Trigger day!

Well, today was my fourth and final monitoring appointment. They were running late and I was running late so I didn't get a chance to see or hear any of the details about my follicle growth. The ultrasound tech did mention that my left side was still falling a bit behind the right, so I figured I would be stimming for another night.

Around 2:00, I received a call from one of the nurses telling me that I would need to give myself - or really, Seth would need to give me - the trigger shot at 11:30 tonight! Oh my gosh, already?!? I was really happy to hear this at first, but before we hung up I asked for some information about my follicle growth. The nurse told me that I had 5 dominant follicles (between 16-20 mm). She said "so if we get 5 eggs, that will be great" and then we hung up.

And then I had time to think about it. I went from thinking I had 16 decent follies to having 5 which, as the nurses love to remind you, may or may not have any/mature eggs inside them. 5 doesn't sound like a great number to me. So I panicked but after being talked back down to reason (thanks friends!), I calmly called the office back and spoke to another nurse, my favorite Nurse Jacki. She explained that yes, there are 5, and yes that's not a ton but they're all ready to go and we don't want to risk losing them while we wait for the others to catch up because that might never happen. As my friends reminded me (thanks again!), it's better to have a few good quality eggs than it is to have a bunch of lesser quality ones. So here we go - I'll trigger tonight and the egg retrieval with be on Saturday morning!

I feel better now. I'm still a little disappointed and really, really nervous but I just need to keep repeating the same thing I've been telling myself for days:

You only need one.

Worrying about it won't change anything.

You only need one.

Please, please let us get one.

IVF #1 Progress Report
Status: Trigger Day!
Lupron: Done!
Stims: Done!
E2: 2265
Follies: 16 measurable, only 5 dominant
Side Effects: Aging, puffy belly, sore back

Follie Scan #3

Follie scan #3 and my pre-op appointment were this morning. These were my results:

Left Ovary: 15.1, 13.5, 13.1, 12.7, 12.4, 12.0, 10.2, 10.2
Right Ovary: 18.6, 18.1, 15.6, 15.4, 15.1, 15.0, 13.5, 10.9
Lining: 8.9
E2: 1640

The ultrasound nurse said that my left ovary looked "sluggish". Boo. They're going to keep me on the same dose of meds to try to get all of those 12-15's to catch up. This nurse said that they like to see a bunch of follicles between 16-21 mm on trigger day, but another one said 18-20 mm so I'm not really sure what to think. It sounded like they expect my egg retrieval to be on Sunday or Monday, which is a day later than their guess on Monday. If it means a better chance of getting a bunch of decent eggs, I can live with a few more days of stimming. I'm worried that we're going to end up with a lot of those follies being either immature or too mature/old but I just need to keep telling myself A) I only need one and B) worrying isn't going to change a thing.

I'm starting to notice a little discomfort. It still doesn't feel much different than a regular cycle to me. It's a lot like endo pain, but less severe. I'm am feeling a little more fullness though. I can't suck in my pouch at all.

The only other negative side effect that I've noticed is that I'm looking really rough lately. I don't know if it's from the nerves or from not sleeping as well, but I look like hell. If Madmartigan and David Bowie as the Goblin King had a baby, it would like me.

That's what I look like in the morning when I wake up and then again by the time I'm ready for bed. I could use a haircut and some Botox. Hopefully I'm the only one who notices though. This week, three different people told me I looked too young to be a professor, so I must not be as aging as much as I think I am. I still want the Botox.

IVF #1 Progress Report
Status: Stimming, day 8
Lupron: 5 units
Stims: No change - 150 Menopur and 150 Gonal-F
E2: 1640
Follies: 16 measurable
UL: 8.9 mm
Side Effects: Aging and puffy belly

Follie Scan #2

My second follie scan was this morning (after 5 nights of stims) and I made sure to ask for more details this time. Not that it means a whole lot to me right now (and I won't have my E2 results until later) but I just needed some reassurance that something was happening in there - and that I didn't shut down the factory with my mishap on Saturday night. To be honest, so far I feel exactly like I do every cycle. I wonder if the pain I always feel is really related to my endo or if I just have strong ovulation pain. Who knows?

Anyway, here are the results of my scan:

Right Side: 14.8, 12.7,12.6,10.3,9.5,8.9,8.5
Left Side: 10.6, 10.3, 9.4, 9.1, 8.1, 7.8, 6.6, 6.3, 6.0, 6.0
Lining: 7.2 mm (up from 3.4 and then 6.0)

So that's 17 measurable follicles. I guess I'm okay with that. More would be great, but I know that it could be much worse too. The nurse said that I will most likely stay on the same dose of my meds to allow all of those 12's, 10's, and 9's try to catch up to the lead follicle. I had to buy more Gonal-F, but at least that's the one I get at 50% off. The nurse also guessed that we would trigger on Thursday or Friday night for a weekend retrieval. That would be nice since I wouldn't have to take and I'd have plenty of time to rest.

