IVF Update | Egg Retrieval

Hopeful and smiling, prior to the egg retrieval.

I've been avoiding writing an update all day, but the day is almost done and I can't hide anymore. I spent most of the hours after my egg retrieval crying, or sleeping in order to forget and not cry. I feel just fine physically, but emotionally I'm shattered. 

I went into the procedure with more optimism than my pragmatic (sometimes cynical) self usually can muster. But I really felt hopeful. Even knowing that I wasn't expected to get a ton of eggs like other women might, I was OK with the 7-8 my doctor estimated. For some reason that number felt safe. And I was so bloated from all the injections, I took that as a positive sign. I had so much hope, and I was trying so hard to trust and have faith. 

But when the doctor who did my retrieval came into recovery with the news, my hopeful heart broke. Only 4 eggs. That's all they got. Apparently the large follicles were still there, but nothing inside. He said sometimes when they get so big the egg dies. Unfortunately, I had a wide spread of follicle sizes, and he told Greg and I prior to going in that he expected to get "a handful," but I still wasn't prepared for the outcome. My husband, like me, said his heart dropped upon hearing the number, that it felt like "a punch to the gut." I wish I'd had the presence of mind to ask the doctor more questions, but it took everything in me not to burst out crying. One tear slid down my cheek before he left the recovery bay. 

From there I quickly sank into a deep depression; to say I was devastated doesn't even fully describe it. I cried as I left the clinic, cried on the drive home, cried when I called my mom to tell her the news. I felt all my hope slipping away. But I know it's not over yet. I know "four is better than nothing" (even though it doesn't feel that way when you know the statistics). Maybe we will beat the odds. Maybe. Hopefully. So that's where I'm at: Trying to fight my way back to hope tonight.

(Image via PocketFuel)

IVF Update | Cycle Progress, 9 Days of Stims

My three-shot cocktail.

Work and a general feeling of fatigue have kept me from posting an update here the last few days. But I'm off work today and there is quite a bit to report!

We started our IVF cycle on Feb. 13 and I have now had nine days of injections and four monitoring appointments. 

My medication dosages have remained consistent; 300 units of Gonal-F (FSH, a follicle stimulating hormone) and 150 units of Menopur every evening. As I mentioned in my last post, we added a third injection, Cetrotide, which I began taking on Feb. 18, the day after my first monitoring appointment. I didn't expect to begin taking the antagonist (to prevent premature ovulation) that soon, but one of my follicles in my left ovary was growing much larger and faster than the rest, and we wanted to give the other follicles a chance to catch up.

So for the last four nights the hubby has mixed and administered three injections and to say we are both a bit over it would be an understatement. My belly is so, so bloated from all the hormones — Greg, thankfully, gave up the sweet husband act of trying to say it looked fine and normal — and I feel like I'm running out of new places to be poked. But we persist because we know it is all worth it. Every single prick, every scan. Every cramp, every headache. It will all be worth it in the end.

IVF may take the mystery out of baby making, but it doesn't steal the love.

Things are progressing well, it seems. Each monitoring appointment has shown my follicles are growing. (And my estrogen levels have increased, as they should, along with my follicle size.) A sixth follie popped up in my left ovary at my second monitoring appointment, giving us 10 total follicles. And we still have one large, overachiever on the left.

These are my numbers from this morning's scan:

On the left: 

26mm, 24mm, 15mm, 12mm, 11mm, almost 11mm

On the right:

two 16mm, 13mm, 11mm

Endometrium (uterine lining):

About 10mm, which is good. The doc likes to see it above 8mm for transfer.

When I was able to check my phone at lunch yesterday, I had several missed calls and messages from my clinic. Even my doctor had called! (Normally I just get instructions from my nurse or, if it is the weekend, the nurse case manager on duty.) Because of my large, overachieving follicle on the left, they are planning to move up my retrieval. As much as you want your follicles to grow, you don't want them to become too big. It's a balancing act. Initially the egg retrieval was tentatively scheduled for this Saturday, but now we are looking at Friday, Feb. 24. 

A chart at my clinic that illustrates just how big my follicles have grown, and why my tummy looks so huge.

The final word will come when I get my instructions this afternoon, but it seems most likely that I will be triggering tonight! (During IVF, you take a final "trigger" shot of hCG, human chorionic gonadotropin, which completes the final maturation of your eggs prior to retrieval. The trigger shot is usually administered 36 hours before the retrieval.)

The past 10 days have been a little surreal and I could hardly believe it when I heard we were already at trigger day. I told my nurse I was excited and nervous and, unsurprisingly, she said that is a common response. When I got home from work yesterday, Greg greeted me at the top of the steps all wide-eyed. He's excited, too.

