"Everything's normal" ~ shouldn't that be a good thing?

After our IVF BFN, Mr. Chef Bud and I talked about our next steps. We can't afford to dive right back into IVF, and honestly I don't even think I would want to at this point. I feel like there is something wrong, and for a doctor to just label me unexplained and want to go right to IVF just doesn't seem like a smart decision. We decided to get a second opinion, and made an appointment with a a group affiliated with the local university.

Photo Credit

We had our first appointment last month and it was such a refreshing change from RE #1. Dr. M sat down with us for almost an hour and talked through all of my issues, our failed cycles and what he thought we should do to move forward. We set our plan for the next three months which included:

Month 1:

Antral follicle count ultrasound and day 3 bloodwork ~ to test for my "maternal age" and see if my eggs are on younger, on track or older than my actual age

Saline Sonogram ~ to check my uterus for abnormal growth such as fibroids or polyps

Month 2:

Endometrial biopsy ~ to see if my cycle is "in phase". This will be done during my luteal phase to see if my lining is doing what it is supposed to be doing during this time of my cycle.

Month 3:

Mock cycle ~ using estrogen and progesterone to see if we can get my lining where we want it and stop the spotting

So far I've completed the antral follicle count (17 follicles), bloodwork (all normal) and saline sonogram (no uterine abnormalities). I feel like I should be happy and consider this good news, but I just want something to be able to fix. I want the doctor to say, "Oh, lookie here...we'll just take care of this and you'll be good to go!" I am trying to look on the bright side and be thankful that everything looks good so far, but I have to keep reminding myself that being normal = good news.

While I wait for the next couple of months of diagnostic testing, I have been trying to improve my fertililty by improving my lifestyle. I got the book Making Babies after a friend recommended it to me, and I am doing my best to follow the program outlined for my fertility type. I have changed my diet to be (mostly) whole, unprocessed foods (eating organic when I can), I'm limiting alcohol to one day a week, taking supplements, focusing on relaxing and destressing and going to acupuncture once a week. I feel like these steps are good for my overall health so even if this isn't going to be the magic formula that gets us pregnant, I will still be healthier. It's been a hard transisition to change my eating habits, but I think I'm doing pretty good and getting better every week. At least I feel like I am doing something while we save for another round of IVF.

So for now we're just moving forward slowly, which is definitely hard for someone like me who likes to be moving full-speed ahead. I'm learning that I have to be patient and give these lifestyle changes some time to take affect in my body. I haven't spotted yet this month and I'm already on CD 18, so maybe this stuff is really working and I will have great news to report at the end of the month.

An overview of an IVF vacation

It has taken me a while to be ready to post this overview of our trip to Costa Rica and Panama for IVF. I wanted to be able to give anyone reading this a great review with details and advice, and I didn't want it to be tainted by my sad feelings about ours being unsuccessful. I hope that this will give some of you who are contemplating this route a better idea of what it was like and will help you make a good decision for you and your family. I'm warning you now, this will probably be long!

I'm going to break it into different categories and then do some general recommendations for those that plan to do a Costa Rica IVF.

Travel:
This was the best perk of the entire process (well, the price was pretty sweet too!). Mr. CB and I got to spend 19 days together traveling through two amazing countries.

Costa Rica is one of the most beautiful places I've ever been. There were so many activities, and our time there was filled with amazing adventures. I know other women who have traveled with their children to do this had a more difficult time traveling, but for us it was great. We spent time in three different areas of the country, plus some time in San Jose where we had our appointments. Being on vacation while doing an IVF cycle allows you to really relax and sometimes almost forget what you are there for. I do admit that I still had some stress and worry, but I don't think there is any way to avoid that while you are doing IVF. I definitely think that I was WAY less stressed and WAY more relaxed than I would have been if I were doing IVF at home.

In Panama, most of our focus was on the actual egg retreival and transfer. We were pretty much forced to stay in Panama City, so we didn't get to see as much as we did in Costa Rica. We rented an apartment near the clinic, which was a really good choice. It allowed us to be comfortable, make our own meals when we wanted and cuddle up on the couch and watch movies.

When you do an IVF vacation, at the end of the cycle, no matter what the outcome, you still have your memories and the time you spent on vacation. Our negative was so difficult, but I look back on our trip and I feel so fortunate to have had the time there with Mr. CB and it's an amazing memory that we will always have.

Price:
The reason we even looked into an IVF vacation as an option was because of price. We are totally OOP for IVF, and were looking at $10,000 for the cycle (not including ICSI if we needed it) plus another $2000-4000 for medication. Here is a breakdown of what we spent for our entire trip:

$2800 Procedure (ER and ET, including ICSI)
$85 x3 Monitoring appointments
$250 450iu Gonal-F (I had the rest donated ~ 1800iu's Gonal-F and 4 syringes of cetrotide)
$100 Estrogen patches (specifically for my lining ~ not needed by everyone)
$100 Progesterone shots
$350 Passport Medical fee

$1600 Lodging for the entire trip ($825 for 11 days in Costa Rica, $775 for 7 days in Panama)
$1000 Flights for 2
$385 Rental car for 11 days in Costa Rica
$2500 Money for food, fun and extras

$9340 Total Trip Cost

Doctor:
Dr. Perez is very nice and personable, and I felt very comfortable with him from the first day. There is defintely a language barrier. He speaks English, but I sometimes thought things I said or asked weren't fully understood. One thing I had wanted to know is if we had a fertilization issue, and I asked Dr. Perez if he could see if our sperm and eggs would fertilize on their own without ICSI. He seemed to understand and nodded and smiled, but when we got to ET we learned that all of them were ICSI'd without trying for a normal fert. My best suggestion is to speak slow, and get everything written down. Also be aware that the nurses don't speak any English.