In typical roller coaster fashion, last night's injection went totally fine. It's ridiculous how I can be so crazy one night and so completely relaxed the next. Hopefully tonight will go okay. I can't believe that I probably have less than a week left of injections. Even though I'm nervous about the next stage, I am so ready for this part to be over!

IVF #1 Progress Report
Status: Stimming, day 6
Lupron: 5 units
Stims: No change - 150 Menopur and 150 Gonal-F
E2: 729
Follies: 17 measurable
UL: 7.2 mm
Side Effects: Insanity

Follie Scan #1 and Stuff

Yesterday morning was my first monitoring appointment since starting the stimulation meds. It was day 4 of stims (so 3 nights of injections). I didn't ask for any details about my follicle growth. I thought if I had the information, I would stress myself out analyzing the results. My E2 was 186. I've seen some clinics say that they like to see a level of 100-300 at this stage, so that seems okay. My instructions were to continue taking my meds at the same dose and come back for the next scan on Monday morning (day 6). I'm going to assume that means that everything is going okay - not too fast, not too slow - otherwise they would have changed my doses, right?

My lucky streak is officially over. I haven't really had many noticeable side effects up until the past two days or so. Now I do. It's like PMS on steroids. I cannot stop crying. Super ugly crying. About anything and everything. On the bright side, I'm not as ragey as I normally am on PMS, I'm just really emotionally unstable.

The weird thing (Good? Bad? I have no idea.) is that I'm not even thinking about whether or not this will be successful. All I can think about it whether or not I'm doing everything right. I'll have a good day with the meds and then the next day is complete shit. I am a mess. Last night I spilled some of the Menopur (fucking Q-caps). I thought it was just a drop, so I continued with the Gonal-F and then at the end I realized I was 1/4 mL short. I freaked out. Luckily I was able to talk to the on-call nurse who said it was fine and not to bother starting over with new vials, but I still spent a good hour crying and shaking. I can't handle the pressure that I put on myself. I'm so worried about everything being perfect and I will beat the shit out of myself if I think I did something wrong. I'm not going to be able to relax until my next appointment. This time I'm going to ask about the follicle growth because I need to know that I didn't (or did) screw it up.

Clearly, I need to work on my stress management. Maybe I will start crocheting again. Or I could find a new book to read. On Friday and Saturday, Seth I took the Binks and Bear for nice walks in two of the parks nearby. That really helps because it takes up a lot of time, it's so nice to be outside, and I just love spending time with Seth and my boys.

I hope that we can keep doing this during the week even though we work on different schedules. I mean, our neighborhood is nice, but it's so much nicer to be in the parks. The path goes right next to the water and the trees smell so good. It reminds me of being at home and that feels good.

Game on!

Yesterday I went into the office for my baseline appointment. Everything looked great (and my AFC was 18 - I hoped there might be a few hiding!), but I was worried that I wouldn't be ready to start stimming because I didn't start a new cycle yet. Luckily, yesterday turned into CD1! I called the nurse back in the afternoon and she told me we could start the stimulation phase!

I'll be starting off with 150IU of Menopur and 150IU of Gonal-F, plus 5 units of Lupron. I was really nervous about this injection because A) I have to mix it myself and B) the needle is a tiny bit bigger than the Lupron needle. I stressed way more than I needed to about the mixing part. It's really easy, but I just can't help freaking out that I'm missing a step or miscounting or something so I have to quadruple check everything. Then as soon as the injection is done I start doubting myself.

Anyway, I think that I did okay. Injecting the needle was pretty painless and I didn't really have too much burning with the solution injection, but it was definitely weird. I didn't really care for the pressure of the medicine going in so it was kind of a mental battle to force myself to keep going. I'm sure it will be easier next time. Hopefully. Puppy snuggles make everything better afterwards anyway.

I have the sweetest nurses in the world.

So that's the plan for the next two days. On Saturday morning, I'll go back in for my first monitoring appointment!

I'd also like to say that I'm really grateful for all of the advice and support I've received so far. This whole process has been really nerve-racking for me, but it's been really helpful to have so many people willing to share their experiences and well-wishes. Thank you all!

