Pre-IVF Appointment

I just got back from the RE where I had my pre-IVF appointment, which consisted of a catheter check/mock transfer, more bloodwork, and injection training. I also got my IVF calendar.

Catheter Check/Mock Transfer
- No one told me this part would hurt!!! I guess I never really asked either, but OUCH. The pain was comparable to my HSG, but the cramping is still going. Basically, the RE puts in the catheter that they use to do the embryo transfer to get an idea of where she is going with it for the real thing. She also used the vag cam, as if I wasn't already uncomfortable enough.

Bloodwork- This was our infectious disease panel. Mr. Sassy Bud got to partake in the blood drawing fun also. Too bad the nurse wouldn't give him the pink bandage like I requested.

Injection Training
- The first three injections I will be taking seemed like no biggie (Lupron, Follistim, & low dose HCG). The post ER drug, on the other hand, NOT fun. PIO- Progesterone in Oil- is painful and the needle is big.

IVF Calendar
- Basically I have one more week of BCP, a few days of Lupron, and then I start my other meds to stimulate my ovaries. Timing wise- I could be PG by Thanksgiving, depending on my response!

I don't have to go back for monitoring until next CD1, which should be about 2 weeks from today.

There, but for the grace of Tampax, go I.

Ah, to be in the house of Dandelion.

I'd love to say that the road to IVF #2 is fraught with blood, sweat and tears - but mostly, it's just blood.

I've been on my favorite devil pills for 6 weeks now. I just started pack number 3 of the desogen. At least I know I only have to take 5 pills from this pack - because my last devil pill will be this friday. Usually, after you stop taking the devil pills, you expect a period. However, i've already been bleeding for almost 3 weeks. Isn't it just fantastic? Usually, the ONLY benefit to BCPs is NOT bleeding. Not in Dandelion land... not this time, anyway. The good news, is that my IVF nurse says I might not bleed like I did last time i came off the devil pills, since i've been bleeding for so long. But I've been through almost 5 boxes of tampons. So, enough is seriously enough already.

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I had my baseline ultrasound this past wednesday. The good news: my antral follicle count is 11. So - that's not great - but it certainly doesn't suck. Our only question is how many of those eggs aren't geriatric. I guess time will tell. I found this chart (below) online... explains a little bit more about AFCs. I think my AFC last time was 14 or 15.

Total number of antral follicles	Expected response to injectable stimulating drugs and chances for IVF success
Less than 4	Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should consider not attempting IVF at all. Rare pregnancies if IVF attempted.
4-7	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10	Reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy success as a group.
11-14	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually adequate. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group slightly reduced compared to the "best" group.
15-30	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 30	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group may have egg quality issues and somewhat lower chances for pregnancy.

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Okay - so the question on everyone's mind... what the heck is causing the bleeding? .... what about the fibroid? Here are the answers to those questions....

The bleeding, as far as they're concerned is just an unfortunate and messy side effect of the BCPs. They are 100% sure that it is NOT from the fibroid, because the fibroid "has not deviated the uterine cavity". In other words, my lining appears on the ultrasound as a straight line. If the lining were interrupted, because a fibroid had broken through into the uterus, the line would be separated, interrupted or deviated in some way. It is not. So, Dr Z is NOT concerned at all. Therefore, I am not concerned at all. However, there isn't just 1 fibroid anymore. Now there are 3. Nevertheless, as long as they all stay outside of my uterus, where they are now, Dr Z could care less, and isn't even considering taking them out. Totally works for me.

I also discussed another concern with him. It seems that the majority of girls I talk to have an ultrasound guided embryo transfer and all have had a mock embryo transfer prior to their cycle. I hadn't had either - and I was curious as to why. Mr DB told me just to ask, so at my appointment i said, "Dr Z, i'm in a support group (he doesn't like that I go online all the time, so i figured he'd take it better if I told him this all came from a support group), and some of the girls were talking about their transfer experiences. I was wondering why it seems that some doctors do mock transfers and u/s guided transfers, and some don't?" He was SO awesome with his answer. First of all, I DID have a mock transfer... it's just that mine happened during my retrieval while I was unconscious. That works for me! Then we talked about the u/s guided transfers.

