First Time Ever

Right after I published the last post, Bob and I had a phone consultation with Dr. Z.  A bit over a year ago before any of the IVF cycles, we chatted with him about potentially cycling with him.  He suggested that we do two to three egg retrievals, freeze the eggs for the first couple of times, thaw the eggs during the last retrieval, ICSI all of the mature eggs, and do CCS testing on them.  I remember that the cost was about $35000.  Since we had never done a cycle before, I wasn’t going to commit to paying him so much money not knowing what was going to happen.  I wanted to try a cycle first.  At that time, my antral follicle count was about 6 to 8.  So I wanted to see how I responded to the stimulation.

Well, we all know how poorly I responded.

Cycle 1: four eggs, 3 fertilized, one embryo left

Cycle 2: four eggs, 2 fertilized, no embryos left

Cycle 3: one follicle, converted to IUI, BFN

Cycle 4: one follicle, two eggs (go figure), one embryo left

So however you look at it, I am a very poor responder.  I feel that not all diagnosis with diminished ovarian reserve is created equally.  Some people with the same diagnosis can create six to eight eggs each time and will have at least couple if not more embryos to work with.  For me, out of four cycles, we made ten eggs and two embryos.  From whatever angle, this is a pathetic performance.

So this is the history.  Dr. Z is well aware of it.  He said, “Looks like you have been busy since we last spoke about a year ago.”  No kidding, doctor.  He went on to ask what Dr. E recommended as the next step.  I didn’t tell him that Dr. E thinks that egg donation is not imminent.  She thinks that we can continue to try with my own eggs and see what happens.  The last two cycles my FSH were 14 and 17, but my estradiol is higher than what she wanted.  To her, any of my cycles with these numbers will yield one viable embryo.

Dr. Z was gentle but straight forward.  He thinks that I should pursue egg donation at this point.

When I heard those words, I oddly felt fine.  My heart skipped a beat.  My cheeks were blushed a little and I felt very warm.  It was a strange reaction on my part.  I guess since I have wondered about whether or not egg donation is my next step, it was not totally surprising to hear it say out loud to me by a medical professional.  But it was still a surreal experience since no one had ever uttered those words to me.  None of the doctors that I talked with before ever told me that I needed to pursue donor eggs.  So here it is.  June 21 of 2014, for the first time ever, I was told that egg donation is the logical next step for my take home baby.

Although I wasn’t surprised to hear him say those words, I was still hoping that he would suggest a protocol that could create more eggs.  I still haven’t given up hope of using my own eggs to achieve a pregnancy.  Not being surprised.  But it doesn’t mean it was a very good feeling to have crappy eggs and a very low chance of conceiving using them.

Dr. Z didn’t sound very optimistic about Dr. Y’s clinic in Irvine.  He thinks that it’s the best whenever you can get more eggs.  He thinks that there is no such thing as high stims frying the eggs.  (I am sure many ladies who bank their embryos with low stims and Dr. Y. will beg to differ.)  He said I can try that, but the more estrogen I put into my body, the bigger my fibroids may grow.  So the sooner I try to get pregnant (with donor eggs), the better for me to avoid enlarging my fibroids to a point where I may need surgery.

I asked him about the state of my uterus.  Will my uterus change significantly if I did a donor egg cycle right now versus a year from now?  He thinks that it makes no difference.  My uterus will not deteriorate like the ovaries.

He said that if I were his sister or daughter, he would recommend the same thing given my history and the state of my ovaries.  D. Y also said the same thing, that he would recommend going to his clinic for mini-IVF if I were his sister or daughter.  Why do doctors all say that???

Dr. Z went on to explain the difference between fresh donor eggs and frozen donor eggs.  He subsequently emailed me many documents to read about this topic.

Bob can go either way.  He asks if I want the fastest way to have a baby.  Somehow I just feel that I am not quite done with my own eggs.  However, going to Irvine and banking embryos takes a long time.  If using my own eggs fails, then we are looking into starting donor egg cycle in a year.  Do I want to wait a year knowing that the chances of me getting pregnant with my own eggs are slim.  But… do I put my trust in statistics or do I put my trust in God, if I pray and feel that God is pointing me to one direction?  How do I remain hopeful and faithful in this situation?