I'm trying to hold onto the bit of excitement I have as well as stay calm. This message from Dr. Willman provided reassurance that my cycle is progressing positively, and that gives me some comfort as well as the strength to keep going:

"I'm thinking we'll get about 7 or 8 eggs, which is a nice normal number. It's not high but it's not low either, so I think you're in good shape. You're young, we should have good egg quality, so I think you're doing just fine." 

-Dr. Willman

(IVF card by Levi & Roen In Print, via Anchor of Hopes)

When you have diminished ovarian reserve, you are expected to be what they call a "low responder," so Greg and I knew going in that we wouldn't get a ton of eggs. (I wouldn't be getting the 15-20+ that other women without DOR might get.) But we are pretty happy with our team of follies and we hope that once retrieved that a high percentage of the eggs will be mature and fertilize normally.

My prayer for now, though, is that God will continue to protect these little (and kinda big!) follicles that are growing in my ovaries for a few more days... That the stragglers and intermediates will continue to grow and that they'll be in prime, embryo-creating condition once retrieved.

Prayers for His protection and my health (this cold is lingering...) in these last few days before retrieval are so very much appreciated!

My prayer.

P.S. If you don't already, follow along on Instagram @dreamingoflullabies. I tend to post updates more frequently there!

SaveSaveSaveSave

Not So Easy to Attain

(image by Natalia Drepina)

Ever since we decided to pursue IVF, we've been working under the assumption that we would use the Attain IVF program, which basically offers bundled plans of fresh cycles and frozen transfers at a discounted price. The idea is that committing to a course of treatment up front, and paying for it up front, will reduce stress and increase your chances of success. And you can reap a savings if you do end up needing multiple cycles to have a baby, which most people do.

The risk — of course, there has to be a risk or else Attain would be too good to be true — is that if you end up getting pregnant and have a baby on your very first try, you will not reap a savings. Instead, you will have actually paid more than you would have if you had opted instead to pay-as-you-go directly with your clinic.

This part of the deal has bothered me from the beginning. How would I feel if we did miraculously find success with our first cycle? Would I be upset? Or would I be happy and not care about the extra cost? My nurse as well as a few close friends that I confided in all said that I would fall in the latter camp. That I would be so ecstatic to finally achieve this thing that I've wanted for so long that the money wouldn't even matter.

So, my husband and I decided to accept the risk and move forward.

But we still wanted to do so cautiously, which is why we decided, after much deliberation, that we would use the 50% refund plan. You pay a couple thousand more for the package (2 egg retrievals, 2 fresh transfers, and unlimited frozen transfers) but you get a safety net: If after you've exhausted all your Attain plan options you still don't "take home a baby," you will receive a refund of up to 50%. (There is also a 100% plan that, again, costs a few thousand more.) It's like paying for travel insurance; if something happens that prevents you from arriving at your intended destination, it's not all a total loss.

Unfortunately for us, as it turns out, we won't be able to have this peace of mind as we go through IVF.

At this point, all systems are a go for starting IVF except the financial component. We've been trying and trying and trying to get it all squared away but it's been difficult and time consuming because there are too many cooks in the kitchen, so to speak: Our clinic (RSC), Attain, and the loan company. Our clinic needed to submit an application to Attain for us, Attain needed to verify information with the clinic, the loan company needed to verify information with Attain, and then we needed to sign a contract with Attain and finalize our loan documents.

I finally got our contract from Attain on Tuesday and when I opened it I was surprised to see not only a higher price tag than I was initially quoted but also that we were slated to use the "Core" plan —  also known as the no-refund plan. When I spoke with my RSC financial coordinator yesterday, she was not much help. She didn't know how to answer my questions and was as confused as I, and told me to just call Attain. Fine. I did.

My Attain rep, on the other hand, didn't miss a beat: We don't qualify for the refund plans because my AMH level is too low. They look for an AMH of 1.2 or higher and mine is definitely not that. My AMH level is 0.4.

I had hoped that it was just an oversight, that my financial coordinator had applied for the wrong plan, or that maybe it was because the folks at Attain thought we would be using ICSI (we are still not sure). But no. We don't qualify for a refund because of me.

Now, let's read between the lines because, well, that's what I do and I think what all women do, especially infertile ones:

We don't qualify because I am too risky. The likelihood that I will get pregnant through IVF is not great and Attain doesn't want to have to give us any of our money back when it doesn't work.

We can't kid ourselves. Fertility clinics and programs like Attain are in the business of making babies, yes. But they are also in the business of making money. And the odds are they'd lose money on me. I'm not worth the gamble. I was willing to throw the dice and use Attain, but they are not willing to bet on me.

After getting off the phone yesterday, all my questions answered, I felt hurt and angry. Sad that the (seeming) sense of security we would have gotten from the refund program was stripped away. Depressed that it was all because of me and my shoddy egg supply. And angry that the refund plans were ever presented to us as a viable option. My AMH level has been known since before coming to RSC. This is not new information. Even while I was on the phone with my financial coordinator yesterday, before talking to Attain, she kept insisting that we qualify for all the plans. BUT WE DON'T. I called her back and left a not-so-nice but not-as-mean-as-I-should-have message with the update.

