February 26, 2014

Bend Over!

It's time to trigger!  Yesterday the follicle measurements were fewer and smaller than the day before, probably accountable to variation between the way the respective doctors measure.  I am not gonna lie, it was tough to feel like everything was "worse."  The doctor I dislike the most in the practice did the ultrasound, and curtly turned off the machine before even telling me measurements and said "one more day." Huh?  I was under the impression that I would trigger yesterday based on Monday.  So I scramble for the meds I now need that I had cancelled since I thought I wouldn't need--added drama and stress.  When I got my estrogen level yesterday afternoon, it was over 2000, and my nurse told me she was pretty confident I would trigger the next day for sure.  

At today's appointment, they only measured the five larger follicles and confirmed today would be trigger.  I have five follicles in the above 18 range and a whole bunch of others that were not measured today.  Some must be getting close to 18, but I have released control of all of this.  I trigger tonight via the dreaded "butt shot." Friday morning the eggs will be retrieved, and at that time, and at no time earlier, I will know how many eggs they harvest.  I just have to let this go until then!  Follicles don't always mean eggs. Eggs don't always mean good eggs.  Etc. Etc.  I am so tired right now that I am not stressing much, actually. Tonight is filled with firsts--a fanny shot, my husband giving me a shot, and a needle twice as big as any I've used so far. BUT, this will be my last shot for this cycle.  I almost managed to get an acupuncture appointment for tomorrow, but it did not work out.  I am releasing that, too.  I have my first acupuncture appointment a week from tomorrow, instead.  I got a good vibe on the phone speaking to the acupuncturist.  We will see.  I have heard such good things about the relaxation aspect, and I actually have insurance coverage for the treatments :)  If it helps during the two week wait, great.  If I have to do another cycle of IVF, then it can only help going into that, too.  I am feeling positive and resolved for now.

February 24, 2014

IVF Day 10

So, this junk just got real.  Eleven follicles measured over 14 mm this am!  Five are bigger than 18 mm, which I am told is a good marker for a strong likelihood of a mature egg being there.  The other six follicles ranged between 14.8-and 16.5 mm, so they are not that far off.  They may or may not produce mature eggs.  There were five more even smaller follicles closer to 10 mm.  The RE tells me that we will either trigger today (huh? wow!) or tomorrow, depending on my estrogen levels in the blood work.  If the levels are not too high, they will hold off triggering so that maybe they all can just mature a little bit more before triggering tomorrow.  Going through the trigger instructions with the nurse felt surreal--not sure why since I've been waiting for this since last Friday, but I am ahead of the sample IVF calendar I was given, so I was expecting to see some growth and to keep coming back every day this week.  I finally got the call after a long day of waiting that we will wait and check back in tomorrow morning.  The RE lowered my dose of stims for tonight.  All likelihood I will trigger tomorrow, per the nurse this am.  Then this afternoon, the same nurse also mentions out of nowhere it could even go one more day.  I hope not because based on her talk with me this morning, I canceled a refill on some meds I would need if it does go to Wednesday.  I can't worry about that right now, though.  I have two big marker circle on my backside to mark where the trigger shot will go....but not quite yet :)

February 22, 2014

IVF Day 8

This morning's check in at the clinic continued to reveal growing egg follicles.  She measured 12 of them over 10 mm, and a few smaller.  They are all in the same size range, which is good news as the RE doesn't want one of the follicle taking off and growing to maturity too quickly and ruining the good "harvest" of many eggs.  My estrogen level was rising steadily.  The doctor said I may need to come back tomorrow-it was borderline, but when I got my call, they said come back Monday.  I am going to assume that starting Monday, I will be going every day now for morning monitoring.  I am letting myself feel happy that the eggs seem to be doing great for me so far.

The hormones are affecting my emotions more as of yesterday.  Not sure if the morning shot of Cetrotide is the cause.  I am not liking that shot too well :(  It is tolerable, but I have been icing it prior and then warming after.  Today was a little trickier because I had to add this am shot into my morning routine before heading out to the doctor's appointment.  I also feel some pain like a sore patch under the skin where the shot goes.  Again, it's totally manageable, and the shot didn't burn going in (not sure if it would without the icing, but I read some warnings and I'm not chancing it).

