How things can change in one day

As you know, yesterday I was feeling rather despondent about all the things going on at once. Honestly, it was enough to make me wonder if I should throw in the towel on everything. The dieting, another baby... everything.

But, I picked myself up pretty quickly and took action.

Here is my update:

1. I no longer have an OB.
I'm still very disappointed about this one. I've gone through 2 c-sections and I want the best doing my third one when the times comes. And, he's the best.

But, there is a silver lining. He only delivers at the hospital where Nathan died and while I won't get into the entire story (the ending is all that matters), that hospital can never hold anything but nervousness and anxiety for me now.

Ryan was born at that hospital as well as my cousin and probably most of Ryan's friends. It's an excellent hospital with top notch facilities. It's where I lost my son, though.

So, a new OB that's closer to home means that when the time comes, I can deliver at a different hospital.

I'm going in for my annual GYN exam next week and I'm going to ask him who he recommends. I trust him to hand me off to someone great.

2. I no longer have an RE.
As of October 17th, that will hopefully change; I've made an appointment with Shady Grove Fertility.

When I called to make the appointment the woman I spoke with put me at ease from the start. First, her accent sounded like my husbands so I assumed she was English (South African as it turns out. Doh!) but, it was comforting. It kind of felt like I was just having a chat with his mum and it felt comfortable and reassuring.

I explained the hassle I had just gone through with my old RE and she was so sympathetic and encouraging. Honestly, that mattered to me.

I won't know yet whether or not they will accept me as a patient. It's not like my old clinic who would basically take anyone who walked through the door and had money to pay.

When I explained my situation and gave her my numbers she said she was sure I would be taken on as a patient.

Call me crazy but, I'm tossing around the idea of giving the new clinic one shot at IUI. I still have three left that my insurance will pay for and IUI might be a good way to get a feel for the new clinic, their procedures and staff before trusting them with IVF.

Opinions?

3. Despite doing everything right, I've gained weight.
This still holds true. But, I believe in what Megan and my husband have both said; weight fluctuates. Particularly for women and where they are in their cycle.

I believe I'm doing the right things to lose weight and I know the scale will reflect that eventually. Meanwhile, as soon as I'm done with this post, I intend to google "does your weight increase close to ovulation?". ;-)

I'm going to keep on doing what I'm doing because I know it's the right thing. I won't obsess over the scale (I have a friend who swears she can retain several pounds of water weight at any given time).

And, lastly.
I got a positive OPK this morning (CD 12). I was on fertility meds for so long, I wasn't sure what to expect this cycle.

CD 12 is about right on target for me so, as usual, my body is doing everything it's supposed to do, when it's supposed to do it, except for becoming pregnant.

I'm still hoping for my miracle before the end of the year so we're getting down to business in the BD department.

We're in it to win it!

Operation May Baby = Bust

11DPIUI = BFN

Ah well, I called it last week, anyway. This kind of cramping has PMS written all over it.

Since I've decided to forego the blood test this cycle, I'll test again at 14DPIUI and again and 18DPIUI just to be sure it's safe to stop the progesterone suppositories.

Funny story regarding this morning's HPT.
I woke up early and everyone else is asleep - hoorah, I get a little alone time!

In the master bathroom I grab a Wondfo and head downstairs. Once downstairs I go directly into the little bathroom where I take the test.

I set it aside thinking I'll return in two or three minutes to read the results. However, I get sidetracked by cat vomit. It takes me several minutes to dispose of it then clean the carpet. Then, I discover more cat vomit. Great.

Once I finish cleaning up this lovely surprise I remember the test and think to myself "damn it's definitely been over three minutes. If the test shows even a faint line, I'll have to test again to be sure".

Good one, Jessica!

That test, after at least 7 minutes, was as stark white as new fallen snow.

I will have to invest in a box of FRER since I'm skipping the blood test this cycle. My Wondfo's have an expiration of 9/2014 so I can't fully trust them before ending progesterone.