Centro Fecundar is THE place to go for Costa Rican women who are dealing with IF. Knowing this before I went, I was expecting a big, state of the art facility. It may have been state of the art as far as technology but boy was it super small! The offices in Costa Rica and Panama were like mini-suites. For the ER and ET, I was on a table under a shelf in the corner of a tiny room.

When you go to your egg transfer, you have to be strong in your opinion of how many embryos you want to transfer. Mr. CB and I had spent a lot of time talking about this, and we knew if we had good embryos we were only willing to transfer 2. Once we got there and saw them, Dr. Perez and the embryologist tried to talk us into transferring more. They said that each grade 1 had a 20% chance of resulting in a pregnancy, so if we transferred 3 we would have a 60% chance. I'm not good at math, but even I know that it doesn't work that way. Using that math, we could have transferred 5 and had a 100% chance of having a baby! Do your homework and know how many embryos you are comfortable with transferring.

Protocol:
Dr. Perez uses a very standard protocol for all his overseas patients. All the other women who I know and have talked to that went were first time IVFer's and we all did the same thing. If you have a specific issue or have had slow responses with injectables, I don't know how or if he would change his plan for you. It seems like a one size fits all approach.

I did have lining issues, and he prescribed estrogen patches to help with that. I actually had the best response out of all my treatments as far as my lining goes. One thing I look back and wonder is if I was oversuppressed. I was on birth control pills for over five weeks, and my antral follicle count and the number of follies I ended up with was definitely low compared to previous cycles.

Passport Medical:
We used a medical tourism facilitator to help book the appointments with Dr. Perez. For me, it was helpful to have someone take care of all of that, and I did get some good information about what to expect before we got there. I think the price was high for the services we received, but the company did do what they said they would.

The other American we met and spent time with that was there for IVF didn't use Passport Medical and booked directly through Dr. Perez by email. She did have some mix-ups about where the clinic was located and didn't receive all the helpful tips that I did.

If you are booked and ready to go, here are some of my tips:
~ Make a binder and keep everyting together and organized. I had tabbed sections and was able to keep my medical records, appointment information, travel confirmations and other travel info together. My binder was by my side the entire trip!
~ Travel in Costa Rica! See the sights and really enjoy all it has to offer while you are there. We went to Arenal, Monteverde and Manuel Antonio.
~ Rent a car in Costa Rica. Many websites have scary stories and people seem reluctant to rent a car there, but we had a great experience. It was so nice to be able to stop on a whim and go where we wanted.
~Get a vacation rental in Panama. We used http://www.vrbo.com/, and it was so nice to have an entire apartment to relax in for the week. Find somewhere close to the clinic...it's in the middle of a nice area with a huge mall so there is a lot going on.
~Bring your own progesterone if you can. I'm still a little iffy on the progesterone they give you. I had a hard time finding information about it online (it's not used in the US) and I ended up switching to endometrin because I started spotting through the progesterone.
~Bring a video camera to ET. You can video your embies while they are on the computer screen and get pictures.

I think that going to Costa Rica and Panama for IVF was a great idea for us. Even though it was unsuccessful, I wouldn't change it. We were unexplained and told we had a 70% chance of being successful with IVF. Going to CR/Panama allowed us to do our 1st cycle, spend less money, and get a great vacation. For our situation it was a good fit.

I hope that this gives you a better idea of how this works, and the pros and cons. If anyone has any specific questions, please don't hesitate to email me at chefbud10@gmail.com.

No Regrets

IVF #1 is officially a BFN. I already had my freak out, hyperventilating, can't speak, heartbreaking moment last week when I started spotting heavily at 5dp3dt. It was so familiar and so much like every other negative cycle that I really felt we weren't successful. I did switch my progesterone support from injections to endometrin and that stopped the spotting, but I had a negative HPT on Saturday and AF arrived today.

At this point I'm surprisingly calm and collected. I've had some sad moments this weekend as Mr. CB and I discussed our next steps. I would like to get right back in the game and cycle as soon as possible, but our finances don't support that move. We made a decision yesterday to work towards paying off all of our credit card debt by the end of the year, and plan to cycle again in January. In the meantime, I'm going to get a second opinion from another RE and talk to them about some other tests such as a hysteroscopy or laparoscopy to see if we can't get a better idea why we're not getting pregnant. When we do cycle again we will go with a clinic that offers the Attain IVF Refund Program. Even though it's more money initially, after having one failed IVF completely OOP we need to know that we will have the option for multiple cycles if we need them.

We have no regrets about our decision to go to Costa Rica and Panama for IVF #1. It would have been sweeter if we had brought back a little souvenir, but for us it was a good decision. I am planning on posting a full overview soon that details the entire experience and what went well and the difficulties we experienced. I will say that if you have a chance to visit Costa Rica, GO! It was the most amazing place I've ever visited.

This little guy says come visit him in Costa Rica!

Mr. CB and I thank you from the bottom of our hearts for your thoughts and prayers throughout our travels and procedures. It means the world to us! We may have lost this battle, but we are still fighting and I know that we will have a baby Chef Bud one day soon.

Embies on board!!!

We just got back from our embryo transfer and everything went great! I had 4 embryos that had grown and divided like they were supposed to, and the doctor took us right back to the lab to see them and explain each one. We had 1 grade 1 (which is the best) and 3 grade 2's.

We went into the procedure room and found out that my lining was at 10mm!!! I was so very excited about that...it's so important to have a nice, fluffy place for the embies to get comfortable. We were able to watch everything on the screen, and saw a little white flash when the embryos went in to my uterus. It was just amazing.

I had to lay on the table for 10 minutes afterwards, which was torture because I had to go to the bathroom so bad. You have to drink a ton of water so you have a full bladder which helps the doctor guide everything in via ultrasound. That was the worst part of the whole thing...all the other parts were quick and easy.

