Update IVF #4, Follicle Check #1

After processing the information in my head for a day and talking to various people, I am feeling okay about things.

I was doing pretty well going into the appointment, although I was still a bit anxious.  My blood pressure was quite high and my pulse was super fast.  Dr. E wasn’t there so her physician’s assistant did my scan.  My lining measured at 7mm.  She saw one big follicle on the right ovary, measuring about 13 to 14 mm.  She searched and searched and finally found the left ovary and saw two significantly smaller follicles that could be about 6 to 7mm.  A lot smaller.  She drew my blood and told me to start Ganirelix tonight.  Since I only have Cetrotide, I’ll use that to prevent ovulation.  She would consult with Dr. E about the follicles and the Estradiol level before she contacts me about the next step.

I walked out there feeling okay.  Not jumping up and down with joy but okay.  It is what it is.  This feels very differently than last time.  Last time I was in shock that there was only one follicle.  This time one dominant follicle seems to be my reality and I need to think about what to do with the information.  I called up Bob and we chatted about what to do.  We haven’t officially made a decision yet but we both seem to want to proceed with egg retrieval and gamble our money.  If each time we will have only one follicle, then I won’t expect anything more than that.  Maybe it’ll be worth it to see if that one egg will turn into one good embryo.  

In the afternoon, I got news from the clinic that my Estradiol level was 281.6.  Apparently after four days of stimulation, that was good.  According to one of my friends, the E2 level should be over 200 after 5 days of stims.  We have only done four days.  So according to people who know their stuff, my E2 level is very good.  I’ll take their word for it.  Dr. E didn’t even mention anything about cancelation in her email.  She will see me on Monday for a second scan.  We’re looking into Wednesday or Thursday for retrieval.

So here we are.  I am thankful that my E2 level is good.  I am glad that the Lord has been keeping my emotions in check.  My husband keeps reminding me throughout the day that it’s in God’s timing, and that we need to keep the faith and believe that good things are in store.  I am feeling grateful that I have a chance to try and am keeping hopeful that this can turn into a good cycle if the egg fertilizes.  Heck, the other two follicles may even catch up.  Really, no one knows but God.  

Awaiting the First Verdict

Tomorrow is the day.  First follicle check.  Two months ago was the first follicle check for the last cycle.  Only one follicle grew.  I can grow one follicle on my own.  No need to use drugs.  Tomorrow will be the first of many hurdles of this making-a-baby project IVF #4.  Yesterday, Bob and I had a brief discussion about the outcome of tomorrow’s scan.  What if we have only two follicles?  Yes we’ll proceed with egg retrieval.  What if we have three follicles or more?  We’ll do a very happy dance.  What if we only have one follicle?  …… Hm……

Yup that’s the big dilemma.  What if history repeats itself that with four vials of Menopur, my ovaries manage to produce only one follicle?  Do we or do we not go ahead to make that choice of egg retrieval?  One egg could still grow to be the golden egg.  One egg could still make a good embryo.  One egg could still be worth it.  With the lab’s help to put the sperm in the egg and break that hard old egg shell, it could be beneficial to proceed with it.  It’s just a very very expensive experiment.  Although we have not made the payment to Dr. E’s clinic, Bob has already transferred the money to my account a long time ago for this cycle.  So to him, out of sight is out of mind.  To him, the money has already been spent.  I do not know how I feel about that.  If we don’t go through with the egg retrieval, we’ll spend over $4000 to transfer Clay, our frozen.  So that’s a difference between over $12000 and over $4000.  

It’s pretty obvious that this is on my mind on the eve of the first follicle check.  I feel calm, as in, what’s going to be worse than the last cycle when we converted the IVF to IUI?  Nothing is going to be worse than a cancelled cycle.  Since I’ve already experienced the worse, I think I am good to go.  The only difference is that I will be going in from work instead of having Bob by my side.  So if I need a shoulder to cry on, I have to go all the way back to work and hold it all together until our dinner date tomorrow night.  

I have rallied many of my friends and family to pray for us, particularly for a good number of follicles, good eggs, and for Clay to thaw well.  And most important of all, for peace, strength, and total submission to God’s plan and purpose.  Keeping the hope alive here.  