You might wonder why I'm skipping the blood test at all.
This is what I wrote on a forum post:

I did my 5th IUI ten days ago and, as a matter of protocol, my RE sends me to get an HCG quant, Progesterone (STAT) at 12DPIUI. 

Every time it's been negative (except for one CP in April) and a week later I get a bill for $35 just to be told I'm not pregnant. 

At this point, I'm tired of the waste of money. For one $35 blood test I can get a few boxes of HPT's that will last several months. 

My doctor likes the blood test to be done to confirm but, this was my last IUI before moving on to IVF in January. 

I doubt my RE or his staff are waiting for my blood test results with baited breath and will hop on the phone to call me if they never arrive. 

I have all the PMS signs so I know that I've had another failed month. What's the point in spending another $35 to confirm that? 

If I were going to try again right away then I'd go get the blood test done because I know my doctor wouldn't proceed without the confirming results. 

However, since I'm taking a four month break from treatments, it's okay to skip the hassle of the blood work, right? 

I figured I'd take an HPT at 14DPIUI and again at 18DPIUI and when it's negative, stop taking the progesterone and let AF come. 

So far I've spent $245 to be told I'm not pregnant. Granted, three blood tests were from a CP that we were monitoring to see if there would be a rise and then to see if it fell.

None the less, that's a lot of money to find out something that, at best, an $.88 test from Wal-Mart can tell me.

Alright, it's taken me nearly an hour to write this post because First Born woke up and requested I put his race track together (then told me I did it backwards, so I had to fix it) and then husband woke up.

So, it's time to put this update to rest. I'll be back soon (if I can find anything to talk about).

Happy Labor Day to my American readers!

Well, hello there PMS!

And how nice of you to bring acne, sore boobs and cramps with you to stay! 

8DPO and if it weren't for the progesterone, I'd be saying hello to Aunt Flo in the next two days, too.

Without progesterone, my LP is 10, maybe 11 days. These days I stay on the progesterone until the HCG blood test comes back as negative. Then two days later I see red.

Ah well, it was worth a shot, right? I can't say I didn't give IUI a good chance to work. 

James and I had a talk this morning because I was up a lot during the night thinking about another health issue that needs to be dealt with. Nothing serious, and I'm sure I'll blog about it at some point.

Until I deal with that, I don't think putting time and limited IVF chances into it is a good thing. In fact, I think it will be a waste of the 4 IVF's my insurance will pay for. If you're going to do it, do it right - right?

Our plan was to start IVF in October or maybe November but I think it might be more prudent to wait until January while I deal with this other health concern. That gives me four months to take Ovaboost along with a host of other supplements that will increase egg quality (hopefully). 

When I mentioned it to my doctor a few weeks ago, she said putting IVF off a few months was okay. But, I wasn't so sure because I feel 40 hanging over my head. I'm 39 and 4 months, so yeah, 40 is on top of me. 

And I know 40 isn't some magic cut-off date where you have to just close down the reproductive shop. 

But, my head is in a place where it's convinced that if I can't get pregnant before I turn 40, I will never be able to.

It's not even necessarily logical to think that. Women get pregnant in their 40's (and older) all the time! I know because I did a google search which lead me to that link. 

And, there is this story of a woman giving birth in her 60's.

So, I'll take the time to concentrate on another health concern and see where we stand in January, I think. 

*Please note: this is my plan today. A plan I think is a good idea to stick to. But, I reserve the right to change my mind in two months when I start panicking about my age again (or the age of my eggs).

It feels right to start IVF off by giving it the best possible chance to work and hopefully, my husband will make me stick to my guns on this one.

 

The calm before the disappointment

My husband pointed out this is a mixed metaphor. Still, it's apt.

The thing is, I know that the chances of an IUI working for me is less than 10% even with 88 million sperm vying for the love of one egg.

And now that we've agreed pursuing IVF next, I have ignored this TWW altogether. With that being said, I think I will still be disappointed next week when I get the inevitable BFN.

Now I can look back on the IUI journey and think about how much hope I had wrapped up in it. I'm not going to lie, I was 100% convinced IUI would work for us. In my head I was rearranging the 4th bedroom into a nursery. I was coming up with good arguments as to why we shouldn't find out the sex beforehand. It was a sure thing.

