Sunday, January 30, 2011

Hey, Jealousy!

I have my first appointment with the new IF specialists this coming Friday. I'm so excited! I have all my forms printed out, but they're so overwhelming! I have no idea what all my hormone levels are at various times of my cycle! I can't remember what year my wisdom teeth were extracted! I can't even remember exactly what therapies were all tried, or how many times. Much less, when. (Femara w/ IUI? Femara w/o IUI? Clomid w/IUI? Clomid w/o IUI? etc etc. I don't remember!)
The down side is that we need to be there at 8:45 AM. Kind of a hardship for someone who has a hard time eve getting up before 9. [Me.] Plus we get to wake up the squirt and drop her off at my mom's house first. Joy. My husband's original plan had been to bring her along, when I was asking him if I should take an afternoon appointment a week later so we could get someone to watch her, or what. But after reading their guidelines, they request that we not bring kids, and if we do, to have a caregiver there just for them. Which makes sense. It's hard to listen to the doctor with someone pulling on your pants legs, whining to use your iPhone (she loves her apps!) Plus it's potentially emotionally disturbing for other patients to see you waltzing in with your kid(s.) I know it would have been for me, my first time 'round. I hated seeing people with babies anywhere, but it would have been a harder blow at the clinic, more and more as each treatment cycle kept failing.

I refused to even meet the next-door neighbors because she was pregnant when they moved in. And. I. Wasn't. My husband would talk about them, if he'd run into them outside or something. I'd see her swollen belly as she went inside from her car. I hated her. After the baby was born, they'd come trick-or-treating. My husband would tell me they had come, and I wouldn't know who he was talking about, since I never remembered their names. We'd see them occasionally, if we all happened to be outside at the same time. I rarely spoke to them. Only if DH wasn't around to do all the talking.
We had gotten married in June of '05, and immediately started "trying." By the time they'd moved in at a few months pregnant (late '05) I was getting frustrated. Then she started "showing," just to depress me even more. Then in May '06, when she had a wonderful new little baby, I'd been trying for a whole year. It was over a whole 'nother year before I got pregnant. A year of hearing baby cries through the open windows all Summer. Seeing them going places as a family. Knowing that they had this treasure, one that I might never find.

I got so used to ignoring them that it wasn't until my daughter was old enough to be interested in their daughter that I even learned their names. My husband would be outside with her and the neighbor girl, about 2 years older, would invite her over. They had a slide. And swings. And a sandbox. Our back yard has... weeds. Always dark with shade. Low-hanging branches. I call it "the Jungle."
When their daughter got a trampoline for her 4th birthday last year, I gave in and got to know them. I had no choice. All summer long we could hear them out there jumping and laughing, and my daughter would start yelling (from inside the house) to try and let Appie know that she could hear her and wanted to come out and play. Every day: "I wannto dump on Ap-pee's tramp-a-neen!" Every time we'd go outside, she'd race into our backyard, since our always-open gate is right next to their closed gate, and she only vaguely knew how to get there. She was only barely 2, after all!

Friday, January 28, 2011

No News Is Not Always Good News

The Rest of 2010
After my (second) polypectomy, my doc wanted to wait a cycle or so, then see me again. Let me have a chance to get a good lining in my uterus. And then she refers me to their in-house fertility specialist (another nurse.) They don't do anything beyond prescriptions and IUIs, but more of my visits might be covered, since they aren't an infertility specialty practice.
I consult with the nurse, and don't really like her. I don't hate her. But we just don't gel. And she's all "so, when you think you might be ovulating, give me a call and we'll do an ultrasound. I charge extra for Saturdays." Um. Okay. But... can we make sure I'm even ovulating first? If a blood test can show that I'm not ovulating that cycle, can't we do one of those before hopping in for an ultrasound? Since the U/S may not even be covered by my insurance? How frustrating. And I have no clue when I'm ovulating. My basal temp hardly ever formed a pattern, the 6+ months that I wasted on that. And the pee sticks never gave anything but inconclusive results. Yet ultrasounds showed big huge egg-making follicles. So, disheartened, I went home.
My husband was not in love with the cost, especially since he was still under the probably mistaken impression that now I would magically get pregnant, with those pesky polyps out of the way.
Plus, over the next summer, we had to buy a new washer, dryer, vacuum, steam cleaner and water heater. Which kind of depleted our savings.
So. Another year wasted. I mean "trying." With no way, other than my iPhone period tracker app, to determine when I was probably ovulating, it was tough to know when to try. Plus my gooey-egg-whites were happening at a different time than the period tracker had down. So who knows?

Magically, despite everyone telling me stories of how women who were told they couldn't have babies got pregnant weeks to months after adopting or having their first child through the magic of science, babies didn't spontaneously appear in my uterus. Nuts.

25 January 2010
I just found out that my health insurance not only covers infertility treatments (at around 80%, I think) but also they cover IVF! Well, they only cover it if more traditional methods don't work, but we may have covered all that with the first go-round. So I made my first appointment, with a different specialists office that our first go-round. Since the first place was so professional and impressive and all. Gag.

Same Song, Second Verse...

Early 2010
So my husband takes the day off work for my polypectomy. We pack up Little Z, with her entourage of toys and snacks and diapers, and go to the special surgery center at the hospital. I'm starving, since I'm not supposed to have eaten for 12 hours or whatever, and since this is a lunch-time operation, the last opportunity I had to eat was the middle of the night. I had woken up for my last opportunity to drink water though.

So we're sitting in the lobby, filling out forms. My daughter is eating blueberries. Omnomnom. She pulls out a half-masticated berry and feeds it to me. I absentmindedly eat it, and continue talking to my husband and signing forms.
Then we're called back to the desk to turn in our forms and answer more questions and cough up insurance cards, etc. The lady is coming back from Xeroxing our insurance card when she catches my daughter popping another half-chewed blueberry into my mouth.
"Oops! No food, remember! Close call!" Ummm.... Shit. I spit that one out... but I had still eaten the first one!
We debate whether or not to come clean with the docs... and we finally do, when our special waiting room nurse asks me if I've eaten anything in the last umpety-ump hours. Yeah. Just one blueberry though. 
So my doctor comes in and tells us the risks involved. Any food could come up and get inhaled and kill me, worst-case scenario. Plus I suffer from acid reflux, which I don't even tell her. Which increases my risk of something like this happening. She gives us a few minutes to decide. 
I'm mortified, and don't want to have wasted everyone's time. DH doesn't want to risk anything happening to me over something so stupid. We kind of decide to go ahead, when the doc comes in and says "You decided not to risk it right?" Weeeeeeell. "I talked to the anesthesiologist, and we both feel like the risks aren't worth it. We still have time for lunch, so our time wasn't wasted, and I'd never forgive myself if something happened." Fine. Twist my arm.
A frickin' blueberry.

