Ursula Is Gone!

First thing first, Ursula has been killed!  I’m very relieved to be able to start Cl.omid tonight.

UCSF’s instructions is to call on the first day of full flow before 4pm so that the baseline appointment can be scheduled the next day.  I was so hoping to be able to go in on Labor Day so I don’t have to interrupt my work schedule on Tuesday.  I have a new desk that is being delivered and it is very important for me to be able to be at work for that.  My work has agreed to pay for a sit-to-stand desk to help alleviate my wrist and shoulder pain caused by repetitive stress from typing.  I have been anticipating the desk’s arrival for a few weeks now.  The delivery guy is apparently only going to move the packages from the truck to the ground.  I’m responsible for making sure that the boxes are all intact without damage and that they get moved into the building safely.  I really don’t want to leave it to my coworkers to assume responsibility for me.

When my temperature dropped below coverline yesterday, I knew that AF would show some time.  But I wasn’t sure if she would come before or after 4pm.  We met up with some friends in Napa yesterday and my phone reception was spotty.  I was spotting at around 1:30pm but full flow had not come.  The more I thought about having to go in for an appointment on Tuesday, the more stressed out I became.  But I felt very uncomfortable lying about having a full flow if it indeed was only spotting.  Bob saw me struggle so much and said, Just call!  At about 2:45pm, I gave in and left a message with the answering service.  Luckily, it had become more than spotting when the nurse called me back.  I didn’t feel like I was lying as much.  And more luckily, the phone actually had reception when the nurse called.  I dared not move from my location being afraid that I would lose her.

I woke up this morning from a very good night sleep.  I kept my eyes closed in a very comfortable position and started praying.  Praying that the cyst would have disappeared already.  Praying that I would be calm and at peace with the process.  Praying for total surrender of my control.  Praying that the schedule would not disrupt life too much.  God is good and He answers prayers.

The clinic did not look like it was Labor Day.  There were still quite a few people sitting around waiting to be seen.  I am grateful that Bob could go with me again because it’s a holiday.  I must have been quite nervous.  My blood pressure showed.  My usually normal 110/70 blood pressure shot up to 136/87.  I wasn’t happy about my weight either. Ever since IVF started 14 months ago, my weight has been creeping up steadily despite breaks in between cycles.  It may  also have to do with the way I have been eating since our international trip.  I cringed when I saw the number.  I really need to get it under control.  First thing first, putting a limit on the sweet things that I put in my mouth.

I was pleasantly surprised that Dr. No Nonsense’s colleague Dr. Swift was the one who saw me.  With this clinic, you just never know if you’ll see a real RE/professor or just a doctor working for the RE, like what happened to me last time.  It was nice to see a real RE.  She got the nickname Dr. Swift because she was doing everything very fast.  She was pleasant.  I learned in this process that you have to ask the necessary questions and advocate for yourself if you want the full picture.  I asked a bunch of questions.  So yes if I don’t use anesthesia, I can go back to work on the day of the retrieval.  No, they don’t do blood draw to check any of the hormones for this protocol (I guess because you are only aiming at one to two eggs?).  She asked if my right tube was dilated.  Not that I knew of…  She just left it at that.   When she said that the cyst was gone and I could start the Cl.omid tonight, I asked for the number of follicles.  We have four follicles!  That’s pretty good in my books.  I had to ask if I should make an appointment at the front desk for cycle day 8, because in a big clinic, you just have to be on top of things.  I doubt that Dr. Swift would have told me that without me asking.  It’s nice to be able to come to the next monitoring appointment on a Sunday again so we don’t have to disrupt my work schedule.

I am excited to be able to move on.  I am really just hoping for one embryo that we can freeze.  It’s not too much to ask for, is it?  Please pray and think very good thoughts for my ovaries and my follicles.  And pray that Cl.omid does not make me too crazy.

IVF #5.  Here we go, again.

Acceptance, Toxic Friendship, and a New Beginning

Those were the topics of my second therapy session.