Apparently, they did do them for about 4-6 months when they first came in vogue. However, their pregnancy rates dropped by almost 15% during that time. Dr Z said that it is a matter of learning new technique and personal preference. He said that in his experience, you can focus too much on the picture, and even a minor movement can cause you to lose embryos. Furthermore, he felt t he full bladder was very uncomfortable for patients. He said as soon as he stopped doing the u/s guided transfers, his pregnancy rates went right back up, so unless he has a patient with a particularly difficult mock transfer, he prefers to NOT do them.

As his pregnancy rates are already above the national average, without u/s guided transfers, I say, "if it ain't broke, don't fix it".

What 8 grand worth of meds looks like

So, where we are now:

• Last devil pill will be this friday
• Suppression check Friday, March 5th
• Stims start, at max dosages, Friday, March 5th
• 1st monitoring appointment Tuesday, March 9th
• ER/ET will be the week of March 14th

This time it is going to work - POF be damned.

Introducing...

The ET went very smooth! We transferred 2 4AA perfect blasts! Before the transfer Dr. B the embryologist (she ROCKS) sat down with me and went over how the rest of our embryos were doing. So far, only 1 fizzled out (the 4 cell) and the rest of our little munchkins are still growing and she said we defintely already have about five to freeze and most likely more. Dr. V came in for the transfer and gave me a high five (he ROCKS too) and said he was very proud. The transfer took no more than 15 minutes and they made me lay down afterwards for 20 minutes. When I showed Mr. Blessed Bud the photo he smiled. Thank you all so much for your Thoughts & Prayers and Encouragement! Beta is 2/22... and God willing Our Little Munchkins are here to stay...

Have a Happy Valentine's Day...

Meetings, procedures & classes, oh my!

The last two days I have been staying pretty busy gearing up for our IVF cycle. Last night I attended the IVF Support Group meeting I talked about yesterday. When I got there, I saw a couple sitting outside in the hall & when I tried them, the doors to my fertility center (different location than my normal office - same place I went for my HSG) were locked. So I rang the doorbell & the group facilitator came out to let us in, the couple sitting outside followed me in, saying they didn't realize that there was a bell to ring! Then the facilitator, who is a licensed clinical psychologist, went back to her office to grab a few things. While we were waiting for the meeting to begin, the couple & I started chatting a bit. The other couple & other lady who was attending showed up about 10 min. later & we got started! It was really great to get to talk to people in similar situations & having similar feelings about their upcoming IVF cycles. One of the ladies attending even has an estimated ER three days before me! We all exchanged information & left saying we'd keep in touch. It was seriously awesome. I have absolutely no regrets about attending & I plan on doing it again next month if I am available - for sure! I highly recommend that anyone facing IF - whether you feel like you are really having a hard time or even if you feel like you are coping with your IF pretty well - attend a support group meeting either thru your RE's office or check out RESOLVE to see if there are any group meetings in your area. Talking to other women in a situation similar to you is really very powerful & takes away a lot of the feelings of being broken & isolation that you may be feeling. (Photo Credit for above photo).

Today I had a saline sonohysterogram (SHG) & mock embryo transfer (MET). I did not realize I was even getting an SHG until I got to the office & they gave me a paper to sign agreeing to undergo the procedure. I thought it would just be a MET, but I guess my RE likes to do both at the same time to ensure there are no problems uterine problems that had not been caught. Anyways, the whole thing went by pretty quickly. He inserted the cathetar & released a little of the solution in slowly. Mr. WB was right there with me & my RE showed us where the catheter was & the solution being released in side my uterus, and also showed us the shape of my uterus & ovaries - both of which he said looked perfect! No cysts or any other problems he could identify.

After that, we headed over to the injection training class. It was very informative & we got to meet a few other couples from our center. The nurse leading it was my nurse, who I LOVE! IMO, the scariest of the shots seems to be the HCG Trigger shot, but I think I will ask my sister (a nurse) to do that one for me. If she's unavailable at the time I need it (doing it exactly on time is VERY important as it must be done 36 hours prior to retrieval), then Mr. WB can do it. We start Lupron injections on Tuesday. I can't believe we are really getting this cycle started...hard to believe that our greatest wish could become a reality in just about a month! I am hoping that everything continues to go smoothly & my body responds well to the meds. As always, thanks so much for the all the T&P (sorry I always end like this ;o), but I really do want to express my gratitude to everyone thinking of us)! (Photo Credit for above photo).

We're approved, part II & staying positive!

