In My Head

Last Wednesday I attended my first therapy session since my senior year in college.  It was a much more pleasant experience than the sessions I had in college.  I had to go back then because I went crazy.  It was the first semester of my last year in college.  I got a B on one of my tests.  This incident caused a lot of anxiety and fear in me because I translated the grade of the test to a bad grade for the class.  This would in turn translate into having a bad g.p.a. and difficulty finding a job after graduation.  I know.  Irrational.  I started crying daily mid-semester.  Then insomnia came.  Everyday I could not fall asleep until 7am and I had to get up at 9am to go to class. I was completely lonely and miserable because many friends didn’t know what to do with me and avoided me.  Finally, I had to go see a therapist to discuss the possible reason(s) behind all the crying and insomnia.  It was such a long time ago that I don’t remember details.  But I remember feeling like it wasn’t helpful.  I was still having a hard time sleeping and was still crying every single day.  I wonder if it had to do with her being a student intern.

With that experience in mind, I didn’t know what to expect this time.  I used a door code to get into the building.  When I got in, I saw a bench and a few chairs with a round glass table in the corner.  There were business cards of all the independent therapists who practice there.  I chose the chair closest to the glass table and read over every single card.  There were two ladies who sat next to me on each side and they were quietly waiting for their appointments.  Down the hallway there were quite a few rooms without any signs or markings.  Down on the floor in front of each room was a white noise machine that was turned on.

My therapist came to greet me.  She looked exactly how I envisioned her since I had seen her online profile picture on her website.  On our phone intake she told me that she just turned 40 last year, so she said she kind of understands how I feel to have reached this milestone.  Somehow I feel better that she is around my age.  I got to say that she looks very good for being 41.  I signed a few consent forms and filled out an infertility questionnaire on which I had to answer yes, no, or maybe for each statement.  Something like… “Infertility is affecting my sex life” or “I feel that I will never be able to get pregnant”.  I went with my first instinct when I answered each question.  Many of them I had “maybe”.  The therapist looked it over and said, “You seem to be doing quite well emotionally.”

We went on to talk about how I have been coping with infertility.  I honestly feel that I am doing better than the first year of trying to conceive.  That was the toughest because we were struggling with not having a clear answer as to why we weren’t getting pregnant, the possible loss of natural conception, and the fear of investing our time, effort, and money in IVF, something that was so foreign to us.  Plus I hadn’t accepted that I was indeed infertile and the best technology may not be able to help us.  I was jealous of others.  I was feeling fearful, lonely, crazy, uncertain, mournful, and sad.  Fast forward to the present time.  I am feeling and doing so much better with my emotions.  So I talked about my daily prayers for peace, calm, wisdom, patience, and submission to God.  It felt a little funny to talk about that to my therapist (assuming that she does not share my belief) but I needed to share about it because God and my prayers to Him really help with my coping.

I had talked to the therapist about the confusion in my head about the next step.  She asked me how I was doing with the decision making.  This is what I told her.  I find myself working on all the pre-cycle prep work for UCSF.  I have not even contacted L.ife IVF to schedule for a financial consultation.  Instead, I have been working to get my lab work done, signing all the necessary forms, scanning and emailing previous blood test and exams to the coordinator, and trying to order this antibiotics that UCSF recommends for the both of us before we cycle there.  But I still haven’t made my final decision yet.  I don’t want to make a decision that I will regret, so I am stalling and trying to make sure that our decision will be the best one for us.  I am stumbling on what IS the best for us.

I think what I get hung up on is whether or not UCSF is the best for my situation.  I still get stressed out when I think about all the logistics I have to deal with if we go the L.ife route.  All the outside monitoring appointments, making sure that the scan and blood work results are faxed over to Irvine before 11am.  Chasing down someone at L.ife to answer any questions I may have.  Getting the doctor’s order a day AFTER the scan because I will be an out-of-town patient.  Buying a plane ticket last minute.  Booking a rental car and hotel last minute.  Canceling clients last minute.  Worrying about premature ovulation prior to egg retrieval.  If we do this once, I think I can handle it.  But we’re talking about banking every month.  I am just not so sure if I really want to do it.   But L.ife does have its perks.  It seems to have a great lab for growing embryos to the blastocyst stage.  Not saying that UCSF does not have a great lab.  Given the conflicting information from Dr. No Nonsense and Dr. Y at L.ife about day 3 embryos vs. blastocysts for women with diminished ovarian reserve, I just don’t know who to believe.

My biggest questions:

1) Am I putting my cycles in jeopardy if I don’t grow my embryo(s) to blastocyst?  On the flip side, am I putting my cycles in jeopardy by growing my embryo(s) to blastocyst?

2) Am I not trying the best that I can if I stay locally for my cycles?  On the flip side, am I doing myself the best service if I put myself through the stress of cycling out of town for months?

3) Will I regret staying locally if the end result is no pregnancy with my own eggs?

My therapist made a few points that became my Ah Ha moments.

