250 Million Angry Birds

Compared to IVF, IUI to me was the most anti-climatic thing ever.  

We got up bright and early on Friday morning, the day after Thanksgiving that we were supposed to sleep in.  We drove 50 minutes and arrived at my RE’s clinic.  I have been used to going over to the IVF Center for both egg retrievals so it was a brand new thing for us to do a procedure at my RE’s clinic.  Bob was asked to go inside to give his sample.  I said a little prayer that everything would go well in there.  He came out with a weird look on his face and his right hand holding his left armpit.  I guess he was told to hold onto the sample and he didn’t want it to get cold.  So he tucked it in his shirt under his left arm.  I couldn’t help but laugh.  He was to hold that container for another 20 minutes until Dr. E’s assistant was ready to take over.  So he sat there holding onto his own armpit while these women walked in and out of the clinic.  I offered to hold it for him but got rejected.  Fortunately football was on TV so he was distracted from the awkward position of hiding something under his armpit.  He said that the collection part of fine.  It was just that he entered into this little room with a sink but no helpful “education material” to help with his collection.  There was a TV and DVD player but again no “educational DVD” to come to his aide.  Oh well, kudos to him for managing to finish strong.  

I was basically useless from 8:30 until 9:30, the time that we were called to go into the room.  I sat there and watched all these couples come in and out of the clinic.  I could basically tell who was there for IUI and who was there for a monitoring ultrasound.  Finally at 9:30, we were asked to go into one of the exam rooms.  I did the usual shedding of my clothes from my waist down.  We joked a little until Dr. E entered with a syringe, A.K.A. turkey baster.  So there was no signing of paperwork, no anesthesiologist chatting with you about the risks and what not of the procedure, no changing into a gown and a surgical hat.  I just lay down, spread my legs, and let Dr. E insert the speculum.  She then asked Bob if he wanted to do the honor and push the syringe in.  I think she probably caught him off guard.  He almost had to ask for a repeat of the question.  Then he said, no thank you.  So she did it herself and the sperms went in.  Then we were done.  Nothing exciting or special about the process.  I don’t know why I was expecting something more magical or spectacular than what had happened.  But that was it.  Just pushing the sperms inside me.  That’s all.

Right before Dr. E did the procedure, she nonchalantly mentioned that his sperm count was 250 million and the quality was good as well.  I had no reference as to what is good for IUI so we just said okay that sounds good.  After the procedure, I updated my Face.book friends about the procedure and was confused on the count, if she meant 250 million pre-wash or post-wash.  One of my friends said she would guess it was pre-wash because 250 million seemed high.  To confirm, I wrote Dr. E an email and she responded with:

250 post
Pre slightly higher
Motility 85%

According to all of my friends, 250 million post wash is very high.  So I guess we have very strong swimmers, 250 million of them trying to get to my egg once it’s released.  My husband has been feeling great all day long about his swimmers.  He has been imagining 250 million Angry Birds jumping up and down, waiting for the egg to come.  I will let him gloat for another day or two.  I am surprised by the number.  We always thought that we had a slight male factor as well.  I guess he performed well on the day that matters the most.  His semen analysis has shown better and better results each time.  His morphology has increased from the usual 5%, to 8% during the first IVF, to 13% during the second IVF.  I am still surprised at the high count post-wash.

Now we just need to have that one good egg to match all the sperms.

My temperature has jumped this morning already.  Thankfully we did the IUI yesterday and not today.  My RE gives me the option of doing a beta 13 dpiui.  I could also POAS if I want to.  I am in the no testing camp. But I am going to start progesterone tonight.  So I need to find a way to know if I should stop progesterone.  Our insurance is changing starting tomorrow so a beta test will not be fully covered by the new insurance.  Do I really want to pay money for something that most likely will not give us a positive result?  I don’t really know.  I am sure I still have time to contemplate.

I really want to be hopeful.  I will let Bob do all the hoping while he gloats in his glory of 250 million Angry Birds for another day or two.  

