Princess and the Pee Sticks

The home pregnancy tests say you can test 4-6 days (depending on the test) before your missed period. So if ER date is "Day 14" of your cycle, then one should be able to get a result around 10 days later, right? Even though the blood test isn't scheduled until 2 weeks after. I remember that I did a pee stick at the earliest possible moment last time too, and got a BFP! I Googled info on how long it takes for an egg to implant (9 days after fertilization, although my sister swears she "knew" when her first pregnancy implanted, and it was 3 days before her period was due.)

Around a week before the blood test, by nips started getting tingly. My boobies feel tighter and fuller. Ad at one point I absentmindedly glanced in the mirror while brushing my teeth and thought "Whoa! Those are big!" So I had high hopes. Same thing happened last time!
My plan had been to do a home test the Wednesday before my blood test (Saturday,) but I'd be at my sister's house, and she's been chomping at the bit. Screeching that she can't possibly wait that long to get results. Yeah. 'Cuz it's sooo easy for me. So I decided to go ahead and try Tuesday, so I might possibly have an answer for her before I got there.

Photo credit

4/26 - (Tuesday) - BFN. Well. Huh. The boobs were still sensitive, so maybe it's just too early. My sister began grilling me on my behavior. Had I been avoiding "offensive" foods like onions and garlic? Resting enough? Thinking positive? Excellent. So now if I'm not pregnant, it's all my fault, because I stayed up late one night playing Farmville. And offensive foods? Really? E-v-e-r-y-t-h-i-n-g gives me gas. In fact, when I was pregnant the first time, WATER gave me gas. What exactly am I supposed to avoid?

4/27 - (Wednesday) - I went and bought a pair of ultra-sensitive 6-days-early tests. BFN.

4/28 - (Thursday) - Tried peeing in a cup instead of directly onto the stick, in case I'd somehow messed that up. BFN. Said goodbye to my little Maybies and cried in the shower.
Called the fertility clinic and asked when I should schedule a follow-up, on the likely chance that my blood test in 2 days will be negative too. (7 weeks after the start of injectibles.) And left a message for the financial counselor to find out if my insurance will pay again, or if we'll need another prior auth, etc. (Apparently my insurance limits to $25k/year, and she estimates we'll have around $10k left. It's too soon to know for sure, since it often takes 3-4 weeks for the insurance to respond to a claim. She kind of suggested that maybe we could wait until the yearly max resets next year. Yeah. I want to waste another 7 months.)
The nurse of course got my hopes back up again. After I'd finally let them go. She told me that my blood test is scheduled for the earliest possible day they'd expect to get results with a blood test. Um. So why do home pregnancy tests work early then? But now I could still possibly maybe be pregnant. Torture. I don't think I'm pregnant, but I can't let go and move forward until I know for sure. I so want to move on.

Started spotting at bedtime. Like a big red punch in the gut. Could just be normal. Could mean nothing. Could mean everything.

4/29 - More spotting. Still tingly boobies though. Had only bought 2 more home tests, and didn't really want to throw away another $10 just to get my soul crushed again.

Scared Little Z when she found me crying in the morning. "Mommy. I don't want you to be sad. [*tears welling up*] I only want you to be happy!" [*crying*] And all day she's been asking me if I'm happy now. And telling me that she's sorry that I was so sad "yesterday." (She is still struggling with the concept of time. Anything before naptime was "yesterday." If the sun is even remotely out, it's "morning." And if it's bedtime, then it's apparently also "morning.")

So depressed it feels like someone's sitting on my chest. The thought of someone bringing up my IVF at the moms club event I had committed to running today (otherwise I would have just played hooky and sacked out at home all day) makes me cry. Thinking about virtually anything at all makes me cry. Seeing the sun shining makes me cry.

My Maybies

I've always found it funny that you are already considered to be two weeks pregnant just after conception. Not that you know yet, in most cases. On my Egg Retrieval date, I conceived twins, and I wasn't even in the room! Heck. I wasn't even in the same city! And they were already 2 weeks along!

We gnawed our fingernails for 3 days, waiting for the Embryo Transfer date. Based on our Day 3 transfer last time, and the lack of embryos to try and choose from this time, they were pretty confident in scheduling us for a Day 3 ET. But based on my poor embryo quality last time, and my even poorer egg numbers this time, my hopes weren't very high. I tried calling on Day 2 to get an update on quality, but all they could tell me was that the cells were still dividing. Well. Not bad news, at least.