Until it wasn't.

So now, to distract myself (between my marathon of Gossip Girl episodes - don't judge) I have been doing as much research as possible on IVF, embryologists, clinics, assisted hatching and anything else I can think of.

I liked to be armed with information (you might recall my RE told me months ago that I am the most well prepared and informed patient he has ever had).

My in-laws are coming late next month and after that we'll decide when to start the IVF protocol.

In the mean time I'll focus on losing weight, getting back on track with healthy habits and working on just getting myself out of this total funk I've been in.

I'd like the blame that funk on the medicine, and it might be true. But, I'm also sure it has something to do with trying, and failing, month after month.

A break will be good for me. I need to find my positivity and motivation again. I'm not naturally a negative person. I haven't liked that side of me and it's been my own personal rain cloud all summer.

I love Fall and it's almost here, giving me every reason to accept good vibes back into my life.

Help from IVF'ers needed

I've been thinking more and more about the IVF process which includes thinking about the clinic I'm currently using.

I'm not unhappy with my clinic all but, since I'm moving on to IVF, I want to make sure I'm going with a place that will give me the best shot at getting pregnant.

The truth is, we chose our current RE because we were going to be paying out-of-pocket for IUI and price was a major factor. And, let's be honest, you don't have to have graduated first in your class to do an IUI.

But, now we have insurance that will pay for IVF and it's something that requires so much more precision than IUI. We need to know we have access to the best option in our area.

So the question to my readers is this: what do you ask when you're interviewing RE's?
How do you make comparisons beyond the typical "success rate"? I don't want to rely solely on success rate statistics because too many contributing factors go into that figure.

I know there are clinics who won't treat women over a certain age, or BMI or AMH/FSH level because they don't want their success statistics to be diminished.

My currently clinic is honest with you about the odds of getting pregnant based on your personal situation but they don't turn women away because the likelihood of it working are minimal.

What data do I use to compare clinics?
How do I know if they have a good assisted hatching program?

Please, any information or guidance you have regarding this would be immensely helpful.

Thank you in advance!

Time to trigger

Since my E2 was 295 yesterday, I was called in for another ultrasound this morning.

Right side:
R1 - 18
R2 - 16

Left side:
Nothing

I have to do a trigger 4AM tomorrow for a Thursday afternoon (CD 11) IUI.
This feels early to me. My fertility monitor only gave me a high reading this morning and last month when I triggered, my E2 was 549.

One hiccup, though. Yesterday the doctor noticed some fluid on the ultrasound. Today, the nurse mentioned it too and asked if I was still spotting. I'm not, so we don't know what that pocket of fluid is.

She said if this were IVF transfer, it would be cancelled if that fluid was there the day of the transfer. Fluid can cause an embryo to not implant.

Because of that, on Thursday they're going to do another ultrasound before the IUI to see if the fluid is still there. She also said the fluid wouldn't necessarily mean that we have to cancel because by the time implantation occurs, the fluid could be gone. We'll see what the ultrasound shows on Thursday afternoon.

Gut instinct tells me this isn't going to be a successful cycle. Not because of the fluid or even because I'm trying to prepare myself for the worst. I don't know where gut instinct comes from really, but, mine is telling me this isn't working out.

Brianna mentioned in a comment that "low and slow" is the way to do this. And, I realized she's exactly right. And one thing this cycle hasn't been is low or slow.

The thing about IUI is I feel like success is just outside of my grasp. However, a little tweak here and a little adjustment there and I feel like we would have success. We're not dealing with MFI which is a huge impediment for a successful IUI. I have a history of getting pregnant and even bringing forth children from pregnancies.

Granted, my last successful pregnancy (yes, I consider Nathan a successful pregnancy) was over two years ago and I'm 39 now. So, IVF makes sense. Right?

But, I don't exactly have a history of miscarriages from IUI either. Four attempts has netted me one CP. That's not really a bad track record given that a woman my age is expected to get pregnant 1/12 attempts (at best).