So I go back on my BCP and we reschedule for the next available opening. This time, my husband doesn't feed Little Z if I'm even in the room. And no blueberries!
My daughter (around 20 months-old) is thrilled that the nurse uses the pulse machine thing on her finger after checking mine. ("White finger pinch" she calls it. Now she asks for it at every doctor visit.) She is sad that they don't have a BP cuff small enough to fit her, but the nurse humors her and pretends.
No hitches. I go into the OR, get hooked up with an IV... by the anesthesiologist's assistant. Ugh. He has to try a few times, which is not cool when you suffer from needle phobia, like I do, but I got lots of practice coping during all my tummy jabs with the IVF meds. But still. Jeez. I also tend to get chilled easily. If you're feeling quite comfortable, I'm a bit cold. If I'm feeling just right, it's a little warm for you. That kind of thing. But they had nice, warm, toasty blankets all over me. Mmmmmmm! And air pump leg massagers. Ahhh. This is the life... except for the needles, and scary medical procedures and such!
"Okay. Count down from ten for me..." 10.. 9... 8.... "Hi there! How are you feeling? We'll just wait a few minutes until the doctor is done talking to your husband, then we'll bring your family in to see you. Would you like some juice or some crackers?" 
Oh, hells yeah! And keep 'em coming!

So it all went well. She got all the polyps, etc etc etc.
And this time, we got before and after pictures! Ewww.

Take Two! Aaaaaaand... Action!

I decided the day we brought our daughter home from the hospital that when she would be around 18 months old, I would be ready to start making another.

Late 2009
So, naturally, at around 14 or 15 months, my body decided to mess with me. 10 days of bleeding. 4 days off. 7 days of bleeding. 7 days off. etc. I called the OB/Gyn office, where the midwives worked who had delivered my baby, and got assigned to an OB/Gyn nurse. Now that I think about it... I have bad luck with the nurses who get to do doctor-y stuff. Not the assistants, who get you in the room and tell you to strip down, and take your temp and such. But the ones who do the exam/consult. They just end up dicking around wasting my time. Precious baby-making time.
But anyway. After that fun little preview...
I go in, and she orders a blood draw, to test for iron deficiency and such. But not hormone levels. Or at least not an in-depth hormone panel. I mention that I have a history of uteran polyps (treated at a different office initially. I chose these guy because they were attached to the hospital I wanted to give birth at. And I came back to them, since I'd use them again for the next pregnancy.) I also have a family history of women's cancers. My maternal grandmother had uteran cancer [dingdingding! Any doctor worth his salt would have ordered a biopsy based on my history and symptoms at this point.] And my sister once tested positive for pre-cancerous cells on her cervix.
So this nurse? She recommends I start birth control. Seriously? I explain my history with BCP, and that I suffer from clinical depression, and that every time I have ever used hormonal birth control, I suffer from depression. It had gone away during pregnancy (very surprisingly!) and I hadn't suffered from post-partum depression (again, a total shock. We were all prepared for it.) So I was somewhat loathe to risk triggering it again, just because she couldn't think of anything better to do. Especially since my goal was to get pregnant again. Birth control seemed a little counter-intuitive.
I go home, with a paper in my hand, trying to decide whether I want to fill this prescription or not. Probably not. I want to know what's causing this. Will it come back? Will it interfere with getting pregnant? Is it polyps again? Cancer?
 My sister had looked up all possible causes for irregular bleeding, and was shocked that a biopsy of my endometrium hadn't been ordered. The irregular bleeding alone should have warranted one, as they are very low risk, and relatively easy to do. When consulting with our Family Practitioner during one of my daughter's check-ups, he said that not only would he have ordered one, but that technically, he could have done it. But he would probably have farmed it out to someone more experienced at actually doing them. So with that in mind, I call back my OB's office and talk to the nurse's assistant and make an appointment for a biopsy. I get a call back the next day that the nurse feels that it is too risky and unwarranted and has cancelled the procedure.

Luckily, my sister is a bull-terrier. Especially after her doctors dicked around, not telling her that she had pre-cancerous cells  on her cervix, but she knew something was wrong, so she demanded a copy of her file and went to another OB/Gyn to get a second opinion. One that she trusted, who she had seen in the past, when she lived closer. Ironically, this OB/Gyn had treated our mom, delivered my youngest sister's first child, seen my sister, and, when I was much younger, did a biopsy on some bumps I was worried might be genital warts, as my previous doctor had diagnosed (they weren't.) She'd seen all the pooters in my immediate family!
So my sister harangues me until I call this doctor. And make an appointment. And actually go to it. A month later, which is the soonest opening she has for new patients. And my sister comes with me. And asks for records release forms, which she fills out and makes me sign, so they can get my records from every doctor who's ever looked up my hoo-hah. But I'm so glad she made me do this. This doctor takes me seriously. This doctor does a full hormone panel. This doctor not only agrees to a endometrial biopsy, but suggests it herself first. Plus she wants to do an SHG to check for polyps.

We schedule these procedures. While waiting, my blood test results come back. There's a handwritten note over one of the results (FSH level I think.) "anovulatory." Okay. What does that mean? So I go back in to discuss my test results. Even after talking to her, I'm not clear. She says that the hormone levels indicate that I wasn't ovulating that cycle. But I was getting the gooey egg-white-like discharge. She said that didn't necessarily mean anything. *sigh* But when I'm getting a period every 14-16 days, who knows what's even going on in there?