4/19/11 - So we go in for our ET. Since we were scheduled for the afternoon, we were able to get Nana to come down and babysit, so we wouldn't have to worry about Little Z. Ironically, this time she could have been in the room with us, since it was a different area than the ER and we got to stay in our room the whole time. Ah well.
The ultrasound tech came in and checked my bladder, then had me drink more water and wait 5 more minutes. When she came back, all was well. Then we got to talk to the embryologist.
One of our embryos was 7 cells and the other was either 8 or 6, I can't remember. I think 8 though. And when we asked about fragmentation, she looked a little sad and said that one of them had 30% fragmentation, which was not good, since they don't like to see more than 20-25%. I could have whooped for joy. 30% was our best one last time. The other? 15%. I was so happy I cried.

The top one is the 30% 6 -or-8-cell one, bottom is 15% 7-cells.
Since they aren't babies yet, I called them my Maybies. 

For some reason they recommended transferring both embryos, even though my doctor told us initially that they usually only recommend one, since in her experience multiple embryos doesn't increase the chances of pregnancy, just the chances of multiples! We had discussed leaving the number of embryos to transfer open, based on quality, but that if we had a good one, we might just try one. Otherwise probably 2. And if they were really poor quality, 3 or more, just so they wouldn't get thrown out.
So I was mildly concerned about transferring both, since I got pregnant off a 30-40% fragmented embryo last time. Chances are good that they'd both implant this time. Last time, I was willing to have multiples. It would be hard work, but anything's better than nothing. But multiples on the way with a pipsqueak at home already? Hard. Harder than hard.
But my husband was leaning towards their recommendation, even though they couldn't tell me why they recommended two. Eh. Go for it. I'll go in on the 30th for a blood pregnancy test. It'll be a looooong week-and-a-half!

ET for Two

4/16 - Egg Retrieval: So we get up at the asscrack of dawn in order to get up, get ready, get the kid up and ready, and get to the clinic by 7:45 AM. We opted to bring her with us and switch off watching her, since it was waaaay to early to drive to and from a family member's house to drop her off. My mom, who would be the only one close enough to drop her off with, was out of town this weekend. And my sister, who was willing to spend the night before to watch her at my mom's house, had a big test for school that morning that she couldn't reschedule.

It went okay. DH and Little Z had to stay out in the lobby the whole time, which was kind of a bummer. Last time, at the other clinic, my husband got to stay in my recovery cubby the whole time, so we had kind of planned on being able to do that with her this time. They would have let him in, but they didn't want her in there since there was another woman just coming out of her procedure as well. Ah well.

I'm not a fan of needles. They make me dizzy and nauseous and I get the cold sweats, especially whenever an IV is involved. So I'm even less of a fan of having to be poked more than once for a blood draw or IV, yet somehow over 75% of the time, end up getting multiple pokes! This time was no exception. She did something wrong with the elbow vein, and apparently my arm was swelling up with the liquid leaking out under the skin instead of in the vein. Yay. So I got a shot of Lidocaine in my hand and an IV there instead. Joy. Three shots.

I was actually surprised that they weren't all double checking my allergies and date of birth and whether I'd eaten yet that day. Every other procedure I've ever had, every single different person would double check the same information. Luckily, I'm me, have no allergies, and hadn't eaten. (I almost ate a tiny bit of peanut butter off my thumb when packing a brunch for Z, but realized my error before closing my mouth and was able to spit it out.)

They have me pee, walk me into the OR, lie down, put an oxygen mask on, give me a nice heated blanket and pillow (*sigh* My favorite part!) but no leg massager thingy, and then I don't remember much after that. I don't even remember counting backwards. As I start waking up, I hear someone say something about how "she should just be waking up now" and then people coming in to bother talk to me. I got juice and cookies at least. And the shivers. I think I often get the shivers after anesthesia. My memory is terrible about that kind of stuff though. It could just be chilly rooms and no heated blankies (which they only give before the procedures.)