The embryologist came and talked to us after it was done, and said the grade 2 we put back was actually very close to a grade 1, so both were excellent quality.

We were able to take a video when we were in the lab, so here are Olive and Oliver! We think they look like little olives =)

So excited to meet my embryos!

I am just so excited for my embryo transfer today. I haven't had any kind of report on my embryos other than six are fertilized, so I have been anticipating my appointment today to see how they are all growing and dividing. I can't believe in 6 hours I will have embies on board! I'll be back tonight with an update and hopefully a picture!

I have embies!!!

Yesterday was my egg retrieval and it went better than we could have hoped. I was very nervous beforehand, but it was a piece of cake. I changed into my lovely hospital gown, hat and booties, laid on the table, the anesthesiologist set up my IV and...that's all I remember! I was completely out of it and couldn't even tell you how long it lasted. The next thing I remember is waking up in a different room and the doctor telling me he retrieved EIGHT eggs. I was so excited since at my last ultrasound on the 10th we only saw five. I think three of them must have been a little camera shy =) but I'm glad they found their way out. I rested for a bit, got my first progesterone shot (which didn't hurt but I'm sure the fact that I had just been under anethesia had something to do with that!), and then Mr. CB brought me back to our Panama apartment. I am SO happy that we rented an apartment instead of just having a hotel room. It is so comfortable and big, and being able to cook meals and relax on our balcony is awesome.

I felt great last night. I had some minor cramping, but nothing too bad. Mr. CB still insisted on taking care of me, and I didn't resist! He made me dinner, massaged my feet and went out to get me ice cream for dessert. He's a good man.

Today we went out for a little sightseeing around Panama City's oldest neighborhood. Before our walking tour, we stopped by the clinic (it's right across from our apartment) to check on our eggs. The clinic here doesn't do a day 1 morning fert report as they don't like to disturb the embryos, but Dr. Perez told me yesterday I could check back to see how many of my eggs were mature. He told me all eight were mature, and that SIX fertilized normally! I am so happy to have six embies growing strong. I can't wait until Thursday to hear how they have progressed. This is the hardest wait so far, and I'm glad it's a short one.

Mr. CB and I are really enjoying our time together. This is the longest we've ever had to spend together without work or other interuptions, and I'm loving every minute of it. We were lucky that our trip coordinated with my birthday (on the 3rd) and our 3rd wedding anniversary, which is tomorrow. I feel like it's been a lucky and blessed few weeks! Here's a wedding pic in honor of our anniversary...

My transfer is Thursday at 2:30 PM (1:30 PM EST). I have such a great feeling about this!

An Overdue Update

Hola! I apologize for not updating sooner, but we've had spotty internet service and have been super busy exploring this amazing country. I am in LOVE with Costa Rica. We haven't even left yet and I already can't wait to come back!

First things first, let me get you up to date on our medical progress. I had my follie check on Wednesday, July 7th and it was a little disappointing. I had 7 follicles that were measuring between 10 and 14 mm, and my lining was a measly 4 mm. I will be honest and say that I was positive that I would have over 10 follicles. I had 8 at my last failed IUI, and now I am doing stronger meds and for a longer amount of time. I teared up in the bathroom as I was changing, but Dr. Perez assured me (as did my friends who are in the know with IVF) that it's QUALITY over quantity. The follicles are growing together, and it's much better to have a few great eggs than a bunch of mediocre ones. The lining was definitely a concern, as I knew it probably would be, and Dr. Perez prescribed estrogen patches to help it along.

My second follie check was today, and the great news is that my lining is 7.4! That's the same as my last IUI, and the thickest I've gotten it. Plus, I still have a few days for it to fatten up even more before transfer. Today Dr. Perez only recorded 5 good sized follicles, so some decided to stop growing or maybe there are even some hiding. I am in a great place mentally right now and I am totally trusting that everything is going to work out. I know my 5 are rock stars!

I have to set my alarm for 3 AM tomorrow to do my trigger shot, then we fly to Panama early Monday morning and egg retrieval is set for 3 PM, Panama time! I can't believe we are already here! I am super excited, but nervous as well. I've never been under any kind of anesthesia, and the unexpected does make me nervous. But I know everything will turn out just right. I had already looked up my estimated due date in anticipation of having my ER on the 12th (just trying to be positive =), and it would be April 4, 2011. That is my Granny's birthday, and she passed away over 6 years ago. She was the most amazing woman ever, and I know for sure that she will be looking over us through this huge event in our lives.

Our adventures in Costa Rica have been unbelievable. After we left the volcano, we headed to Monteverde, where we ziplined through the rain forest and over huge mountain valleys, and also hiked in the Monteverde Cloud Forest. We saw the rare and famous quetzal (a bird that people from all over the world travel to CR to see) and hiked to the continental divide and a waterfall.

We headed next to the beach and Manuel Antonio. We visited the national park with a guide and saw a ton of sloths, monkeys and even a boa constrictor. We hit the beach for the afternoon where Mr. CB had a chance to surf and had some amazing meals. The best part of the stay there was our visit to La Reserva, where a friend has an amazing house. It was between rentals so we were able to enjoy the infinity pool for the entire morning and then had a couples massage on the back deck. It was ultimate relaxation, and just what we needed to relieve some tension before heading to Panama.

Now we are in San Jose and plan to spend tomorrow in the city checking out some historical sites, the market and finding a fun place to watch the World Cup final. Then bright and early Monday it's off to Panama for the next step of our adventure! We have internet in our apartment in Panama and I'll be on bed rest that first night so I will make sure to update you on our ER.

Pura Vida!

Hola from Costa Rica!