I was paying a lot more attention to my feelings and thoughts after our first session.  I noticed that I didn’t think about the next steps as much as I thought.  One morning I woke up at 5:30 am.  The first thought that came to my head was the amount of money that we may end up spending for this whole process (for my own eggs and then possibly donor eggs).  Thinking about that huge, inconceivable amount, my heart jumped and I was instantly stressed out.  Reminded of the technique that the therapist taught me, I immediately stopped what I was thinking, took a breath, observed my thoughts and my feelings, and told myself to let go at this moment and to revisit it again at night.  Instead of being worried, I fell asleep again until the alarm clock went off.  The technique is useful.

I shared about feeling like I am living a double life at work at times.  This is the place that I spend most of my time outside of my home and the coworkers are the people that I see the most other than my own husband.  I only feel comfortable sharing with two people at work.  One person knows many of the details. The other person knows some.  The rest of the people, my colleagues for the last ten years, I don’t share with.  I go to my appointments and have been in and out of the office during my cycles.  I am glad that no one has tried to pry.  I just don’t feel comfortable sharing the details.  But I do feel like that it’s very weird they don’t know the biggest part and struggle of my life in the last three years.

I also shared about my infertile pregnant friend, who is obviously no longer pregnant because she gave birth already.  I have included the links about her in this post.  Basically she is somebody who had tried to get pregnant for four years and finally did.  She was less than upfront when she wanted to share her pregnancy news with me.  She has been saying all sorts of things to me that are very insensitive, like asking me about details about IVF so that she could do gender selection for a boy for number two, telling me not to give up because as long as I ovulate, there is hope…  I had been keeping a good distance from her since she gave birth.  I saw her and her baby at the baby’s party.  I let my guard down.  One day she asked me where we were in our journey and I opened up and shared about the early pregnancy loss with her.  I really shouldn’t have.  So this is the exchange:

Me:  Back in February, we transferred two embryos. Got pregnant, then lost it.  It has taken me 3 months to start thinking about trying again.

Her:  Just keep trying.  Things will be ok.  Do you move around a lot after you transfer.  Try not to move around too much or do heavy lifting.

Can you see why I would be annoyed with her?  There was no “I am so sorry for your loss”.  What does it mean by “Just keeping trying”?  Is it that easy?  And how does she know that “things will be ok”?  And why blame ME for the loss by asking me if *I* moved around a lot?  Thanks a lot for making me the culprit for the loss.

I was stunned that that was the response I got.  It took me a whole hour to write back with this:

Me: You know, my embryos not sticking had nothing to do with whether or not I moved around or not.  I was being careful with my movements.  It was probably the embryo quality. I did everything to give my embryos a fighting chance.

What I didn’t tell her was, “Back off!  You’re not being a nice friend.”

She wrote me back an email:

” Yes I know. I think you are right. Please do let me know if you have any questions and I can try to get you answers.  Don’t give up. It still looks very hopeful.”

ARRRGHH.  I hate it when she says “Don’t give up”.  Hate it.

She works for the reproductive endocrinology department for some hospital and she thinks that she can get me answers from one of the REs.  I know she’s trying to be helpful, but am I really going to go through her to ask an RE a question?

Most recently she has been offering me tips for saving money, such as a clinical trial offered by her hospital, for which I won’t qualify.  She suggested Attain program, for which I won’t qualify either.  Then she tells me to ask if my new IVF clinic offers clinical trials that include meds so it’ll save me money.

I have had enough with her advice.  I knew about the clinical trial.  I knew about Attain.  I have been doing this for a while.  I really don’t need her to tell me information that I already knew.

So… as a parting comment for that day, she said, “Don’t give up”.  Again??? For the freaking tenth times!

So I wrote, “I don’t think I’ll ever.  And even if I stop, I won’t call it ‘giving up’.”

I’m sorry.  I know that I should be very loving and forgiving to my friend.  But she annoys me to no end.  She knows what to say to push my button.  The thing is, she does not even know that she is doing this.  She genuinely wants to help and is trying to help.  But I don’t need her help.  When she writes me and asks me about the next step, I just want to close the window and not respond.