So basically good news, plus I get to sleep in tomorrow!

February 20, 2014

Just Keep Stimming

Today is IVF day six.  Been taking my nightly shot--only one in my belly--with not too much trouble. Pretty much this procedure is the same as my last few IUI's, only with more medication.  I am trying to just "enjoy" the relative ease of things for the moment.  I know by next week things will be getting crazier, adding another daily shot to prevent early ovulation and daily office visits.  I joined a cycle buddy group on Fertile Thoughts full of ladies all doing IVF this month.  I feel really positive about the decision to join.  Everyone seems very supportive and friendly.  I know we are all at the beginning stages, so hope is the mood for the moment.  Most of them (if not all) have done IVF at least once before.  What a great resource.  I also got a few phone numbers for acupuncturists in my insurance to try to call.  It is probably too late to really do that much, but I figure it can't hurt, might help with control and anxiety, and could be valuable down the line if more than one cycle is needed. Honestly, it's just being overwhelmed with the IVF stuff, insurance stuff, and medicine stuff that has held me back from getting in gear to check on the acupuncture.

On day four of the cycle (Tues), I went in for my first office check. (Side rant--another 2 inches of snow to clear off my car that morning and then drive through to my appointment.  DIE WINTER DIE.)  I was delighted to hear a report of 16 follicles starting to grow--7 on the right side and 9 on the left.  That is pretty much the best number I could have anticipated given my age and my previous follicle counts.  I took it in as a "win" for the day and felt really happy to get started on a positive note.  They kept me on the same dose of meds.  I already had to call and order a refill on one of them. I guess the meds are a very day to day thing, and I will need to stay on top of it after each office visit to make sure I don't run out on a Sunday!

Today, day six of the cycle, I went in for my second office check.  They measured nine of the follicles, now at around 10 mm each.  They counted six others still there below that size.  They are keeping me at the same doses, but starting tomorrow morning, I add a new am shot to the regimen--Cetrotide, which will help prevent the eggs from releasing before the doctor goes to retrieve them.  I am happy that nine are growing well, and the doctor said not to give up on the other follicles yet, so I will wait and see if any of them catch up.  I go back in two days for my next check.

We also seem to be getting the best deal possible so far on the insurance front.  Looks like the plan covers the meds fully once the out of pocket plan limit is reached.  The refills I ordered for one of the medicines that had a copay last time, cost $0 this time!!!  YAY!  I need to do some more legwork to see what counts toward this out of pocket limit and what we still might have to pay, but it looks very promising indeed.  

February 17, 2014

IVF Day 3

We got our huge box of IVF medicines in time to start injections on Saturday night.  In spite of 30" of snow during the preceding two days.  I did start to panic about 3:30 on Saturday when the delivery had yet to arrive.  Previously the estimated time on the FedEx site had been 1:30.  Then once that passed, no information.  Right when my panic and what iffing was starting to peak, I look out the window and the FedEx lady is walking down our driveway carrying the box.  She must have had a really crappy day all day in the snow covered "wonderland" all around us.  

My protocol for the first three nights is three vials each of Menopur and Bravelle.  The Menopur does burn somewhat, and definitely more than the Bravelle ever did.  So far it is manageable, though I had an inauspicious start when my belly bruised almost instantly as I removed the needle the first night.  As of now, I only need to do one shot, since I guess up to six vials is okay for one injection.  Tonight I take the third shot and tomorrow I go in for bloodwork and ultra sound.  I'm pretty expectation-less as far as what I will see tomorrow.  I feel more curious than worried.  The tentative IVF chart has me going back every third day for the am ultrasound and bloodwork visits until things proceed into more frequent checks. 

I have started doing some audio guided meditations since Wednesday.  I am enjoying them.  I fell into a nap the first two times while meditating, so I guess I was pretty relaxed!  Hee hee.  One of the things the soothing voice says in one of the tracks is "be just as lazy as you ever wanted to be."  I absolutely adore hearing that.  How wonderful to be given permission to just relax and not feel bad about not doing something.  Why do I need permission?  That's too much to analyze for the moment, but I love that voice telling me it is okay.