Hello Bloomin' Babies readers! I only have time for a quick update, but wanted to let you know that we arrived here in Costa Rica safe and sound. We have had an amazing 3 days, and I can't believe we still have over a week left to explore this beautiful country.



My first appointment was on the 1st, and we drove straight to the clinic from the airport. We met Dr. Perez, discussed my history, did a quick ultrasound which revealed that my ovaries were quiet as expected, and did my first injection of Gonal-F. I'm taking 225iu's a day, and I go back on Wednesday the 7th for my next ultrasound. That will be the big one that gives us an idea of how I am responding and how my follicles are looking. I have been thinking about it and hoping for the best, but we have been able to do some really cool stuff and also relax a LOT, so I'm not stressed or worried at all. Thanks for all the good vibes coming my way, I appreciate it!



Here are two pictures from our stay at Arenal Volcano...the first from a hike we took to a waterfall and the second was the view from our lodge.



Pura Vida!

Goodbye USA, hello Central America!

Today is our last day at home, and I am running around like a chicken with my head cut off. I procrastinated on packing, and now I am frantically trying to get everything together. So far I am shocked that a. everything seems to be fitting in to our suitcases and b. that I haven't had to make a last minute Target run for something I forgot.

I had mentioned before that there were some definite pros and cons to choosing this option for IVF. Since I'm short on time, I'm going to do a quick version and if you have any specific questions feel free to contact me!

Pros~

1. The most obvious positive is cost. $2800 for IVF (including ICSI), $85 for each monitoring appointment, and about half price medication. Freezing of embryos is $500 and a FET is $1000.

2. In addition to an IVF cycle, you have the opportunity to vacation in two amazing places...Costa Rica and Panama.

3. During your cycle you are away from work and everyday life stresses so it may be easier to relax and keep your stress levels low.

Cons~

1. You have to be away from home for at least 18 days. For me it was easy because I work at a school and am off in July. For Mr. Chef Bud, not so easy.

2. You have NO contact with the doctor until the day you show up in Costa Rica. I coordinated everything through Mark with Passport Medical, and he was quick to get back to me or pass my questions on to Dr. Perez, but I will not personally speak to Dr. Perez until we get there tomorrow.

3. There is a lot of planning you have to do for the traveling part of this whole thing. Personally, I love to plan trips so it was fun for me, but I know not everyone enjoys that.

That's a quick and dirty version of the pros and cons. The biggest thing I will say is that you have to have a pretty laid back personality, and be able to trust in the doctor and his method (even though you've never met him) for this to be a viable option for you. For Mr. CB and I, we felt like this was our only option. We weren't willing to pay $14,000 to cycle at our local RE. We have one shot right now...if this doesn't work we will have to take a year or more off to save money and figure out a next step. But it was important for me to feel like I had tried EVERYTHING to get pregnant, and that ended up being IVF. So even though I tend to be someone who needs to control everything and wouldn't usually describe myself as laid back, for this I had to let all that go and just trust that this could work for us.

So, off we go! Our plane takes off tomorrow at 8:04 am EST, and we should be in Costa Rica by 1:30 EST. I will try to update as I can along the way. We appreciate all your positive thoughts for us as we embark on one of the greatest adventures of our life!

Photo Credit

Our planned adventures in Costa Rica and Panama

One of the biggest things that attracted us to doing IVF out of the country is that in addition to getting a great price for the procedure, we would also be able to visit two amazing countries that we've never had the chance to experience. I'm sure many people would want to take it easy and relax during an IVF cycle, but for me, the busier I am, the better. I need whatever I can get to keep myself occupied so I don't stress about the cycle and how it's going.

Mr. CB and I are adventurous travelers and since it's just the two of us, it was easy to find great things to do in Costa Rica. I bought a Frommer's Costa Rica book and pretty much focused on three major attractions that were close enough to San Jose for us to travel to around our appointments.

The Chef Bud's Costa Rica/Panama Itinerary:

Day 1: Arrive in Costa Rica, pick up rental 4x4 ($385 for 11 days), and head directly to first monitoring appointment with Dr. Perez. After our appointment we are driving about 3 1/2 hours to Arenal, which is an active volcano. We're staying at the Arenal Observatory Lodge (cost per night $104), an ecolodge that offers lava views from your room!

Day 2-4: We'll be touring and hiking around Arenal. The lodge offers free guided hikes each morning, and horseback riding for $7! There is a waterfall nearby called La Fortuna Waterfall that we plan on hiking to, and we'll celebrate my birthday on July 3rd by whitewater rafting on the Rio Toro.

Photo Credit

Day 4-7: On the morning of July 4th, we'll drive about 5 hours to Monteverde. Monteverde is known as the cloud forest, and is a huge ecological reserve. In Monteverde we plan to zipline and hike through the reserve during both the day and night (unless I chicken out at the thought of a nighttime hike!). We're staying at Pension Santa Elena, a hostel that has great reviews (and is only $45 a night!).

Photo Credit

Day 7: We'll leave Monteverde and head back to San Jose for our afternoon appointment with Dr. Perez. Hopefully we'll have great news with lots of follicles and a thick lining! After the appointment, we are heading 2 hours southwest to Manuel Antonio.

Day 7-10: For the next 3 nights we'll be staying at Verde Mar ($70 per night), and exploring Quepos and Manuel Antonio National Park. This is Costa Rica's smallest national park, but one of the most diverse with rainforest, beaches and coral reefs. By this point, there is a chance that I will be feeling a little uncomfortable so we don't have many plans other than to lay around on the beach and see the famous monkeys around Quepos. Mr. CB wants to surf, and I'll stick to taking pictures.

