So as many of you know I went to my "Next Steps" appointment today with my questions in hand. Basically I think Rob and I -together made a choice to at least start the ball rolling for IVF.
Here's how it went down-
I met with Dr. S who was very honest and said he doesn't know why I am not pregnant. While I do have PCOS I do respond very well to medication to induce follicle stimulation and ovulation. He doesn't have an exact answer for whats going wrong and he isn't going to pretend and try to give me one. For what its worth I respect this far more than someone feeding me lines of crap. His inclination is that there is either an issue with the egg descending to the uterus such as scar tissue or Rob's sperm just aren't making it to fertilize the eggs. (He called them "lazy sperm" lol)
So why move to IVF without those answers? Because no matter what the answer is to those two questions IVF would end up being the ultimate answer to achieve a pregnancy. Our pregnancy.
When I asked about the laproscopy he said that he has no problem with me going through with it, but he also doesn't think its necessary. He pretty much said that the risk may out way the reward. There are additional complications with laproscopy -such as infection. And if an answer is revealed, such as you have endometriosis, ultimately you will end up down the same road leading towards IVF.
He also said if we were not ready for IVF we can peruse more IUI's or the laproscopy. His professional opinion is to move onto the IVF, but he isn't going to pressure us into it if we aren't ready for it.
He also put it like this for us- Say he has 100 patients that present just like my husband and I. Some issues with egg production, but good sperm counts and healthy relatively young couples that respond well to medication. Those 100 patients all start with 3 Clomid or Femera IUI cycles. Out of those 100 patients 50 normally end up pregnant by the end of the 3 IUI's.
So now you have 50 patients left not pregnant and those 50 move onto 3 injectable medicated IUI cycles.At the end of those 3 cycles of those 50 patients 25 more end up pregnant.
Now you have 25 patients out of the original 100 patients who are not pregnant. Those 25 patients move onto IVF. Of those 25 patients 63% end up pregnant after the fresh IVF cycle. Since I suck at math lets just say around 10 patients of the original 100 are now left not pregnant.
Now those 10 patients move onto a frozen transfer and 30% more end up pregnant. Basically yes our luck is pretty craptastic these days, but the odds of us being one of the 3 people or so out of 100 original patients that don't end up pregnant are very very low.
So what about getting a second opinion? There are additional issues with this that Rob and I are faced with. The main issue is that the next closest clinic that I would feel comfortable with would mean an hour farther drive. This would disrupt my work schedule even more and would not be feasible without multiple schedule changes. The other issue that neither of us want to deal with is redoing all of our testing and starting back at one. We want a baby… like yesterday like 3 years ago..
Rob and I haven't come to a definite decision on this just yet. I think we are both pretty confident that IVF with our current clinic is a great option and the numbers really are in our favor. We plan to think about it and pray about it as well.
My IVF coordinator should be calling me sometime this week to start talking about financial and insurance coverage as well as where/when we start. I'm thinking we will be ringing in the New Year with our first IVF cycle. I can't believe I just wrote "My IVF Coordinator". If you would have asked me 3 years ago about an IVF coordinator my head may have detached from my head and spun around in circles. I never thought we would be here.
But, here we are. Faced with decisions that we never thought we would be faced with. Ultimately we have amazing insurance coverage right now. We have no idea what 2014 will bring us. What I mean by that is we still may be moving. We still maybe changing our jobs and thus changing our insurance. Here we are with coverage that so many people do not have and I think ultimately that helps us move forward comfortably in our decision.
My IVF coordinator will be in contact with my insurance. IVF cycles are covered for 4 cycles lifetime. Cryopreservation of our embryo's is not covered and so we will have to pay that out of pocket up front. We were quoted with a $700 fee- give or take. All in all that is amazing and I know so many of you are not that lucky. I wish that everyone had the coverage that we do. I wish I could share it with you all. If we didn't have this coverage right now this wouldn't be an option without pulling money from one of our retirement funds or going into debt with loans. Not that we wouldn't do that, just that having the coverage helps us with our decision.
Dr. S recommended that if my insurance will cover it that half of my follicles go through ICSI. Basically inject the sperm into the follicle to insure that they become embryo's. He feels I will respond very well to the medications and that the ICSI will cover all basis if Rob's sperm don't meet my eggs during conventional IVF, rather than finding this out at the time of embryo transfer. My insurance should also cover this as well.
We are still on a break. I am not taking any medications other than vitamins right now. I am already down almost 10lbs in a weeks. Primarily water weight from the bloat, but I don't care its still 10lbs. I am hoping for an additional 10lbs before we move forward with anything.
We are going to finally tell Rob's parents what we are going through. The thought behind this is that we will need positive support from all directions. My parents are pretty much already in the know, but I also plan on telling them about IVF and getting their take on it too.
In real life I don't think we will be sharing the news. At least not on any public forum such as FaceBook. That is unless you read my blog. Then if you could respect our wishes to not share our news please until we are ready to share it ourselves.
So the next thing to happen is for my nurse coordinator to contact me to set up a second consultation. This is where we will get more in depth about our specific treatment plan and have a meeting with our IVF team. We will also be able to ask any questions we have, so if anyone has any constructive questions that you think we should ask please let me know.
This is a major choice. I don't know if this is the right choice. I still need some time to process what I am feeling. But, after talking with my husband this is our choice. We still have a lot of hurdles before this is definite, but it looks like we are moving towards IVF and hopefully towards our baby… a baby we want so very badly.
I did it.
I tested today despite knowing it still may be a touch early.
Despite knowing I could upset myself for nothing.
But there was also that chance. That looming chance of seeing a positive.
12 DPO- BFN.
From Count Down To Pregnancy : "Based on these statistics, if you are pregnant and take a pregnancy test on 12 days past ovulation you are most likely to get a Positive test result, with the most common being a Faint
Positive.
The instances of false negatives on 12 days past ovulation are less common, but do still occur. 16.5% of test results were False Negatives. A false negative result is when a pregnancy test indicates that you are not pregnant but you actually are."
So basically there is a chance- albeit slim- but a chance none the less that its a false negative and my BFP is still out there. I can't help but let some of the positivity I was holding onto about this cycle slip threw my fingers though, which makes me sad.
It also causes me to think about the future..
It forces me contemplate my next steps- my original plan was to take September, October, and November off from treatments. There is a run in Richmond that I want to do with my friends and I was going to take these months to train. I can't train on the medications because they don't want me running or exercising for fear of an ovarian torsion. The real issue is that I can't guarantee our amazing insurance into 2014. I have no idea what 2014 is going to bring us, and if we end up moving I have no idea what kind of insurance we will fall into.We may be forced into a break at that point and so I don't want to waste the amazing insurance that we currently have, which covers so much of our treatments. I also don't know if I am ready for a break just yet. Mentally I know its not giving up, but I also know each passing month we are getting older and older. I also have it in my mind that "what if its meant to be over those months..."
I know Rob isn't ready for a break either and when I dig deep I know either am I. My nurse told me that we are going to give Menopur 3 tries. It would look like try number one is slipping away and so I think we are going to move forward with Menopur take 2 without taking a break.
I don't know honestly. I guess I still have some more time to make a decision. My period will probably be held off by the Endometrin, which means I will probably still have a Beta on Monday and then can discuss what to do from there.
I'm really not ready to make a choice.
I guess I just need to keep this in mind~
I'm praying for an answer for what to do. I ask for some guidance into the next cycle. A sign for what path to take and some patience to handle whatever becomes of this cycle.
Like the picture says- maybe he is saying wait.
And so I'm going to wait until the answer of what to do is clear.
How did you know when it was time to take a break?
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.