I have been receiving some emotional support on a few fronts, and I am grateful.  A dear old friend from my teaching days has sent me a few articles and letters in the midst of all of this.  Getting these pieces of mail brightens my day immensely.  Even though she is not near geographically, it's nice to know she is thinking of me.  One of my sisters-in-law read an infertility memoir that I had read called Breeding in Captivity.  It meant a lot to me that she even wanted to read it, but after she finished, she sent me the nicest text messages just saying how horrible this all must be and how she can't imagine what we are going through.  How thoughtful and touching it was of her, and how much I realized I craved something like that--to have another person realize just a little bit what it might be like to wear the scarlet I and be shaped by infertility.  None of our family were sent this blog, and sometimes I think I would like to let her read my entries, but I don't want to put her in an uncomfortable spot of knowing something her parents and other siblings aren't privy to.  I need this place to be "safe" for me to vent without worrying whose feelings I may injure.  Another former coworker, one who has actually just gone through a successful IVF herself, has been reading my blog and sending me messages of support.  I cling to her success and appreciate how she has been rooting for us.  There's something so reassuring about knowing a "real person" who has gone through this herself just recently.  My longtime friend and former college roomie has been my original blog reader and best supporter through this long long journey.  Today I woke up to this awesome email of love and kindness she had sent to support this IVF phase of the trek.  I just had to crack a huge smile and think how lucky I am.  How did the roommate pairing gods get it so right with us back in 1992?  Who knows, but they sure nailed it!!

So many other people seem either to ignore the fact that you are going through this huge drama or to offer unhelpful (though usually well-meaning) advice or commentary, that it's sometimes easy to forget these few people who have the gift of caring in the way we need them to care.  One of my meditations is to send out loving kindness into the world for others, and I have been thinking of these people as I meditate that track.  I also think of the people who don't offer support and try to send them peace and understanding, too.  Most of all I think of my husband, who absorbs so much of the "ugly crazy" of me in general, but specifically when I am stressed and overwrought with worries about all of this working out somehow while injecting six vials of hormones into my emotional self.  I don't know how he manages to pick up the pieces of my crazy sometimes, to be honest, but I am incredibly lucky to have a partner in my life of such strength and endurance.  Yes, I am a very lucky person, indeed. 

February 11, 2014

A Freakin' Whirlwind

I am just all over the place with ups and downs, happenings and changes!  It's been a stressful week, as our power was knocked out from an ice storm during last Tuesday night.  The roads were not passable with ice and downed trees on Wednesday, so I had to reschedule my mock embryo transfer a second time but managed to get it done Thursday. Everything looked "perfect," to quote the Physician's Assistant.  Unfortunately, our power did not come back until late Saturday.  I did not handle roughing it for four days overly well :)  We had our wood stove burning, so that kept the chill away.  We have solar panels and a battery back up system, so our fridge was fine, and we had power for some other little things like lights.  The main "modern luxury" that doesn't really cooperate is running water.  Blah blah blah--I am bored just rehashing this!  We managed, but it was frustrating. Our neighbors right across the street had power back a full 24 hours before we did, which felt like a kick in the teeth, especially since they seemed to have decamped for a hotel and weren't even there.  I realized anew that I hate not knowing when things are going to be resolved.  If you told me right from the start I was looking at four days with no power, I would know how to handle myself to make it to the finish.  The not knowing is unbearable.  What a recurring theme in my life.  I just want to know.  I really wish I could be more Zen about everything instead of attempting to control and manage.  I know in my head that any semblance of control is just a delusion really, but I still grasp after it.  

Which brings us to trying to control infertility.  YOU CAN'T.  Today more uncertainty (on top of the uncertainty of will this IVF work) arrived.  They are calling for yet another major snow storm tomorrow night into Thursday night.  My first appointment was scheduled for Friday morning.  I have been stressing out about "what if the snow interferes" for the past two days.  I broke down and contacted the nurse today and asked her what my options would be if I couldn't get in Friday since they run on such a tight schedule over there.  She offered to have me move everything up two days and come in tomorrow, which means starting the ovary stimulating shots on Saturday now instead of Monday.  OK.  Let's be flexible and move it on up.  Just as I am patting myself on the back for having already gotten the medicines all set to deliver tomorrow morning, before the unknown of the snow, I get a call from Freedom Pharmacy.  There is a hold up with the insurance authorizations.  Mind you, I haven't been able to even find out if we have any insurance coverage for the injectibles.  So Freedom had sent word to my doctor to fill out a form to send to the insurance company.  Do I want to wait for all of this (time frame unknown) or just pay out of pocket and have it tomorrow morning?  So we spend some time debating pros and cons.  The biggest con being the medicine doesn't get here by Saturday and we possibly have to delay everything to get back on the next schedule with the clinic.  Although I hated doing that, we had to give the insurance a chance.  There is still a good chance the snow would be cleared in time to have the medicines delivered on Saturday, just under the wire for my first shot Saturday evening.  