She is the most insensitive infertile woman I have ever met.

I told my therapist about her.  My therapist asked.  Why do you want this friendship?  Well, because I may not want to talk to her right now, but I still want to be friends with her.

My therapist then said, It seems like she is a trigger for you.  Whenever you talk to her, she triggers your negative emotions.  So it seems like you want to keep her for later?

Bingo. There you go.  She is a trigger for my negative emotions.

I feel guilty for not wanting to talk to my infertile no longer pregnant friend.  My therapist tells me that I have to feel okay not sharing because it seems like whatever she responds makes me angry.  I don’t need this friendship at this moment.  I have to let go of the feeling of guilt.  And I have to learn to keep a distance so I won’t feel hurt or annoyed every time I talk to her.

I’m so glad that I shared about this so now I know that I don’t have to feel guilty to keep a distance from this friend.

I told the therapist that sometimes I feel like I am not missing my embryos enough…. I see people grieving for the loss of their pregnancies for a long time… and I only sometimes think about the embryos.  She guaranteed me that everyone grieves differently.  I do get sad at times and I acknowledge my feelings.  Then I move on.  She thinks that it’s healthy and there is nothing wrong with not thinking about the embryos all the time.  She said that I am not cold blooded and I am being too hard on myself.

Another take home message for this session is acceptance.  My biggest fear is that I may regret the path that I have chosen for myself.  It seemed like I had already chosen UCSF since I did all of the pre-cycle preparation work.  But in the back of my mind I sometimes wonder and fear if I will regret my decisions.  How do I not regret?  My therapist thinks that I have to work on acceptance.  How do I work on acceptance?  I have to remind myself to live in the present instead of the past or the future.  If I think about the What ifs, the worries are going to take away the energy that I have to put into the present cycle.

With these points in mind, I am working towards acceptance.

*****

Phone follow-up consultation with Dr. No Nonsense went well yesterday.

He answered all of my questions.

Using anesthesia will cost an extra $763 for the retrieval.  I remember that the online friend who has banked her embryos doesn’t use anesthesia and she said that it is tolerable.  Doctor said I should be fine without.  It feels like a needle going through you.  He said I can try one to see.  My pain tolerance is usually pretty good so I’ll try it once.

I asked him the logics behind choosing Femara over Clomid.  He said that it makes no difference.  I have tried Femara twice and both times I made one embryo.  So he said we should try 100mg of Clomid this time.  It won’t affect the lining much and won’t make my FSH jump higher.

Do we freeze on day two?  Day three?  When we thaw, should we transfer on day two or day three?  At first he said we could freeze on day three and thaw/transfer on day three.  I told him that my history shows that my day three embryos are usually four-celled only.  Is that the best for transferring?  He then said we’ll freeze on day two and thaw/transfer on day two because of my history.  For those people who have fewer eggs, it’s better to put back in the uterus for a chance to grow.

Depending on my response each cycle, it’s possible to bank each month instead of taking a break.

We’ll see how I respond in order to know if we need to add injectibles like Menopur/Cetrotide.

Realistically it’s hard to see how many banking cycles we need.  I told him about the worry of running out of resources in preparation for donor egg cycles.  He said we should and will evaluate the situation one cycle at a time.  This is what my therapist told me as well.  I said that I always feel pressured when Bob asks me how many cycles I want the money for so he can save it up once and for all.  I get stressed out having to make that decision right now.  Now both professionals told me that I can’t really do that.  My therapist said that I may decide after one cycle with my own eggs that I have had enough.  I can plan all I want but in reality we just won’t know what will happen.

Dr. No Nonsense guarantees me that although he may not be the one who will be present at every single appointment, he’ll monitor my cycle and progress closely.  So I don’t have to worry about my questions not being answered or my concerns not being addressed.

Today is ten days past ovulation.  My period should come in five days.  I hope to call the pre-cycle coordinator next Monday to have the nurse create a calendar for me.  On cycle day one, I can call the clinic and start the clock.

Friends, we are back in the game.