Photo Credit

Day 10-11: We go back to San Jose on July 10 for our final monitoring appointment. At this point, Dr. Perez will schedule our egg retrieval date. For these 2 nights we're staying at Out of Bounds B&B ($80 a night) which I am so excited about because it looks super cute. We don't have many plans for San Jose, other than dinner out with Holly and her family. I "met" Holly online through Tracie (who went to CR in May for IVF), and Holly is doing IVF with Dr. Perez as well. We've been emailing and I can't wait to meet her!

Day 12: Off to Panama!!! Once we land in Panama, we have a driver meeting us to take us to our apartment. I knew a lot of our time in Panama would be spent relaxing and on bed rest following egg retrieval and egg transfer, so I wanted to have all the comforts of home. I found a great apartment on vrbo.com, and we'll be staying at Posada del Rey ($770 for the week), which is right near the clinic I'll be going to for ER/ET. Panama City reminds me of New York City.

Photo Credit

Day 12-19: We don't have anything specific planned during our time in Panama because we don't know yet when ER and ET will be. We plan to see the Panama Canal and go out to a nice dinner to celebrate our 3rd wedding anniversary on July 14th. Other than that, we're going to play it by ear! We fly home July 19th, hopefully with some great embies on board!

Photo Credit

You're going where to do what???

Planning this trip to Costa Rica and Panama has been a very interesting process. We decided early in April that this was the best option for Mr. CB and I, but there was so much uncertainty about Mr. CB and his work schedule that it wasn’t possible to book everything right away. It was a weird place to be ~ we knew I was going the whole time, but didn’t know if Mr. CB would be there the whole time, or if he would be there half the time and my mom would be there the other half, or if all three of us would be there together some of the time. For someone who likes to go full steam ahead once a decision is made, it was very difficult! We finally made the decision the first week of June that Mr. CB will there the entire time with me. This makes me extremely happy, of course. In a future post I’ll detail our travel plans and the fun exciting places we will be visiting, but I think most are wondering about how this whole IVF in another country works…so I’ll start there.

The doctor I will be seeing is Dr. Ariel Perez Young. His practice is established in San Jose, Costa Rica, and from what I’ve heard, it is THE clinic to go to if you’re struggling with infertility. I haven’t spoken to Dr. Perez at all. Any contact I have is through Mark Semple, the president of Passport Medical. He’s basically my middle man (which is good since I don’t speak any Spanish!) and he has set up all of my appointments and answered any questions I have about the process. If I have a question for the doctor (I was wondering a few weeks ago what his minimum lining thickness was for transfer), then Mark will email Dr. Perez and then get back to me.

I started birth control pills when I started my May cycle. Luckily I started my period towards the end of the month, so I will be on the pill for a total of five weeks. This will suppress my ovaries and allows my cycle to line up with the time frame needed for travel. I stop the pill on June 26, and fly to Costa Rica on July 1. I will have my first monitoring appointment that afternoon, and start my stimming medicine that day as well. I go back for monitoring on July 7 and July 10. Hopefully I have tons of great looking follicles and at this point my egg retrieval will be scheduled.

On July 12, we fly to Panama with Dr. Perez. The reason you have to go to another country is because IVF is illegal in Costa Rica. I did a little research, and basically back in the early 2000’s IVF was banned in Costa Rica because of religious reasons. There are still some artificial reproductive technologies that are acceptable, but IVF is not one of them. So to get around this law, Dr. Perez takes his patients to nearby Panama to perform the actual retrieval and transfer. We’ll be in Panama from July 12-19, and during this week we will have the retrieval and transfer. We fly home on July 19, and then wait a few days before POAS! Any after care I need will be through my OBGYN.

So this in a nutshell is IVF in Costa Rica and Panama. It’s a lot of planning and traveling and uncertainty, but the same can be said for an IVF cycle in the US. What is really different is the price. We had a quote from our local RE of about $14,500 for IVF and medications. We will be approximately $4500 for the same procedure and the same medications in Costa Rica/Panama. The IVF is $2800, three monitoring appointments are $85 each and medication is roughly $1500. Even when we add in our travel costs, we will be well under what it would have cost us here. And we’re going on a vacation for 19 days! You can't beat that!

Hi, my name is Chef Bud and I am BACK!

Hello to all the Bloomin' Babies readers...I know it's been a while and I'm sorry to have kept you waiting so long but I am back and boy has my story taken a different turn!

In my last post way back in March I told you all that our doctor had suggested we move to IVF, and I was looking into the split donor cycle that my RE offered. Shortly after that post, I heard back from the split donor coordinator, and she basically told me that because of my family medical history, I would only be accepted with reservations (and this would be after extensive tests and interviews) and that most likely I would never have a couple choose me to be their donor. It was so hard to hear this...I am a healthy young woman and my RE seemed so sure of this being the perfect fit for us. But I also understand that when a couple makes the hard decision to use donor eggs, they want everything to be as perfect as it can be with those eggs.

So once that option was out, Mr. CB and I were back to square one. The OOP cost at my clinic for IVF is $9300 (ICSI is an additional $1100) plus the medication which could be anywhere from $3000-4000. I was prepared to do anything to make this happen, but I also wanted to be financially responsible. We have worked so hard over the past few years to get out of debt and neither one of us wanted this to put us right back where we were.

While posting on my favorite message board I had seen a post that talked about going out of the country to do IVF. I thought it sounded interesting, so I started doing some research. I found a company called Passport Medical that assists people with medical tourism. I began emailing with Mark, the company's president, and discovered that IVF in Costa Rica/Panama costs $2800 (including super-ICSI) and the medications are half the price of what they cost here. Right away I got on the internet and started pricing out flights, accommodations, rental car and other costs that we would incur over a 19 trip to two countries. I was amazed to find that we could travel to two beautiful places, stay in nice hotels and apartments, see some amazing sights...oh yeah, AND do an IVF cycle...for under $10,000. I was immediately ready to sign up! Photo of Arenal Volcano

It did take some time for Mr. CB to warm up to the idea, and even longer for our families. Once I showed them the statistics for the clinic, and Dr. Perez's credentials and training (he even trained and worked at a top US hospital), everyone was on board. What made me even more comfortable with doing this was that Mark and his wife were going to do their cycle in Costa Rica/Panama in May. He was able to share his experiences and why they felt good about traveling thousands of miles for IVF.