This week, I have been working out all of the many financial details that go along with OOP IVF. We received final approval & signed off on our $20K loan for the shared risk program. Mr. Worry Bud & I are going to pay the other $2K OOP tomorrow when I go in for my mock embryo transfer (MET) & injects training class. Now, the only other thing money-wise is completing the FSA forms for reimbursement. Usually with FSAs, they require that all services you are being reimbursed for have been rendered, but in this case I'm not sure how they are going to handle it since technically "services" could mean anywhere from 1 cycle (hopefully!) to 6...more if you count the FETs that are included in the program. The financial coordinator from my fertility center says that she has had to deal with several patients who did shared risk & used their FSA for partial reimbursement & she doubts there will be a problem. I had a few conversations with an FSA representatives before signing up & they assured me that my IVF would be covered, so I hope we don't run into any road blocks with them. Mr WB & I agreed that I, Worry Bud - an avid questioner of circumstances - will never be completely satisfied with any answer any one gives me & to just take a leap of faith that everything will work out how it should, and so that's what we did. I will be talking to our RE's financial counselor tomorrow a little more about how to get the documentation for FSA reimbursement.

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Tonight I am attending a free (woot!) IVF support group the counseling group that works with my fertility center is holding. I am hoping to meet other women in a similar situation & gain even more hope & confidence that this will be it for us!! Tomorrow is my MET & injects training, and we got all of my meds on Tuesday (I'll post a pic of all the meds next time). I start Lupron injections & baby aspirin next Tuesday, so in just a few short days. So far, I'm feeling good & very positive about this cycle. As I mentioned before, I am doing a lot of preparation emotionally to get through this cycle - I know it'll be tough & I definitely have my moments of being worried if it will work or not, scared & nervous about everything I will have to endure, but I am trying not to focus on those feelings right now. I am acknowledging & accepting the fact that they are there...my IF counselor I went to see last week says that those are normal feelings & that I need to just accept that there is a certain degree of uncertainty, but in the end there's nothing you can do to change that, but how much energy you put into those feelings are what matter. So I am making a conscious choice to focus my energy on being positive & reflecting on the VERY exciting possible outcome!!! Again, thank you SO much to everyone who is keeping us in their T&P during this time...it means so much to us! :o)

We're Approved!!!

Yesssssssss. One less thing to worry about: we got a letter in the mail on Friday that we have been approved for our Fertility Center's Shared Risk program!! I was told that acceptance into the program was contingent upon completion of all fertility workup screening results + your mock embryo transfer (MET). All the testing is done, but we don't do our MET until this Friday January 22nd. I guess my RE, after looking over all of our test results, spoke to the committee & they felt confident enough to approve us for the program! I am sooo happy that we know we are approved, but now we have to pay up! We owe the full $22K for the program by January 23, 2010. We plan on putting down $2K, financing the other $20K & then using both of our FSAs to immediately pay the finance company $10K back. Then we hope to pay off the remaining $10K within a year. I left a message with my RE office's financial counselor to call me tomorrow to help me apply for the loan. Mr. WB & I have always been very responsible with money & thankfully, we both have excellent credit, so I don't anticipate there being any issues getting the loan. But, of course, I'm a worrier, so I always worry until something pans out, lol.

I also got the call about shipment our my meds from the mail order pharmacy - I overestimated how much the meds would cost us OOP...they will only be about $260 including shipping! We should be receiving our meds on Tuesday. I know that we are truly very fortunate to have this Rx coverage & God willing, if this cycle gives us a little baby Worry Bud, then I plan to donate any unused meds to an internet message board that I frequent's Rx donation program.

On January 22nd, I have my MET & injection training class, so hopefully that'll help me with my fear about giving myself injections. Then, on January 26th, I start my first Lupron injection, along with baby aspirin. That's only a little over a week away & I am surprised how quickly this cycle is coming up on me! I told my mom & sister the tentative dates for our IVF cycle & my sister is SO excited! She's trying for #2 & is hoping that we are pregnant together. She is so confident that it WILL work & she's hoping for twins for the WBs! We went to Target & browsed the baby aisle; she was just so positive & enthusiastic for me, it feels good to have her in my corner.

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Her confidence that this cycle will work for us really lifted my spirits & I have been really positive about everything all weekend. I hope to keep this optimism going into our upcoming IVF cycle. I don't think she'll ever know how much her support means to me. And with any luck (& some divine intervention), we will both be expecting new nieces or nephews soon!