She said that it seems like I am someone who is pretty much in my head.  I gather a lot of information in my head.  Sometimes too much information and thinking a lot about it may not be the best.

I said that I see all these people on forums flying to Li.fe and banking embryos one cycle after another.  I feel weak if I don’t go the same route.

She said that after talking to me for an hour, she would not associate me with the word “weak”.  If anything, she thinks that I am strong.  Since I have been taking the more difficult route of cycling with an RE one hour away, maybe this is the time for me to just take it a little bit easy and walk down the street from work.  She said that although it has been proven that stress does not affect pregnancy rate, having a choice to cycle close by definitely will keep my psychological wellbeing in check.  Other women fly to L.ife to bank because they don’t have other choices.  But I do.

She said that human beings are very prone to be hard on themselves.  From what I have told her, she sees that I am being hard on myself.

She also said that it seemed like I might have made a decision already.  I just hadn’t acknowledged it or hadn’t realized it yet.

She asked me if I think about the next step and worry about it throughout the day.  I do, but not when I am very busy at work.  She discussed a technique with me to contain these thoughts to a scheduled time.  She wants me to schedule a time in the evening to think or worry about things related to the next steps.  Throughout the day, if I have thoughts, feelings, or questions about it, I am to do the following acronym STOP:

Stop (Take a step back from what’s happening)

Take a breath (Slow down)

Observe (Observe thoughts and feelings, physical sensations, what’s happening)

Proceed (Let it go, laugh, do something different)

Whatever questions, feelings, or thoughts I have filed away, I bring them back up to surface at my scheduled time at night.

This is to help me to react to a stressful event by having a calm and conscious response rather than an automatic reaction (such as anger, frustration, panic, worry, negative thoughts).  If I worry too much about the past (I should have) or the future (What if…), then I am not living in the present.  She asked if I had any regrets.  I said… Yes.  If I didn’t proceed with my last cycle, then I would have enough  money to do two more mini cycles at UCSF.

She also gave me a self-care plan to cope with this.  It’s a list of ten things.  One thing that stands out is having a calming mantra that works for me.  I am still trying to find one that fits me.  One of them is “I am doing everything I can to become pregnant”.  I  may just use this one.

I enjoyed the hour that I spent with her.  The things I told her were things that I had been telling my husband and my friends.  But having her insight was actually more helpful.  I have to remember not to be too hard on myself, that I am doing everything I can do get pregnant, that I may be thinking too much, and that not going to SoCal to cycle does not equate being weak.

I am going back to see her at the same time on the same day next week.  I think it’ll help me solidify our plan for the next steps.

Maybe A Therapist Can Help

The ups and the downs in the world of diminished ovarian reserve.

I have been so excited for my blog friends who have gotten pregnant using their own eggs or donor eggs.  I was particularly excited for Maddie.  She went through a hell of a time banking her eggs for many cycles because of her husband’s sperm issues.  She eventually had to use donor sperm to fertilize all the eggs that she tirelessly saved up for a long time.  She got her first BFP ever in her life only to find not-so-good news at her first ultrasound.  It has not been confirmed yet but the situation doesn’t look good.  My heart breaks for her.  I was overjoyed when I learned that she was pregnant.  I hate it so much that this already difficult journey is not smooth sailing for her.  I know I project a lot of my hopes and dreams on her because of the similarity of our situation.  I really didn’t want her to experience the chemical pregnancy/early miscarriage that we all dread.  If you have a moment, could you please go give Maddie some love and hugs?

*****

I have so many questions in my head for the next steps.

I had two phone consultation last week with the clinic that suggested egg donation for me.    I did it just for the heck of it.  I want to see what a donor egg cycle entails with this particular clinic just to see how doable it is.  The first one was with the nurse coordinator.  During the hour-long phone call, I learned a dizzying amount of information regarding donor egg cycles.  I have been reading the Insider’s Guide to Egg Donation so I am not unfamiliar with the process.  However, it is still a lot to learn.  This particular doctor/clinic requires specialty blood tests to be done for anti-phospholipid antibodies, natural killer cell assay, and TH1/TH2 intracellular cytokines.  This costs $1322 for the lab in Chicago and $55 for this clinic to send the blood over.  The coordinator also explained the difference between frozen egg cycles vs. fresh egg cycles and what each entails.  It seems like each batch of frozen egg costs from $10,000 to $15,000 depending on the agency, and a fresh donor cycle will cost $5000 to $10,000 for the donor compensation and $15,000 for agency fees. That doesn’t include the fees for the clinic.

The second phone call was for a financial consultation with the same clinic.  They offer frozen egg cycles and fresh donor egg cycles.  I learned how much everything cost for this one particular clinic.  There is a choice of frozen egg cycle, which is the least expensive.  It follows by a single fresh egg cycle.  The most expensive option is the shared responsibility plan that refunds 90% of part of the fees if you don’t get pregnant after transferring all the embryos.  The kicker is that the full fee that you end up paying is $12000 more than the package price that is quoted.  These are fees for necessary procedures such as ICSI, assisted hatching, culture for embryos, etc.  You would’ve been fooled by the fee structure published on the website.