I will say this option isn't for everyone. There are some drawbacks that I will talk about later...let's just say you have to be really laid-back and able to just trust in the system without a lot of questioning. I will say for me, so far so good...I am excited, nervous, hopeful, scared, optimistic. A lot of emotions all rolled into one.

I have so much to tell you about the process but I don't want to bombard you all at once! So over the next few weeks I'll explain how it all works and give details about what went in to planning the trip. Right now I'm on week three of devil pills, which I will take until June 26th. We fly out July 1st and will have our first appointment that afternoon.

In Costa Rica, they use the term "pura vida" as a greeting or farewell. When I looked it up, I found that they use the phrase to express perseverance, resilience in overcoming obstacles, enjoying life and celebrating good fortune. This is definitely our theme for the trip, and our new mantra!

Photo Credit

Not a Goodbye, but See You Later

I will be the first to admit that I haven't been around much. The past few weeks have been a bit crazy, both with TTC and just our lives in general. We've had two weddings, a shower and bachelorette party (that I planned and hosted), a bad car accident and having to buy a new car, crazy work schedules and trying to sell our house. Oh yeah, and IUI #2. Needless to say, I feel like we've been spinning in circles. And the trying to conceive part hasn't gone too well.

Photo Credit

In my last post, I talked about my injection class. I learned how to use the follistim pen, and was gearing up for my first injectable cycle. I will say now that the follistim injections were a piece of cake, and after the first couple of days I couldn't even feel the needle when I gave myself the shot. I ended up doing six days of shots, and at my final ultrasound I was told that I had five mature follicles. Yes, you read that correctly...FIVE mature follicles. The nurse said that my RE would cancel my IUI cycle if we had six follicles, but with five the choice was mine to continue or cancel. Mr. Chef Bud and I had many conversations about our options, and I talked to a close friend that has dealt with IF, and we decided to continue with the cycle. I didn't want to look back and have any regrets. I triggered, had a lining that was thicker than ever before (7.4), had 37 million sperm post wash with five follicles. Everything was lining up for a perfect cycle and a BFP...



Until AF arrived. I started my period 9 dpIUI, and honestly, I was devastated. If 37 million sperm and five follicles couldn't produce one baby, there had to be something else going on. I stayed home from work on Monday to get myself together and made an appointment with my RE for Tuesday to talk about what happened and what to do next.


She had no explanation for why it didn't work, which is what I expected with an unexplained diagnosis. What she did suggest is for us to move on to IVF. The way she explained it was that she would have more control with IVF, and would be able to look at other factors including egg quality and fertilization to see if those might be something that is affecting our ability to get pregnant. I understand the rationale behind moving to IVF, but I will be honest when I say that I was really scared. I just never thought I would be at this point, and it was really hard to deal with. Mr. CB had a really hard time with it, especially the financial aspect. He is the money man at our house, and thinking about the cost associated with IVF just blew his mind. We knew we definitely had some long converstions ahead of us.

Photo Credit

We ultimately decided that we needed to move forward in our journey to start a family, but we needed to be financially smart as well. Lucky for us, our clinic offers what is called a split donor cycle. Basically, we will be matched up with another couple who needs an egg donor. I will do an IVF cycle and donate half of my eggs to this couple, and in return I will have a reduced rate for my cycle. In my eyes, this is a win-win situation. Mr. CB and I are able to pay about half of what a standard IVF cycle costs (really important since we are 100% OOP) and we are also able to help another couple whose only shot at having their own child is with an egg donor. I feel very strongly about this since I have seen firsthand on my message board the heartache that women face when they are told that their own eggs are not good enough to create their baby.

Right now we have filled out the donor paperwork, I have talked to the coordinator and we are waiting for them to go over my chart and decide if we are accepted. Once we get the approval, we have to make sure we have all the preliminary testing done, and then we wait for a match. To be matched, a couple has to choose our profile as their donor. It is all anonymous, and I've been told it takes 2-3 months. Once a match has been made, we will do genetic and psychological testing and if all looks good, the recipient and I will go on BCP's to make sure our cycles coincide and then we are on our way. I am hopeful that we will be on our IVF journey sometime this summer. That thought is both exciting and scary.


I have decided that for the next couple of months I will take a break from the blog. We won't be doing much other than waiting to be accepted and then to be matched, and I think it's important for me to focus on other aspects of my life. I have pushed so many things to the back burner since I've been TTC, and now that I have a plan in place and know I have a break ahead of me, I think I should focus on some of those things that have fallen by the wayside. I hope that you will still be interested in my story when I return, and I promise that as soon as I have a match and my IVF cycle is underway (hopefully soon!) that I will be back to let you all know what the process is like. Thank you so much for all of your support and love as Mr. CB and I embark on this next part of our journey!

Injection class = check!

Today Mr. CB and I went to the injection class to learn how to do the injections for our next cycle. We got there and the nurse brought us back to the conference room and had all the supplies laid out on the table. I found out I will be on follistim, and we're using an injection pen. It was really easy to learn how to use, and I'm confident that Mr. CB and I will be able to figure it all out once we start. When my RE gave me the estimate for the cost of an injectable cycle, she said it would be $1500-$2000. That was definitely a little bit stressful, so we were really excited to find out that the amount we need will be $750. Still a lot of money, but half as much as we thought!

