I started my Bravelle shots on Thanksgiving night. While it has been anything but pleasant, it wasn't too terribly bad. I feel so blessed to have a supportive, patient and gentle husband who was willing to give the me the injections!
Today I went in for my appointment to check my follicle growth. My doctor monitors follicle growth two ways: ultrasound scan and blood work. Today we got some good news from my check up, and some bad.
I'll start with the good news. First, my AMH levels came back from my blood work last week and my level was excellent. AMH is a marker for ovarian function and reflects egg supply and quality. My level was a 2.96 and my doctor said that they see the most pregnancies in women whose levels are between level 2 and 4. My Estradiol levels today showed that there was lots of activity in my ovaries and my ultrasound showed that I had a 19 mm (full-grown) follicle on my left ovary! I was directed to take my trigger shot tonight to induce ovulation and get busy in the bedroom. When I heard this I said, "Wow! That was fast!" The plan was to stimulate for 7-10 days and I've only been on my injections for 4!
The reply I got from my doctor leads me to the bad news. Apparently my dosage, while very conservative, was too high and my follicles grew too fast. The doctor said that when follicles grow too quickly, they often don't release high quality eggs. We'll just have to hope for the best and see what happens. Basically, it was just a nice way of saying, "Don't get your hopes up." That's the tricky thing about these medications--everyone responds to the injections differently and the doctors don't always get it right the first cycle. It's just a guessing game the first go around. We'll be doing the dreaded "Two Week Wait" from Wednesday until December 14, which is the earliest I can take a pregnancy test. I feel frustrated and defeated already, and I haven't even ovulated yet.
There is always a silver lining, though, and there are a few good things that can come out of this (assumedly) failed cycle. For one, I didn't end up using much of my medicine this month. Hopefully we can use what we have left for our IVF cycle to cut down on the cost. Secondly, I will know if I'm pregnant or not before Christmas. Also, we were a little worried that if I had a particularly long cycle this month, it could make it difficult for us to start our IVF in January. We would have had a very small window between this cycle and the date we will need to start birth control for our IVF cycle, but since I'm ovulating so early this month there should be plenty of time.
We're not giving up hope just yet, but we're definitely not as optimistic as we were this time last week.
Monday, November 28, 2011
Wednesday, November 23, 2011
Shots, shots, shots, shots, shots, shots
You get brownie points if you get the reference of the title for today's entry. Hint: think Lil' Jon.
Today we went back to Dr. D's office to get the results of yesterday's blood work (all which was normal), be trained on how to give our injections, and have a baseline ultrasound done. Our nurse was wonderful and really took a lot of time with us, not only explaining how to give the injections, but teaching us how the medicine actually works.
She told us that all women have a hormone called follicle-stimulating hormone (FSH) that tells their ovaries to produce follicles. Women who go through menopause have much higher FSH levels than younger women. This is because their body is not producing any more follicles, so their brain goes into overdrive and tells their body to make more FSH in an attempt to keep producing more follicles. My medicine, Bravelle is derived from the urine of menopausal women because they have such high FSH levels in their bodies. Crazy, huh!? It comes in a powder form that we mix with water before injection. I'll start my shots tomorrow and will take them once a day for about 10 days. I go back for more blood work and an ultra sound on Monday (and tentatively Wednesday and Friday) of next week to monitor my hormone levels and follicle development. They will adjust my medicine accordingly.
The injectable medications have similar side effects to Clomid and Femara--nausea, headaches, dizziness, irritability, hot flashes and possibly (less than 1%) Ovarian Hyper Stimulation Syndrome. This usually happens after ovulation, when follicles that did not release an egg fill will fluid. Having one or two of these cysts is no big deal, but if you have lots it can be very painful and can even require hospitalization. The bottom line is that cysts are common, but too many can be harmful. My ultra sound today actually showed that I had a cyst on my right ovary. The nurse was not too concerned, and said that we should still start our shots tomorrow. It was probably left over from our last cycle on Femara and will go away on its own.
Our medicine is coming in the mail through a pharmacy that works closely with fertility clinics and ships overnight. We spoke with a representative from the pharmacy on the phone today and they informed us that our insurance would cover $1,006.16 of our medication! We were only responsible for $95. This was great news!
It seems a little sad and strange to be starting our shots tomorrow, on Thanksgiving day. At our last OB appointment when I was pregnant in April, we found out that our due date was Thanksgiving day. It's hard to think that here we are, eight months later, still not pregnant. But we do know that we are very blessed to have the love and support of so many people, and we are definitely very grateful for that!
Today we went back to Dr. D's office to get the results of yesterday's blood work (all which was normal), be trained on how to give our injections, and have a baseline ultrasound done. Our nurse was wonderful and really took a lot of time with us, not only explaining how to give the injections, but teaching us how the medicine actually works.