I was quite shocked at the sticker price for a whole IVF cycle with donor eggs.  I originally thought that it’d cost about $35000 for a fresh donor egg cycle.  Now I have to rethink the whole thing.  I know I can do frozen egg cycles.  We do want to have two kids though, so it seems like a fresh donor cycle that goes well has the most potential of giving us multiple embryos and a chance to freeze.  I have a problem with paying this clinic so much money as their success rate isn’t even the best.  UCSF’s donor egg cycle success rate is even better than theirs.

With this new information, I have become more reluctant with the thought of exhausting all of our IVF fund on mini-IVF cycles with my own eggs.  What if they don’t work?  Then we’ll have to spend many many months saving up again.  So I told Bob that maybe we should do at most three mini-IVF cycles in order to leave some money for egg donation if those fail.  He told me to take some time to think about it as he wants to do as many cycles as I desire.

I have been doing research on other clinics that have a good reputation with donor egg cycles.  S.DFC seems to be a good choice.  R.BA is a bit too far away for me.  I would love to talk to the ladies who are cycling at these places or have cycled and have found success.  Egg donation in the States is so pricey.  I joke with Bob about having a donor with blonde hair and blue eyes as we learned about Aramis’ wonderful news with her donor egg cycle in the Czech Republic.  We doubt that we can find a donor with black hair and brown eyes there, but the cycles are so much more affordable.

The interesting thing is how open my mother is to this idea.  I shared with her about my various online friends’ life and mentioned about Aramis’ success.  She said excitedly, “You should go try too!”  I asked her if she realized that it’d be most likely with a donor who is of European descent.  As first she was taken aback by it and said to find an Asian donor first.  I joked with her and asked, “What if we really decide to go for a cycle in the Czech Republic?”  Her answer surprises and warms my heart. She said, “As long as you and Bob think that this is the right choice.  We’ll be 100% supportive and will love the baby all the same.”  I had never expected or imagined my mother to be so open with her thoughts.  She is a Chinese parent after all.  To me, it shows how much she loves me and how much she wants the best for us.  She told me to let her know when we get pregnant.  I said, it’ll most likely be four months into the pregnancy.  She was again very much okay with it, as long as we tell her.  Bob said that his mother would’ve demanded to know right away (if I were an Indian daughter-in-law).  My mom has a beautiful soul.

Anyways, back to my decisions.  At this point, it’s not simply (which is not simple at all) about choosing donor eggs vs. own eggs and SoCal vs. UCSF.  It’s about how many mini-IVF cycles we do so that we leave some money for donor egg cycles knowing the cost.  Our preference is not to borrow money so saving up money is the only way.  I am very grateful that we’re in the financial position to save up.  It doesn’t come very easily and we have to make good choices financially along the way so we can achieve our goal faster.  Bob has the vision, intensity, and the passion to save up towards this goal.  I feel this very heavy financial burden while we get ready for our next cycle.

I think I am leaning towards UCSF.  However, I have irrational (or not so irrational) fear that I am not doing the best I can and taking the “easy” way out (again, it’s not at all easy) if I don’t bank embryos for 6 or 9 cycles in SoCal.  Am I not trying my best if I don’t go the difficult, stressful, but maybe more promising route?  Is SoCal actually a more promising route?  One lady who got pregnant after banking many cycles in SoCal actually transferred a day two embryo (that was immature to begin with) for her first transfer instead of the other blastocysts that she banked.  My point is, it wasn’t Life’s good culture for growing blastocysts that made it possible for her to be pregnant.  It was the normal egg and an element of luck plus her good lining.  So it could happen to me at UCSF as well if we bank and transfer day 2 or day 3 embryos.

Instead of going crazy with my questions, I searched and found a therapist who specializes in infertility and even third party reproduction.  I wrote her an email and was pleasantly surprised to find that 1) her clinic is a few blocks away from my work, 2) she has evening hours, and 3) her rate is reasonable.  Ever since Bob switched to small companies, we don’t get coverage for therapy anymore and we’ll have to pay out of pocket.  I am happy that he’s very open to it. (See, he’s reasonable when it comes to important things and to him, flowers are not important.)  Anyhow, the therapist and I had a phone intake.  It was a fresh breath of air to know that she didn’t need me to explain anything about IVF or egg donation.  I just told her my history and she knew exactly what I was talking about.  We made an appointment for our first session next Wednesday.  I would really like this time with a professional to sort out my thoughts and feelings regarding this whole thing.  I love talking to various friends but I think it’s about time to talk with a professional.  At the end of the phone call, she asked me what insurance we had. I told her that we had Ka.iser which does not cover for mental health outside of Ka.iser.   She gave me a $20 discount, stating that it’s unfair for Ka.iser patients that they don’t get reimbursement.  That was so nice!  It’s still a lot of money but I think it’ll be helpful for us.

*****

Wow that’s a load of information.  Ladies who have gone to S.DFC or R.BA, could I get some input from you?  Thanks in advance!