This is a tough one.  I just don’t feel complete if I don’t give my eggs another honest try before I say I have done everything I can.  Am I being a fool?  I guess it’s a very personal decision.  And it’s really hard to balance being realistic vs. believing in the supernatural that only God can accomplish.

Good thing Dr. Z is only one doctor.  And his opinion is just one person’s opinion.  I still have to talk to a few more doctors.  We are not making a decision until then.  But I feel that it’s good to gather all the information.  So I will also speak with Dr. Z’s nurse and financial person in a few weeks.  I also purchased the book “Insider’s Guide To Egg Donation”.  I feel better being equipped with the knowledge so that we can make an informed decision in the future.

Let’s Talk Money

On this fine day, my first day past ovulation, let’s talk money.

Money has been on our mind recently.  First there were all the phone calls I had to make to inquire about the cost for outside monitoring at local clinics.  Then Bob and I were talking for days about his job offers and money and decisions.

It’s been daunting, to say the least.

As I have said before, UCSF’s IVF clinic is just down the street from my work.  It would be the ideal place to do my outside monitoring if we decide to go with the Irvine clinic.  I also wanted to meet with one of the REs there.  A lady that I met on an online forum has been banking her day 3 embryos there using mini-IVF with this particular doctor.  I would like to consult with him about the cost and the protocol so we can make an informed final decision of our clinic choice.  

So this is the lowdown.  Seeing the doctor for one hour for consultation and an ultrasound scan will be $325 as someone without insurance.  It’s reasonable and I am okay paying that.  The in-person consultation is scheduled for mid-July.  I can also wait for that.

The staff member responsible for outside monitoring was not available at the time of the phone call so she had to return my call.  When I listened to the voicemail, I thought I heard it wrong because she was heavily accented.  I left her a message requesting for an email confirmation of the fee schedule.

An outside monitoring appointment will cost $385.

Three Hundred Eight Five.  For a ten-minute appointment.  How in the world can they think that they can ask for this much?

Sticker shock.

The cost of blood work ranged from about $48 to $77 each, with $16 for each blood draw.  So imagine… every single time you go there for a monitoring appointment, it will cost at least $545.  Average three appointments per cycle.  You’re looking into $1635 for each cycle.

It is so depressing to think about it.

I was determined to find a cheaper place.  The next day I called two other clinics.  Clinic XYZ that Jane Allen’s RE uses charges $325 per ultrasound, but the blood work for each type of test is $135.  Clinic number three in the city is even more ridiculous.  The grand total of an ultrasound comes to $450 each, with blood work for each test being $110.  So you’re look at $595 to $670.  Per monitoring appointment.  Three times of that will be $1785 and $2010.

I got even more depressed.  

So turns out, UCSF is the least expensive out of the three clinics if you take everything into account.  I can still go to a Quest or LabCorp for blood work.  That should be a lot cheaper.  But in terms of taking time away from work, it seems to be the best to stick with one place.  UCSF is the most convenient.  I can also go back to my own RE who is one hour away.  She is cheaper and I trust her.  But can you imagine that drive for three times each cycle and then traveling to SoCal for retrieval?  Just the thought of it makes me want to puke.

It’s almost a crime to ask for so much money for such a simple thing.  What do they have to do?  Measure the lining.  Measure the follicles.   Nothing else!  Is it because I am in the Bay Area?  It’s just so….. depressing to think about the cost.

*****

Bob had been struggling with making a decision with the job offers that he had.