And then the doctor comes in to tell me the results. Which was nice, sort of. Last time they didn't tell me any numbers until the following day. The "sort of" part was the numbers. 3. 3 eggs. Last time we did this, I had 13 eggs. When she did the follicle count before we started the BCP, she counted 11 follicles. Apparently, after starting the shots, I had only 5 follicles they'd been monitoring (plus the cyst.) And 2 of those also turned out to be cysts. I'd been wondering why she was only measuring a few black blobs each time, but I thought they were just watching the bigger ones. I'd had no idea that those were all we had!
Three. Eggs.
Out of the 13 our first IVF cycle (3.5 years ago,) 10 were mature enough to ICSI. So already 25% attrition rate. Then of those 10, 8 fertilized. Additional 20% failure. Then, of those 8, all had higher than normal fragmentation rates. (Normal is 20-25%, my best 4 were 30-45%. The others went up to 80%.) So 3 out of the original 13 were even worth bothering with transferring. Slightly less than 25%. And of those 3, only 1 implanted.
So with only 3 to start with, my hopes kind of plummeted. The doctor and later the nurse told me that we only needed one to be successful, but I can't imagine these ones being any better than the last ones. It's not like eggs get better with age.

So there were some tears, and a lot of numbness. And the depression I've been fighting ever since I started the BCP came and hit me. Hard. I almost don't even want to try again, if it doesn't work this time. If I didn't have my little girl to take care of, I don't even know if I'd be able to function.

4/17 - The day after the retrieval was my husband's *cough*ty-second birthday. We had a fun time. We all ate brunch at the mall, shopped a little. Played at the kiddie play area for a bit. Hit a Half-Price Books store on the way home. And we got the call with our results so far.
Of the 3 eggs retrieved, 2 were mature enough to ICSI, but both fertilized. So that's good news, I guess. I'm hoping my body put all its energy into making those some really quality eggs.

4/18 - After getting the info for my Day 3 egg transfer, I called back to ask about my little embryos. They couldn't tell me whether they were fragmenting or not, but could tell me that they're still dividing, so that's good. They're both still alive. So that's where I'm at today.

Are they twins if they haven't implanted yet?

A Day Without Needles

4/14 - To celebrate getting to stop my meds, we went to Ikea to lie about Z's age so she could play in the play area. But we were thwarted by a new policy that no diapers or training pants were allowed. Nuts. So we went to the kids furniture area and played with the toys and jumped played on the beds. We had a great time, until I realized that I had totally forgotten my final antagonist shot (I had planned to do it after my appointment,) and I either hadn't listened or hadn't heard what dose of HCG I was supposed to be doing. And everyone at the office was in a company-wide meeting, and wouldn't be available until 3pm, several hours later. Ughhhhh.
When the nurse finally got back to me, she told me to go ahead and take my antagonist shot, even though it was very late, and to take the full dose of HCG. And they even let us reschedule DH's "appointment" time for the egg-retrieval on Saturday to a half-hour before mine, so that we could tag-team watching Z, since my mom was out of town, my sister who normally could have come out to watch her had a big test that morning, and my other sister and his mom were both over an hour away - not fantastic when you're supposed to be there at 8:15 AM.
That night my husband wanted to go to poker night, since there was a friend visiting from out of town. And I had a meeting with my MOMS Club. And was supposed to do the shot at 8:45pm. He's always done the IM shots, since they're a lot harder to do, both angle-wise and muscle-resistance-wise. But now I'd be on my own. I was going to have to leave my meeting early to meet a nurse in Seattle who would do the shot (for $50,) until I remembered one of the MOMS was an MA. So after checking to see if she'd be there, and be willing to do it for me (in a public restroom at Starbucks!) I cancelled the nurse.
There was a lot of giggling and clock-watching from about 8:30 on, since everyone knew what was going on. Then we trooped in, with my daughter, to the restroom. Luckily, it was a family-style restroom, with just one toilet and a sink and lots of space. She used the Koala diaper-changing station as her table, and had me lean over the sink. The nurse that morning had drawn on a "target" for me, so that part was pretty easy. And it was a lot quicker and less painful then I remember from years ago when my husband did them. But we were doing the progesterone shots back then, which got more and more painful as my muscles got stiffer and hurt more. The police who had arrived for coffee just before we went in gave us a funny look (I mean, really. Two ladies walking out of a single-person bathroom, with a very tiny minor?) but didn't hassle us. I made sure to thank her for being a pain in my heinie. :)

4/15 - Friday morning's pregnancy test was positive (and I fully enjoyed the irony of doing a pregnancy test when we all knew full well that I was not pregnant. They just had me do to to make sure that the HCG had been absorbed properly.) Ahhhh. A day without needles!