The Big 4-0

I am a 40-year-old woman.

Wow.  Looking at the above statement.  I still can’t believe that it describes me.  I always thought that it was going to take a long time for me to get to forty.  The time has come.

In terms of fertility, I never imagined myself to be 40, not pregnant, and childless.  I always thought that I would have at least one child by now, and would be pregnant with number two (since we started trying when I was 37 1/2).  How naive were those thoughts.

I was more demanding this year when it came to my birthday.  I usually let Bob plan whatever he wants to do for me.  This year, as if wanting to compensate for what I don’t have, I requested a few things.  I didn’t want a party as I have never been a party person.  I wanted a massage, a particular place for dinner on my actual birthday, and flowers to be sent to my work.

Bob is usually very agreeable with what I want.  He booked the restaurant of my choice for my birthday.  He secretly enlisted the help of one of my best friends to find a good massage therapist.  He was also planning other festivities on Saturday, two days after my birthday.  He truly wanted to make my 40th birthday memorable for me.

Bob usually gives me flowers in person.  He gave me roses last year on my birthday, the day of our first IVF egg retrieval.  He is willing to buy me flowers but thinks that flower delivery is a big waste of money.  I had been nagging him about ordering flowers to be delivered to my work on my birthday.  He had been resistant.  But being me, I continued asking every other day.  I know it’s something that I should not be doing… but I did.  I don’t know.  I was just so anxious to want to make my birthday memorable this year that I started to be a bit unreasonable.  I was thinking, if he could make me happy by just clicking on a few websites and paying a little bit of money, why not?

The day before my birthday, Bob came home and asked me what website he should go on to get me flowers.  I was annoyed at his questions since I thought that he should have done his research and better yet, should’ve already ordered the flowers.  I told him a website and he was muttering something, making comments about how it was a waste of money.  I wasn’t happy about his attitude so I fought back.  One thing led to another.  We got into a huge fight about money.  That was the last thing I wanted to do right before my birthday.  I wanted everything to be “perfect”.  There is no such thing as perfect.  We reconciled by the end of the night and realized that the fight was more than just about flowers.

In my mind, I was not feeling good about turning 40 and being childless, so I wanted to make things nice and happy by requesting things I thought could make me happy.  I thought that my husband should just fulfill my wishes since I was a bit depressed about turning a big milestone.  In his mind, he had already planned an actual birthday dinner, another activity on Saturday, a massage, and a pricey dinner for Saturday.  Everything added up to quite a big amount of money.  He just started working again and we agreed that we have to save up a lot of money for donor egg cycles.  He thought that he had already planned enough for my birthday.  He couldn’t see why he couldn’t just buy me flowers and hand them to me rather than ordering a floral arrangements that would double the cost.  I thought he should indulge me.  He didn’t see the value of flower delivery to work when we have to save up so much money for future cycles.  You see the differences in our views?

My argument is that ordering me flower delivery is not going to prevent us from doing a donor egg cycle.  The amount of money is so insignificant in comparison to the tens of thousands of dollars that will come out of our pocket.  After all, we should not let infertility rob us of our joy in life right?  But Bob thought that it was an unnecessary waste.  We just think very differently in regards to flowers.  He was willing to do it, just not without making comments about it.  That made me mad.  He eventually did order the flowers and I ended up loving them.  But I didn’t feel nearly as happy as I thought I would, under these circumstances.

The fight was just not worth it.  But it did expose the stress and pressure that infertility has brought on in our marriage.  Imagine not having the burden of needing to save many tens of thousands of dollars in order to fund our donor egg cycles?  Imagine what we could actually do with that money?  We could replace our car.  We could pay off the house faster.  We could put more into our retirement account.  We could save up for our kids’ college now.  I know Bob is feeling the pressure.  He wants to provide for me.  He wants to fulfill my wishes of pursuing as many mini-IVF cycles as I want before we embark on the egg donation journey.  In his mind, spending money on floral delivery just does not make sense when we have such a huge goal to reach.

My birthday day.  With puffy eyes, I went into work and had a great birthday celebration.  A bouquet of flowers, a card, and a box filled with homemade blueberry scones were on my desk when I arrived at work.  An hour later, the same coworkers brought a birthday cake with four candles into my office so I got to make a wish.  At lunch time, my closest coworkers took me out to lunch and surprised me with a spa certificate.  We usually don’t give birthday presents to one another but I guess this year is the exception.

Here are the flowers from Bob:

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Bob and I had a wonderful dinner.  We had this:

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The crab was perfect.  The garlic noodles were yummy.  The mango salad had shrimp and scallop and this wonderful dressing.  The shrimp toast was nice.  I also had a pear martini.  That dinner was perfect.

The next morning, I went into work and was surprised by one of my best coworkers who put 40 post-it notes all over the four walls in my office.  This is one of the walls:

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These notes were filled with wisdom, humor, and historical facts about my birth date.  Things like, “It’s not old if you’re a tree” and “7/10/1913 Highest temperature recorded in USA Death Valley 134 degrees! Pass the iced coffee”.  I had a busy morning so I finally read all the notes by lunch time.  She is crazy and I feel very loved.