Early 2010
After waiting for pre-authorization from my insurance, I go in for both. And my period is so heavy, she can't do the SHG (since there's a risk that shooting the saline in can push blood up in and block my tubes.) We opt to go through with the biopsy, since there's a slim chance it could detect a polyp too. Plus, you know. I was already there with my knees in the air.
Now, I'd had an SHG at the fertility clinic, and it hadn't hurt a bit. A little discomfort. But nothing like the HSG in 2006. But this? I wasn't expecting this level of pain. Like the HSG. Only I was caught unawares, with no time to prep myself psychologically. This hurt like a motherfucker. It hurt so much I had a hard time remembering to breathe. Like a rod of pain had been inserted into my cervix opening. And was prizing it open by force. Only, I don't normally feel anything all up in there. And to top it off, while hurting like a motherfucker, she made it hurt in a new place while taking the biopsy. Not as bad a pain as the insertion procedure. But like someone pinching off a bit of flesh in a place woman was not meant to be touched.

We hold off on rescheduling the SHG, until the biopsy results. And, Lo and Behold! She happened to snag a polyp. Well! Mystery solved! Polyps! Thanks for nothing, useless, time-wasting nurse biotch at the first office!
She recommends that I start birth control pills, so that we control my cycle, so we can schedule a D and C with polypectomy for the right time window. So, with a valid reason, and not just a lazy shot in the dark, I agree to try BCP again. And had to go back on my antidepressants. Surprise, surprise. Bleah.

After waiting a month, to suppress my period, she has me stay on the 'active pills' and not stop them until a few days before my procedure.
Since this doctor is totally awesome, and understood my sense of urgency about the whole thing, and that every month counts when you're trying to make babies, she scheduled my operation during her lunch hour since it was the soonest opening in the surgery center that didn't fall on one of her days off.

I Love You One Cheerio

1 November, 2007
I go again for my second ultrasound. And my final visit to this clinic. From here on out, I need to find an OB or midwife. Squee!
This time my husband was present. So this was his first live view of our little miracle of science. And this time it looked vaguely humanoid. Like a little Kewpie Doll Gummy Bear. Big Kewpie Doll head, with Gummy Bear arm and  leg nubs.
And then... it moved. Waved one little arm bud at us. We were goners. That one little involuntary arm bud movement, and I felt all my love for everyone else in the whole world drain away, all moving over into a big pile of love for the baby. I told my husband on the way home that it was like all my love was a box of Cheerios. There was a Cheerio for him. All the rest was for the baby. This feeling didn't go away for a while. But eventually I restocked on Cheerios, and had some left for other people too.
But it's fun to say to him "I love you one Cheerio" on special occasions.

To make a long story short, and one I will probably eventually get around to typing out at length on another blog, we had a baby girl 32 weeks later (full term. I'm subtracting the time before the final U/S at the infertility clinic.) And because we got the money for the IVF treatment from my Grandma, I like to joke that I got knocked up by my Grandma!

If you want to read more about her and us now, my main blog, Biting The Hand That Feeds You, is about activities and crafts, but mostly food and fun meal ideas (and my ineptitude in the kitchen.) I (much) less frequently post on War And Peas about toddlerhood and Motherhood issues. I chose different venues both for the fun titles, but also because our families are subscribed to my main blog, and I don't need his Grandma reading about his sperm count, or his mom reading about what days we're scheduled to have sex, or my dad reading that we even have sex. Hahaha! And no one we know needs to read about how much I hate him some days. Irrationally. Probably hormonally-driven. But still. I don't need anyone testifying at my trial that smothering him with my pillow for snoring all night wasn't temporary insanity!

Aren't Pregnancy Tests Pass/Fail?

My sister had told me that I should be extra sleepy on the day an embryo implants in the uterus lining, and she remembers exactly the day she got pregnant, since she took a nap. I didn't feel the need for a nap.

Roughly a week after the ET, I started feeling... different. Sensitive boobies. Plus a little... something. Undefinable. I took a pee-stick test the first possible moment I could expect to see any results.
I. Got. Another. Line. I'd never gotten another line before (or a plus, or whatever.) Never. No false hope. No miscarriages. Nothing. Not that miscarriages would have been a blessing or anything. But I'd never ever had that little flash of an inkling that my body actually worked properly, or that my eggs or uterus had ever been good enough to at least fool the test. I'd never even gotten anything other than an inconclusive result on the ovulation predictor pee sticks. (I got a line, but fainter than the faintest example shown on the instructions.)
What to do? Call my husband? Wait until he got home? Plan some cute and clever way of telling him? Bah! I called him. But we were both very aware of a few depressing facts. There are false positives, and we had a good risk of miscarriage for the first trimester.

Some time in October, 2007:
A few days after my in-home test, they had me come in for a blood test. On my way to work after, they give me a call.
Nurse: "So, we got your test results back. 110."
Me: "Umm.. Okay." Gee. I'd thought this was a pass/fail test. I didn't realize we got graded! 110. What does this even MEAN?
Nurse: "Oh. You don't sound very excited."
Me: Suck it, bee-otch. "Um. Should I be? Does 110 mean I'm pregnant?"
Nurse: "Oh! Ha ha! Yes! It's a very high result. It may mean multiples."
Well. Every silver lining has a cloud! :) But really, this was a silver lining, with a possibly slightly less silver lining. I mean, multiples would be hard. I mean hard. But we were emotionally prepared to embrace the concept.

We decided we'd tell no one until the second trimester.
That lasted until about 30 seconds after encountering any female in our immediate families. I think I was able to stand firm for the first few weeks. Except at work. I mean, they all knew what was going on. It's hard to get them to juggle schedules at the last minute, or give you a moment to pop back and jab needles into your tummy during your shift, unless they kind of know what's going on. And, being in pharmacy, they could all do math. They knew when I'd be able to start getting test results.

