  I'll save that for when/if we get there!

This is why my answer is now always a sad, "no" when you ask me if I have any vacations or travel planned.  (A slight lie, as we are planning to go to Australia to visit Ian's family this winter - we haven't been since July, 2010.)

In the meantime, I haven't gotten results back from my biopsy yet.  I know it can take a couple of weeks, and it is just two weeks today. I've done some research in the meantime on the benefits of the biopsy beyond potentially gathering some information.  Dr. Tran had mentioned that this procedure can sometimes help just itself by causing some cell regeneration in a some way that leads to higher rates of implantation in patients who have had repeated failures.  I didn't dig too deeply, but did find some anecdotal evidence that made me feel like I'm glad I did it, in spite of the pain.  I definitely want to walk away from this cycle, success or failure, feeling like I did everything I could.

The worst thing, though, is that I keep seeing it (and hearing it) referred to as "tickling" the lining.  It sounds so gross to me, and also FUCK YOU THAT DID NOT TICKLE.  Every time I see that term I want to vomit all over the place.  I've also seen it called "scratching" which is slightly more accurate, but still NO.  It is a horrific painful suctioning.  Don't sugar coat this shit.  I've had so many things inside of my vagina and uterus in the last year and a half and my bullshit radar is turned on high.  Calling it a tickle does not make it a tickle, guess what.

Anyhow.  I'll keep you posted as I move through this cycle.  All aboard!

It Hurt

In case you wondered, it hurt.  Like a lot.  Just ask Ian how his hand felt from my squeezing it.  It hurt more than I think anything else I've had to do so far.  Suctioning out bits of my uterine lining, it turns out, is not pleasant.  #shocking

On the plus side, I was surprised when Dr. Pittenger, my amazing doctor from my IUIs through the study, ended up popping in to do the biopsy.  I love her a lot, and it was really good to see her. Also, I was feeling sorry for myself that I was getting some random doctor I'd never even met before to do something scary to me when she walked in the door and crossed his name off and wrote hers in.  YAY!  She does not lie to me.  She told me to sing happy birthday to myself and it would be over in that time.  It was.  She told me it would hurt.  It did.

Results in a week or two.

(PS I did a Google Image search of "endometrial biopsy" so I could add a picture to this post, but looking at those drawings sort of made me want to cry.  It's like just seeing it made it hurt again.  Ick.)

OPK OK

I finally, the other day, saw what a positive test stick looks like, although it was an ovulation stick, not a pregnancy one.  I haven't used OPKs (Ovulation Predictor Kit) before, beyond my fancy monitor, so the whole two lines, one showing up darker thing was new to me.  Anyhow, I was expecting to see a positive on Monday, but it didn't come until Friday, so this has pushed some things out a bit more than predicted, but since I never shared what was happening on the blog, I guess it doesn't matter so much to you.  It's just my body causing me additional stress by fucking up my schedule!  Anyhow...  I'll share now.

I go tomorrow for an endometrial biopsy.  This is the final test we are doing before moving forward with our cycle.  I was supposed to take progesterone starting 3 days after ovulation until the day of the biopsy, but that didn't happen, since I ovulated later.  Apparently it doesn't matter, since they do the biopsy anyhow.

Not entirely sure what this biopsy will do, but if I recall correctly it is to just test that my lining is on the day that it should be....they want to make sure that when they are transferring 3-day embryos, they are transferring them into a 3-day lining.  If I find out anything else about it, I'll let you know.  Supposedly it won't hurt, but I'm not holding my breath for that.

We got the results back from our karyotyping and all is normal with us both chromosomally.

So, biopsy Monday, and I start lupron on Friday (everything is 5 days later than the original plan because of my stupid late ovulation).  I should start all the stims about a week and a half later.  I am adding some growth hormone this time, in hopes that it will improve egg quality.  (Not, as Ian guessed, so that I would finally be taller.)

We've spent a lot of time these last weeks talking about and figuring out our finances, since insurance isn't covering anything anymore.   We've also welcomed an adorable new niece into the family and have talked a lot about our low hopes for this to work.  Go us?