Friday night was my birthday dinner with my brother and sister-in-law.  We had German food.  I had the best beef stroganoff ever:

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Saturday was a big celebration.  Bob did a great job.  We first visited the zoo.  We live like five minutes away from the zoo but had never visited it together.  I got to see giraffes, my favorite animal, and some very cute gorillas.  I also bumped into my ex-boyfriend’s mom who volunteers there.  Bob and I had so much fun walking around seeing every single animal.

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I hope that this stork would help bring me a baby:

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The zoo was also filled with pregnant women who were apparently carrying their number two, number three, or number four.  They walked around pushing strollers or holding their kids’ hands.  I was okay with them though.  I didn’t feel like I had to hide from or avoid them.

The massage in the afternoon was heavenly.  It was 90 minutes of bliss, thanks to my husband for arranging for such a long massage.  The spa was tranquil and calm, and smelled very good.  Bob waited for me for the whole 90 minutes out in the waiting area.

Finally, he surprised me with this meal. He told me the location but I thought it was another restaurant.  When he walked me over to the restaurant and I saw the sign, I was very surprised.  It was a French bistro for which we had to cancel our reservation a few years ago.  I had always wanted to try it but never had a chance.  I was pleasantly surprised that he remembered I wanted to try it.   The ambience was lively, the service was great, and the food was excellent.  I didn’t know it at the time but one of the owners actually served us throughout the dinner.  I ordered the chef menu that included filet mignon with bone marrow.  She told me that the bone marrow was not available for this menu but was available for the prime rib meal.  I didn’t want prime rib so I was okay with not having the bone marrow, although it was disappointing.  The server lady actually asked for the bone marrow and included it for me in my plate!  That was so nice of her.  Here are the pictures:

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This fish just melted in my mouth.

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The beauty of the bone marrow with the filet mignon:

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My lava cake.  I made a wish that I will be holding my baby on my birthday next year.

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That was such a memorable birthday celebration.  Whatever fight we had the previous week, this had made up for it all.

Finally, one of my best friend took me out to lunch and we had dessert before the main course, french toast bread pudding and sticky bun.

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My husband placed a birthday card on my side of the bed on Sunday.  I opened it and started tearing up.  The card says “Wishing you a year that soars with possibilities”.  He wrote: “Possibilities is one word that I want you to keep in mind as you start a ‘new’ year.  Looking forward to walking with you as we encounter new possibilities.”

Yes.  The possibilities are endless.  I really look forward to what possibilities my year 40 may bring.

Tearful

I have been feeling tearful today.  The trigger?  My last phone consultation with an RE.

I had scheduled this phone consultation a month ago.  It was scheduled for July 8th at 1:45pm.  In anticipation of it, I called the 2pm client’s mom and scheduled them for 2:15pm.

Yesterday I scheduled an phone conversation with the precycle coordinator at UCSF to go over the checklist of things that I need to get done.  It was to take place  today at 10am.  I figured that I could do one phone call in the morning and one phone call in the afternoon.  No problem.

A little later in the afternoon, I stared at the appointment reminder email for the phone consultation and realized that the time of the phone call was supposed to be 1:45 pm, but EASTERN TIME.  The RE is in New York so of course the phone call is 1:45 pm his time, which translated to 10:45 am my time.  DUH.

Good thing I caught this mental mistake the day before the appointment.  I was confident that I could finish the UCSF phone call by the time I call the New York RE.

Fast forward to today.  The phone call with UCSF was 40 minutes.  My head was spinning writing down all the previous lab work and procedure that I have to check and all the new lab work that will be ordered.  When the phone call ended, I quickly went and got ready for my 11am client.  At 10:45 am, I called the clinic of the New York RE.

Very nice guy on the phone.  Very obviously did not read my history that I took a lot of time to fill out.  He asked me a few pertinent questions.  Then his conclusion:

1) There are usually three causes of high FSH: familial, autoimmune problems, and endometriosis.  It looks like mine could be endometriosis (a small patch of endometriosis was removed during my surgery to remove fibroids back in 2011).

2) He suggests doing an immune testing panel with him, which will cost $3000.

3) He suggests doing laparoscopy to remove all the endometriosis that exists inside me.  Usually he will have to accurately diagnose it.  But since endometriosis has already been discovered in my system, we can skip that part.  He predicts that since the surgery was three years ago, the endo may have worsened at this point.  He recommended going to a doctor that specializes in stripping away the endometriosis rather than just lasering it away.

4) I should go see him for a workup and he can talk about the next steps.  He can work with local doctors if we decide not to do IVF again.  If we do IVF, we have to do it there.  He thinks that for my age, I should continue to pursue IVF because I don’t have a lot of time to waste.

5) He thinks that my high FSH, poor responses to stimulation, and egg quality all have to do with endometriosis.  After treatment, my response should be better.

All this information was gathered in a 10-minute phone conversation.