Photo Credit

One of my biggest worries is overstimulation. When I asked the nurse what would happen if I had too many follicles, she said the cycle would be cancelled. I didn't know if they would be able to convert to IVF or what. I really don't want to spend over $1000 on meds and doctor visits only to be cancelled at the last minute. The nurse said I would be on 150IU per day for five days. Since I don't have any problems with ovulation or follicle growth I worry that this will be too much. I am just going to trust in the doctor and know that they know best.


The only issue that I don't know if the RE has addressed for my upcoming cycle is my lining. It's bad timing, but my RE that I've been working with is on maternity leave so she didn't have any input on my meds for the next cycle. I asked the nurse today about my lining, and if the follistim will be enough to get it to where it needs to be or if I need to take something else to boost the thickness. She said my doctor is returning from leave on Monday so she will talk to her and find out.


So now it's just a waiting game. I should start my period the first week of March, then I will go in for a baseline ultrasound and get my medication ordered. The amazing thing to me is that I usually don't ovulate until around day 17. But on the follistim, I will take the medicine from cycle day 3 to 7 and then should be ready to trigger! So my 27 day cycle will be cut down to about 19 days. Crazy.


Today when I got home, I checked the mail and I had a package from Worry Bud! She sent me the cutest little penguin, a prayer card to keep in my wallet and a sweet card. With all that she is going through right now with her IVF, I am so thankful that she is also thinking of me and what I'm going through. I love you Worry Bud and am praying for amazing news for you in a couple of weeks!

IUI #1 = BFN

I found out last week that our first IUI didn't work. It's been almost a week, and I think it's taken me that long to come to grips with my emotions and to start feeling like me again. I will be the first to admit that I was a wreck. When I first found out Thursday morning before work, I felt like someone was standing on my chest and I couldn't breathe. I spent Thursday in a depressed fog, and then Friday became a miserable brat. I was mean to Mr. CB and just felt so sorry for myself. We went to Orlando to see my best friends, and had dinner at a friend's house Saturday night. When the talk turned to babies (they all have little ones around a year old) I just couldn't take it. I left the table, cried in the corner of the kitchen and then felt like crap for making my friends feel like crap.

Photo Credit

I am still sorting through my roller coaster emotions, but I think I am getting a better handle on how to stay positive. I think I spent so many months being ok with what was happening and getting through the BFN's without a lot of melt downs, but now it's caught up to me. During the IUI cycle, I kept thinking it wasn't that big of a deal, it was JUST an IUI, that so many girls have been trying longer and are doing much more serious procedures like IVF and dealing with worse diagnosis, like MFI or PCOS. I have realized that I can't minimize what I am going through, and my struggles and emotions are just as valid as anyone else dealing with a different stage of IF.

Our original plan was to take a few months off if the IUI didn't work, but of course that has changed! When I realized the IUI didn't work, I decided that night that I wanted to move on to the injectable cycle right away. I called the doctor first thing Friday morning, and learned that I had to take an injectable class before I could even start. So February was out. Right now, I'm signed up for the class next Friday, and my nurse is working on getting my medicine list and doseages. We are all out of pocket for injectable meds, so we are expecting to spend $1500-$2000 on the meds I will need. I can't believe we are spending so much money for something that may not even result in a baby, but right now we're in this 100%, and will do what we need to in order to bring home our Baby CB.

Photo Credit

We've also looked into acupuncture. I read a post on an IF message board about a woman who saw an acupuncturist and had significant lining thickening, so I figure it's worth a try. We're hoping to get in next week for our first consult. I feel like even if we don't get specific results in regards to fertility, it will be something to help me relax and de-stress...which I definitely need right now!

Photo Credit

Feeling strangely calm this 2WW

I really thought I would be a mess right now, stressing and feeling anxious about our first IUI 2WW. But honestly I am feeling pretty good. I don't have any inclination one way or the other if the IUI worked or not, but I know that we are doing all that we can and if it doesn't happen this month we will figure out our new plan and move on. That is a pretty big deal for me to feel so calm!

Our IUI on Sunday was very uneventful. We were up really early to be at the RE's office at 7:30 for Mr. CB to do his thing. I had a sono that showed my lining went up to 7.05...not great, but better than it has been. Then came the waiting game. My appointment was for 9 am, but we didn't end up getting called back until about 10. I was surprised that it wasn't a doctor that did the procedure, but a nurse. She was very sweet, and talked us through the entire thing. She did have some problems getting the catheter in and had to use some kind of other tool but it found it's way eventually. I had a little bit of discomfort but nothing too bad. Mr. CB held my hand and when it was over and the nurse had left, he kissed my belly and we said a little prayer that this will be our month.

Photo Credit

On Monday, I had an appointment with a therapist to talk about all my emotions that I am feeling as I deal with infertility. I have an EAP program through work that is free, and since we are spending so much money on my treatments, I wanted to try to use it to save some money. They sent me a big list and I basically just had to pick someone out and hope for the best. They didn't have any providers that specialize in IF, so they gave me family counselors. I went in to the appointment hoping that she would help me deal with some of my crazy feelings, but when she told me to wear a rubber band and snap my wrist each time I thought about getting pregnant so I could "refocus" my thoughts, I knew this was going to be an unsuccessful visit!

Photo Credit

I am going to try to find a support group or counselor through my RE's office or some websites friends have shared. I know now that it's really important to find someone who has experience dealing with an IF patient.

IUI #1 is scheduled!

