U/S-BT Follow Up Visit #1

My first follow up didn't go quite as well possible.  Dr. C said that my ovaries aren't showing much development.  Apparently this is pretty common with PCOS and I shouldn't worry, which is easier said than done.  My blood work came out better than my ultrasound.  The conclusion.  I need more medication.  I upped my Menopur inject tonight and my Follistim amounts will go back up to 125 units for the next two days.  I won't have a follow up until Friday due to my slow start.  Sarah told me that this is perfectly normal and shouldn't impact our odds or time line.  Here's hoping.

On a side note, I have been keeping a spreadsheet of the fertility bills.  So far we are at about $1,500.  This includes my surgery and all its related expenses, like the anesthesiologist's bill.  This is more than we were expecting at this point in the process, but we hadn't accounted for all of the lab work.

PS:  Menopur is my least favorite medication.  It leaves me with awful looking bruises and terrible diarrhea.

Racking up the frequent flyer miles

Tuesday was my baseline appointment.  This was a preview of my life for the next two weeks.  The appointment lasted all of fifteen minutes.  Sarah was running the ultrasound machine as Dr. C was out of the office for the holiday.  It took her quite a bit of maneuvering to find both of my ovaries.  Apparently one of them was hiding, hehe.  I then headed down for my blood test. 

Sarah called me about four hours later and told me I was good to start my medications on Saturday.  She also scheduled my next appointment, Tuesday at 7:15am, which is far too early in my opinion.  This will be my life for the then week or so.  Starting Tuesday I will go in every other day.

I started my Follistim and Menopur on Saturday.  So now I get up in the morning and take my Vitamin D and my Levoxyl, then I inject myself with Follistim.  Then at dinner I take my Metformin ER, prenatal vitamin, and my low-dose aspirin.  And before bedtime I inject myself twice, once with Luprion and once with Menopur.  Three shots a day!  My abdomen is starting to look like a connect the dots page.

I will be making a brief post after every follow-up.  These are going to be very short posts just intended to keep you up to date on the latest in the saga of my developing follicles. 

Insert foot into mouth and chew

Recently I dealt with an extremely rude and thoughtless human being.  One of my regular pharmacists is on vacation and thus I have had a week of unfamiliar faces filling in.  One of these fillers isn't so unfamiliar. I have worked with her three or four times a year for the past three years.  Not to long ago I ran into her outside of my store and brought her up to speed on operation baby, so it wasn't surprising that her first question when I came in what about how the IVF was going. What was surprising was her complete and utter lack of good judgment in her next comment. 

Picture this short, loud, and almost 30 year old woman pretended to listen as I explained in a brief couple of sentences what our timeline is.  She nods impatiently and then launched into a statement that can only be described as rude and thoughtless.  "Would it upset you if I said I was pregnant!?" Insert big shit eating grin.  What a bitch!  I understand being excited about a little one, I don't understand the apparent need to try and make me feel like shit.  I wasn’t about to let her see how much her statement hurt me, so I answered, “No, of course not,” with a sincerity I didn’t feel.

Do I understand that my fertility challenges aren’t her fault?  Yes.  Do I understand that people will not stop getting pregnant just because I haven’t been able to?  Yes.  Do I feel the sting with others around me seemingly get pregnant just by looking at a penis?  Yes.  And do I resent it when a woman presents her good news to me with the subtly of a shotgun?  Why, yes I do.  I have made it through several pregnancy announcements without wanting to deck the woman, but this presentation, this “in your face you infertile chick, I’m better than you” na-na-nah-bo-boo approach left my palms itching with the urge to slap the bitch.  But I resisted the urge and tried to remind myself that this particular woman has no brain to mouth filter.

She then spent the next three hours telling me about all of her pregnancy symptoms.  From her sudden fondness for bagels to her aversion to Alfredo, from her slightly crampy tummy to her inability to touch her toes anymore, from her frequent cries to her irrational anger, and from her tender breasts to her increased cup size. Yup. I got all these details and more.  Then I asked a question, how far along she was.  I had a hard time not laughing my ass off when she said five weeks.  Five fucking weeks and she would have you believe that she has experienced every symptom imaginable. 

I asked if she had made the big announcement.  She has not told anyone but her husband and her sister.  So why then am I lucky enough to have her joyful news rubbed into my raw nerves?  It turns out she’s having some problems with her progesterone levels and she knows how much research I’ve done of fertility challenges so she wanted to pick my brain.  Unfortunately I don’t know that much about progesterone levels, only that a level too low can cause a miscarriage and that it’s normally treated with progesterone oil injections, progesterone suppositories, or Prometrium taken orally or inserted vaginally.  She is using the latter vaginally so I had no new information for her.

I can’t imagine what she must feel like, to be so close to one of her dreams but teetering on the verge of losing it.  Terrifying.  Rudeness aside, I’ll be praying for her and her precious little one.