We're not sure where to go from here but we spent the evening pricing out various scenarios on a pay-as-we-go basis to compare to the Attain Core plan. At this point I'm leaning toward pay-as-we-go because I think all value in Attain has been lost. If we get pregnant on the first go, we're screwed (we've paid double what we needed to). If we don't get pregnant at all, we're screwed (we're in the hole $25,000+ with no baby to show for it). To make Attain worthwhile, we would need to have one failed round of IVF, followed by a failed frozen transfer, then another failed IVF cycle, and then a frozen that finally takes. That's the only way the numbers make sense.

I don't have a pretty bow to tie up this post with, so I'll just go back to the beginning and state the obvious: IVF is most certainly not easy to Attain.

Our TTC Story

My husband Greg and I knew we wanted to have children right away. In fact, when my birth control pills ran out a couple weeks before our wedding in May 2014, I didn’t even bother to refill the prescription. When the topic of having kids came up, we had already told a few close friends and family members we hoped to be pregnant by the end of that year.

Of course, life doesn’t always go as planned, and we were flexible. When my best friend got engaged two months before our wedding, I decided we should hold off on the baby-making. I didn’t necessarily want to be a pregnant maid of honor and, more importantly, I wanted to be able to fully participate in all of my friend’s pre-wedding celebrations just as she had been able to for mine. Feeing a tiny bit impatient, we only casually started trying (read: not preventing) in December 2014, about three months before my bestie’s big day, and then slowly began ramping up our efforts in February 2015.

If you’re doing the math, that’s two years now that we’ve been TTC — trying to conceive. Two years since I entered the land of “alphabet soup,” as my dad would call it. By June 2015, I was fully immersed: From checking and charting my BBT (basal body temperature) the moment I woke up to paying attention to the status of my CM (ahem, cervical mucus)… I tried OPKs (ovulation predictor kits) a few times to further help with timing BD (baby dancing!) but they mostly left me frustrated and confused. 

Oh, and I can’t forget the dreaded 2WW (two week wait) before taking an at-home pregnancy test, only to ever receive a BFN (big fat negative) and then, usually the next day, AF (Aunt Flo). The amount of acronyms swimming around in this skull is, well, mind boggling. 

I read Taking Charge of Your Fertility — what is akin to the fertility bible — cover to cover in a day, and ordered several more books that seemed to promise answers. I’m not typically such a voracious reader but I was thirsty for information, for a solution. 

It’s hard to explain but I just knew in my bones that something wasn’t right. And no amount of “just relax, it will happen” or “get drunk, that’s what we did!” was going to fix it. But we needed to wait the requisite one-year of trying unsuccessfully before reaching out to a reproductive endocrinologist (RE).

You can read a recap of our TTC journey thus far here (you’ll see the prevailing theme is lots of tests and lots of waiting). But to summarize, following several blood tests and procedures, including a diagnostic laparoscopy, we learned:

• I have endometriosis. I guessed as much based on my symptoms, but only a surgical procedure called a laparoscopy can officially diagnosis the disease. My doctor classified my endo as stage II or III.

• I have low AMH, or anti-Mullerian hormone, and a low antral follicle count, both of which are indicators of ovarian reserve. Essentially, my remaining egg supply is very low (about that of a 40-something woman) but, because I am just 31, the assumption is that the eggs I do have are of good quality. Related, my FSH (follicle stimulating hormone) is elevated, which means my body has to work harder to grow a follicle each month.

• A blood test also revealed that my TSH (thyroid stimulating hormone) was higher than doctors would like it to be for someone trying to get pregnant. I’ve been on a low-dose thyroid medication for almost two months and my TSH has been brought down into the ideal range. I just have to keep taking the pill every day :)

Those are the main issues at play, and while it will be an uphill battle, I feel somewhat fortunate to at least know why I am struggling to get pregnant since there are others who are simply diagnosed with “unexplained” infertility. (I can only imagine the additional frustration that brings to the infertility journey!) Knowing what we are up against makes me feel ready to fight and, hopefully, beat the odds.

Recently, our current RE, Dr. Willman, called us with some test results and it was not exactly good news. Greg expressed to our doctor how difficult and defeating it is to constantly be presented with new roadblocks as we attempt to move forward. Now, what I appreciate most about Dr. Willman is that she’s typically very direct and matter-of-fact. She doesn’t have the warmest bedside manner — she’s not one to spout off encouraging words to make you feel better — and yet, in that moment, she said just what my wounded heart needed to hear:

“I believe that one day, I will be calling you with good news.”

SaveSave