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!

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.

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.

What IS the next step?

Looks like this is the trend that I don’t have much time to blog until the weekend.  How’s everyone doing?  Hi to those who are here for ICLW!  This is where I am at in my TTC journey.  My husband and I have been TTC for 21 months.  That does not quite equate to 21 cycles because of my short cycles due to diminished ovarian reserve.  At one point my cycles were 23 to 24 days depending on when I ovulated.  Sometimes ovulation could be as early as CD9.  Acupuncture has helped me push back ovulation to day 12 and even 13, which makes my cycle a little longer.  Anyhow, Bob and I have done two egg retrievals.  The first one resulted in a day 6 blastocyst that was graded 2BB.  We had it frozen and was waiting for it to be transfer back at our second retrieval.  The second retrieval in September resulted in zero embryos to be transfer.  We also couldn’t transfer back our one frozen embryo because of a fibroid that looked like it was in the uterine cavity.   We have yet to do a transfer.

I am relieved to report that my visit to the RE last Thursday was great.  The fibroids are NOT in the uterine cavity!  So we’re all cleared to move onto the next step.  Now here is the fuzzy part.  What IS the next step?  Well, it all depends on what we choose to do.  

A few possible scenarios:

1) Do a fresh cycle with Dr. E and thaw Clay (our little frozen embaby) no matter what so we have something to transfer

2) Do a frozen embryo transfer only and thaw Clay

3) Begin to go down to Southern California and start trying to bank embryos at L.ife IVF hoping that we will be able to bank at least four to five blastocysts before we start doing frozen embryo transfers

Why so many choices? Well, they all have to do with money.  My husband’s employer currently offers $10,000 lifetime maximum of fertility insurance that surprisingly goes a long way when it comes to cycling with a doctor who is in network.  Compared to the $12,400 price tag as a cash-paying patient, a doctor agrees to be paid at a discounted, contractual rate by the insurance company.  Since we have not done a full cycle and just the two retrievals, we should have at least a couple of thousand dollars left.  Now here comes the problem.  Since we only have a couple of thousands left, the doctor’s office is not going to take the risk of billing the insurance company first.  Since the remaining amount is not enough to do a fresh cycle, we will become cash-paying patients if we want to do a fresh cycle that includes a retrieval and a transfer.  I have been emailing Dr. E’s financial person back and forth.  Now I understand that we will pay the whole $12400 package price up front, in full, at our first monitoring ultrasound.  We will get a super bill from Dr. E’s office with the full amount that we paid and ask the insurance company for a reimbursement of a portion of the cost.  So we will no longer have the fortunate privilege of paying a $35 copayment at every visit.  We will pay 350 times of that.  On top of that, Dr. E recommends going back to the first protocol which was 4 vials of Menopur and Omnitrope.  The reason?  I responded well to it and we have one blastocyst.  The second protocol was a lot cheaper (Femara was covered by insurance) but nothing resulted from it.  Did it really have to do with the protocol?  Or just the egg quality for that particular cycle?  Really, nobody knows.  But we would want to be safe and do the one protocol that seemed to work.  The downside is that it will cost about $5000 in medication.  Are you doing the math for me in your head?  Don’t you think that this is A. LOT. OF. MONEY for ONE CYCLE?

If I had all the money in the world, I would do a fresh cycle with Dr. E because she knows my body.  With DOR, you just need to try your luck every single cycle hoping that you will encounter that one good normal egg.  But, I don’t have all the money in the world.  So what do we do?

We could potentially just do a transfer and see if Clay would stick.  That way, insurance should cover for the whole FET and we don’t have to worry about meds and other things.  If it works, then it’d be great!  But we do want to have two children.  If we could do a fresh cycle now and gamble to get more eggs/embryos, we may have something to freeze with younger eggs/embryos so that we can help Clay get a sibling in the future.  Younger embryos are theoretically better than older embryos.  

Another question is whether or not we could switch from Insurance Company A to Insurance Company B and still get a new batch of $10,000 lifetime maximum.  If so, then we could start our new insurance in January.  If not, then we have to seriously think about how to spend our savings on subsequent IVF cycles.  