IVF #1 Progress Report
Status: Stimulation Phase!!
BCPs: Done
Lupron: 5 units
Stims: Menopur and Gonal-F (150 IU each)
Other: Doxycycline (yuck)
Side Effects: Bad headaches since stopping BCPs. Eating seems to help.

A Hopeful Heart

On Saturday night I took my last BCP. Now I'm only taking the Lupron and waiting to see if I get a period. My baseline appointment is on Wednesday morning. Hopefully I'll start the stimulation phase of my first IVF cycle by the end of the week.

I'm nervous about what the fertility drugs will do to my body and about what the injection process will do to my anxiety levels.

I'm scared that I won't respond well to the medication; I'm scared that I'll respond too well and end up with OHSS.

I'm terrified that they won't retrieve very many mature eggs and we find out that I have poor egg quality or diminished ovarian reserves.

I'm afraid that the eggs won't fertilize without ICSI; I'm afraid that ICSI will result in poor or damaged embryos.

I'm afraid that we won't make it to embryo transfer; I'm afraid of how I'll feel if we do and it still doesn't work.

I'm afraid that we'll have nothing to freeze; I'm worried that we'll have "too many".

I'm terrified of going through all of this and getting nothing but more pain and heartbreak. Empty hearts, empty womb, and empty pockets.

I'm really effing scared.

That said, I also know that worrying about all of this isn't going to change the outcome. Stressing about all of the things that could go wrong isn't going to make them less likely to happen. The internet tells me that I have a 35% chance of success. The odds are not in our favor, but being realistic about the possibilities isn't going to make it hurt any less if this fails. I can go through the next 3-4 weeks resigned to the fact that this might be a whole lot of pain for a whole lot of nothing.

Or I can go through it will my head held high and hope in my heart. This might not be the best situation, but it's the best that we can do right now. It might not be the best shot, but it's our best shot. And a 35% shot is a whole lot better then the 2-4% chance that we have on a regular cycle. Maybe it won't work, but maybe it will.

TB IF Feb '14 IVF badge.

So I'm going to be hopeful. It's pretty much the only thing that I'll have control over in all of this.

IVF #1 Progress Report
Status: Suppression phase, waiting for period
BCPs: 20/20 - Done!
Lupron: Day 10 (10 units)
Days until baseline: 2

ICSI or no ICSI?

I mentioned a few days ago that we were dealing with a little bullshit regarding our IVF bill. Since we're part of our clinic's special program, we receive 45% off all IVF procedures (which I'm super grateful for) BUT you have to pay for everything up front whether you use it or not. So even though we (Dr. M, Seth, and I) decided that we would not use assisted hatching or extended culture, we still have to pay for it. Even though we chose to leave the decision of whether or not to use ICSI up to the embryologist, we still have to pay for it. We can choose not to pay for it, but if we end up needing it we would have to pay the full price ($1500 for up to 10 embryos, $2100 for more than 10). I don't get it. I don't understand why a program that is meant to help people without insurance and without a ton of money would be kind of sneaky like that. We were awarded the discount because they think we need it, but only if we're willing to take another gamble on top of everything else? Okay. I'm annoyed that this wasn't explained to us until after we paid the bill (the woman at the desk said we would get a refund for procedures we didn't use) but I'm trying not to dwell on it. I have enough to worry about.

The second issue is that our letter/contract states that our package includes cryopreservation of embryos if we have any, but the woman at the desk told me that we would have to pay extra. Of course, the financial coordinator was busy at the time I paid the bill. She called me back about a week later and confirmed that we would have to pay more. When I read my letter to her, she pulled out her copy and said "Oops, that was a typo" but she did agree to honor that pricing. I'm glad that they're doing that since a huge chuck of our decision to go with IVF was based on the financial aspect and the price they quoted for us, but it makes me a little nervous. My paranoid side is thinking "Oh my gosh - what if our embryos are fine but they lie to us and discard them because they know we're not really paying for it". I don't really think that would happen. I trust our doctor and the nurses, but I'd be lying if I said the thought didn't cross my mind.

Anyway, back to the ICSI. Now that we know we're paying for it whether we use it or not I'm wondering if we should just change our to decision to "Yes, use ICSI". What if we have a crap fert report because we didn't do it? Dr. M said that if you don't need it, don't do it because you are risking damaging the egg by poking a needle into it but there are risks with spontaneous fertilization too. At least with ICSI they're picking the very best sperm. With spontaneous fertilization, we could end up with a bunch of poorly fertilized embryos. I don't know what to do. Seth doesn't know what to do. It was a relief to leave the decision up to someone else because the less decisions I have to make, the less I will have to feel guilty about if this doesn't work. We still have some time to decision and I am open to all advice and options whether you've dealt with this before or not!