Anyhow, nothing too exciting to report, but just wanted to share the sort of where we are stuff.  Sorry this isn't even a tiny bit funny, or a little bit touching.  I just have a lot of stuff to get written today and wanted to at least get this out here.  I'll try to make you laugh and/or cry next time.  Apparently these days I can do both with one sentence, right Nick (not that Nick reads this)?

Here's my calendar (click on it to open it bigger and thus readable):

The Latest Humiliation

This week and next week I have to pee on a very fancy and specific brand of very cumbersome and large ovulation test stick each day between 10am and 2pm.  Guess where I am most days between 10am and 2pm...  If you guessed WORK then you win the grand prize!  (The grand prize = you are not an idiot.  YAY!)

Nothing like finding my way to the bathroom carrying this thing, peeing on it, and carrying the peed on version back down the hall to my office (through the library's public hallway) and into my cubicle while I wait for lines to appear 5 minutes later.  Then I get to pull out my peed upon stick right here at my desk and compare the lines to each other and to the picture in the instructions, all while people walk around behind me wondering what the hell smelly peed on thing I'm crouched over at my desk and why.  Then I get to either throw it away in my tiny visible trashcan where it can sit there looking very much like a pregnancy test, or I can carry it into the kitchenette in my office where it can be thrown into a larger trash can with a lid where I will hope no one notices that I put pee in the kitchen trash can.

Today I brought a notebook (inconspicuous right?) into the bathroom with me and placed the un-peed-on as well as the peed-on stick in between sheets of the notebook paper so it wasn't visible while I walked around.    Now I just hope no one needs to get in my desk drawer when I'm not around.  

Yesterday, Today, Tomorrow

If anyone has made their way over here because of my post on Kveller, welcome and thank you so much for reading!  I really appreciate everyone's amazing support and comments.

So, let's go back a little bit here, as I know I've left everyone sort of in the dark in terms of what is going on and what our plan is.  We had thought that after this last FET we would move forward to another IVF, this time growing all of our embryos to day 5 and doing some genetic testing on them pre-transfer, so we would be transfering only embryos we knew were viable.  Well, when we finally met with Dr. Tran to discuss our last failed cycle, we made a pretty major change to those plans.

I want to keep this short and not too boring, so here it is:  the two embryos (of 6) that made it to day 5 in our last cycle were not in great shape.  Dr. Tran basically said he barely counts it as an unsuccessful transfer, since they would have been so unlikely to have implanted.  I wish he had been our doctor for the transfer so we might have had this information before the two week wait, but he wasn't.  So, anyhow.  Because of this, he didn't feel that, if we were truly thinking about doing only one more retrieval, our initial plan made sense.  He said that it would give us more information but make us less likely to successfully conceive.  We aren't going to be looking for info at that point, we'll be looking for success, as it is likely our last chance at going at this in this way.  Instead of growing embryos to day 5 and risking losing most or all of them, we will do more of what we did before - three day transfers.  This time, though. he will transfer 3 at a time, instead of 2 by 2.

In order to give ourselves the best odds possible, we've decided to move forward with a bit more testing before another IVF.  This is why I had the Hysteroscopy last week - to look for any potential issues in the uterus that could be preventing implantation.  I'll get to the results of that in a minute.We will also do a uterine biopsy during a "false" frozen cycle to make sure that my lining is at the day we think it is, to ensure the age of the embryos we are transferring match the age of my lining.  Lastly, Ian and I will each do a full chromosomal karyotyping.   This is to make sure that we aren't a rare combination that cannot successfully produce a genetically healthy embryo.  Obviously, if we learn anything from any of these tests, we will move forward accordingly.  If not, we will go with the plan of IVF and transfers 3 by 3 at day 3.

The Hysteroscopy itself was less horrific than I imagined.  I was drugged up enough to not really feel anything, and to not care about what I could feel.  Dr. Tran turned the screen so I could watch what he was doing and talked to me about everything we were seeing (I told you he knows me well).  At one point the screen was turned so far toward me he had to ask the nurse to turn it back so he could actually see it well enough, which sort of made me giggle.  The nurses were, as always, kind and personable.  They make me feel good.