Our last resort is to travel 500 miles to L.ife IVF and try doing natural IVF or mini-IVF.  The pros are that it’s a lot cheaper ($9900 for three cycles) and the cost of medication is also a lot cheaper (Dr. Y there is known for using Clomid).  The cons are that we will have to travel there monthly to do egg retrievals and I’ll have to take a few days off each month to do that.  I was thinking that this would be the way to go since I only get one embryo or no embryo each IVF cycle so far.  The cheaper option will mean a higher chance at pregnancy but also a lot more taxing on my persistence and patience in this process.  The lab at L.ife is known to be good at culturing blastocysts.  However, recently I have read that the policy for out of town patients has changed for the worse, i.e. OOT patients do not get their instructions until noon time the next day AFTER a blood draw or a monitoring ultrasound.  L.ife is simply getting too big and a little more chaotic.  It makes me nervous to know that it will be stressful and hectic to get information and to ask questions.  

Bob and I have a lot to pray about.  If we go with Dr. E for more cycles, our IVF fund will be depleted quite quickly.  If we go with Dr. Y at L.ife, we will have more chances at a lower cost without compromising the quality of the embryos/blastocysts.  L.ife is a lot farther away and requires out of town monitoring and traveling.  I love Dr. E and love the care and attention that I get.  It’s such a tough decision.  

My thought so far: We’ll do a fresh cycle with Dr. E in November and thaw Clay no matter what.  We’ll have to pay out of pocket for this visit.  Why November?  Because Dr. E will be gone for four days in October (for Disneyland with her kids, how cute is that?) which will coincide with my egg retrieval.  I am paying HER money for the cycle so I don’t want other people to be doing my egg retrieval.  If we do a cycle in November, I’ll be guaranteed to have Dr. E doing all the procedures and also have the time to figure out the insurance money part.  If we don’t get pregnant after that, then we will most likely sign up for L.ife IVF in January as it is more wallet friendly and makes the most sense.  I will hate to part with Dr. E but financial reality will force us to do so.  

Life is so complicated when money is a requirement to do the simplest thing such as making a baby.  I know I have thought about this a lot and really want to have some control over it.  But really, who is in control?  We have to go back to God and ask God for wisdom, strength, and His timing.  Not an easy task, but I am trying to depend on Him.  And I am grateful that we have a chance and the means to try.  

Tough decision between conventional IVF and mini/natural IVF

It took me and Bob quite some time to accept the fact that natural pregnancy might not be the easiest thing for us and we should move on with something more aggressive.  We started TTC back in January 2012 and by November 2012 we started talking about attending IVF seminars.  At that time, we only had a very vague idea of what IVF actually was.  So we attended four IVF seminars at four clinics in our area in three months.  We also did two phone consultations and one in-person consultations with three reputable REs in our area.  All the doctors agreed that the chances of natural conception for us are low and IVF is the way to go.  All the doctors wanted to pump me with high dosage of drugs to get the best response out of me.  At that point, I only knew that my FSH was borderline high and my AMH was abysmal.  One of the doctors who runs a famous local clinic and is known to be aggressive wanted to do the following: do one egg retrieval, freeze those eggs, do another egg retrieval, thaw the first batch of eggs, fertilize all the eggs with ICSI, test all the embryos with comprehensive chromosomal screening (CCS), pick out the normal ones, freeze them, and do a delayed frozen embryo transfer in a subsequent month.  This all sounds very good.  Do you know how much this whole thing is going to cost?  Something close to $30,000 or even more because of all the freezing and thawing, extra testing, and all the drugs.  I wanted to shout to the financial adviser lady on the phone: “Are you kidding me? Who can afford this kind of treatment for one cycle??!?”  But I just politely asked my questions, hung up, and felt a little defeated.