I was feeling very overwhelmed.  This is a brand new suggestion.  I have asked Dr. E, my previous RE, and Dr. No Nonsense about the cause of my high FSH.  They both said that it is difficult to know the cause.  I asked Dr. E if it could be because of immune issues, and she said that it could well be, but there is no treatment for it.  Dr. Y from Southern California is the only doctor who has ever said that my endometriosis is a factor in my response to stimulation.  However, he never suggested a surgery to remove it.

My head felt overstuffed with ten thousand pieces of information.  Where do I go?  Do I do a surgery?  Do I just go with the local doctor and try a few more cycles?  Do I try to remove the endometriosis to see if my response is better?  Am I not trying my best if I don’t do what this doctor suggested?  Am I not giving it my all if I don’t go the difficult route of traveling out of town for treatment?

I am going to turn 40 in two days.  A year ago, we started our first IVF cycle and had the retrieval on my birthday.  I played in my mind many scenarios last year.  Will I be pregnant in a year?  Will we already have a baby by then?  What will the next year bring?  Will my 40th be a happy occasion, celebrating with a new baby or one growing inside me?  Or will it be the same as last year, only a little grimmer, a little less hopeful, a little more fear-filled?

I am usually pretty good at being hopeful.  But today, I allow this fear to set in.  In a year, will I be still in the same situation?  At a crossroad?  No baby?  No pregnancy?  No clue what to do?

I know it’s hard to predict what is going to happen around the corner.  But when we first embarked on this journey, I really didn’t anticipate myself in this situation: 40 years old.  No baby.  No pregnancy.  I never thought that I will still be childless at this point.

I have been holding back tears all afternoon long.  I had kids I had to work with.  I had coworkers around me and I couldn’t show this weakness on my face.  Deep down I feel like hiding under the cover and having a good cry.  But I had to put on a happy front for my clients.

This huge sense of unfairness came upon me today.  Why in the world do some of us have to make such difficult decisions all the time?  Why can’t we have a break?  Why do we have to wait so long and have to do so much just to have a baby?  Why do some people have it so easily?

Of course there will not be an answer to any of my questions.  They are rhetorical.  But I have to ask them anyways.

In order to make myself feel better, I made a detour on my way home and got this:

hot chocolate

 

It is making me feel a little better.  We’ll see how I do on my actual birthday.  I may just break down and cry like a baby.  Stay tuned.

More Consultations

Cell phone reception was nonexistent in certain parts of the mountains when we were in Denver.  It said “no service” the whole duration driving out of Estes Park.  You can imagine how shocked I was when my phone suddenly rang.  It was a San Francisco number that I didn’t recognize.  I looked at Bob and asked if I should pick it up.  He said of course.  I am so glad that I did.  It was UCSF calling me to let me know that there was an opening on Monday (6/30) for the consultation that was originally scheduled for July 17th.  My first reaction was that I didn’t have access to my work calendar so I couldn’t say for sure if I could take that spot.  I hung up and Bob looked at me funny.  He said, Can’t you just call work and ask?  Duh.  Sometimes my brain doesn’t function.  So I called work and was pleasantly surprised that my schedule was clear for the available time slot at UCSF.  I tried to call the number from the previous caller ID but was being passed around in the automated phone system.  I finally hung up, looked up the reproductive health clinic’s phone number (thank goodness for cell phone reception), and happily connected with the clinic and snatched up the opening.  I was very relieved to have the appointment move up to Monday as Bob didn’t start his new job until Tuesday.  It was nice to have him around when we met the doctor.

So the whole reason why I scheduled a consultation was because I chatted with a lady who also frequents the High FSH forum that I visit.  We talked about six months ago and she shared all of her experiences with me cycling at UCSF.  She has been banking her day 2 embryos for many cycles and recently started transferring.  The cost of each minimal stimulation cycle is about $6500, a lot more affordable than going back to my own RE.  Since UCSF is so close to my work, I figured I should really speak with Dr. No Nonsense before I make a decision.

Yup I am naming this doctor Dr. No Nonsense.  He was gentle and kind, but was also direct and non nonsense.  His intern went over the history with us first and I felt that I was being quizzed.  Good thing I remembered most of the details of our cycles.  Then Dr. No Nonsense went through the history with us again.  He did an ultrasound and found that there was one antral follicle on the right ovary and possibly two antral follicles on the left.  When we finished, we had a talk about the next steps.

He drew a diagram for us.

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Given our history of not getting pregnant naturally, IVF is of course the best way to achieve fertilization.  However, given the low egg reserve, we may not encounter a normal egg for quite a few cycles.  The first thing he wrote on the paper was the words “Egg Donation”.  His point was, if we only had a limited amount of money enough just for one thing, he would recommend egg donations.  He looked up and looked me in my eyes.  He said, “I don’t feel that you’re quite done with your own eggs, right?”  He knew that I only had one transfer.  He could sense that I couldn’t really say that I have done everything that I could until I finish doing a few more transfers with my own eggs.  So, if we had some money to spare, then he would support us trying to use my own eggs first.  He drew the graph of number of eggs and age.  We are fighting the battle of trying to find that elusive good egg.