Anyway, make it through this cycle first, right?
One thing at a time grasshopper.

Glamorous? I don't think so!

Ultrasound today

CD 5

3 days of injections: Gonal-F 112.5 (increase from 100 last month)

Right ovary = 3 follies total - 2 x 10mm, 1 less than 10mm

Left ovary = 2 follies total - both less than 10mm

Lining = perfect (I didn't ask for number)

I'll get a call this afternoon with the estradiol results which will tell us if I should continue on 112.5 dose or dial it back to 100 since I appear to be responding a bit quickly. 

I take all the numbers this early with a grain of salt because last month on CD 6 I had 7 follies and ended up with only 1 mature. 

What's interesting this month is that the right side seems to be responding better than the left. That's never happened to me before. 

I have to return Monday morning so they can check again. Since I'm on a rather high dose of Gonal-F (for an IUI cycle, at least) they're going to be checking me a lot more often.

It's weird because now that we've decided to move on to IVF, this cycle feels perfunctory. It's like I'm not really expecting any results from it so just going through the motions so that we can start the process of preparing ourselves for moving on. 

I feel like I have nothing vested in this cycle; I'm not feeling hopeful or hopeless. In my head, we've already moved on.

Probably not a good attitude to have and my dearest friend Felicia will get on me when she reads this. She's always reminding me to "think positive". 

But, maybe it's better this way. Let the course run and what happens, happens. At least I know I'm not likely to get super anxious this time around. 

Notice Olivia Wilde on Glamour magazine in the background. There is nothing glamorous going on in that room, with that machine!

Update: Estradiol 119
Sticking with current 112.5 Gonal-F protocol.

The final IUI

I love my RE clinic, I really do.

As soon as I walk through the door the receptionist always asks "where's my Spider-Man today?" referring to Ryan. 

Every single nurse that walks by me says "hello Jessica, how are you?". I feel like I'm getting individual treatment and that's the benefit of going to a small practice. You never feel like a number or statistic. 

I've heard of clinics turning women down for treatment due to various factors simply because they want to keep their success rate statistics high. That's utter bullshit. My office is not like that and I appreciate it so much.

When the nurse took me back to get the ultrasound she asked if I was going to do another IUI and I said yes. She said something along the lines of "are you sure it's not time to move on to IVF? I hate to think of you spending all this money on IUI's". I know that you might read that and think she was being rude but it really wasn't. 

I told her that insurance pays for both she got excited and said "Do it girl! We want to see your pregnant!". 

I told her that I had come to that same conclusion and had gotten my insurance ducks in a row to proceed on to IVF.

Then Girl Doctor came in. 

Side note: my RE's office has two doctors - who I refer to as Girl Doctor and Boy Doctor.

She was able to see both ovaries without any trouble. No cysts so I'm cleared to proceed with this IUI cycle.

Then I told her that if this doesn't work, I'm moving on to IVF. She said she was 100% in support of that decision.

We spoke about logistics and she told me she thought it would be beneficial if I lost 10 pounds. She only mentioned it because I asked and I'm glad I did. I appreciated the complete honesty, I needed to hear it.

Also, I made the decision then that if we do have to go the IVF route, I want Girl Doctor taking over my cycles. 

Don't get me wrong, I LOVE Boy Doctor. He's fabulous and incredibly kind and attentive. Girl Doctor is a bit more matter of fact. 

However, Boy Doctor has rarely been able to find my right ovary. I don't know why this is but he tries and tries and moves that wand around like he's checking my tonsils. But, my right ovary always seems to elude him. 

Girl Doctor finds it in seconds. So, she is my best bet for egg retrieval purposes in my opinion. 

She explained that I'll come in on the first day of my period just like with IUI cycles and I'll be put on birth control for 2-3 weeks. Then we'll start injections and go from there.

I didn't talk to James about it last night at all, I guess I wanted to mull it all over before I spoke to him.

This morning as we're getting ready for work I told him about the appointment. He agrees also that it's time for IVF. We both agreed that waiting until October/November would be a good idea, too.