Here is the list:

1) Big huge corporation – It’s a contracting job.  Hourly rate is wonderfully high.  No benefits.  The team likes him so much that they immediately said they could request to have Bob hired as a fixed term employee for one year.  That would mean a salary for one year plus the full benefits that the company offers.  I know that this company offers great fertility insurance.  So we were very hopeful for a weekend… before the word came back that the team had already reached its quota for full term employees so the request got denied.  How disappointing.  The contract is for nine months only.  After that there is a very low chance that he will be hired on as a regular employee without having to go through the vigorous interview process.  So… most likely he will be looking for a job again in nine months.  But the pay is going to be so so good…. Imagine saving up money for donor egg cycles…

2) Small but established company that is far away – Bob likes the type of things that he’d do at this job.  But it’s so so far away.  He went to the interview for giggles as well as to gain as much experience as possible.  They turn out loving him.  They offered him a job with a decent salary.  But the drive is just too far.  Bob had done that before with his previous jobs and hated it.  This drive is going to be even more brutal.  After thinking a whole lot for days, he decided to decline.  The CEO immediately called him back and offered to let him work from home one day a week.  He also agreed to raise the salary by a few percent.  It was very tempting and Bob was very exciting for only driving there four days a week, until the next morning.  He slept on it, opened his eyes, and found that the commute at 7am would take an hour.  It takes driving on five freeways to get to this job, and the last freeway is notorious for being crazy.  In fact on that Thursday morning we checked, the traffic didn’t clear up until after 10am.  So even with leaving later like at 9, it will still take him an hour to get to work.  After struggling for one day, he finally said he didn’t think he could do the commute four days a week.  It was a very tough decision… and he had to decline the job, again.

3) Start up company in the city – He is also very interested in this job.  But because of his past experience in his previous startup company, he’s a bit leery about this company.  It is more established than his previous company.  It has enough money for another six months and its founders are currently looking for investors.  Bob at first got what we considered a lowball offer.  After a bit of negotiation, the salary went back up to be comparable but still less than the desirable level.  The great thing about this job is that commute takes only a mere 37 minutes with walking, public transportation, and walking.  Totally comfortable and doable.  He has always wanted a job in the city.  So this IS an answer to our prayer.

4) Another small company across the bay – This is also an interesting job.  It’s accessible by public transportation, which would take about an hour.  However, these people are very laid back.  They are slow in taking their time to get back to him with an offer.  At the same time, Bob had been pressured by the other two companies to respond.

Given these choices, Bob had had a few very stressful days.  The pressure was creating some stomach problems for him.  We talked for numerous times on the phone about these offers, what to say in the emails to negotiate for better terms, about the commute and evaluate what was more important.  I prayed.  He prayed.  And we thought for more.  Finally, we decided to forego the bunch of money that the huge big corporation offered.  We declined the far away job because the commute is just too brutal.  The small company across the bay is still taking its sweet time.  The final winner is the job in the city.  Not the easiest decision.  But we both feel at peace about it.  We are blessed with choices, so we’re thankful for that.  But boy, it was a very very tough decision.  It proves that money is not everything.

So, after three months of being unemployed, Bob has a new job!  Hooray!

*****

Glad we made a decision about the job.  The decision about outside monitoring clinic is still pending.  I will have several phone and in-person consultations in the next few weeks so we’ll make a decision about my next cycle soon.

We were good with baby dancing this cycle.  I went for my pap smear yesterday and my doctor commented on how much cervical fluid I had.  I guess it was my fertile time.  We acted on it last night and I got a temperature shift this morning.  I told my doctor that I was not counting on it to give me a baby.  She said… things happen when you least expect it.  I usually would get annoyed with comments like that but I wasn’t bugged by it.  I hope she’s right this time.  Maybe after all, we don’t have to decide on how much money to spend on anything if this is the cycle we’ll find success.  I really really hope so.

Missing Clay and Eli

Today, I miss Clay and Eli, our precious embryos that were lost.  I actually hadn’t thought about them in a while.  When I do think about them, I don’t usually get overly emotional.  I think for a little, then my thought would pass.

But today.  Today was a little different.

A friend of mine had success with her first IVF.  She transferred a blastocyst and a morula.  One of the embryos became her 18-month-old daughter.  The toddler is a beautiful girl and I can’t be happier for my friend.  From the batch of embryos that fertilized in that cycle, there was one that was growing slowly.  It turned into a blastocyst on day six and was frozen.

