The Next Steps

In life when something doesn't work out we move forward with a new plan. A next step. 

This morning I met with my favorite APN at my RE's office for my Next Step Appointment. Our new plan appointment. I'm not going to call it a Why The Fail. I'm not going to focus on them anymore. Done. They are the passed. Here is the present and the future.. A new beginning.. a New outlook. 

 I'm not feeling well to being with -I think the start of a cold, I'm a bit stressed- and I am PMS'ing. 



So to say this appointment was emotional is an understatement. 

As I was waiting in the office I could hear the APN say to the nurses that she wanted to do the last ultrasound prior to bringing me back because she needed to spend some extended time with me. Which made me cry in the waiting room. 

Ugh. I don't even know why I was crying- I just was. 

It was okay though because the other couple in the waiting room handed me a box of tissues. The lady looked mortified that I was crying. I think it may have been their first appointment.  They seemed so hopeful and happy. I felt so defeated and sad and anxious. 

I didn't want to be the girl that the doctors need extended time with that's for sure... but seeing the other couple's hope reminded me I can't lose mine and that I was having this appointment to restore some of that.

After a little while they took me back and I had my blood pressure taken- which I was scared was going to be sky high given my anxiety- but it wasn't. I think that sweet couple helped bring it down some just by looking at them. Even if they weren't hopeful they had an air about them that filled me with hope. I would have thanked them, but they probably would have thought I was bat shit bananas. Then I had my weight done- In my full work uniform and anyone in EMS knows these uniforms have weight to them. Thankfully even in uniform I was only up 4lbs. I will take that as a win. Then I sat in the office reserved for consults for a bit- just staring at the pictures of ovaries and explanations of IVF and IUI scattered about the walls. 

When the APN finally came in I had stopped crying and was ready for whatever she was going to throw at me. We went over all of my previous cycles. All of my blood work and then began to discuss where to go from here, what needed to improve and what was working already.

Since the three cycles with Clomid did not work they have recommended to move on to Follicle Stimulating  Medications (FSH) and Human Menopausal Gonadotropins (hMG). 

Injectibles.

Purpose of this as outlined to me- 
- To increase the number of eggs for fertilization. 
- To improve ovulation in patients unresponsive to other therapies 
- To improve the over all chance of conceiving pregnancy. 


The medications I will probably start on is Follistim and Menopur. 

-However the billing department is going to see if Gonal-F or Bravelle are better covered by my insurance. That will determine which actual medication I try. Which I think is actually really nice of them to look into it for me. 

And can I take a moment to say thank you sweet Jesus for our insurance company. We are so lucky to be covered and have so much coverage at that. Without coverage this cycle could cost upwards of $2500. Its truly a shame that all insurance companies are not required to cover some of these costs. It breaks my heart that all of you are not given the same oppurtunity because your insurance doesn't cover anything or covers very very little. It makes me very thankful for our insurance company because without it we would not be able to afford treatment. 

I will take the medications for 8-10 cycle days and they are given under the skin. 

I will have blood tests and ultra sounds very frequently during my cycle while on these medications- they said I can expect to be in and out of the office about every other day. 

I feel like a puzzle if falling into place because I took much of August off so this won't be difficult for me. I won't have to juggle my work schedule and making appointments at least.

IUI will be done once a mature follicle is found. For this cycle the IUI will be done once a mature follicle reaches 18mm- and as long as I actually respond to the medications (which I have no reason to believe I wont.) -As long as I don't have too many follicles that would increase my odds for multiple gestation (anything over 3 is canceled by my MD, anything over 1 we can choose to wait for another cycle or go ahead). -as long as I don't show signs of ovarian hyper-stimulation.  -and as long as I don't become ill with any other sickness.

I should expect pelvic discomfort and bloating. 

My risks are- increased risk of multiple gestation pregnancy 30% for twins and <5% for triplets <1% for more than triplets. 
Ovarian Hyper-stimulation Syndrome- 1% risk of severe symptoms, Enlarged ovaries, fluid accumulation in the abdomen that may need to be drained. Risk of blood clots and ovarian torsion -1% which can be decreased by decreasing my activity. 

Every time the APN hit a different bullet point and asked me if I understood I had to hold back tears. I think it was more of a realization that this is what it is going to take now for us to get pregnant at this point.

So cycle day 1 of my August cycle I will call in and go in for a baseline ultra sound and blood work. They will have the pharmacy contact me to set up delivery of my medications.  They will do a consultation with how to inject the new medications and I will be closely monitored throughout the cycle. 

Since I was already there and since I've been having a recurrent cyst issue they did an ultra sound and blood work. As zero surprise I have a cyst. As a bonus I have two cysts. Which is the root of the pain and the reason I had to buy bulk heating pads to stick on my abdomen and a bigger bottle of Motrin. 

PS CVS's large back heating pads- the bulk size- are on sale this week. They are the kind you peel the backing from and stick onto your skin. They stay warm up to 10 hrs - are discretely hidden under your clothing and fit perfectly onto your abdomen. 

On Cycle Day 13 of this cycle I will have acupuncture. I'm very excited to try it out and if nothing else am praying it helps with a bit of the stress and anxiety I am dealing with currently. I haven't decided if I am going to do OPK's this cycle or not. I have a ton of them so I wouldn't need to purchase them, but I think a cycle where I attempt to not focus too much on my fertility or lack there of would be good for the soul and the brain. 

I plan of working on my health a bit- returning to the gym. Sleeping more. Relaxing on the beach some and working less. 

All in all I am excited to try something new. I hope that this is what we need. I feel hopeful again where as the last few months I've lost some of that hope. 

It feels good to have that back again. It feels good to be less anxiety ridden and it feels good to at least have a plan.

It feels good to be moving forward.