This gives me time to lose that ten pounds, save up more vacation days and save money. Even though all these treatments are paid for, it's not without some costs to us. Affordable costs for sure, but costs none the less. 

So there we have it. This is it, our fifth and final IUI. 

Come on sperm, hook up with my egg - you know you want to!

I choose to jump

"Jump or stay in the boat."

-Margaret Stohl, Beautiful Darkness

Or am I choosing to stay in the boat?

Either way, I'm signed up for another cycle.

Good news:

• I have 4 IUI cycles left
• I've reached the point where insurance will pay for IVF (4 cycles)
• They pay for assisted hatching!

Bad news:

• It's not likely they'll pay for ICSI because the only criteria for that is 2 abnormal sperm samples two weeks apart. My husband has excellent sperm.
• PGD is only paid for if we're both tested for a host of genetic factors and it's determined either of us are carriers of some sort of mutation. Unlikely since we've had two children with no genetic problems. Recurrent pregnancy loss and a stillbirth aren't factors at all.

Sad news:

• My friend is moving away. We've become close to her family after meeting through a stillborn support network. Her first daughter was stillborn the year Ryan was born. She's gone on to have two other beautiful daughters who I adore. She is an outstanding person and her husband is wonderful. Her husband and my husband both are Cricket fans and both support Liverpool. I love getting together with this family. But, life has called them to an opportunity is Georgia and they're leaving in a few weeks. It makes me sad because she and her husband are the only people we know in person who understand what it's like to have gone through what we did with Nathan. They understand the absolute pain of having a family member missing.
• We had a play date with one of Ryan's friends this weekend. I have become very friendly with his mom and I've confided our struggles with her. It turns out she's been there, too, having more than one failed IVF cycles herself. (She went on to conceive her two boys naturally!) Anyway, she sent me an email today saying I seemed down on Saturday when we met up. I honestly though I was hiding the disappointment quite well. Turns out I was wrong. But, I'm glad she asked because it let's me know that I need to make more effort in finding things to lift me up, even when things are very difficult. I have never been a mopey person and I don't want to become one now!

As for the IVF struggle going on in my head - obviously I chose to put that off another month. But, I did call the insurance company (who were very helpful and reassuring) and got all the information I needed/wanted regarding IVF.

So, I've taken the first steps towards accepting that IVF is probably the next rung in our infertility ladder. 

I never thought we'd be here. I never thought that getting pregnant would require multiple people in the room with me and one of them wouldn't even be my husband. 

Right Ovary: MIA - Last seen in April

Monday I had my baseline ultrasound to start this cycle of IUI.

Once again, my right ovary was nowhere to be found. This is frustrating because that can impede a successful IVF cycle should we need to go that route. If they can't see the ovary, they can't remove eggs. I've read other women who have had this problem and no eggs could be retrieved from the unseen ovary.

Alright well, that's a problem for the future, right? Right now we're not in an IVF cycle, so that is a bridge I don't need to stress about crossing. 

I started gonal-f on Monday and I have to say, easy peasy. I can stick that needle in my stomach all day long. 

You know why?

Because, I don't feel a damn thing. 

Two c-sections has left my stomach numb from the belly button to about the c-section scar (same deal for a friend who has also had two c-sections - no feeling there at all).

I'm now wishing I could take ALL shots in my belly. In fact, I intend to ask my doctor if the trigger shot must be done in the bottom. My guess is, yes, it has to be. But, it doesn't hurt to ask. 

Also, when (not if) I do get pregnant, I'll have to take a Lovenox shot every single day and I'm hoping that is done in the same area. 

So, Saturday I'll be going in for another ultrasound to see how the follicles are coming along and I hope my right ovary makes an appearance.

The nurse did mention that OHSS is a concern at my age with Gonal-f and if there are more than two mature follicles, the cycle will be cancelled due to the risk of multiples. 

Next week, for ICLW, I'll be paying it forward by giving away a lucky gift to a commenter. 

So, watch this space!