Anyhow, he saw, and removed (with teeny tiny scissor things) a very very small polyp.  My uterus also had a very minor septum which he bisected.  He doesn't believe that either of these things would really explain our troubles, but felt strongly that removing them would potentially alleviate early miscarriage and would only help our chances of conceiving.  So, they are gone.  I bled a lot that night, and slept a lot for a couple of days (although I returned to work the next day), and had some weird internal pains (well, I guess not weird - probably completely appropriate pains for having had things scraped out of my uterus), but feel totally fine now.  I'm on a month of estrogen to help my lining heal before we can move on to the next test (the fake FET cycle and biopsy).  I just made my appointment to get my blood drawn for the karyoptyping.  I assume Ian is taking care of his appointment (hahaha for those who know Ian).

At this rate, I feel like we're looking at late summer/early autumn for the IVF if all tests come back normal.   We haven't really started looking at/talking about adoption in a more serious way, other than that we know it is the next step after this, we know we are looking at domestic, and we know that there will be a real mourning process before we feel excited about it, although I am certainly excited about it as an alternative to not being parents - it helps get me through the rough moments.

Speaking of rough, and less rough moments....

Pre-Hysteroscopy - the drugs have kicked in

                               

Post-Hysteroscopy - Mmmmmm crackers

Way Post-Hysteroscopy - kitten cuddles

Hysteroscopy

I haven't had time to give the full update on what is to come for me, so this is super short just to let you all know that I'm having a hysteroscopy tomorrow afternoon, and I am really nervous about it.  More painful procedures.  Fun fun.

If I am up to it, I'll tell you how it goes tomorrow, and give the update on what else we are doing.

Where do we go from here?

There are studies that show that the stress of Infertility is comparable to the stress people go through when dealing with a terminal illness.  That is sometimes hard to believe, and other times less hard to believe.  My life is not in danger from this, obviously, and I try not to make comparisons between different pains and hardships.  All the same, though, this is a disease and it is choice-limiting and it has the potential to majorly change the course of my entire life and my plans for it.  When your Plan D turns into a plan A and you have to start thinking about Plans E and F...  Stress?  What stress?  I'm out of sick leave, out of insurance, and about to enter another set of medical procedures that are overwhelming and scary to even think about.  So, that.  Some might see it as a choice I am making, and in some regard it is a choice.  Oh boy, though, does it not really feel like a choice.  This or what???  Well, this or Plan F.  Which we may get to eventually.

This article was making the rounds a month or so ago, and I thought it was really eye-opening in terms of how to handle people who are going through anything that is hugely challenging and hard to understand.  The author of the post is talking about when his wife had breast cancer, but of course I read Infertility in everything.  I'm sure you can read this same post and think about challenging things you have gone through and see how it relates.  To me, it is a concept that is just useful overall in how we think about other people and how we provide comfort.

I was planning to make a post about some of this a couple of week's ago, when it was National Infertility Awareness Week, but i didn't feel like delving into it then.  I was in Ohio spending time with family and friends and enjoying my life.  I did, though, post a banner on my facebook page, because I do think it is important - the whole awareness thing.  I am so open about all of this compared to most, and I still feel a lot of guilt and a lot of shame and a lot of discomfort around this.  I fight it as best I can and I power through the same way I've powered my way through other uncomfortable emotions in my life (painful shyness, debilitating jealousy).  What I want, though, is for it to not feel like this for women (and their partners).  I want health insurance and health care to be more fair around this particular disease (it's not the only one, I know, believe me - but don't get me started on health care).  Awareness can't hurt, right?  The fact that I cringed every time I saw that banner on my Facebook page is exactly what told me I needed it to be there.

I will say that I do still feel so so lucky in my life...there is so so much good in so many parts of it.  I have to have the most amazing partner in the world, at least for me.  I do know that together even our Plan F life can be beautiful, even if it takes a lot of pain and a lot of mourning before it feels beautiful.  Each loss of a plan is a whole new cycle of grief, loss and mourning before we can move on and each new cycle of grief gets harder as the likelihood of things working out the way we've always imagined our lives working out becomes more and more distant.

I think I'm going to end this here.  My intent was to actually write about what is going on and what our next steps are, but that just seems like too much for one post.  I'll come back in the next few days and update you on the next steps for us.  We had one plan, but it's changed a little bit, due to information we got in our last frozen cycle.  So, I'll be doing some more testing before we move forward.  I'll tell you about that all soon.