Surgery went fine

My surgery went fine.  We got to the Surgery Center at 6:30 am, uggg, so early!  My surgery was scheduled for 7:45 am, and while I don't know exactly what time I went in, I know it was pretty close.  The scariest part was walking into the operating room.  The room was bigger than I imagined and after laying on the table the flurry of activity around me was very disconcerting.  One person was attaching sensors, another person was getting my arms and legs in the correct positions.  And the anesthesiologist was talking to me the whole time, asking me questions about Tony.  I really appreciated the distraction.  The last thing I remember is asking the Dr if it was normal to feel kind of strange.  Then I woke up in recovery.

Dr. C told Tony that I was only under for 15 minutes and that things went wonderfully, he even showed Tony pictures.  He didn't anticipate any trouble, and there really hasn't been any.  I hardly had any pain or discomfort yesterday, just some mild cramps and lingering fatigue.  I napped on the couch from 10 am until 2 pm and still went to bed at 9 pm.  I apparently was catheterized and that's been the source of most of my discomfort, a burning sensation during urination.  I upped my water intake and had Tony get me some cranberry juice and that sensation has mostly passed now.  I bled a little the first day, today its mostly discharge from the Betadine they used on my cervix.

All in all the experience wasn't bad at all.  The procedure I had was called a hysteroscopy with polypectomy in case anyone wants the official name.

I also gave myself my very first injection today.  10 units of Lupron in the belly.  I was a little hesitant at first, its one thing to read about injections and quite another to actually do it.  My first try wasn't quick enough and didn't have conviction, so I didn't break the skin at all.  So I tried again, with feeling.  And it didn't even hurt!  Not until I pushed the plunger did I feel anything, and that sensation was just strange, not painful.  The needle was so tiny.  I draw up flu shots at work from time to time and those needles are huge compared to these.  I could barely even see the bevel on the needle, that's how tiny they are.  I didn't bleed from the injection site at all.  Quick and pretty much painless, a good first experience.

Frankie has been my constant companion for the last two days.  He's napped with me and napped on me and been a great help making me feel better.  Everyone should have a sweet kitty like him after surgery to help you get better faster!

IVF update: Surgery and steps

Last Thursday Tony and I headed over to Dr. C's office for our IVF and Injection class. For the first hour one of the nurses, Sarah, sat down with us and went over the results of my ovarian assessment report. The results were good folks. Better than they had anticipated. This means that it should be easier to simulate to ovulation but more difficult in that they have to be careful not to over-simulate. She also went through our time table and stressed that all of those dates (that I put up in my last post) are just estimated and I only have a 50% chance of hitting them. Odds are that I will be close to those dates, but they will proceed according to how my body is responding to the medications.

What this means is that I will start my medication on schedule next week Tuesday, the 15th. I will stop my birth control as scheduled on the 20th. And on the 23rd I will go in for my baseline ultrasound and bloodwork. This will be the guideline of how my ovaries are reacting to the medications once I start them three days later on the 26th. I'll inject as directed by my calendar for four days and then I will head back to the office for another ultrasound bloodtest combo (which I will refer to as U/S-BT from now on to save myself from typing that everytime). Later that same day they will call me and tell me how things are going and direct me further on my medication. I will continue on the Follistim and Menopur, I just won't know at what the doses are until the 26th. Then two days later I will head back in for another U/S-BT. And later that day they will call with my new doses. And two days later I do it all over again. Lather, rinse, repeat...

Now this can change. If I'm developing slower than normal, I won't go every two days, I'll go every three days. And conversely, if I'm developing faster than normal, I'll go in every day. Sarah explained that these appointments are going to be super quick. I'll probably only be there for 15 minutes. Because of that, these are not appointments where you can ask questions about anything that isn't urgent. Its in and out. She said that they can feel hurried and impersonal and that's only because of how many they have to get through. Picture 15-20 ultrasounds from 8 - 10 am. With a nursing staff of two and one Dr. C. That's a busy morning for sure. She told me that later in the day, as they make the phone calls, they will be in a better position to field any non-urgent questions.

So, here I am, earning some serious frequent flyer miles at Dr. C's office and they get to U/S-BT to their hearts content. And all the while I'm injecting this and that, taking this and that. So one day, after one of my short and sweet progress report appointments, I will get a phone call telling me I am ready. This means that my ovary's follicles look nice and my bloodwork confirms it. When this happens I'll have about 36 hours until my retrieval.

They will schedule my surgery and 35 hours beforehand Tony will get to take out any of any frustrations he has with me by giving me an hCG intramusclar injection in the ass. Yes, you heard that right, my husband gets to shoot me in the ass. (The day of my retrieval he'll also start injecting progesterone in oil in my soon to be very tender hiney.) hCG will help mature the eggs for retrieval. Timing in this is super critical. Too soon and I'll ovulate the eggs they want to collect and my ovary will be empty. Too late and my eggs won't be ready for retrieval. So this is not a shot I will be able to put off until its more convenient. This one will have to happen exactly on schedule.