When my friend wanted to try for number two, she thawed this embryo and transferred it.  Luckily, she became pregnant and is currently about 12 to 13 weeks.  Somehow I am not jealous of this pregnancy probably because I just love this family so much and I love this little girl.  I really didn’t want my friend to have to go through with the anxiety of a fresh cycle and waiting for the embryology report.  It’s a wonderful thing that the embryo implanted.

I always thought that the embryo was a morula on day five and turned into a blastocyst on day six.  I was told by her today that it wasn’t even a morula on day five.  It somehow grew into a 5BB blastocyst on day six.

Today after dinner, I told Bob that this friend’s embryo was just like any other ones that they had.  Not even a morula on day five.  Somehow it miraculously became a blastocyst, attached to the uterus, and is now a baby forming inside my friend.  I commented, “What a fighter this embryo was.”

Bob said, “Just like our Clay.  Clay was a fighter.”

I was in the car while Bob was driving.  Tears started streaming.  It wasn’t because of my friend’s pregnancy that hurt.  Bob’s comment just touched a special spot in my heart.  It was so raw.  It was almost like I could feel the touch on that tender spot in my heart.  Sometimes I wonder if I am cold blooded because I don’t always get emotional when I think about Clay and Eli.  But today, I am again grieving the loss of these embryos.  My babies that tried so hard to hold on… but gone forever.

Bob held my hand and let me cry for a while. He apologized for making me sad.  I assured him that it had nothing to do with what he said or with my friend’s pregnancy.  I just needed a moment to grieve those lives that were lost.  And that was the right moment.

Sometimes we need that moment to just stop what we’re doing and think about the past.  Then we move on again.  I think this is part of healing.

My husband drove me to a restaurant, stopped, and bought me bread pudding.  The sweetness of both his action and the bread pudding more than made up for the sad moment for today.

I do have a wonderful husband.  Having him makes this journey easier.

The First Steps to the Next Step

I think I am slowly coming out of my cocoon.

My friend Jo continues to gently poke at me every single day in regards to contacting other REs for a second opinion.  So here is what I have done.

I contacted Li.fe IVF down in Irvine on my day off.  I chatted with the new patient coordinator about the process to cycle there as an out-of-town patient.  Bob and I went to the clinic’s IVF seminar in April 2013 and received all the paperwork.  I knew the clinic had raised their fees so I needed to know the new fee schedule.  The coordinator emailed me all the paperwork, which included the new fee schedule, all the pre-IVF screening requirements, registration and history forms, and explanation for their assisted reproductive technology and CCS testing.

For the first time ever, I actually sat down and calculated the amount of money it will take for us to buy a 3-cycle package there at Li.fe.  Of course it is not just the package fees.  It includes all of the following:

• 3-cycle package fees
• out-of-town monitoring management fees required by Li.fe, for three cycles
• estimated cost for ultrasound scans and blood work at local facilities, about three to four times each cycle
• estimated cost of medication for three cycles
• plane tickets from SFO to Orange County (times seven assuming Bob only needs to go the first time, four round trip tickets for the three retrievals and three round trip tickets for three transfers)
• hotel room times six (three retrievals and three transfers)
• rental car times six (three retrievals and three transfers)

In the fee schedule, it didn’t specify the cost of freezing and thaw sperm.  From one of the high FSH forums, I learned that you can request for the sperm to be frozen at the first retrieval so that your partner doesn’t have to go give a fresh sample at every single retrieval.  I had to email the coordinator and ask about the cost.  And yup, there is a fee for that too.  I am sure frozen embryo storage also requires a fee.  

I calculated the estimated cost for going to Li.fe, which takes a 1.5 hour plane ride to get to.  Then I calculated the cost of doing three regular cycles with my own local RE Dr. E with the cost of medication.

It will cost us $20,000 less to fly to South California and bank our embryos than to go with my own RE again, for three cycles.