 

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IUI #1 Final Scan and Show and Tell

So nice to have today, the day before Thanksgiving, off. The ultrasound appointment gave me an excuse to stay home from work. In the last two days, Bob and I had the repeated conversation of whether converting to IUI was a wise choice. We didn’t have to decide on injecting the Cetrotide until last night. If we continued on with IVF, the Cetrotide was necessary to hold off ovulation. It is not needed for an IUI. Right before the Menopur injection, we again asked each other if we were sure about the IUI. The answer was positive. Why did I seem to be uncertain about it? Well, I was most sure about the decision. Then I came across someone’s post on a forum that I frequent. This girl, who is my age, almost cancelled her cycle this time because she only had one follicle growing. Her RE told her to continue on because she might get two. Right before retrieval, a third one popped up. At the retrieval, they were hoping to get three eggs and they actually retrieved six eggs! Out of the six, five were mature and fertilized. One early blastocyst and one compacting morula remained on day five. She got pregnant after transferring those two. I am not saying that this will happen to me. But these freak things do happen. You hear about all these people with follicles that were hiding and they got pregnant from a cycle that they almost cancelled. I was secretly/not so secretly wondering if we would have another follicle showing on the scan today. The result? One nice 18mm follicle on the right ovary. There were two tiny follicles on the left side that probably won’t do anything. My lining is nice and thickening, at 9.5mm. So IUI it is. We’ll do the trigger shot tomorrow at 8pm, probably right after Thanksgiving dinner. IUI is scheduled for Black Friday morning. When Dr. E asked what time we would like to go in for the IUI, Bob joked that we should get there at 4am since it’s Black Friday. He’s such a troublemaker. Always trying to create trouble. 🙂

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I am starting to get into the holiday spirit. I am participating in the ornament exchange that is put together by Teresa. I have been searching and looking and finally found these ornaments that I fell in love with. I picked out one for my partner Jennifer. I am super super super excited about it! I bought one for her and one for myself. I went over the limit by $1. Hopefully nobody is going to yell at me because of that. I will show mine once I have shipped Jennifer’s.

Finally, remember the family photo shoot that we did a few weeks ago? We finally got our photos back! I am so grateful that we have a cool photographer who takes wonderful photos. I am in the process of finding a good Christmas card to order. The following are a few photos of us. (Well, I am not quite ready to out myself on my semi-anonymous blog so we just have to be headless or show our backs for now.)

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Too bad I can’t show you my makeup! The girl at the Mac counter did a great job. I am super happy with the photos. I wanted trees and water. And we got trees and water. Enjoy!

IVF #3 –> IUI #1

Remember what I said my biggest fear was?  That we don’t have any follicles?  Well, this is not too far from that.  My biggest fear has come true.  Today was IVF #3 scan #2.  Dr. E found one lonely follicle on my right ovary and nothing on my left.  The decision that we had to make was:

1) Going forward with the cycle and trying to retrieve that one follicle/egg, hoping for the best

2) Converting to an IUI and continuing with the meds

or

3) Doing it the old fashioned way with timed intercourse.

Too bad Bob wasn’t with me this time.  I headed out to speak with Dr. E’s finance person.  Since we still have some insurance coverage, as long as we complete the IUI before December 1st, the whole procedure will be fully covered.  We gave the big fat check to the clinic for the IVF on Saturday.  The clinic had not cashed our check yet.  I could get the check back right then and there and wait for another cycle to decide if we would want to proceed with a fresh cycle or frozen embryo transfer.

I headed out to the car and talked with Bob on the phone about it.  If we decide to NOT go through with the cycle and convert to IUI, does it mean that we do not have enough faith that God could turn that lonely follicle into a great juicy mature egg, that could turn into a good quality blastocyst?  If we decide to go through with the fresh cycle with one lonely embryo, does it mean that we are a fool, throwing tens of thousands of dollar into a seemingly bad cycle?  So many questions.  No one can answer for us.  We can only go with our gut feeling.  We talked for about ten minutes on the phone and decided to get the check back and convert this cycle to an IUI.  Just about two months ago, I had four follicles on each side.  I could have a repeat a month or two down the road.  No one can tell us.  My biggest concern with moving on is, what if that follicle does not have an egg?  What if the egg is not mature?  Anyhow, I walked back into the clinic, waited for the finance person, and was given the check back.