18 October, 2007:
I forget how many weeks along I was when I went in for my first ultrasound (math says... 30 days after fertilization... so 4 weeks. But then you add 2 for the average weeks before ovulation. In a normal conception.) But this one would tell us how many barnacles I'd be hosting. So naturally, my husband was out of the country! He actually had a convention for work in Germany, which was a huge opportunity for him, and it was a real treat for him to get to go. I think this was only the second time he'd been chosen to go to this annual event, and he'd been working in this field for almost 14 years at this point. So I only begrudged him a little because it was impractical for me to go with him. I've only ever been to Canada before. (And Mexico when I was 2, but I don't remember.)
His sister harassed me until I acquiesced offered to come with me to my first ultrasound. She snapped pictures of the whole thing. Plus I got U/S printouts. And a CD with all the pics. She rushed home to email him a picture of the ultrasound after. I got to go to work after.
They found one fetus. One beautiful, perfect, booger-shaped little blob. I'm pretty sure I cried like a little girl. With joy. With relief. But mostly joy.
After I got back to my car I called my husband. He was at lunch (or dinner. Some kind of meal) with peers. He tried to play cool and not say stuff that would make them ask what was happening, but he failed, and got to tell a bunch of industry folk our little tale of joy (so far!)

We had a substitute pharmacist at work, so she got to hear my news. Then she says the stupidest, least thought-out comment humanly possible.
RPh: "Well. I hear that the third one's the charm! You usually lose two before you get lucky."
Me: [crushed and horrified] "Um. This is my first pregnancy."
RPh: "Oh yes. I meant that you lost the other two that were transfered in."
Um. Thanks. I hadn't ever thought about it that way. Here I was, stupidly thankful for the one that "took," blissfully ignorant of the fact that this meant I had lost two of my babies. They didn't last more than a few weeks, if that long. But they had been alive. My babies. Thanks for nothing, Bitch.

E.T. Phone Home

I get a call at work the day after retrieval. They harvested 13 eggs. 10 of them were mature enough to try and fertilize, with ICSI. Of those, 8 fertilized.

At work we had 2 shift schedules for the next 2 weeks, since a Day 3 transfer would occur on the Friday of one schedule, and a Day 5 transfer would occur on Sunday, the first day of the next week's shift schedule. I managed to only have to involve one other tech in swapping shifts last-minute. Because we all had to rotate working weekend days, and tried to give people 3-day weekends if they had the weekend off that cycle (since Sundays are in a new week, you'd have Fri/Sat off one week, and Sun and another day off another week. Everyone worked Mondays!) So I was normally scheduled to work that Sunday, but if I needed her to work it, she wanted Friday off, so she could at least have 2 days off in a row. So I was scheduled to have Friday off, and work Sunday, with a back-up schedule if I needed to switch either week.

We get a call, saying that they've decided to do the Embryo Transfer on Day 3, instead of Day 5.

Friday, September 21, 2007
We go in. I didn't bother taking the Xanax they prescribed for this visit. I had thought it was silly when I first saw the prescription list. I mean, why would I be nervous? I could have used a Xanax on the retrieval day, sure. But now? This is the first day of the rest of my life!
I've been downing water all morning. Since they'd be doing an external ultrasound to guide the tube into my cervix and to watch and make sure everything goes in (you can see the fluid as it moves in, plus the saline wash they follow up with just to make sure everything with the embryos in it goes on. (Although at this point, they are also technically zygotes. Until Day 4. Then they also become blastocytes.) We had done an SHG (sonohysterogram) with a saline wash in the weeks earlier, as a test run, so my doctor knew how my cervix was angled, and if she'd need to make any adjustments. And while my legs and butt were sore from the progesterone injections, it was very nice to finally be free of the yellow or pink (depending on dose) gloppy goop I'd had squelching from my nether regions every day for the past year+, from the vaginal Prometrium suppositories.

We had decided at the beginning of this process that we were going to attempt to transfer 3 embryos. Apparently the standard is 2, but I don't know if the doctor told us that or not. But we were willing to keep 3 babies, without having to resort to selective reduction. In fact, if all 3 had implanted and split, we would have done our best to keep all 6, if we could keep us all as healthy as possible. Any risk of miscarriage due to the selective reduction was too high a risk for me, and how could I choose? What if we weeded out all the girls, leaving me with all boys? What if we kept the sociopath, and removed the one who would have discovered the cure for cancer? Obviously, I would spend my whole life "knowing" we chose the right one(s), but I'd still wonder about the others.
Plus we wanted to hedge our bets. Since we could really only afford this once, we needed it to work.

Then the doctor comes in and talks about our eggs. She says that of the 8 that fertilized, they were all lower quality than standard. She explained about something called "fragmentation," which is where you get extra blobs of stuff in the embryo, from when the cells split, but without any chromosomes in them. She says they can't gauge what is normal when the whole thing happens naturally, but that for all the IVF embryos they've experienced, the normal fragmentation rate is 20-25% (where that's the percentage of space taken up by extra blobby bits. I think. It may mean % of cells making extra blobby bits.) Our best embryo was 30%. Next best was around 35%, then 40%. Another at 45%. I can't remember the rest, other than that they went up to 80%. This was why they wanted do do the transfer on Day 3. They wanted to get them into a uteran environment as quickly as possible, in the hopes that they'd have a better chance of survival. Plus they didn't want to watch them all fail over the next 2 days and have us get mad at them. But that's just my take on things!
She wants to transfer the best 3, and try and freeze the next one.
At this point, part of me is thinking. "Go ahead. Huck that one in too." Plus I thought that trying to freeze the 4th one would be a waste of effort (and our money.) But I'm usually too shy to speak up, until I've had time to think things through, which we certainly didn't here.
Off we go to the special, super-sterilized transfer room. First they spend about a thousand years showing me the little blobs in a petrie dish, magnified a bajillion times. Then they show that my and my husband's names are written on the paper under them, so we can verify that these are ours (yeah. Like I've been watching them 24/7 to make sure no swaps were made. And like I know that that paper stayed with them the entire time. But whatever.)
We get to watch the process via ultrasound. Tube. Squirt. Back-up squirt. Withdraw tube. Ta-dah! They want me to stay lying down for a while, and they know I probably have to pee (oh, very yes!) so they give my husband a bedpan to hold under me and pull the bed apart at just the right spot so I don't even have to move. Nothing says "I Love You" like holding your bedpan for you.
So I pee. And pee. And pee. Did I mention I'd had a lot of water? I tend to over-prepare for ultrasounds. My bed pan was almost full, and I wasn't done yet. My husband hands me some TP to wipe so he can dump out the pan, and the paper lightly brushes the top of the liquid and gets sucked in, because its sooooo full! We can't stop laughing. At this point the doc comes back in, and now, not only do I still have to pee, but I'm not wiped properly. Ugh. Oh well. It's not like they don't clean the linens between patients. (I held in my pee though.)
They wheeled me back in to the recovery room, and told me to stay lying down for at least some amount of time, and then we could go whenever we were ready. They gave us pictures of our 3 embryos, all blown up, and a photo of the ultrasound at the moment of transfer. I fell asleep. Then, when I woke up, we got our stuff together and went home. And forgot our pictures. :(
At home, I was a Pretty, Pretty Princess for the rest of that day and the next. Thirsty? DH got me a drink. Bored? He'd find me a book. I got to control the remote.
I sat on the couch, reclined, and did my best to implant me some embryos!