Bob switched jobs last June.  His old job’s insurance was wonderful with everything else except for zero coverage for infertility.  We were pleasantly surprised to find that his new job offers a lifetime maximum of $10,000 of fertility insurance as well as  a lifetime maximum fertility drug coverage of $5,000.  This coverage should pay for most of one cycle if we go with an in network provider.  So we prefer to find a doctor who is in network so we can minimize the out-of-pocket cost.

I found Dr. E.  She has a TV presence in my area as she sometimes would appear on a local news program to talk about infertility treatments.  I have seen her talk on TV multiple times in the past.  Not in a million years did I think that I would in the future sit face-to-face with her discussing the best course of treatment for my situation.  After all the other phone and in person consultations with other doctors, I tried to schedule an in-person consultation with Dr. E.  Unfortunately, she would have to take her board exam in the month of April and could not see us until May!  And it was in March when I called.  I really wanted to go see her because of all the wonderful things that I had heard about her.  So we scheduled the appointment and patiently waited for May.

While we were waiting for Dr. E, I discovered an online forum that is dedicated solely for women with high FSH.  From there, I learned that for women with diminished ovarian reserve (DOR), conventional IVF may not be the best course of action for them because they may not respond well to high dosage of fertility drugs.  With even the highest dosage, some women have only a few follicles.  The terms mini IVF and natural IVF repeatedly came up on this forum.  There are a few clinics around the country that not only accept patients with high FSH but also offer natural and mini IVF that aims at using very low dosage of drugs to stimulate a couple of follicles with the goal of preserving egg quality.  One of the clinics happens to be in my state but a 7-hour-drive away.  It happened to offer its monthly seminar in April.  I wanted to check out what the RE there had to say about treating women with high FSH.  Since we had to wait for Dr. E’s appointment in May, I thought we might as well go check out this clinic.  I was pleasantly surprised that Bob was all game when I made the suggested.  So one fine Friday after work, the two of us went on our mini road trip to the other side of the state.

What we learned was quite fascinating.  Dr. Y believes that high dosage of fertility drugs for DOR ladies would fry the eggs.  Even if the drugs help create multiple follicles, the egg quality may not be good.  His clinic opened in 2010 and appears to have pretty good results for my condition and my age group.  Many of the ladies on the forum travel out of town to this clinic.  They do egg retrievals, try to grow the embryos to blast, and bank them by freezing them.  They will then transfer the embryos back at a later time.  Many women on this forum have gone through the conventional IVF route but often had very poor responses and were forced to cancel their cycle or had crappy embryos that didn’t result in a BFP.  At the time of the seminar, we got a 10-minute in person consultation with Dr. Y.  He learned of my FSH, AMH, and antral follicle count and said, if I were his daughter or his sister, he would urge me to do natural or mini-IVF.  He said that many of his patients treat his place as the last resort.  I could go try conventional IVF first and if it doesn’t work, come back to his practice.  Another thing is, Dr. Y’s practice offers a 3-cycle package for about $10,000.  This is so much more affordable than conventional IVF that would cost more than $10,000 for each cycle.  Everything sounds good but I wonder about logistics of traveling, out of town monitoring, and taking time off work.  Most importantly, I wonder about my response to fertility drugs.  What if I happen to be one of those lucky few who responds favorably to high dosage of drugs and could create many follicles?  Do I learn from the experience of so many women with DOR who had already gone the conventional IVF route and failed?  Or do I try my luck?

Dr. E shared her view with us during our consultation in May.  She thinks that there is no such thing as high dosage of drugs frying the eggs.  She thinks that the more follicles the better.  Given the state of my ovaries (having about six resting follicles), we shouldn’t wait and should begin IVF as soon as possible.  She will put me on 300IU of Menopur plus human growth hormone.  Dr. E is in network, I have been very impressed with how available she and her clinic staff are to questions, and she appears to know her stuff.  We finally decided to go with her for our first round of conventional IVF.  My plan B is to see how my old ovaries are going to respond to the drugs, and go from there.

We have made our choice.  If you were me, which way would you have chosen?  Local RE with high dosage of fertility drugs and conventional IVF, or out of town clinic with low/no fertility drugs and mini/natural IVF?