Well, I already feel this is the most rambling, boring post.  I am reminded of one of my favorite movies Clue, where the butler keeps saying "to make a long story short," and everyone else calls out "TOO LATE."  I know I am doing it, but I am too hyped up from all my scrambling to even make sense of anything.  As it stands, it APPEARS we have some type of coverage for some of the medicines, so right now it looks like the cost will be around $1800.  Yay.  There is still a lot of confusion as to why this amount and what it all means, but I am happy that we will pay so much less than we thought we would pay even as of getting all my discounts and price comparisons a few days ago.  I was at around $2500 without insurance covering anything, so delaying the order today worked out from a financial standpoint.  (SIDE TIP: If you are ordering your medicines out of pocket from Freedom Pharmacy, take a minute to do an online quote on the computer.  That will generate a "quote ID" good for an additional discount off your order if you tell them the code over the phone.  In my case, it was $100.  I just randomly did that to double check prices from the phone and got that code!)

Soooo, I am taking my last birth control tonight and getting up super early to get everything checked out for a final okay to start this IVF cycle.  Then I do nothing except brave the next storm--this time I am 100% ready for the power to go--and hope my medicines will get here by Saturday without any hiccups.  Even better--enough with this winter.  How about some boring rain??

February 4, 2014

Keep shoveling

This winter is our third winter at our current (and final--never moving again) house, and the first winter of substance with multiple snow storms of significant accumulations.  My saline sonogram (practice transfer) was cancelled yesterday due to snowy weather and rescheduled for tomorrow.  Now they are calling for more snow and ice.  I just keep telling myself that the weather is out of my control.  All during December and January when snow storms were piling up, I kept being very grateful that I didn't have any fertility appointments to attend.  I still have some flexibility to reschedule again if need be, but I am getting an icky feeling and creeping worry in my dark mind, "what if a storm hits when an important appointment rolls around like egg retrieval or embryo transfer?"  Then the rational half of me (ok, rational 1/4th of me) says, "wtf...don't worry about these made up things!"  

I got my fertility meds priced through three pharmacies--one local and two online (Freedom Pharmacy and Walgreens Specialty in Frisco, TX).  With having $900 worth of Bravelle already here, the cheapest for the rest of the meds was Freedom Pharmacy, at just under $2700 after a rebate of $100 on some of the items.  While it is huge chunk of money, and I am composing a protest/complaint letter to send regarding the sliminess of the insurance company sneaking these medications out of the coverage categories for a covered process, I am glad we are on the "lower end" of the $3-5k that our fertility doctors kept quoting to us from the beginning.  We may need more of any of the medications as the cycle progresses, so the tally could certainly go up.  Needless to say, but here it is, please let this shit work.

I have been exercising very well and eating well, including tracking my calories.  Still--no freaking weight loss in the past two weeks.  In fact, as of yesterday, up a half pound.  I know, I know...it's probably muscle or something.  Still, it is frustrating to eat so many salads and vegetables and be hungry for what feels like nothing.  Just venting a little.  I know rationally that I am in great shape physically to undergo this procedure, and I feel strong and healthy physically.  I am enjoying being on the pill, not starting injections yet, and being able to not think about my cycle days very much.  I downloaded some guided meditations to practice starting now and through the IVF cycle.  I think I feel relaxed on one level because a great deal of this is beyond my control.  I feel acceptance for the fact that I cannot really contribute to how my eggs will respond to the stimulating medications--how many, how fast, what quality, etc.  Maybe I am deluding myself and a real panic attack is lurking in the week(s) ahead, but I actually feel calm about things today.