If I'm in the 50% of the population that sticks to schedule, this will happen on December 7th. But there is a strong possibility that is could happen anytime before or after that, probably within a few days. This poses a little bit of an issue with my work schedule. Retail and last minute day off do not go well together, but it can't be helped and we will just cross our fingers that the timing works. And if it doesn't... I'm going to have bigger things on my mind. Like making a baby :-D

At this point Sarah sent us to the lab end of the practice. The guy that actually will introduce Mr Sperm and Miss Egg. Mr. LabGuy has been doing this for over 30 years and said that Dr. C is as good as anyone he's ever worked with and has fantastic success stimulating the ovaries. He talked to us about what happens during the retrieval. Dr. C will aspirate a follicle and collect all of the fluid. This fluid will (hopefully) contain and egg and the cells that "feed" it. Everytime he aspirates a follicle the fluid retrieved will be turned over to Mr. LabGuy. He will then verify that there is an egg by doing a simple visual inspection, these guys are large enough to see without assistance.

This egg, and all eggs successfully retrieved, will be labeled with my name and date of birth and a color that will be assigned to me. They will aspirate all the follicles that have developed. Not all of these will contain viable eggs. But hopefully we will get enough. Once everything is collected they will place Tony's "sample" and my eggs on our own shelf in an incubator. After a few hours Mr. LabGuy will introduce them in a plastic petry dish with a growth medium. After about a day they will check them. At this point normal fertilized eggs should have two nuclei visible. If there are three in any they will discarded for having extra chromosomes. If they have not fertilized, they will be discarded. And someone at the lab will give us a call to let us know how our future possible babies are doing.

Sometime between day three and day five it will become obvious which embryos are the best. Either through process of elimination, or just from experience with their appearance. At that point they will book me for the implantation procedure. This will be another mystery date, but could fall on the 12th of December. I will not be allowed to work for four days. Again, this is not ideal in retail, but this is my baby we are talking about.

We both left with a better understanding of the process. I can't help but feel even more excited! Its getting so close, its starting to feel so real! It felt really real on Tuesday when I went if for my saline ultrasound. This was needed to really "see" the uterine lining. The process was simple. A vaginal ultrasound using the wand, which I've already begun to hate, and a catheter attached to a very large syringe of saline. Sarah had warned me to take 800 mg of ibuprofen before my appointment so I was sure it wouldn't be a fantastic experience. Personally I thought it sucked and was one of the most uncomfortable things I've ever had done.

First Dr. C inserted the catheter, which was also kind of a dry run for my implantation as a similar instrument will be inserted in the exact same place. Then Dr. C inserted the ultrasound wand and they added a small amount of saline. This caused a bit of pressure and cramping but worked to open the uterine cavity so the lining was visible. After about ten minutes of uncomfortable crampiness it was over. And they'd found two areas that could be a problem. Both of them were at the top of the ultrasound screen in little "clusters." One on the right the other towards the center. Neither were very big, and 99% of the time are completely harmless. But, the fertility medication can make these small, harmless polyps grow and become a problem. So I have to have them removed.

Sarah wanted to schedule this on Thursday, two days later. That was not going to be possible so we compromised and I will be going in for my first ever surgery on Monday at 6:45 am. I'm trying to focus on the positive in this. I get an extra day off that week. It's and outpatient procedure. It shouldn't hold up my IVF in anyway. And most importantly, its going to very similar to what will happen the day of my retrieval so that part of my stress from not knowing will go away. So wish me luck for Monday the 14th! On a completely side note, Tony and I might be moving. A friend of his family is a realtor and she has a client that is looking for a two bedroom, two bath condo in our area and he will be coming by to take a look on Sunday. Talk about a lot going on!

ps.  They had to reduce my dosage of Metformin to just one a day thanks to ALWAYS being nauseous and diarrhea like I've never had in my life.  For a month I dealt with that.   No longer!

I have drugs!

We received a very large box today containing all of the "goodies" I will required over the next couple months.

I sat down and laid everything out.  It still looks like a lot, but a little less intimidating.

The large red thing in the back is my needles disposal box and almost everything in the left two rows are needles and syringes (with the exception of the two amber vials and the bottom of the second row.)

I received my Lupron.

Lupron (aka Leuprolide) $5.00

I received my Follistim and Menopur.

This is just the injector, the drug is placed inside the pen.  Follistim $30.00

Menopur $283.96 (The expensive one!)

I also receive hCG.

hCG $$5.00

And my progesterone in oil.

Progesterone in Oil $47.00

And then the more normal things like the Doxycyline, diazepam, Prometrium, and methypredisolone pills.

All together my medications were $385.22.  Add that with my metformin, pre-natals and birth control and my total medication costs for IVF are $407.22.  Considering most people pay upwards of $3000, I don't think that's half bad at all.

I will be learning how to use all of these tomorrow.