Bob the Pro

So… My period came yesterday.  The luteal phase was only 12 days this time, which kind of confirmed that maybe my basal body temperature spiked a couple of days after ovulation as my usual luteal phase is 14 days.  I emailed Dr. E to ask about the next step. She said she’d send me a calendar today.  Today came and there was no sign of said calendar from Dr. E at 5pm.  I usually wouldn’t want to be pushy, but I do want to know what the plan is.  So I emailed her.  She actually thought that she had already sent me the protocol and calendar.  In my mind, I thought she was going to prescribe Femara to me, alternating two pills and three pills and then add Menopur on day five.  But apparently she had other plans for me.  I received two options.  One is to do pure injectibles, meaning four vials of Menopur a day.  The second option is to take three Femara for five days and start Menopur on day four or five.  She asked me which option I felt like doing and my gut was telling me.  

I never thought that I would have a say in what protocol I would like to use.  I sat there minutes before I had to leave work to go to my Bible study and had to quickly make a decision.  I considered quickly the two protocols.  Our first IVF brought us the most success (one frozen day 6 blastocyst) and it was that protocol that we used four vials of Menopur.  The difference is, I had 6 antral follicles at the time and this time I don’t really know how many follicles I have.  The second option with Femara happened to be the same as the second and third IVF cycles, which yielded poor results.  One gave us embryos that didn’t grow.  The other one gave us one follicle.  What did my gut tell me?  My gut told me to go with the protocol with four vials of Menopur a day.  I quickly wrote back Dr. E.  She said that was her gut feeling as well.  So that was the decision making process: gut feeling. 🙂

I emailed Bob who enthusiastically said, Let’s do it!  I had to change my plans for tonight.  I led my group discussion and left early without listening to the lecture.  I still had 26 vials of Menopur left.  Bob was watching a cricket game online, India vs. New Zealand.  I took out all of the Menopur vials and the Omnitrope vial, sterilized all of them, and set out the syringes.  Bob began to draw out the liquid and started mixing the powder.  I sat there and watched him.  He was keeping an eye on the score on the computer screen while mixing the meds.  I found it so amusing to watch him do both at the same time.  I still remember six months ago when we were doing the same thing for our first IVF cycle.  I wiped the table and laid everywhere out in an orderly manner for him.  He was very focused and did everything meticulously without any distraction.  Compared to the very first time when table was free of any non-IVF related stuff, the table this time was chaotic.  It had my laptop, his laptop, a Bible, a water bottle, two placemats, my cup, Menopur packaging, and other miscellaneous items.  This time, it felt like second nature to him.  He knew exactly what to do and did it like a true pro.  It’s definitely NOT a skill that I would want him to master since it means that we have done it one too many times.  The upside of it is that at least I won’t worry about him spilling anything on the table.  Every drop is worth a lot of money.

So here is it guys.  IVF #4 has begun.  I feel pretty good.  We shall see what these Menopur vials can do for us.  We’ll find out more on Friday.

 

This Makes Me Happy

One of the things I like living in the Bay Area is its proximity to the ocean.   I love looking at the ocean.  It makes me feel good.  Those few times when our IVF cycles were not going well, we went together to watch the waves.  Somehow things looked brighter again when we were facing the ocean.  From my house, there are a few routes that I can choose for my daily commute to work.  Recently I have been choosing this route:

 

I have been craving this view every morning.  Once I turn onto Great Highway, this view of the Pacific Ocean just makes my day better.  I often wonder what the ocean looks like daily.  Choppy waves?  Calm?  Once I pass this point, I start my daily prayers to the Lord, giving thanks to Him and intercede for those who are around me and physically far from me.

Tonight, on my way back, I realized that it was still bright out and I could still catch the dusking sky.  So I went on the same route back home.  This was the view I got to see:

 

I love it here.  Life is so much better when we can slow down and enjoy the view, whatever that is pleasing to your eyes.

Just thought I’d share. 🙂

Working Lady Parts and Money Matters

Hi everyone!  Sorry for not posting for over a week.  Last week I was busy listening to the Mind Belly Summit that was posted by GradualChanges.  Thanks girl!  I learned a lot from it, although receiving all the information was very dizzying.  I was forever trying to play catch up since I didn’t want to pay for the upgrade.  In hindsight, I should’ve just paid the $47 upgrade fee so that I can listen to it without the time crunch.  It’s kind of too late now since the upgrade price has gone up to $97 and I really am not going to pay that.  Oh well.  I would like to learn more about all the meditation techniques and maybe learn how to quiet my mind down.