TWENTY THOUSAND DOLLARS less.

Told my friend Jo.  She said, “No brainer”.  I am sure she meant she’d travel to SoCal.

So that means that I will have to do a lot more hard work.  The list of out-of-town monitoring sites that Li.fe offers for the San Francisco Bay Area are all in the South Bay…  Very far from me.  One of the clinics is my own RE’s clinic.. but she’s also far away.  I wish I could just walk over to UCSF since it’s so close to my work.  I have been dreading picking up my phone and calling the IVF clinics in SF to see if they do out-of-town monitoring.  But if we’re seriously thinking about cycling down south, I will have to do that.

I will pat myself on the back though.  I have done more planning and calling around than I ever wanted to do in the last three months.  And guess what?  I also scheduled phone consultations with those two REs that I said would contact for a second opinion.  One is scheduled for June 21st.  The other one on July 8th.  This is a start, isn’t it?

One of the problems I have with traveling to SoCal for my cycles is that I will have to take off two days for retrieval.  It will be difficult to figure out in advance which day to book the plane tickets and it’ll have to be a last minute cancelation on my clients.  I hate to cancel on them so much.  But I’ve got to do what is important to me.  So I’ll have to handle telling my clients’ parents about the reason for my cancelation.  Maybe I am thinking too much about it.  Maybe it’s going to be fine.  It just stresses me out a little having to think about coordinating the logistics.  I also run the risk of ovulating before retrieval.  

And the thought of cycling all over again is still daunting at this moment.  

You guys… I am going to turn 40 next month.  I know I shouldn’t let fear take over.. and I believe I am not.  Otherwise, I would have started my cycles again shortly after our chemical pregnancy.  When I got married at 36, I never thought that I would be childless or not pregnant at age 40.  But the thought of me approaching 40 without a baby doesn’t do my emotions any good.  

Today I survived going to my first baby shower in a very long time.  I went for only 30 minutes since I also had to attend my infertile pregnant friend’s baby party.  I wanted to go to support my friend Anna who struggled to get pregnant and will give birth in August.  I actually had dinner with her last night so I don’t feel too guilty only going to her shower for 30 minutes. I am glad I had a reason to escape the second part of the shower which was the present opening part.  It would’ve been a lot harder for me to sit through the whole shower smiling.  The second party was at a Chinese restaurant with a 10-course meal.  Bob and I sat with a bunch of ladies who were my friend’s former coworkers.  The conversation turned to one of the ladies’ grown kids and whether or not they would get married any time soon.  One of the ladies said, “Don’t wait until you’re 40 before you have your first baby.”  

I was sitting there thinking…. Uh.. that’s me.  Forty years old and no babies.

I didn’t react much to that though.  Bob was concerned that I was offended.  But I was not too affected by it.  In a lot of people’s eyes, 40-year-old is old to have a baby.  I didn’t want to wait until 40 but if this is the path, then what can I do?

Anyways, I am back in the game.  I started taking my prenatal vitamins and all the supplements again.  I even placed an order for more.  My friend Jo gently challenged me to stop drinking coffee.  Her argument is, since I have to pay so much money and put so much effort into making a baby, why not also give up something that may influence the outcome?  So… I am taking up the challenge and haven’t had my daily morning coffee at home.  I arranged for my medical records for all of my IVF cycles to be sent to me and one of the physicians.  I am doing what I can do right now to put my toe in the water for the next chapter of my life: IVF #5.  

We still don’t know what the solid plan is.  But it’s the first step to explore all the different options.

Maybe things will change if Bob gets a job that offers fertility insurance.

We shall see.

 

 

 

It’s Been a Year

I knew that my one year blogoversary was coming up. I knew that I wanted to write something on the day.  The weekend came and the weekend was gone.  I woke up groggy and did not go to boot camp.  I was not completely myself and forgot.  WordPress then reminded me that I started blogging one year ago.