I still go back to see Dr. E on Wednesday for another monitoring ultrasound.  I saw Dr. E in the waiting room and asked her if she still wanted to see me.  She said she would prefer to see me on Wednesday just to make sure.  If I’d prefer, I could do OPK without an ultrasound.  However, my OPK is usually a few days earlier than the rise in my temperature so I don’t want to risk it.  I have already taken that day off.  I might as well go.

So that’s the update.  Not the best news ever.  But I am feeling amazingly okay about it.  No crying.  I am at peace with it.  This cycle I have been praying for peace regardless of the outcome of the cycle.  So here is the peace that I am experiencing.  We look forward to the IUI.  If this cycle doesn’t work, we will check the antral follicles again next month.  If it looks like I have a few, I may do a fresh cycle in December.  If not, we may decide to just transfer Clay back and see if he/she would stick.  If that doesn’t work, we’ll move onto plan E, which is to start trying to bank embryos at the Southern California clinic.  Maybe traveling is really in my future.

In an IVF cycle, anything can happen, especially for a woman with diminished ovarian reserve.  One just has to press on and keep the hope and the faith alive.

IVF #3, First Scan

I’m grateful that Bob could come with me today for my first scan for IVF #3.  It’s a lot nicer to receive good new, bad news, or any kind of news together with your partner in crime.  Well, I have to say that the news was neither good nor bad.  I really didn’t have an expectation going in.  Last cycle I had five or six antral follicles so I was very nervous whether they were growing evenly or not.  This cycle since my antral follicle count was so low that Dr. E didn’t even give me a number, I really didn’t know what to expect.  So I did not expect anything.  My biggest fear before today was that none of the follicles were growing.  That’s kind of silly because I usually ovulate on my own so there should be at least one follicle, right?  Dr. E was her usual cheerful self.  She first searched in my right ovary and commented that my ovaries looked a lot better today than at the last scan when she didn’t show me the screen or tell me the count.  Then her face was beaming with a big smile when she found a 10mm follicle.  There might have been a smaller one in the same ovary.  There also might be a couple small ones on the left side.  That was the result of five days of 3 Femara daily, with Omnitrope every other day, and two vials of Menopur for the last two nights.  Our next step is to continue with two vials of Menopur for the next two nights and go back for a scan on Monday.  Our goal has indeed shifted this cycle.  All we want is to have more than one mature egg.  There were four eggs last cycle but only one was mature.  The interesting thing is that the one egg that fertilized and divided better was one of the immature ones.  Dr. E said that if she pumped me with high dose of medications now, she would expect the follicles to shrivel rather than to grow.  So she wants to whisper to the ovaries some more and encourage the follicles to grow steadily.

How do I feel?  I feel okay.  Of course I want more follicles.  But knowing my body and the egg quality in the last two cycles, I need to shift my focus and pray for a couple of fat eggs, just like what Aramis has commented in the last post.  That’s all I want.  After failing the last cycle without any embryos that would grow beyond day three, it almost seems like a miracle to have an embryo better than six cell on day three.  And having four follicles doesn’t not equate to four mature eggs, which does not equate to four embryos.  Praying and hoping for one or two nice mature eggs seems to be a good goal to have.

Regardless of the outcome, we will proceed with transfer this time.  If we get a couple of good embryos on day three, we may just transfer them on day three and see what happens.  If they look very good, we may wait until day five to see if they turn into blastocysts and transfer them with Clay, our frozen blastocyst.  Dr. E said that we should totally transfer the frozen blastocyst unless I feel so sick after the retrieval that a transfer is not advisable.  With the quality of the embryo, she predicts that it’ll have a 90% chance of thawing successfully.  So friends, we’ll finally proceed to a transfer this cycle.  I am both nervous and excited about that.  I hope that my lining will be as good as last cycle’s.

Compared to people with many follicles, many eggs, and many embryos, my chances of getting pregnant seem so slim.  I have been doing a lot better with my jealousy though.  I am truly happy for my friends who have many follicles, many eggs, and many embryos.  I have been cheering them on and genuinely celebrating their pregnancies.  As for myself, I still keep the faith that it only takes one.  God will make it possible if it is in His will.  Total trust and submission.  Not easy to do but I am trying my best every single day.  I’m grateful that my partner in crime also has the same faith that it will happen.  Now let’s focus on having a couple of nice fat juicy eggs that could be our key to our take home baby.