Our first IUI is scheduled for Sunday and I am feeling such a mix of emotions. I am excited, nervous, optimistic, scared and worried all at the same time. When we went in this morning for our ultrasound, they told me that my follicles looked great (I had three at 18, 15 and 14) and the my lining looked better but not great (6.5). I asked the nurse what she thought about us doing an IUI and she said it was up to us. We asked to talk to my doctor, and she is on maternity leave! So we just had to make the decision on our own. We talked to the financial person to get an exact price, and we decided to just go with it!

I am doing two more days of the estrogen patches in hopes that by Sunday my lining will get a bit thicker. We have to go in on Sunday at 7:30 am for Mr. CB to do his thing =) then the IUI is scheduled for 9 am. It seems like a pretty easy, painless process. It's amazing to me that when I first started this TTC journey, things like IUI's, RE's, trigger shots, etc. were foreign and scary, and now they are my everyday life.

I have been feeling the past few weeks that IF is taking over my life. Mr. CB has been very worried about me, and how down I've been. I know I need to not worry and not stress because I can't control any of this, but I haven't done a good job of staying happy and positive. I decided to call my insurance and get some information about seeing a therapist. I have an appointment scheduled for Monday and I hope that she can help me sort through all my feelings.

So we have a big weekend ahead for the Chef Buds...wish us luck!

Trying to stay positive

I am on CD 10, and I am having a hard time feeling positive this month. I know I need to do just that but it's so hard! I am finished with my femara for this month, and started my estrogen patches today. My midmonth follicle/lining check is on Thursday, and ever since we decided to do an IUI this month I just feel like there is so much more at stake. I just want everything to look good so we at least have the chance to try the IUI. I don't know how I'm going to get through the next three days, but while I wait I will have everything crossed and will be praying 24/7 that we get good news on Thursday!

So that's what that was...

When I went to the doctor last Monday I had been spotting on and off since right after Christmas. My lining was thin, my follies were small and my trigger was cancelled. I continued spotting all week and then Friday I found myself with full-on flow. But if this was my period it was over 7 days early! The flow continued through Saturday and then stopped altogether on Sunday. I called my nurse this morning and after describing everything she thought it was probably my period, making today CD 4 and with that I had to schedule a last minute appointment to go in for my baseline sono and to get my prescription for my last month, last ditch effort of femara/estrogen patches/HCG trigger/progesterone. I go back on the 21st for my midmonth check. I've stocked up on pomegranate juice, cut out most alcohol (hey, I give myself two glasses of wine on the weekend...with all that I'm going through I deserve it!), have been listening to fertility meditation CDs and am trying to stay calm and stress-free so my body can be healthy and ready for a little baby to make itself comfortable.

Mr. CB and I also decided today that if all looks good on my midmonth check (a manageable number of good sized follicles and a lining over 7 mm) we will be doing an IUI this month. My insurance covers half of an IUI, so we figured we may as well do everything we can to maximize our chances this month.

In other life news, we are the proud owners of a brand new laptop! My old laptop was ancient by computer standards (bought in early 2003) and I have been feeling like it was going to kick the bucket any minute. I asked my family for Best Buy gift cards or "computer cash" for Christmas and we got enough to almost completely pay for it! It's a shiny black Toshiba Satellite with lots of ram and gigs and memory and all that computer stuff. I had our tech guy at work help me pick one out so I know it's good, but I just care that it has a big screen, surfs the web at a fast speed and burns CDs and movies. It's so much fun getting new big girl toys!

Photo Credit

Accepting the label

I've been seeing an RE since September. I'm on cycle 11. Not one of my medicated cycles has produced the results within my body that I need to get pregnant. But I was still struggling with saying that I was dealing with infertility. I don't know why it has been so difficult for me to accept...I guess it's something about being labeled as something that is so negative and sad. I didn't want that label to define who I am and my attitude towards life. I've realized that I need to deal with this the same way I would deal with anything else in my life. Aggressive and with confidence. And also with hope and optimism.

Photo Credit

The first thing I usually do when I need to get as much information on a subject as possible is get a book. I know the internet has a ton of info that is readily available, but I am a book lover and enjoy learning new things as I turn the page. So I went to the library after work today and picked up three books on infertility, including Conquering Infertility by Dr. Alice Domar. This book has been mentioned by both Dandelion Bud and Worry Bud so I figured it would be a good start!

Where we are right now - I had an appointment on Saturday and Monday and my follicles didn't do so hot this month (on CD16 I had only one that was worth anything and it was only at 15) and my lining was a depressing 4.8. I was pretty much expecting this as I had been spotting for almost 6 days. We actually met with the RE on Monday, and she reviewed all of our cycles and said that my body was not responding to this protocol and that we probably need to move on. Our options? An injectable/IUI cycle with a cost of about $2000 for one month and a 20-25% success rate, or IVF with a cost of about $6000 (for a shared donor cycle...more on that later) and a 70% success rate. This was a pretty big shock and something I was hoping to never hear. She also offered to do one more cycle like we did last month (since I did have some improvement) to see if we got a better response and also to give us some time to think about our options.

Right now we're kind of in a holding pattern, just waiting...which seems like is all you ever do when trying to get pregnant! We're going to do one more month of the femara/estrogen/progesterone meds and then make a decision based on how the cycle goes. If it doesn't work, I would like to go straight to what gives us our best shot which is IVF, but we also have to consider the cost (no insurance coverage, so all OOP) and if we are comfortable with a shared donor cycle. What this means is that half of our embryos will be donated to a couple struggling with IF and that couple will pay for half of our procedure. My initial reaction is that if we can help another couple going through this, especially one who is probably looking at their last options with the help of people like us, I will do it. I could be someone's one shot at having what they so desperately want, and I'm at the point where I can really relate to that desperation. But Mr. CB and I will have to have some serious discussions about this to see what our hearts tell us to do.

Photo Credit

I'm praying for a miracle to happen in the next few months and hoping I see that BFP before we have to make all of these tough decisions.