A Cyst Assist

It's been a while since my last IVF post, and a lot has happened... or not happened. I was a little over a week away from my suppression check, and the potential start of my meds. Well. Not so much, apparently.
I dutifully take my BCP, go in all excited for my suppression check (3/16)... and see a big black blot. I could tell immediately that something was not right. I've had cysts (from the Clo.mid) and seen follicles and all that jazz before, and this was the largest black blot I've ever seen. 28mmx28mm. A big whopper of a cyst. They tell me that it may be nothing, blah blah blah, but we'll do an estrogen check to see if it's active or whatever. So keep taking the BCP. Next day's lab results: high estrogen. Continue on the BCP and come back next week. Joy.
So I go back in for another U/S and bloodwork (3/23)... still there. Slightly larger (31mmx25mm.) And my estrogen is still high. Come back next week.
3/31 - still there. But slightly smaller this time. 25mmx25mm. I ask more questions this time, since I'm still not sure what this all means. The estrogen interferes with the stimulation meds, so there's no point in starting until the cyst stops interfering. And they aren't concerned about a cyst unless it's there "for too long." 12 weeks, apparently. *sigh*
But this time... the estrogen levels are down. We're a go! They were going to have me start stim meds on Sunday 4/3, but then one of my appointments would conflict when I'd committed to babysit my nieces. So we moved it to Tuesday 4/6. And I moronically remembered to stop taking my BCP Saturday night, as if we'd be starting Sunday, even though I knew we were moving it to Tuesday. Doh! Luckily I remembered for Sunday night.
 4/6 - Meds Day 1: I got to start my shots at my sister's house. Glee. I forgot how hard it was to remember all the little steps they don't tell you at the injection training class. I forgot to pull 1cc of air into the Meno.pur syringe before attaching it to the vial of saline. If you push the air in first, you don't get the suction trying to push the water back out of the syringe once you've drawn it (basically, you negate the pressure you've created by trading 1cc of air for 1cc of water.) If you just draw the water out of the vial, you create pressure where the syringe wants to push the water back out. All while you're trying to pop the lid off the powder vial (because you forgot to open all your stuff before starting.) Then you push the water into the powder vial, but you;re just moving the pressure from the syringe to the vial, and when you draw the medication back out, you have the same issue, with the syringe trying to push the liquid back out. And now you're trying to tear open the needle wrapper and put the tip on without letting the liquid push out.
4/7 - Meds Day 2: I got to do these ones at home. This time I remembered to open all the wrappers, but still hadn't thought to push the air in first.
4/8 - Meds Day 3: We were out to dinner with DH's family, so I got to do my shots in a restroom stall. And just as I unwrap everything, 5 ladies come in. Someone had just stared using the only other stall right before they arrived, and I knew I'd still be several minutes. So I opted to put everything away again and letting them all go first. Like there wasn't already enough pressure in handling needles and not messing up doses, I needed to feel rushed?
4/9 - Meds Day 4: Got to do shots at home. Invited Little Z to come and watch. She was to sit on her stepstool and not move. So naturally, just as I'm about to pull out the needle from my second shot, she stands up, trips and crashes into me. Joy.
4/10 - Meds Day 5: Had my Day 5 bloodwork and U/S. The technician couldn't tell which of two large black blots was the cyst, and which was a follicle. I forget the numbers, but I think they were both around 18mm across. She wasn't measuring too many follicles, but I assumed she was just going for the largest ones, or that they were blocked by the cyst. They also had my start the antagonist shot that morning, rather than the next day, which is what my calendar had said.
4/11 - Meds Day 6: Back at my sister's house, to babysit for the next morning. Only this time she was out of town, and after about 15 fruitless minutes of trying to kick various toddlers and preschoolers out of the bathroom (Really? You have to pee right now? You too? And you? You never use the potty when *I* ask you to! YARGH!) So I retreat to my sister's bedroom, and my poor BIL comes in just as I'm doing my first shot. I was cool, since I'd heard his footsteps and guessed that he was headed there. But he was mortified to be barging in. But I'd had a feeling he was going to come in, so I just folded down my waistband (I have plenty of fat to pooch out without having to take my pants off!) I even made sure my panties weren't peeking out the top.
4/12 - Meds Day 7: After a fun-filled day trying to find an urgent care out in an area where there's only one or two McDonalds per city, then waiting at the pharmacy for my daughter's ear infection meds to be filled, we got to the ferry in time to miss it and instead arrive to meet DH an hour later than planned. Then we all went out to dinner at The Melting Pot, where I got to do my shots in a restroom stall again, only without any pressure or interruptions this time!
4/13 - Meds Day 8: Time for Day 8 labs and U/S. I scheduled it in the Seattle office, so I could drop my husband off at work and leave Z with him for my appointment. But apparently he had an "all-hands"meeting at work for several hours, and it would have been difficult to leave to bring her out for me. So we gave her the choice, and she opted to come with me to my appointment. I felt bad about bringing her, for everyone else's sakes, but there were 3 or 4 other families with kids there too, so it wasn't so bad. And she did fantastic. Other than asking every 10 seconds whether they were going to put the wand in my "ba-dye-nah" yet. She stayed out of the nurse's way for the blood draw, and held my hand to "help me be brave."
She was fascinated by the U/S wand and was sad that she didn't get to see it "going in."
They decided to have me continue meds for another day, and come back the next morning for another U/S to see if the large follicle and cyst changed any.
4/14 - Meds Day 9: My husband had yet another crucial meeting, and had lunch plans with a friend, so drove himself to work, so I took Z with me again. This time we were in a different U/S room and she got to see the whole process from a better angle, in her point of view. But we were a go for the HCG shot that night!