Wednesday, January 26, 2011

The Big Day

Tuesday, September 18, 2007
We go in. Nervous. I'm alone in the recovery room, while he's doing his job. The anesthesiologist comes and hooks me up with an IV. I warn him that needles make my nauseous, so he has an antiemetic and anti-anxiety drug ready. Hey. That wasn't so bad. Nah. I'm fine. Thanks! See you later!
NoooOOoOooo. Clearly I forgot from my polypectomy in April. The crappiness kicks in after they leave! Only now I'm desperate to lie down, and I'm all alone! Waaaaaah! My husband is off doing important things. No nurse in sight.
After about a thousand years, my husband comes in and saves me helps adjust the bed so that I am lying down. Lying down helps me feel better. So does pooping, usually. Don't ask me why. [I've found out, years later, from a nurse at another office, that if I talk through the puncture that the act of talking either puts pressure or relieves pressure on the vagal nerve, which helps prevent the vaso vagal reaction. Good tip. For most of the blood draws, just picturing my husband, or when he was present for the blood draws, really helped. But maybe that's because I was also probably talking.

Now the doctor comes in to talk to us. It's the lady doctor. The one I like. The only one who hasn't directly miscommunicated or messed up with us. (They're all at fault for the medication snafu. But the other doctors had said or done contradictory things while we were there, and not just general things that may have been some nurse's (failed) responsibility.) I had basically switched to her after seeing her for one of the visits before the IVF process (but after we had decided in May that we were going to do it.) I had requested that all my consults be done with her after that, and she happened to be available during my procedure times. The week after my projected transfer, she'd be going on vacation! Whew! Perfect timing! She explains about Day 3 transfers versus Day 5 transfers, and why they wait longer or don't wait longer. [Meaning they transfer them into the uterus 3 or 5 days after the retrieval and fertilization. Depending on how they look.]
Anyway. Blah blah blah, something something. Wheel me in. Okay, count down from ten for me. "10...9...8... Oh! Hey honey! Is it over now?"
Not long after I wake up, a nurse comes in (the one I like the best. But she only works back in this area, with the IVF stuff, not with blood draws and ultrasounds and in the rooms before routine exams and such. I've only ever met her in the halls before this visit.) She teaches us how to do the progesterone injections [Oh joy!] and watched as my husband administers my first dose. Yeowch! It has to be him doing it, since the injection goes in the butt cheek. And you have to jab it in. Pulp Fiction adrenaline-shot-to-the-heart-style. No lie.
She tells us to 'turn the other cheek' for each shot (alternate sides) since if we only do shots on one buttock, I won't be able to walk. As it is, by Day 2, I'm walking like a very sore cowboy. My coworkers think this is the Funniest. Thing. Ever. And my husband is "cracking" jokes [get it? Crack? Butt?] like nobody's business. "I need to put a prick in your ass." "I'm jabbing my wife in the ass every morning!" And so on. And so on.

I V Eff You!

Obviously, we wait a bit after the surgery. I don't think we started the IVF protocol until late July. I lost my calendar, that had all the dates in it. Which makes me a little sad. 
I filled out the paperwork to see if the special IVF insurance would cover us, or how much it would cost. Since, while my health insurance covered the IUIs and ultrasounds and all, IVF was not covered on my plan. The insurance had the benefit of reducing the procedural costs, since the plan my doctor's office worked with had contracted [fixed] prices, so you'd pay a flat fee for the whole shebang, rather than line-iteming it, like an ultrasound here, a blood test there, etc. So if extra tests were needed, they wouldn't charge for those. And each cycle would include a retry, with frozen embryos from the previous attempt, if applicable.
For a very weak reason (they said it was due to my low FSH levels, but still within normal parameters) they said they'd only insure us if we did a 3-cycle plan. Meaning we'd have to shell out for 3 rounds of IVF (which would include the 3 retries.) Ugh. My grandma had given me $10,000, against any future inheritance, so that we could even afford this at all. And the estimated cost of just 1 cycle would be around $10k. So we couldn't do the IVF insurance. We would just have to hope for the best. Darn it. 

June or July: We decided to finally bite the bullet and do the big expensive semen analysis. Not just a volume count, like the $100 test we'd done in 2006. No. This baby had all the bells and whistles. Morphology. Motility. They even determined what percentage had the caps that could dissolve, so the sperm can even enter the egg. For one easy payment of somewhere over $700. Oof.
They told us percentages. Average percentages, and his percentages. They recommended an additional procedure called ICSI.
Now. Let me tell you something. Something I'm a little ashamed of. Something that I hope my husband, or anyone we know never, ever reads. I cried. I cried with a profound sense of relief and joy [and a little shame at my joy] when we got the results. Because finally, finally, there was some indication that the problem wasn't just with me. It wasn't my fault! It wasn't all MY FAULT. Until you've been there. Until you've peed on too many sticks to count. Until you've watched, month after month, as your body betrays you. You cannot possibly understand the guilt, the shame, the disappointment in yourself for not being able to do this one. simple. thing. This ONE thing that every other teenage girl seems to be able to do, without even trying. This one thing that so many people can not only do effortlessly, but accidentally. And complain about it! This one thing that both your sisters have done, by accident. This one thing, that every single female in your immediate family has done. This one thing, that out of the 2 grandmothers (6 total,) 1 mother (5 total,) 2 aunts (4 total, maybe more,) and 2 sisters (4 or 5 total, at that point) have done (making an average of 2.71 to 2.85 per person) you just cannot seem to do. You cannot create life. 
So to find out that maybe it wasn't all me. Well. You cannot even imagine the relief. 
But, to be fair, chances are good it's not all him either.