This is the route he’s suggestion:

  • Do minimal stimulation cycles
  • Use Letrozole (Femara) from CD2 to CD6
  • He may add Cetrotide/Ganirelix depending on the cycle
  • ICSI all the eggs that we have
  • We may get no embryos, one embryo, or two embryo each cycle
  • We can decide to transfer each cycle
  • We can also decide to bank the embryo(s) at day two or day three
  • Banking embryos will allow us not to have the emotional effect of the two-week wait every single cycle
  • He doesn’t suggest growing the embryo(s) out to day five or six due to the low number of eggs.  He thinks when we don’t have many to play with, each one counts
  • He believes that a good egg can be stressed out too much and not grow to day five in the culture, but can survive in the womb
  • Day 2 or day 3 embryos’ thaw rate is over 90%
  • He thinks that my uterus should be fine with transfer because the fibroids that I currently have are in the posterior position of my uterus and not in the cavity

Did I tell you that this clinic is three blocks away from work?  So convenience is a huge plus for me.  I received the fee schedule in the last couple of days and found that each cycle of mini-IVF with UCSF IS about $6500, which is a fraction of the cost going to my current RE.  Medication will not be much because of the low dose stimulation.  The only downside is that this is a big clinic so I will not be seeing the same doctor for any of the monitoring ultrasound or egg retrieval.  This clinic has over eight REs.  Dr. No Nonsense will be managing my cycles though as he will be the one making the decisions for me and with me.

I feel very comfortable with this doctor as I felt the compassion and warmth from him.  It’s very different from some of the online reviews I have read about his bedside manner.  I like him and I think I can work with him.

Fast forward to this past Wednesday.  I rushed home to be available for the scheduled 5:30pm phone consultation with Dr. Y down in Southern California.  Phone did not ring once for another 25 minutes.  I called the Li.fe IVF phone number. Fortunately someone picked up.  I was told that Dr. Y was still talking to another patient.  My phone didn’t ring until 6:30, a whole hour after the scheduled appointment.  I don’t know if I should be worried if that is an indication of their future performance, stressing me out with a doctor that does not respect other people’s time.

We were on the phone for half an hour.  I felt that I was driving most of the conversation, as I asked him many questions.  The following are the highlights:

  • Given my history of having one embryo or no embryos each cycle as well as a history of endometriosis, he suggested doing natural IVF (no stimulation) or minimally using just half of a pill of Clomid (25mg).
  • (A little patch of endometriosis was discovered during my surgery to remove uterine fibroids.  I don’t know if that is enough to say that my endometriosis is messing up my system)
  • I asked him why he uses Clomid and not Femara, he said that Clomid has the function of blocking the estrogen receptors.  Somehow that helps with preventing premature ovulation.  He said that Femara doesn’t help with that.
  • Since we’ll be banking embryos rather than doing fresh transfers, we don’t have to worry about the effect of Clomid on thinning the lining
  • He also doesn’t think using Clomid will make my FSH go higher in subsequent cycles
  • He believes in growing embryos to blastocysts.  He doesn’t believe that an embryo that doesn’t grow to day five can survive in the uterus if transferred on day three (an opposite view of Dr. No Nonsense)
  • He thinks that at my age, I would need at least 4 blastocysts if not more to have a chance at having a life birth
  • He recommends doing PGS on the embryos (which we have decided not to do a long time ago)
  • The blastocyst rate at his clinic for patients my age is 50%
  • He suggests that I do six cycles
  • He said that we can start planning the travel when the follicle(s) reaches 14 to 18 mm
  • He doesn’t suggest using Cetrotide/Ganirelix but he does suggest using trigger shot

Those are the points.

So now I have a decision to make.

Egg donation vs. own eggs?

Most likely we’ll try my own eggs first since Bob started his new job and we can start saving up money again for donor egg cycles if my own eggs don’t work in a few months to a year.  My uterus is not going to grow old as fast as my ovaries.  So if my own eggs don’t work, my uterus hopefully is still in good shape.

With my own eggs, SoCal or local?

That’s the biggest question.  I have no gut feeling.  I just feel that there is a huge dilemma in my heart.

In terms of cost, both places are about similar.

In terms of expertise in minimal stimulation, Dr. Y is no doubt the one to go to.  He does this day in and day out with many many many patients.  He’s been doing this for a few years and this is all he does.  Dr. No Nonsense started doing this a couple of years ago and also does IUI as well as conventional IVF.  Dr. Y may know more about how to tweak the protocol for each individual in terms of FSH level, estradiol level, and the state of the ovaries.  Dr. No Nonsense may do a one size fits all model.

In terms of day 2 embryos vs. blastocyst, it appears that there is a higher chance for transfer if we bank day two embryos.  But does having a chance to transfer mean a chance for a baby?  Or is the chance for a baby higher if we can make blastocysts?  For this point, I don’t know which doctor I should believe.