So, some basic injection tips they generally don't tell you:
Open all the wrappers for each step before starting that shot. It's much harder when your hands are full of syringe.
If you'll be drawing water out of one vial to mix with the medication powder, pull that much air into the syringe first, then push the air into the water vial before drawing out the liquid. You don't need to do this when adding the liquid to the powder, since you aren't starting with a pressure imbalance. The unpressurized water going into the powder vial does what the air did for the water vial.

Letting Go of Guilt

The ladies at SITS are hosting a "Letting Go" Link-up, to inspire us to let go of our hang-ups and redefine "our best."

Now, this isn't my normal blog, which is far more fun. I come back and dust this one off once in a while, when something comes up, or when I need to vent. But I'm too chicken to strip my soul naked on the one that our friends read and families subscribe by email to.

This is hard for me. Not just the thought process, but the sharing process. I don't really advertise my infertility issues (except here, obviously,) but I don't keep it a secret either. And I never share the emotions: fear, guilt, shame. Not even with my husband, really. When I first read this challenge, I thought... "Huh. What can I let go?"  My first thought was maybe some vague parenting hang-up, but nothing came to mind. Then I thought, "My guilt?" and my gut reaction was "No! It's mine!"  

Because I don't share it, because I don't let it go, it's almost like a friend. Not a good friend, mind you. But one that's all mine, and no one else's. Someone I can go and play with whenever I want, even if I don't have a good time. Someone who will come to all my birthday parties, even if a part of me wishes they wouldn't. But this isn't someone I met through work, or my husband. Not a friend of a friend. Mine, and mine alone.

I have no reason to feel guilt. I didn't do anything to cause my infertility. And no reason to feel shame. Lots of men and women experience this. More than anyone could imagine.

But it's hard to let go. Sometimes you just feel like sitting there poking at your emotional wounds. "Does it hurt now? How 'bout now? Oh, and remember this?" [poke, poke, poke] "Now how do you feel?"

I've let go of so many things. Issues from childhood. Issues from my parents. Issues from my siblings. Even issues from my husband. But I just can't seem to part with the issues I created for myself. A teacher in High School once said something about how we shouldn't regret anything we do. If you did something bad, learn from it so you never do it again. But don't spend your life regretting what could have been, or what you did wrong. I took that advice to heart. I've always been a firm believer that everything that has happened to you makes you who you are today. And you need to love who you are in order to be happy, and in order for others to love you as well. So everything that has happened, and everything that I have done made me the person I am today. Made me the person who met my husband. Made me the person that he loves. Made me the person who created our daughter with him. And made me the person that she loves. How could I possibly regret being that person?