And also...
IVF #1 Progress Report
Status: Suppression phase
BCPs: 18 down, 2 to go!!!
Lupron: 6 down, who knows how many to go?
Days until baseline appt: 4

Only 2 more days of BCPs! Hopefully my period starts soon after that and I'll begin stimming some time next week. Now that I'm less than a week away from my baseline appointment, I'm starting to get a little bit excited. I still can't believe this is actually happening, but I'm not feeling as much dread as I was feeling earlier this week.

100!

Yay! This is my hundredth post so I had to title it accordingly.

IVF #1 Progress Report
Status: Suppression phase
BCPs: 14 down, 6 to go
Lupron: 3 down, who knows how many to go
Days until next appointment: 8

So far I haven't really experienced any side effects. Well, I've had a mild headache almost every day which I think is from the BCPs. I also have a very mild rash to the right of my belly button, but I think it's just sensitive skin and not really an allergic reaction to the Lupron itself.

My first two nights of the Lupron were uneventful. The needle is teeny tiny and I barely felt it pierce my skin. Even injecting the medicine was pretty painless. It stung for a minute or so but that's it. Last night...ugh last night was a little different. For some reason, it took me three tries to get the needle in. I don't know if it was a crap needle, a bad angle, or just nerves, but it was not as pleasant as the first two shots. There was a little bleeding too, but nothing to worry about (thanks Chickin!). Then this morning I noticed the rash. I'm thinking that either A) I did it too close to the first shot, B) I didn't pinch enough skin, C) I'm crazy or D) all of the above. D is probably the correct answer. It's always "all of the above".

I feel like such a baby, but the whole thing (all 15 seconds of it) really set off my anxiety. It's been almost 10 years since I was diagnosed with Generalized Anxiety Disorder and since then I think I've done a really good job of managing it. The last two years especially have been great. Still, every now and then something will trigger a panic attack or the type of anxiety where I just can't think clearly at all. Last night when it happened, it was completely unexpected. I had been totally fine over the weekend. I don't know what went wrong, but I spent most of the night thinking that there's no way I can do this. I'm dreading giving myself another shot tonight.

The practical side fragment of my brain knows that I can do this. I just need to figure out how to let that part of my brain take over. The pep talk from Jaytee helped for sure (thank you <3). And more Cool Runnings is on the agenda tonight. I just need to remember that I'm a bad ass mother who don't take no crap off of nobody. Or no needles. I mean look at me:

Climbing an active volcano with an ice pick.

Check out my ice pick. I am bad ass.

Injection Day!

Today is my first day of injectable meds. This evening, I'll start taking 10 units of Lupron and I'll keep that up for the next 10-14 days. I'm excited to get started. Everyone tells me that the anticipation is worse than the actual injection and I believe them. My imagination has been running wild since I thought I needed to use the giant needle, but I think once the first shot is done I'll be able to relax a bit. Plus, it feels good to be moving on to the next step and making progress. I'm very much less excited about experiencing the side effects of these drugs, but it's part of the deal that I signed up for.

It seems like ROAR is the go-to song for pumping people up during the IF process. While it is definitely on my pick-me-up playlist, it's not really my pump-up style. If we're being totally honest (which we always are), this is what has been playing in my head over and over again since I picked up my meds:

I have no idea why. I haven't watched this movie in years, but this is what I think about when I think about giving myself the injections. This is more my style. I'll probably watch it a couple of times before I give myself the first shot tonight. I could probably inject myself with the horse needle after watching that.

Holy. Shit.

I picked up my injectable meds today. Surprise - I cried. I always cry when I'm overwhelmed though. It was worse than I hoped for but not as bad as it could be. The total bill was $2755. I think for a fresh IVF cycle, that's not bad but for us it's a huge amount of money. Looking on the bright side, when you consider the discount we got on the actual IVF cycle bill it's kind of like getting the meds for free. Except there's a little bit of bullshit going on with our cycle bill. I don't feel like dealing with that today though.

Anyway, here is the obligatory meds shot, all set up on my IVF station. It's a tighter squeeze than I expected on my little table.

That's a 2 week supply of Lupron, 12 vials of Gonal-F, 24 vials of Menopur, 10,000 units of Novarel, and 15 days worth of Crinone. Plus an ass load of needles and other injection paraphernalia. 