Late July (or maybe Early August): This facility uses a unique protocol, that is apparently longer and more carefully regulated than most other practices. I spent a month on birth control, to suppress my egg production (and to get me on the schedule they wanted.) As an added bonus, they wanted a specific brand of birth control, and not the generic. Not only did my insurance pay nothing, my copay was more than the drug cost at the pharmacy for a "cash" patient (not billing insurance.) Whuuuuuuck?! I got that fixed quickly. [Working in the pharmacy has some advantages! It was easy to look up the price without insurance!] Since my prescription plan policy stated in our packets that this special higher non-preferred brand-name copays is when "the patient chooses the brand instead of getting the generic equivalent," I read that to mean that since my doctor chose the brand-name-only, that I should get the lower, preferred brand copay. I spent a year fighting my insurance. They stopped answering my calls, emails and faxes. Jerks.
I got most of the rest of the medications through a mail-order pharmacy, since they were by far cheaper than Costco or my pharmacy's cash prices. Since this mail-order specializes in infertility drugs, they have all kinds of coupons and discounts from the manufacturers to apply towards the prescriptions that aren't covered by insurance. I got all the oral medications and the progesterone injectible from my pharmacy, since they were covered, and I happened to know which pharmacy locations had some rotting away on their shelves, so I got them filled at various places to help them use them up, rather than losing money when the drugs expired eventually! :) 
My mail-ordered drugs were Follistim. Menopur... and a third one. Plus oodles of syringes, needle tips, pen needle tips, a Sharps container, gauze pads, and more. I was kind of annoyed that the shipping box didn't mention that the contents needed refrigeration, since I let the box sit around for a week or so until I opened it closer to when I'd be needing them. Argh! Luckily, they said they could be left out for up to two weeks. But still. Argh. $500 not down the drain!
We got an injection clinic, where they showed us what each of our meds would look like, which syringes and tips to use, which ones we needed to mix, how to mix them, what to do if our Follistim pen ran out of drug in the middle of a dose (which came in handy several times for me!) and more. I was kind of appalled at some of the basic stuff they didn't talk about. Silly little questions people were too shy to ask. But I could see their lost little lamb faces. So I asked loads of questions that I knew the answers to, and totally annoyed the nurse giving us the tutorial. But really. You tell us to use this needle to draw out the drug, then take that needle tip off and put on another one to use for injection... people will wonder why. Why that extra step? Why risk messing it up and jabbing yourself with the biggest needle you have ever seen in your life? Well, because the act of putting the needle into the rubber of the vial lid dulls the needle a little. Making it harder and more painful when trying to bust into your skin. See? Worth the extra effort. (Although, then why not get extra drawing needles for all these other meds too? But I didn't want to confuse things too much!)
As my protocol went on, I'd start looking up random stuff. Usually in the middle of the night. Supposedly I could log onto their site and look all this stuff up, since they don't post their protocol publicly, so it can't be copied. But we could never remember our logins or passwords, and you had to talk on the phone to the IT guy to get them, which doesn't help at 3AM. So I found stuff on other clinics' sites. And they only had 2 weeks of gonadotropins (the follicle stimulants.) We were doing 4 weeks.
Since I'd be injecting myself with various medications throughout the day, obviously my husband couldn't do them all. And since they said that I needed to inject them 12 hours apart, but that the actual time I chose wasn't as important, as long as I stuck to those times the whole protocol, I opted for 7. 7AM - not too early, even if I didn't have to work until 1PM. And 7PM - not in the middle of a busy time at work, or a commute home, or whatever, depending on my shift. So when I worked 9 to 5, I'd inject when I'd normally be getting up, and then after I was already home. An 11 to 7 shift would see me up, shot, back to bed for a snooze, then work until my last shot on my way out the door. The tough days were my 1 to 9PM shifts. I'd have to get up 4 hours early, but could go back to sleep. But I'd have to do my evening dose at the tail end of dinner rush, when people are getting off work and picking up their drugs and groceries. All without the benefit of a smartphone with a handy-dandy timer to remind me. I can't even tell you how many times I just hid in a corner at the back of the pharmacy to pull my pants down in front enough to jab myself before rushing back to help the next customer. (We would often opt to come in half an hour later or leave half an hour earlier and skip our lunch break, but smoosh together our two 10-minute breaks into a lunch instead of clocking out. Technically against the rules, but hey. The downside was I wouldn't have a break left to wander off to leisurely do my injection in private.)