And yet... we tried for years to get pregnant. I've heard stories more heartbreaking than mine. But they aren't my story. I know some of what they felt, and they know some of what I feel. But no one can know exactly how another person feels. Not exactly.

I've wanted kids, like, forever. At eighteen I was planning what I'd do to become a single mother. Yes. You read that right. There wasn't anyone I wanted to be tied to for the rest of my life, but I wanted a baby. I was willing to move back in with my parents, if that's what it took, to be able to take care of one. But I didn't want to trick anyone into it. No "Yeah, I'm taking the pill." kinds of deceit. Plus I wanted to find good breeding stock, if you get my drift. So I dated a few guys, got into a few emotionally unhealthy relationships. One of those was without protection, as I recall, but nothing happened. He later had several kids. Then I had a long-term relationship with someone, and my recollection is that we'd kind of been "trying," or at least not not trying (he doesn't recall this, and shudders and takes a deep sigh of relief any time he thinks about it,) for several years. Nothing. Then I met the perfect guy... only one hitch: He didn't know if he'd ever want kids, but if he did, he wanted to be married first. But he didn't know if he'd ever want to get married. I'm not one of those people who deludes themselves into thinking "Maybe he'll change." So sometime in the first year of our relationship, I sat down with myself and forced myself to make a choice: Him without kids, or someone else with kids. I chose him, and no regrets. And no blame or resentment for not having kids. Because he didn't lie to me about what he wanted, or give me false hope. I chose him, and all that that entailed.

But over the years, his friends all started getting married. And having kids. And on our 5th anniversary, he proposed, with the caveat that he wasn't actually ready for a wedding yet. Just ready to commit to me. Well, I hadn't ever expected him to marry me, so, bonus! Then four years after that, on our 9th anniversary, we got married. And he said he was ready to start having kids with me.

So 2 weeks before when my husband and I got married, we immediately started trying. I had had a feeling there might be issues, so had started seeing someone at my OB/Gyn's office for fertility issues before we got married. Nothing. Got bumped up to an actual doctor, who started prescribing stuff and ordering expensive tests and doing ultrasounds to check for things. Nothing. Then to an infertility clinic, who said they were sure I'd get pregnant without anything fancy. Nothing. Then fancy procedures. Nothing. Then my Grandma let me cash in on my inheritance early, so we were able to afford IVF without going deeply into debt. Noth... oh wait. What? Pregnant? Really? 

But that was still two years of feeling like a failure. Two years of having my soul crumpled into a ball and stomped on every 28 days (26 for me, actually, the first year. Until they found a problem unrelated to fertility, but fixing it regulated my cycle. Let me tell you what a treat it was to get that extra 14th period every year.) Two years of watching my sisters and everyone else I knew with a uterus popping out babies like Pez dispensers. Two years of hating my body for not being able to do the one thing I wanted most. Ten years of cramps, moodiness, long periods, periods even though the pill I was taking was supposed to prevent them. Yeah. Ten years since I first went crying to my mom as she welcomed me to womanhood. All that, for nothing.

Until the miracle of science (and a hefty dip into our savings account.) And still, then only one egg out of the three we transferred "took."

I decided that when she was 18 months old, I wanted to start working on the next one. Since then we'd have a little time for delays to space them at least two years apart. So my body failed me again. At around 16 months, my cycle started being 14-17 days, irregular, and mostly bleeding. One month I didn't bleed 3 whole days. Yay. After wasting a few months being jerked around by the first doctor I saw, who didn't want to try and discover the cause of the problem, I had to wait another month to get in to see someone else, then it took months to wait to get tests and procedures done, before we were back on track trying to make babies. Then our vacuum, steam cleaner, washer, dryer and water heater all broke within 3 months of each other, so we ran out of funding for infertility treatments. So now she's almost 3. And now we get to start paying to try trying again! 

I can't make any promises. But I will try to let go of my shame. And my guilt. But just in writing this today, I felt a weight lift off my shoulders. The smattering of rain didn't keep us from playing outside. The sunshine was sunshine-ier. I wasn't as quick to race out the door the minute my sister got back from work to take over watching her kids. And I was a lot nicer to them today.