She told us that all women have a hormone called follicle-stimulating hormone (FSH) that tells their ovaries to produce follicles. Women who go through menopause have much higher FSH levels than younger women. This is because their body is not producing any more follicles, so their brain goes into overdrive and tells their body to make more FSH in an attempt to keep producing more follicles. My medicine, Bravelle is derived from the urine of menopausal women because they have such high FSH levels in their bodies. Crazy, huh!? It comes in a powder form that we mix with water before injection. I'll start my shots tomorrow and will take them once a day for about 10 days. I go back for more blood work and an ultra sound on Monday (and tentatively Wednesday and Friday) of next week to monitor my hormone levels and follicle development. They will adjust my medicine accordingly.
The injectable medications have similar side effects to Clomid and Femara--nausea, headaches, dizziness, irritability, hot flashes and possibly (less than 1%) Ovarian Hyper Stimulation Syndrome. This usually happens after ovulation, when follicles that did not release an egg fill will fluid. Having one or two of these cysts is no big deal, but if you have lots it can be very painful and can even require hospitalization. The bottom line is that cysts are common, but too many can be harmful. My ultra sound today actually showed that I had a cyst on my right ovary. The nurse was not too concerned, and said that we should still start our shots tomorrow. It was probably left over from our last cycle on Femara and will go away on its own.
Our medicine is coming in the mail through a pharmacy that works closely with fertility clinics and ships overnight. We spoke with a representative from the pharmacy on the phone today and they informed us that our insurance would cover $1,006.16 of our medication! We were only responsible for $95. This was great news!
It seems a little sad and strange to be starting our shots tomorrow, on Thanksgiving day. At our last OB appointment when I was pregnant in April, we found out that our due date was Thanksgiving day. It's hard to think that here we are, eight months later, still not pregnant. But we do know that we are very blessed to have the love and support of so many people, and we are definitely very grateful for that!
Monday, November 21, 2011
Consult with Dr. D
Today we had our consultation with Dr. D, our fertility specialist. The first thing we noticed today in the office was a bulletin board covered in birth announcements and Christmas cards. We both noticed right away there were as many twins as singles...even a few triplets! Scary, but also exciting!
The appointment went well and while we still have lots of questions, we were able to come up with a plan for the next few months.
We began our appointment by reviewing our fertility history. A few things from our history jumped out at Dr. D as being important. First, he was encouraged that we have been able to get pregnant. Even though we lost the baby early on, he thinks it was a good sign that we conceived and were able to see a heartbeat on the ultrasound. Second, he determined that I may have a Luteal Phase Defect. Your luteal phase refers to the 2 weeks of your cycle after you ovulate. When you have a Luteal Phase Defect, your hormone levels are below normal and can inhibit implantation of an embryo. Whether or not that turns out to be the case, it was nice to hear a potential diagnosis for the first time. It's also very frustrating that this wasn't determined earlier by my gynecologist.
Based on our working diagnosis, Dr. D offered us two options.
Option 1: IVF
Pros:
Option 2: Gonadotropins (Injectable Fertility Medication)
Pros:
Cons:
We have opted to try one cycle using injectable fertility medications (option 2). Since we have missed the deadline to begin IVF in December, we would be forced to wait until January to start that process. At Dr. D's office, he starts groups of couples at the same time each month to help with scheduling and provide community support. Leading up to IVF you take birth control pills to regulate your cycle and he uses that to get all the couples on the same cycle. Some couples take the pills for 2 weeks, others maybe 5 weeks, but they all stop on the same day. Since I will be starting a new cycle any day now I have missed the chance start in December. We are going to take advantage of an extra attempt using injectables before moving on to IVF in January.
The injectable medications (gonadotropins) are different from the Clomid and Femara that I previously took. Clomid and Femara block your estrogen receptors in your brain and basically trick your brain into telling your body to produce more hormones. Gonadotropins are made up of two hormones (LH and FSH) and they act directly on your ovaries to stimulate egg development. We have an appointment on Wednesday morning to go back and learn how to give me the injections. We will also find out which of the gonadotropins (there are 4 types) we will be trying based on results of blood work that was done today.
When I asked Jeff recently what he wanted for Christmas, he replied, "My wish list has 10 fingers and toes (hopefully) and smells like spoiled milk." If all goes well this month we could get a Christmas baby! Keep your fingers crossed and say a prayer that this month will be our month!
The appointment went well and while we still have lots of questions, we were able to come up with a plan for the next few months.