We just handed over a check with an amount that was enough to buy a nice used car.  I surely hope that it’s not all for naught.

IVF #3 Has Begun

IVF #3 has begun.  I didn’t quite know how to feel about it.  Many people have asked about my feelings.  I was feeling ambivalent for a while.  You know, the constant struggle between trusting that it will happen to us and doubting that it’d ever work.  After last week’s BFN, I got all 40 vials of Menopur just like the first protocol that Dr. E and I had talked about using for this cycle.  I had a luteal phase of 15 days.  I often think that a luteal phase of 15 days is such a tease.  There is a glimmer of hope that we might just be one of the lucky ones that beat the odds and got pregnant in between IVF cycles.  Especially when the basal body temperature was well above the coverline.  On Satuday, the temperature dropped and that little sliver of hope disappeared.  I knew that I wasn’t pregnant even before the drop of the temperature but that was still a little disappointing.

When AF came at full flow, I notified Dr. E via email.  I assumed that we would start four vials of Menopur on CD2, just like the first cycle.  She responded with a whole new protocol.  I was to get my bloodwork done on CD2 and start taking three pills of Femara on CD3.  Huh?  I was confused.  The schedule said to take 3 Femara from CD3 to CD8, and to start two vials of Menopur on CD6.  Dr. E will see me on Saturday for the first monitoring ultrasound.  Okay.  I just got 40 vials of Menopur but good thing I got them through a friend at a discounted rate.  But still.  And I was again confused.  Last cycle, I was put on 2 Femara at first and then four vials of Menopur.  There were no embryos left to be transferred.  I am a little weary about being on Femara again.  But, since I decided to go with this RE, I have to trust that she knows what she is doing.  My FSH turned out to be 19.  This is the highest I have ever gotten but it’s not too far off from my previous highest, which was 18.7.  I asked Dr. E why the change of protocol.  She responded with this: 

“When women have less than 5 follicles they respond better sometimes to starting the Femara first.  When I saw your ovaries on ultrasound I saw very few follicles.  Given the FSH of 19 and the few follicles, the ovaries want me to whisper to them.”

Remember I never asked her the number of antral follicles?  I guess I really only had a few on the scan.  Dr. E has officially become the “Ovary Whisperer”.  I hope that she is not talking so softly that the ovaries are put to sleep instead.  

This cycle is not without its minor dramas.  My RE’s medical assistant called in the script of Femara for me.  I called the pharmacy down the street from work at 4pm on Monday to make sure that they had my prescription ready.  The lady reassured me that they were working on it and it should be ready by 5pm.  At 5:30pm when I arrived at the pharmacy, I was told that it wasn’t processed because my insurance only approved for one pill per day and denied three pills per day.  The pharmacist tried to override it online but was rejected.  He said he’d call my insurance and see if he could get it overridden.  I had to be at my Bible Study at 6:35 or so and it was 45 minutes away with traffic.  I needed the meds that night.  Needless to say, I was antsy and stressed out.  But then, I quickly reminded myself that this was something out of my control and there was no use to be stressed. I prayed and calmed down.  Once I was done praying, the pharmacist called my name and said that as long as I and my doctor knew the risk of taking a high dose, the insurance was okay with paying.  Yes, we are aware of that.  So I got my pills for that night.  The pharmacist rocked.  And guess what?  There was no traffic so I got to Bible study on time.