I hate the Menopur already. First of all, it was more than half the total bill. Second, you have to mix it. I've worked in geochemistry lab for 6 years so I should be used to this, but I've never had to inject my solutions into myself. Third of all, the needle is fucking enormous. I didn't expect that at all. I thought the 22 gauge needle for the Novarel would be the scariest thing since that's the only intramuscular (IM) injection, but when I opened up the bags and found dozens of 18 gauge needles I knew I was mistaken.

I don't think I can do it. I did a Google search to find a picture and the first site that came up was a veterinary supply store. The 18 gauge needle says "for horses". It's a fucking horse needle. I don't understand how that is going to make it's way into my stomach. I don't think it will. Hopefully someone who has used Menopur can tell me that I'm overreacting. If not, please lie to me.

ETA/Update: I went through all of my supplies again and it's true - the 18 gauge needle is just for mixing the Menopur! The Gonal-F needles were hiding in the boxes with the vials, so the perfectly innocent looking 25's must be for the actual injection. Thank God. And thank you doodmama and tigger!

Back to School

Today was my last day of break. Waaahhhh!

Really, though, I'm pretty lucky. I've been off since December 17th. That's not a bad deal. I'm excited about my new classes too. And I only have one day of classes before 11 AM. AND one of my classes doesn't start until the last week of January so I still get two days off for a few more weeks. Teaching at a college is pretty awesome. It's like being a student, but better because I'm getting paid.

The other cool thing is that since I usually don't have morning classes, I'll have plenty of time for all of my monitoring appointments in a few weeks. Bonus - there is a satellite office less than a mile from my campus so on class days I can go to that office for the basic monitoring appointments.

Not much else to report IF-wise. We're still waiting to hear back about Seth's infectious disease and genetic testing, but I don't anticipate any problems with that. I've already had some basic genetic testing and I'm not a carrier for anything so unless he's got something really rare, we'll probably be okay.

On Saturday, I received a call telling me that my drugs were ready to be picked up. It was quite a bit more than I expected because instead of just using Gonal-F (for which I have a 50% discount), I'll also be taking Menopur which ends up being more than half the total bill. Oh well. If this is what Dr. M thinks will give us the best shot, then this is what we'll do. Wednesday is my day off so I'm going to head back to the pharmacy to pick everything up so that it's ready for when I start Lupron on Saturday. I'm excited to stock my IVF station!

For now, I'm on day 8 of BCPs and it's been pretty uneventful. I think that's the way it's supposed to be so I'm good with that.

Check! Check! Check!

This week we checked almost everything off our pre-IVF checklist. We had the blood tests and ultrasounds on Monday. This morning, I went in for a pap test and the trial transfer. I didn't need a full bladder and I completely forgot to take any pain relievers before I left, but it wasn't too bad. Uncomfortable and overwhelming, but not painful and it only lasted a minute or two. Dr. M said that everything looked great and he made notes for whichever doctor will be performing the embryo transfer for me.

We also had the official IVF consult with Dr. M. It was kind of silly (especially considering that it cost several hundred non-discounted dollars) because we already went through most of the information at the consult with the IVF nurse, but I get why it's important. We made some big decisions - for example, we'll almost definitely be doing a single embryo transfer - and we talked about things like ICSI, assisted hatching, and genetic testing. For now, we're just having Seth do the Recombine carrier screening since he has insurance coverage and then we'll make some more decisions based on the results. We decided to leave most of the other stuff up to the embryologist.

Dr. M also decided on my protocol. I'll be doing a Luteal Protocol which means that I'll be taking BCPs from CD4 to CD20 (January 18th). On CD16 (January 11th) I'll start taking 10 units of Lupron and I'll keep doing that until the nurses tell me to stop. For stimming, I'll be mainly using Gonal-F but Dr. M is still waiting on the results of my AMH test to figure out specific dosages. On January 22nd, I go back in for ultrasound and E2 and hopefully I'll start the stimulation phase!

Finally, we had to pay our bill. We had to pay the total bill for the IVF cycle (minus meds and anesthesia) before we start any medications. It was scary as fuck. I don't even want to think about it right now, but it's done so that's good.

I'm still feeling really nervous. I cried in the exam room (alone, not in front of anyone) just thinking about how much we're spending and the risks and wondering if we're making a mistake. During our consult Dr. M did mention again that IVF is the best way to bypass any of the issues that can be caused by endometriosis, so that helped. On the other hand, watching the Lupron injection training video did not help and that's one of the easy subcutaneous injections. Oh well. I'm just going to follow the great advice that I've been given and just try to take it one day at a time. I wonder if it will feel like the next weeks are flying by or going super fucking slow...