A year ago, on a Sunday afternoon, after lurking and stalking everyone in the blog world for a couple of years, I felt the urge to have my own space, to talk about my own journey, to comment on other people’s blogs, and to make connections with those who might know what I was going through and how I felt.  I didn’t know what to expect and didn’t think anyone would be interested in what I wanted to say.

And then I found all of you.  Or you found me.  Whichever way it was, that afternoon, the little voice in my head and the little fire in my heart helped me make one of the best decisions I have ever made in my life.

So I just want to share my sincere appreciation for all of you who have read my words, commented on my posts, given me advice, listened to my rants, cheered for my successes, mourned my losses, prayed with me and for me, walked side by side with me on the worst day of my life, and encouraged me to pick myself up and try again.

I know I would’ve survived the last year without this blog, but my quality of life would’ve been so much worse.  And because of you continuing to read and comment, it motivates me to continue to document my journey because I feel like it will matter to someone out there.

A year ago, we were about to embark on our IVF journey at the end of the  month.  I was wondering how Bob’s and my life would be different if I had lasted a year writing this blog.  I was imagining being pregnant or about to be giving birth.  I was being positive and thinking positive.

Fast forward a year.  We are not pregnant.  We don’t have a baby in our arms.  So did we not gain something in this past year?

I have definitely made gains this past year.  Intellectually, I know my situation and I understand it a lot more than one year ago.  I know that the diagnosis of diminished ovarian reserve is no joke. It’s a cruel diagnosis.  Even the most advance technology in the reproductive science field cannot help with many cases like mine.  I know how I respond to meds.  I know it doesn’t matter high stims or low stims.  I get one embryo.  Or no embryos at all.  I didn’t have this knowledge last year.  I was anxious to try and was hoping that my body would be against the odds.  A year has passed and I just know that I am no different from the majority of the women with DOR.  It’s good to know, so we can have closure and move onto the next step.  It’s good to learn about your own individual case and be realistic about the odds.  I have a clearer direction as to the path that may lead to a forever baby for us rather than how we were one year ago, hoping to be one of the lucky ladies that proved “It only takes one”.  I am a lot more open to egg donation and am seriously considering the possibility of it if trying with our own eggs doesn’t work in the end.  So yes.  I am better off than a year ago.

Spiritually, I’ve also learned that God is in control.  Not the doctors.  Not myself.  God is.  Everything is in God’s timing.  Even though I am not pregnant yet and don’t have a baby yet, God is the one who makes the supernatural possible.  Yes, I believe that the supernatural needs to happen for me to have a baby.  And I have seen numerous times in the past year that the supernatural and miracles do happen.  I am looking at all of my DOR blog friends who are pregnant or even have given birth.  You know who you are.  I feel tremendous joy for you that miracles have happened.  There is hope for the supernatural to happen in our household here.  In what or whom am I putting my trust and hope?  My answer is God.  Even through my loss and the darkest time in my life, the Lord came through and lifted me up.  He has shown me repeatedly that He is there to wipe my tears and pick up my broken pieces.  For that, I am grateful that my eyes are open to the Lord that has always been there for me.

I am also grateful that I have not become more bitter.  In fact, I am getting slowly better with being around pregnant women, hearing baby news, and holding newborn babies.  I am in general feeling more liberated than one year ago.  In about a week, I am about to attend a baby shower and a baby party.  I can’t tell you the last time I went to one of either.  But I am going to try.  And I think I will be okay.  So I feel that I have matured in the past year.  Do I still feel jealous at times?  You bet you.  Am I being able to come out of it and go back to being okay?  I can confidently say Yes.  So this is the blessing that God has granted me after so many months of prayers.

There are still so many unknowns in the future.  One thing I know is that I will continue blogging.  This space has given me the kind of connection that I can’t find anywhere else.  I want to write and I want to update you on what’s going on with me.  I hope I will continue to have a voice in this space in a year’s time to write a post about my second year blogging.  And I hope that by then our little binky  moongee will be growing inside me (of course without the binky yet) and will soon debut to the world.  I am holding onto that hope.  Maybe then the blog should be renamed “In Quest of Another Binky Moongee”.