A bigger drama was due to my husband’s work.  We have been on COBRA from his old job so we still have our fertility coverage.  His current company agreed to giving us a monthly stipend to cover for the cost of COBRA.  So I have not been in a rush to finish up any treatment or medical appointments because I thought that we would keep the same insurance.  Last week, his current job rolled out their healthcare coverage.  It’s not a Cadillac plan like the one that we have now but it’s okay.  It’s more like an Accord or Camry.  I am okay with switching over in January as long as I can finish my fertility coverage for this cycle.  However, I didn’t realize that his current company is going to start the new coverage on December 1st instead of in January 2014.  In order to use up our fertility coverage, we have to finish a portion of the cycle by November 30th.  We have about $2900 left.  Unfortunately, because the amount is not enough to cover for the whole cycle even with the insurance contractual rate, we are now officially “cash-paying” client.  As a cash-paying client, we hand over a $12,400 check at our first ultrasound visit, which is this coming Saturday.  My RE’s clinic is going to hand me a superbill for the claims so we could be reimbursed with the remainder of $2900 from the insurance company.  I know that $2900 is not much in comparison to $12,400 that we have to pay.  But every single bit of money helps.  Dr. E’s finance person reassured me that as long as we do our retrieval by 11/30, the cost of the cycle up to the retrieval should be enough for us to claim the $2900 back.  I think we’re cutting it very close this time.  It looks like the retrieval will most likely be Friday 11/29.  

“If there is going to be a retrieval.”  I keep hearing that sentence in my head.  That’s the part of me that does not trust and does not believe.  That’s my biggest fear, that we wouldn’t even get to retrieval.

Anyhow, because of this, Bob has been feeling a little guilty about switching jobs and giving us this drama with healthcare coverage.  He is also feeling the stress of IVF as well as the same ambivalence that I have been feeling.  Needless to say, all of these stresses make us prone to fighting.  A discussion of the insurance coverage late a night after a long day of work turned into another fight.  We’re fine though.  We usually talk things out then and there.  But I could totally feel the nervous energy yesterday throughout the day.

I also think Femara is giving me a headache everyday.

On the plus side, I gathered enough courage and told my mom about our history of IVF #1 and 2 and that we were about to start #3.  My mom is a very sweet and supportive person.  I never doubted that I would get tremendous support from her.  However, I was afraid of her not being able to keep a secret given her history of sharing everything with her sisters.  I hadn’t told her anything because she was traveling in Asia during our first two cycles.  I considered not telling her and hiding all the medications.  Bob and I discussed about it and felt that we should come clean so we don’t have to tell any white lies.  We wanted to be open about what goes on in our household.  And open we are.  The talk with my mom went very well.  She had read up on the process before and had some basic understanding of it.  She promised me that she wouldn’t tell my aunts.  She was probably a little mad that I had shared with my dad but not with her.  She can’t blame me for doing that.  My dad is the best secret keeper in the world.  

My mom has been cute ever since then.  On Monday she checked on my husband several times in the evening whether or not I got home already because I had to do my injections.  (We were doing 25 unit of Omnitrope.)  She asked me many thoughtful questions and was concerned that the process was painful.  I hope that she does keep her promise of keeping things to herself.  We shall see about that.

I chatted with God for a long time this morning.  I prayed to Him and talked about all my fears and my ambivalence.  I talked about our desires to be parents but at His timing.  I prayed for my total trust and submission to His authority and to be joyful and hopeful regardless of the outcome of this cycle.  I prayed for protection over our marriage so that we are for each other rather than against each other.  Unlike the nervous energy that I felt all day yesterday, I have been feeling tremendous peace throughout the day today.  I hope that this peace will remain with me the remainder of this cycle.  

And I hope that we see a few follicles growing on Saturday.  

Time to Spend Money

As expected, Wondfo showed one pink line only.  I wasn’t even nervous, as I didn’t expect any other outcomes.  I dipped the peestick, set it aside, and did my other things.  At least I have an answer now.  So it’s time to move full force onto IVF #3. 

One of my friends was right.  She said, “On the plus side you have a great luteal phase, a very comfy place for babies to burrow in next month.”

That’s a great way to look at things.  🙂

Dilemma of the Day

To test, or not to test?

More importantly, to order medications, or not to order medications?

My temperatures have been up.  My boobs are sore at times.  But, I have never gotten a BFP in my life.  I don’t expect this cycle to be any different.  Today is 12DPO.  AF is supposed to come on Friday.  It occurred to me this morning that I should start thinking about ordering medications if I want to be ready for this cycle.

What if I’m pregnant?  Do I spend thousands of dollars on medications without knowing whether or not I could be pregnant?

I detest testing.  I hate that stark white staring at me.  I hate the absence of a second line.  

If my temperature is still up tomorrow, I might test and go head with purchasing the medications.

That’s the plan… I think???