Okay onto updates.  Thanks everyone for being there for me last time when I felt super lonely.  It hits me once in a while when I don’t expect it.  Thanks for the encouragement and I have felt much better since then.

There was finally a glimpse of hope for my long cycle to end.  My temperature finally spiked about one week ago, out of the blue, on cycle day 30.  That was about six days after the last bit of egg white cervical fluid and the last baby dancing session.  We had lost steam and momentum following the every-other-day ritual for a few weeks.  When my temperature rose, I almost cursed aloud because I felt that we didn’t time it well.  How could one time it well when the egg was so elusive?  My hope is that ovulation actually happened a couple of days before the actual temperature spike.  It happened before so I am hoping that this was the case.  I doubt it that we had caught the egg.

Today was the big ultrasound day to check on the cyst and antral follicles.  It felt kind of surreal to go back to the office since it has been such a long wait for the cycle to get moving.  My expectation was low; Given our past cycles, it was kind of difficult to get excited.  Apparently I was still nervous (although I didn’t feel it) as my blood pressure was a bit high.

Dr. E entered with a huge smile.  She first looked at the lining and commented on how beautiful it looked.  Then she pointed out how beautiful the corpus luteum looked.  I was nodding but really didn’t see the physical beauty of it on the screen.  Only REs would say that a corpus luteum looks beautiful.  I wonder how she defines beauty for such a thing.  Apparently on the left ovary, which is usually the dormant one, there were two follicles.  She couldn’t really see on the right side since the corpus luteum was so round and nice and blocked the view.  We should have about three follicles if not more.  And the greatest news of all is the cyst is gone!  From the looks of it, my lady parts all seem to be working properly this time.  The antral follicle count is a bit low but it doesn’t stop us from trying for another cycle.  My best AFC has been six and I haven’t really seen that since our first IVF.  The plan now is to move forward with this cycle and see if the drugs could stimulate any of the follicles to grow.  She said she has seen recently that some people respond well to alternating two Femara and three Femara and then adding Menopur on day five of stims.  Why?  She has no idea.  But it’s worth a try.  She does not suggest bombarding the ovaries with Menopur right away when it’s under five antral follicles.  We can see how the follicles react.  Regardless of how result of this cycle, we will thaw Clay.  Dr. E said that successful thawing rate is 98% so the odds are good.  We have a plan.  🙂

When we drove by the IVF center where the retrieval took place, we waved to Clay in its direction.  Mama and Daddy are coming to get you very very soon.

I presented our new insurance card today to the clinic.  I knew that treatment will not be covered but was hoping that consultation and ultrasound would.  This afternoon I got an email from Dr. E’s finance lady saying that she checked the coverage and unfortunately infertility is not covered regardless of preferred or non-preferred providers.  My heart jumped out of my chest for a tiny bit.  Well, I really do not want to pay for the office visits and ultrasound scans of course.  So I called my new insurance and got hung up twice by the automatic recording.  Good thing I did not give up after two failures.  I finally spoke to somebody live on the phone.  “Steven” said that an office consultation with an in-network reproductive endocrinologist will be covered with a $25 copayment.  Any scans like an ultrasound will be covered at 75% (we pay 25%) after we meet a $500 deductible.  I made sure and asked one more time that yes, if it’s not treatment but consultation, it will be covered.  I thanked him and emailed Dr. E’s finance lady back.

She wrote back quickly, “That is very interesting and thank you for the information because the codes we use will all be infertility therefore should be denied.  We will try it under different things to get it covered for you.”

It’s worth a try and it’s always good to advocate for yourself.  Fingers crossed that these visits were covered.  Otherwise, I am sure we’re looking into $150/office visit and $300/ultrasound.  Yikes.