And as I gave myself the IVF shots today (Day 2 of probably 10,) that little part of me didn't hate myself for needing them. 

New Beginnings

Our first appointment at the new IF clinic was at 9am, with an 8:45am check-in, and bringing children is somewhat frowned-upon, (understandably!) So rather than waking up before the sun and then waking up the sprout to drop her off at Grandma's, we opted to spend the night at my mom's house and just wake her up before leaving. So naturally, Little Z refused to fall asleep before midnight. Argh. And woke me up. A lot. All. Night. So we opted to leave without waking her and hope for the best, since chances were good that she'd sleep until 10 or 10:30, and we should be back by then.
We met with the doctor, who I liked, and she kept asking if we have any questions. Like what? We've done this before. And I'm normally just waking up around now, so I need a little help jump-starting my brain here, lady. She suggests that we can do an ultrasound today, and some genetic testing and the FDA-required bloodwork for IVF (Hepatitis tests and such.) Wow! Moving things right along! Love it already!
She checked out my uterine lining, since I have been a little concerned due to my relatively light periods since my polypectomy a year ago. Looks good. She checks out my ovaries to see if I have been ovulating (looks like I have) and how many eggies are in the works (3-4 on the left, 4-5 on the right.) She says they wouldn't recommend IVF if the numbers had been lower than 5 total, so we're good. Whoop! And since we aren't going to fart around with Clomid or Femara and timed intercourse, or IUIs and other stuff, she says we can start with my next cycle! Holy crap, that's fast! They bang out a preliminary calendar, based on a projected cycle start of Feb 15, in a little over a week.
Start BCP on Day 4, 4 weeks of BCP before suppression check, 2 days after that, start injectibles! We could be doing an egg retrieval as soon as 7-8 weeks from now! FROM NOW! Part of me is super excited to finally be proactive again. And part of me is resistant, because it's all happening so fast! And yet a third part of me is frantic that we get this done, and that it's successful, since we don't know how long we'll have this IVF-coverage insurance plan, since they've been laying off a bunch of my husband's department.
After talking to the doctor and being whisked in to get an ultrasound, we wait for our blood draws before talking to our personal nurse (we get 2 actually, since they job-share. But they are the ones who will be contacting me and answering any questions. Which is a large part of why I chose to switch to this clinic. Already more personal service!)
My one concern is that this clinic only has a 2-week protocol with the medications, and my previous clinic had done a 4-week protocol. And I hadn't been developing as expected, so my dose stayed high. Hopefully this clinic will stay open-minded about trying it, if things aren't looking good.
Since the U/S and bloodwork has made us stay later than expected, and my mom has an appointment of her own at 11, we have them take my husband's blood sample first, then he goes to pick up Z, so my mom can leave. Then he comes back for me. So I get my blood draw, talk to the nurse and get a preliminary calendar, and such, then I'm told that they need another blood draw, since they didn't take enough for all the tests. Urk.
Then off to the financial counselor, who tells me that infertility isn;t covered on my insurance, and that my projected out-of-pocket will be around $15,000. Whoa, hold up, lady! I would have bee panicking here, except that I personally called my insurance, even though my husband already had, just to be clear on my coverage. So I told the financial counselor that my insurance does cover infertility, but that ours is the only plan they have that does. Ah. She looks at my actual file and sees that they, to, called and verified my coverage, and rattles off the same information I got, about it being covered at 80% after my $200 deductible. Whew! So then I ask her about the IVF coverage, since all the insurance could tell me was it's covered if I "can't get pregnant by other means." So I ask her if they'll be calling to get a prior authorization or whatever, since I don't want to be scheduling IVF appointments if the insurance is going to want me trying something else I haven't done yet first.
Apparently, they can't be bothered to call for me to find out. She says that since IVF is covered, it doesn't need a prior authorization. I don't know about you, but if something is only covered under certain conditions, that's usually what a prior auth is for. To determine that those conditions have been met. Argh.

So I call my insurance after I get home, to talk to the PA department, and they say they have to call my husband's employer to find out what they mean by "can't get pregnant by other means." Well. Finally. At least someone is willing to find out what I need to do to get this done! I wonder if that means that his employer pays the 80%...

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.

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!

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. 

2007

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.

2007:
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.