We began our appointment by reviewing our fertility history. A few things from our history jumped out at Dr. D as being important. First, he was encouraged that we have been able to get pregnant. Even though we lost the baby early on, he thinks it was a good sign that we conceived and were able to see a heartbeat on the ultrasound. Second, he determined that I may have a Luteal Phase Defect. Your luteal phase refers to the 2 weeks of your cycle after you ovulate. When you have a Luteal Phase Defect, your hormone levels are below normal and can inhibit implantation of an embryo. Whether or not that turns out to be the case, it was nice to hear a potential diagnosis for the first time. It's also very frustrating that this wasn't determined earlier by my gynecologist.
Based on our working diagnosis, Dr. D offered us two options.
Option 1: IVF
Pros:
- most effective option (50-60% chance per cycle)
- more control over potential multiples (we can choose how many embryos are transfered
- expense ($15,000-$20,000)
- start date of January 2012
Option 2: Gonadotropins (Injectable Fertility Medication)
Pros:
- less expensive than IVF ($1500; possibly some expense covered by insurance)
- can start immediately
Cons:
- less control/higher potential for multiples (if we have many large follicles, we will have to determine whether or not to proceed so we don't end up like Octo-Mom)
- if this cycle fails, it would be an added expense on top of IVF
- moderate success rate (30%)
We have opted to try one cycle using injectable fertility medications (option 2). Since we have missed the deadline to begin IVF in December, we would be forced to wait until January to start that process. At Dr. D's office, he starts groups of couples at the same time each month to help with scheduling and provide community support. Leading up to IVF you take birth control pills to regulate your cycle and he uses that to get all the couples on the same cycle. Some couples take the pills for 2 weeks, others maybe 5 weeks, but they all stop on the same day. Since I will be starting a new cycle any day now I have missed the chance start in December. We are going to take advantage of an extra attempt using injectables before moving on to IVF in January.
The injectable medications (gonadotropins) are different from the Clomid and Femara that I previously took. Clomid and Femara block your estrogen receptors in your brain and basically trick your brain into telling your body to produce more hormones. Gonadotropins are made up of two hormones (LH and FSH) and they act directly on your ovaries to stimulate egg development. We have an appointment on Wednesday morning to go back and learn how to give me the injections. We will also find out which of the gonadotropins (there are 4 types) we will be trying based on results of blood work that was done today.
When I asked Jeff recently what he wanted for Christmas, he replied, "My wish list has 10 fingers and toes (hopefully) and smells like spoiled milk." If all goes well this month we could get a Christmas baby! Keep your fingers crossed and say a prayer that this month will be our month!
Wednesday, November 9, 2011
How did I get here?
We expect that most people reading this blog will be friends and family, who already know a good deal about our fertility issues. But we wanted to provide a little information about our history for those who may have stumbled upon our blog looking for information related to IVF.
My husband and I have been dealing with unexplained infertility for almost 2 years. A common misconception about unexplained infertility is that it means that nothing is wrong, but that's not the case. It just means that science is not advanced enough yet for the doctors to determine exactly what is wrong. We started trying to conceive our first child in March of 2010. After about 10 months of trying on our own with no luck, my gynecologist decided to begin some basic tests. My day 21 blood work confirmed that I was indeed ovulating and Jeff's semen analysis proved that he had plenty of good swimmers. I had a hysterosalpingogram (HSG) done, which is an X-ray test that uses dye to check for blockages in the fallopian tubes and abnormalities in the uterus. My results were normal--great looking uterus and no blocked tubes. The plan was to start a fertility drug called Clomid in March, but we found out that we were pregnant that month. At my first OB appointment, my doctor discovered that my HCG (pregnancy hormone) levels were very low and was concerned that it was not a viable pregnancy. We monitored my HCG levels over the next few weeks, but it was inevitable--I had a miscarriage on April 1, 2011 at 7 weeks. A few months later, we had a new doctor and a new game plan: try a few months on Clomid, then move on to IUI (intrauterine insemination). We tried Clomid in June, July and August of 2011 with no luck. We did our first cycle of IUI with Clomid in September and tried a different drug called Femara with our second attempt in October. Each time I had 1 ovarian follicle (each follicle has one egg) that was over 19mm. Since IUI has an average success rate of only about 10-30%, we have recently decided to move on and explore the option of IVF, which has a much higher success rate. We have scheduled a consultation appointment for November 21 at the fertility center that conducted each of our IUIs. Right now we are feeling very overwhelmed by the prospect of IVF, which is very expensive (the cost can range from $10,000-$20,000 per cycle and is not covered by many insurance plans, including ours) and physically straining. But we are also very excited to move forward and to be one step closer to having a baby!
Our hope is to update this blog during each step our of our IVF journey, so please check back. I hope to have more information up after our November 21 consultation.
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