I think I started with the Menopur. I can't remember if it was once or twice a day at the beginning. So the first time I had to get up and inject myself... I almost passed out going back to bed after. The second time went better. But the next morning, I got a bad needle. It hurt pretty bad going in, and when I ripped [Yes. Ripped] it back out, I saw that the needle had some kind of jagged line along it, like flash. Oh. My. God. Needless to say I got a little dizzy, what with the pain and bleeding and all. And I had a terrible bruise there for days.
Later in the protocol they introduced the Follistim, and whatever the 3rd one was. At the peak, I was injecting 3 medications for a total of 5 jabs a day. But that overlap only lasted a day or so, if I recall.
At this point my tummy flab was one big bruise from all the injections. I'd routinely bleed out of an injection site and need a Band-Aid. It wasn't until the last week that they told me I didn't need to stay within that specific area (they initially showed me how to use my fingers to measure over and down to where I should be injecting, so I had stuck to those general areas.) Thanks for nothing, guys.
At the tail end of a Follistim vial, I'd just take it out and get a fresh one, to avoid risking running out and having to do a second injection for the rest. At one point I hadn't been paying attention, and did run out with a vial. Doh! Luckily they had shown me what to do and I had written it down! [Thanks again guys. A sheet with all those tips already on it would have been a great hand-out. FYI.] Don't touch the dial. Remove needle from flesh. Remove needle tip from pen. Remove vial. Replace vial. Replace needle tip. Re-inject. Finish releasing dose dial. Ta-dahhh!
Since they decide the specific protocol, doses, strengths, etc at the beginning, they'd have me come in every few days for a blood test and/or ultrasound, just to see how things were progressing. Apparently my follicles or hormones weren't performing as expected, since my dose wasn't lowered when the schedule said they'd probably be lowering it. So I kept going in, getting my tests done (at the office not near me, since they could do the tests in-house and get the results within hours, which they needed in order to determine what does(s) I'd be taking next. So I went without complaint,) doing my doses as instructed. As we neared the end, they had on my schedule that on this visit, [named after a specific test they'd be doing at that point in the protocol. The date was determined by how I was progressing] I'd be getting my next schedule, now called a 'calendar.' This would have my projected retrieval and possible transfer date(s.) Plus the final doses of medications. But on the day of that visit, they didn't have my calendar ready for me. What? Seriously? But since I'd be coming back in two days, they'd give it to me then. Well... okay.
So. I go back in for the next round of tests and to [finally] get my calendar. And I read it over, later at work, to familiarize myself with what's in store and whatthefuck? My husband was supposed to start an antibiotic TWO DAYS AGO?! The day I was SUPPOSED to get my calendar, so I would have KNOWN he was supposed to get a prescription?! Are you kidding me? Not only that, but they didn't even have a prescription called in for him anywhere from 2 days before. Nope. I cannot even emphasize enough how much oversights like these eroded my confidence and trust in this office. But too fucking late [and expensive] to turn back now! I just loved having to be the one to even spot this lapse in their protocol, and have to call and harass them. Never mind all the fear that this might mess the whole cycle up and we'd have to do it all over again. Over some stupid little detail. ARRRGHHH!
So. My retrieval is scheduled for a Tuesday afternoon. (1pm, to be precise.) I had had to juggle shifts around at work to get that day off work, since it had only been decided late the week before. So. On Friday night, mere days before my retrieval. Business is slow. I'm fiddling around. Looking at all my Follistim vials, and seeing that I'm on my last one. And it's getting low. All the rest are the low ones I had set aside to avoid having to do a double-shot. It doesn't look like enough for Saturday, Sunday, Monday and Tuesdays doses. 7 more doses. Hmm. So I go back through all my schedules on the protocol, where I've recorded the doses I was instructed to take. And I count all the fractions of milliliters I'd used each dose. Subtracted from the total volume of medication I got. And... don't have enough to last. I can barely last through Saturday, and to squeak out the last dose, I'd have to do 3 shots to get the last bits from 3 vials. And it's after business hours on a fucking Friday night! I call my doctor's office, and ask for a call back. I call all the pharmacies in the area to see if anyone has this medication, in any size (although I only need the lowest volume.) I find one pharmacy that happens to have this uncommon, and freakishly expensive, medication (over $500 from them for this one box. Naturally they don't have the smaller package size.) But beggars can't be choosers. But - they're only open until 1pm on Saturdays, and closed on Sundays, so I'd need my doctor to call in a prescription ASA-fucking-P! [Sorry for all the swearing. Normally I try to filter it out, but I am using it now to evoke the sense of emotional and hormonally-driven stress and frustration and distress I was going through at the time. And let me tell you. This is nothing, nothing, compared to the vitriol that spewed forth while experiencing all these snafus and miscommunications throughout my time with this office.] 
And, for that matter, why was it me, at 7PM on a Friday night, doing the math to determine that I wouldn't have enough medication. I mean, they had a team of doctors and nurses, checking my charts and determining my doses practically on a daily basis. What? No one there can do math? It never even occurred to anyone there that Hey, her ovaries aren't doing what we want. Let's keep her on a high dose. Oh and hey, will she even fricking have enough? What? I was supposed to discover that I was completely out of medication halfway through a dose?! I cannot even believe the ineptitude. I mean, it's not like these people are racing out in the middle of the night delivering babies. No. This is all they do. And they get paid a shit-ton of money to do it. 
So finally the doctor deigns to call me back, after I called his office multiple times, shrieking like a crazy person at the answering service. Almost 3 hours after my first call. "Oh, no big deal. We have the medication in stock. Just pop by the office tomorrow morning and we'll get you enough to last you until the end." Thanks. For. Nothing. But at least I got my meds, and wouldn't mess the whole thing up and have to start over. And I wouldn't have to do the 3-shotter to squeeze out the last few molecules of medication! [So he gives me a box, then orders a box from the pharmacy to be mailed to them instead of me. But the bill was sent to me. Over $200. All the other medications together were only $500. *sigh* But they probably couldn't use the coupons again for me.]

In Utero InCelebration?

After the Clomid and the cysts (or not cysts. He told me anything larger than 5mm (I think) was called a cyst, even if it wasn't harmful) we tried Femara, which also got no results (ie: pregnancies.) But also no cysts. So, a wash.
At some point in 2006, but I think near April and my polypectomy, we did a semen analysis, and his count was good. So yay for him. But still no answers as to why we were having problems.

March/early April: The fertility specialists he sent me to had an office across the street from his office, which was a huge selling point for me. I also opted not to shop around because of the hefty $200 consultation fee, not covered by insurance, even if you have infertility coverage (which my insurance was covering!) During our initial consult, he said that I could do most of the stuff at that office, rather than either of their other two offices, and that he didn't think we'd need to do an IUI. He wanted us to just come in for an ultrasound to ensure I was ovulating, then do an hCG shot, and try and conceive the regular way (on a carefully timed schedule!)
So imagine our surprise/consternation/frustration/confusion when we come in for our ultrasound and the doctor there that day wants to schedule us for an IUI. Us: "But the other doctor said we weren't going to do one." Him: "We always do them after this kind of ultrasound." Us: "But..." So we scheduled it. At worst, it would work, right? Only a couple hundred bucks, to increase our chances of conceiving that month, rather than dicking around for a while (21 months,) like I did with the ARNP and then the OB/Gyn.
But it shook my confidence a little. Either the first doctor never put in my chart that he didn't think we needed to do an IUI our first round, or else the second doctor didn't even look. Neither option inspires confidence, now does it?
So. On the assigned night, I get my first shot. Not administered by a trained health professional. I have a severe needle phobia. I get dizzy and cold-sweaty and lightheaded and nauseous. (Apparently, this is called a vaso-vagal reaction.) So I think I had him mix the water and the powder and draw up the dose. And administer it. But I may very well have done it myself. I don't recall.
The next morning (Easter Sunday!), my husband gets up early and does his thing. Or... tries. He calls me from his special room at the clinic to express his frustration. I got to sleep in, since they didn't need me until later. I get there a little early, to help him out, just to discover that he had managed to complete his task, and had left already. Yay team! I'm sure I got some bloodwork taken, and then off to the races!
I've never been so excited to take a pregnancy test. This had to be it! We'd finally broken down and paid for an expensive medical procedure (covered at 90%, since they were a preferred provider! But only the parts involving me. My husband had a different insurance plan through  his employer, so my insurance didn't cover anything having to do with his "contribution.") I think our out-of-pocket for this procedure was around $200 or less after insurance. But it was an actual official infertility procedure. Not just a test, or a drug-and-a-prayer.
Nope. So we talked to the doctor, and he suggested giving it at least 3 more tries.