In terms of convenience, UCSF wins.  I cringe every time I think about having to schedule and go to outside monitoring appointments, coordinating with L.ife for their instructions after each scan/blood draw, keeping a watchful eye on my follicles so that I don’t ovulate before the retrieval, timing the travel and booking plane tickets for the right date, booking hotel and car rental, letting clients know last minute that I will be traveling, and traveling/making it to the appointment.  Those are the things we have to do.  And I cringe.

I am at a crossroad.  Can you feel that I have lost my sense of direction?  It’s compounded by cycle day one today, AF showing up, and the feeling of inadequacy as a woman who cannot bring a life into this world in the most natural way.

This is a lonely road.  I know Bob is traveling it with me.  I know that God is there for me.  I know that many of you are out there rooting for me.  But it’s still a lonely and scary road.  I know that once I make a decision, I will be much better.  But at this moment, I am overwhelmed.

Maybe I’ll go hide under a blanket for a little while.

A Fun Trip to Denver – Take Two

(I don’t know what happened.  Wordpress has been acting up.  I wrote this whole post, triple-checked the preview, and posted it.  Then I found out that 2/3 of my post was not published.  This is take two.  Hopefully it works this time!)

It’s been a while.

Since my last post, we have flown over to Denver for a vacation and a wedding as well as done two more consultations. Let’s talk about the fun part first.

Bob and I had never been to Denver. When we received the wedding invitation to my friend K’s wedding, Bob had just lost his job. We calculated the cost and found that flying two people out of state with airfare, car rental, accommodations, and cost of food would cost more than a few hundred dollars. When you lost one income, you have to be cautious.  When we got married, K flew from Denver and sang at our wedding.  I felt that it was the least we could do to celebrate her and her fiance.  So we bit the bullet and bought the plane tickets.  I am so glad that we did as the trip happened right before Bob began his new job.  The timing couldn’t be more perfect.

We made plans to go to the mountains first before the wedding.  We rented a B&B in Estes Park just right outside of Rocky Mountain National Park.  We found ourselves with the most hilarious innkeeper who happened to LOVE Bob.  He talked a mile a minute, made us the yummiest breakfasts, and sat in the same room and chatted with us the whole duration of the breakfast.  Very interesting character.

Here are pictures of the breakfasts:

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We saw the most spectacular views.  We drove on the Trail Ridge Road and the sceneries were breathtaking.  The mountains were covered with snow.

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We saw this at one of those gift shops in Grand Lake:

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Bob loves it.

We visited many lakes and hiked up to one of them.  I was okay reaching the altitude of 12000 ft while riding in the car.  However, hiking one mile uphill starting at the altitude of 9450 ft was a bit much for me.  I can normally walk a mile or two without a problem.  However, at that height I was huffing and puffing every single second.  It really took me a while to get used to it.

Here is Bob’s back in front of a lake.

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This is called Dream Lake and it did look like a dream.

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One of the most interesting things is seeing one UPS truck after another driving in the deep mountains.  Seriously we saw more than six or seven USP trucks in one evening.  I guess people living remotely tend to do online shopping?

Remember a secret Face.book group that I have been a member of?  I had never met any of my friends in that group in real life, until this trip to Denver.  One of the ladies lives in a suburb.  We arranged to meet up and we had such a nice time with her.  She looks exactly like she appears online.  We got to see her newly built house, met her sons, and were treated to a very yummy lunch.

The wedding was so much fun.  We got a gift bag as out of town guests.

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I don’t want to out my friend on this blog so I will not post any pictures of the wedding.  But I did take a picture of my Sweet Tea Lemonade, with Sweet Tea Vodka and lemonade:

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All I can say is that I love her and I love how happy she looked on her wedding day.  My mind did go directly to my reaction if she announces her pregnancy in a few months.  Well, I’ll worry about it later.

When we came back from the trip, my mom was on her way to my cousin’s wife’s baby shower.  My cousin got married last October.  Shortly after that, I heard from my mom that his wife was pregnant.  She is due in September and my mother has been knitting her sweaters for her baby boy.  This has created a feeling of jealousy inside my heart as all I have hoped for is for my mother to make ME baby clothes, not for my cousin.  It’s a constant struggle to keep my feelings in check.  I surely do not want someone else to suffer from infertility like the way we do.  However, it’s not a good feeling that his wife, who is about 38, did not even have to try for a little bit before she found herself pregnant.  I told my mom that I am sorry but I usually don’t go to baby showers anymore.  I am glad that I wasn’t invited to this one.  My mother brought home two bars of chocolate that were given to us as favors from the shower.  Each bar was custom-made with the baby’s information and the parents’ information.  I guess this is a current trend for favors for baby showers since I’ve seen it from someone else’s shower.  I quickly flipped the chocolate bars over so I wouldn’t have to look at the content of the label.  I just can’t believe that some people get lucky so easily and others have to struggle for so long…

Anyhow, that was the trip!  It was lovely.  Bob started his new job a few days ago.  So far so good.  I will write another post about the consultations.