AF should arrive in about a week.  IVF #4 and/or FET #1 should start then.  I’m hoping for the best and am thankful that God is taking care of my body so the lady parts are working the way they should.  I am still not too late in reaching my goal of having a baby in my arms by the end of this year.  🙂

That Lonely Feeling

Today, I feel lonely.  Lonely in this world of pregnancy announcements, pregnancy news and updates, sight of pregnant women, newborn babies, and successful adoptions.  Lonely even in the world of my fellow real life friends, online friends, and blogger friends who finally, after waiting for a very long time themselves for those two lines, or that phone call/email about a potential adoption, or the delivery of their newborn rainbow babies.  I am happy for them, but I still feel lonely.  Today.

Especially when my body is not cooperating and my basal body temperature continues to stay below the cover line.  There is no ovulation in sight on Cycle Day 29.

Especially when my friends start to talk about trying for number two or three.

Especially when one by one, my secret Face.book friends have a “baby boom” and have gotten a BFP one after another.

I cheer them on.  But I hurt deep down inside.

Not so much that I want them to suffer any longer.  Not that I envy them that it came so easy, because it didn’t come easy.

For one, she lost two babies and finally could try to get pregnant once she started to have health insurance coverage.  I can’t imagine what goes through her mind right now.  Probably terrified to see what her beta number will turn out and has a mix of elation and anxiety of whether or not this baby will survive.  You’re robbed of the joy and innocence when the false hope fools you repeatedly.  But I am feeling lonely in that world of congratulations and those two lines that get darker and darker each day.

It took another friend 4.5 years to have her first child.  It has taken another three years to get this fresh BFP, out of the blue, when she is taking a break from fertility treatment.

I am happy for her.  I really am.  But at the same time, I feel lonely.  That yet another friend gets her BFP.  One after another, I am becoming one of the only few people who don’t have children or who aren’t currently pregnant in this group.

That is such a lonely feeling.

Today, the unknown is killing me.

Right before Christmas, a coworker of mine finally got engaged after dating her long time boyfriend of seven to eight years.  You know what my first thought was?  Oh no, I don’t want her to get pregnant before I do!  It’s such a shameful thing that my mind went straight to making a baby and was not thinking about the joy that she has of finally becoming engaged and planning a wedding.  I thought of myself and how I would react if she got pregnant right away.  I didn’t have enough faith that my time would come even before she walks down the aisle.  

That made me feel lonely and silly to think that someone who hasn’t even gotten married would get pregnant before I do.

A week ago, one of the girls in the Bible study group that I lead emailed me to notify me that she is no longer going to attend because she recently discovered that she is expecting and she has been very tired.  This is the second lady in my group who has gotten pregnant in the last year.  It was such a happy news but again, I felt lonely.  

Of course I don’t expect myself to feel good every single day.  It’s in my constant prayers that I have peace and strength to go through everyday.  I am confident that I will feel fine again.  Maybe tomorrow.  But today, I am lonely in this world of fertility and struggles.  

Waiting to Ovulate… ZZZzzzzz

Quick update.

This fertility journey requires tremendous patience and a lot of waiting.  My 2014 begins with waiting to ovulate.

Today is cycle day 21.  Guess what?  My basal body temperature has not risen.  No confirmed ovulation.  In fact, my BBT has been very low, way lower than usual.  Yesterday’s was 96.5.  It’s usually above 97 before ovulation.  I thought that the thermometer was broken so I went ahead and changed the battery.  Today’s temperature was 96.7.  Still no O.  For someone who usually ovulates on day 13 or 14, this is like missing a flight and waiting at the terminal for another plane that may or may not have room for a standby passenger.  

I usually don’t spot mid-cycle.  The one and only time I had mid-cycle bleeding was exactly one year ago.  In that cycle, ovulation occurred on cycle day 29.  My cycles are usually 25 days to 28 days.  Not ovulating until day 29 felt like an eternity.  Currently, no sign of ovulation on cycle day 21 also feels like time is standing still and not moving.  I wonder if the mid-cycle bleeding I had from cycle day 12 to cycle day 14 was due to the cyst.  There is no way of knowing.   

This is a little bit frustrating.  Natural conception or the next IVF cycle will not happen until this body decides to release an egg or to just go directly to breakthrough bleeding.  

Plus, BD every other day gets a little…. tiring.  I am sure Bob will agree with me.  

Back to waiting……