Early and Mid-May: So we try, try again. At this point, I'd been in for various ultrasounds to check that my eggs were forming; bloodwork, to check hormone levels; and whatever else needed to be done. Oh yes. And remember how pleased I was that I'd be able to do most of this at the location near my home? Bzzzt! Wrong! All the major procedures are done at one location. The others are mostly for consults and the occasional ultrasound. And it's kind of based on whether one of the three doctors is at that location on any given day, and whether they have an opening that fits with my work schedule. I had to get pissy at them before they agreed to take my blood at the nearby location. They didn't like doing that, since the hospital has restrictions that offices on their premises must use the hospital's contracted labs, rather than being able to do their own testing. Tough nuts people. The other locations are 30 minutes away from me. Each way. As much fun as it is, fighting the worst traffic in the Seattle area for a 30-minute (in light traffic) drive, just to get a blood draw, is not how I like to spend my time.
Our second IUI was also a fail. But as an added bonus, my husband, who had been getting killer headaches all year, had gone in for an MRI right around the same time as our IUI. And they found an aneurysm. And wanted to operate. Like, now. So he goes in for brain surgery.
You read that right. Brain. Surgery. How scary is that? On day 3 after his surgery, while he's recuperating in the same area housing post-stroke patients, and suicidal and other mentally unstable patients, I go off to meet with my doctor to talk about doing more IUIs. On my birthday.
I basically ask him if doing more IUIs will increase my chances. Does doing them regulate my body or make it in some way more likely to get pregnant? Apparently not. Your chances decrease with each attempt. So. Bollox that then. I tell him we're done pussyfooting around. What's the next step? In-Vitro.

Friday, January 21, 2011


So after being told the 'good news' that my tubes weren't blocked, but that they had found polyps in my uterus, I went back to my Ob/Gyn. Uterine polyps are just extra growths in the uterine lining. Like skin tags, but all up inside. But they can interfere with the egg's ability to implant, and can also lead to irregular cycles.

He wanted to do a polypectomy and D&C. Sure. Whatever. It was scheduled for my husband's birthday. Sorry honey.

The polypectomy is really part of the D&C process, purely by default. A D&C, which stands for "dilation and curettage," used to be done as part of an abortion, but is now mostly used after a miscarriage, or for irregular bleeding. It's where they dilate the cervix and go inside with a curette, and scrape off the uterine lining (endometrium.) Since the polyps are growths in the uterine lining, it's pretty much two birds with one stone on this one.

I was admitted to the hospital, dressed up in threadbare [ie: freezing] cloth gowns with ties, and questioned not once, not twice, but three times by various medical professionals. "Your name? Date of birth? Any allergies? Did you eat anything in the last 12 hours?" Etc. They set me up with an IV. Now, normally needles make me feel dizzy and nauseous. [I found out years later that it's called a vasovagal reaction.] So when they first hooked me up, and I didn't immediately feel wonky, I stupidly sent the guy away with his precious anti-nausea and anti-anxiety meds. Then my dizzy kicked in. Cold sweats. Shakes. Desperate need to lie down and... howthehelldoImakethisliedown?Whywon'tthisfuckingbedlayback?!  Finally my husband was able to rescue me and make the bed lie flat until I felt better. Then, a thousand freezing years later, the nurse came back with some prophylactic IV antibiotics just in case. The nurse warned me that sometimes these antibiotics itch a little going in, so to buzz her if there was some discomfort. Itch, my ass. It burned. It felt like a swarm of bees flying through my veins. After much crying and screaming (on my part) and the return of the nurse, who thought I was totally over-reacting, [bitch] the numbing agent she added did the trick.
Wave goodbye to my loving husband, and get wheeled into OR, where they have massaging air booties and warm blankets to drape all over me. Ahhh. Now we're talkin'! Okay, count backwards from ten... 10... 9... 8...

Wake up back in room with loving husband. Hooray! I didn't die or something. And feelin' no pain!

They gave me a prescription for some Vicodins, which I didn't end up using, since I felt okay. I got a lot of World of Warcraft time in, the rest of that day and the next.

Then back to business as usual. We tried a few rounds of Clomid (to stimulate egg production) and I started feeling sore in my ovaries. The doc was worried that my ovaries were developing cysts, since they were getting big when I was ovulating, and they hurt. After many months of drive-by pelvic exams and ultrasounds, we stopped using the Clomid and he sent me on to fertility specialists.

I call them 'drive-by pelvic exams' because he'd leave the room for me to change, come back in, flip the switch to signal for a nurse to come in and observe, and start without her, and be in-and-out before she'd even arrived! It took me longer to take off my socks than it would for his exam!
I figured out over a year later that he did these perfunctory exams in order to bill my insurance for a pelvic. Easy money!
And I also figured out, after years of trial-and-error, pelvics, vaginal ultrasounds, etc, that any time anyone had anything all up in my junk, my ovaries would hurt for a few days. So what we thought were follicular cysts on my ovaries, were really just big juicy egg-makers. But he'd poke around to see if my ovaries felt too big, which would make them hurt for a few days. Then the ultrasound wand would knock them around. And they'd hurt for a few days. Then he'd feel them again. Hurt. U/S. Hurt. Wash, rinse, repeat. There were never any more signs of follicular cysts, or over-stimulated ovaries.