An Update and An Announcement

It's been a while since we've blogged, but it's had a rough few months around our house. Here's a timeline that will quickly catch you up to speed.

April: I started a new cycle on Easter weekend and our doctor gave us the "thumbs-up" to begin hormones in preparation for a frozen embryo transfer (FET). I took oral estrogen for 3 weeks, went in to have an ultrasound and schedule our FET and the ultrasound showed that my uterine lining was not thick enough. Our doctors wanted things to look perfect before transferring, so our FET was cancelled and were told to wait a month before trying again.

May: I started hormone injections since I did not respond well to the oral estrogen. My uterine lining looked perfect this time so we transfered our 2 remaining frozen embryos on May 21. A week later we found out we were pregnant again.

June-August: Weekly blood work showed that my HCG was doubling normally over the following three weeks, but I began to have some spotting, which turned into heavy bleeding. Diagnosis: Subchorionic Hemorrhage- a pocket of blood in the uterus. Dr. D told me it would not impact the pregnancy, but it was scary nonetheless.  Our 6 1/2 week ultrasound on June 18 showed one embryo with a fetal pole measuring normally. They couldn't detect the heartbeat yet, but assumed it was still just too early to show up. A follow-up ultrasound 5 days later showed no heartbeat and no growth since the previous ultrasound. Our pregnancy was not viable. We were devastated. How could this be happening AGAIN!? We got a prescription for a medication that would help my body rid itself of the pregnancy, and then took off to the beach for the weekend to grieve and process our loss. It's now two months later and my miscarriage is still not over. I had to take the medication twice, as it did not work the first time, and continue to have spotting and weekly blood work to check my HCG until things are complete. I am feeling much better physically, but look forward to days where I don't have the constant reminder of our loss.

Jeff and I have had some time over the past few months to grieve, do some soul searching, and think about our next steps. We've signed up for an infertility support group that will start in September. We've also made the decision not to pursue any more fertility treatments at this time. Our doctor still does not have a cause for my repeated pregnancy losses and says another round of IVF could work for us, but we are physically and emotionally worn down. I've been on fertility medications and hormones for over a year now and the idea of another round of IVF feels scary, uncertain, worrisome, stressful, draining....the list goes on. Becoming parents is our number one goal right now, not pregnancy, so we're looking into adoption! Like fertility treatments, adoption is scary, but it holds so much more promise and hope for us. We are really excited! We're in the very early stages--still reading books and blogs and requesting information from various agencies. We're hoping to schedule some consultations over the next few weeks and find an agency that is a good fit for us. Looks like our IVF blog is becoming an adoption blog! Stay tuned! :)

Moving Forward

We had a consultation with Dr. D this afternoon to get some of our questions answered and talk about how to move forward from here. We feel good about our meeting and our doctor remains hopeful that we can get pregnant. He feels better that we got pregnant and miscarried, than he would if we had not gotten pregnant at all. He told us that most miscarriages are a result of a random chromosomal abnormality in the baby, and have little to do with the mother. However, he did test me for an immune disorder that causes the mother's body to attack the embryo. If it turns out that I do have that disorder it can be easily fixed with medication. The only other thing that can be tested for is a chromosomal defect in either or us that is being passed on to the baby. Insurance won't test for this until you've had 3 miscarriages, and if we did test positive for the disorder there is nothing that can be done. It just means that we will have a greater chance for miscarriage than the average couple.


Dr. D told us that we can decide when we're ready to try again and transfer another embryo. (At the very least, I have to wait until I get my period, which should be about a month from now.) He also explained how our next embryo transfer will work since we won't be doing stimulation this time around. It's up to us to decide when we're ready and if we want to transfer one or both of our frozen embryos next time. We have a lot of decisions to make, but we're excited to be moving forward again.

At this point, we haven't decided how quickly we'll move forward and how early we'll share information about our next transfer. We've been doing fertility treatments for nine months now and we feel like we need a break from talking about it. We're so appreciative of your love, support and prayers. We hope that you understand that we're just mentally and emotionally exhausted. Our plan for now is to stay busy, travel, spend time with friends and family and enjoy lots and lots of Tarheel basketball!

Thank You

This has been a crappy week, but because of each of you, it's been a little less crappy. Throughout the week we've gotten the kindest voicemails, text messages, emails and e-cards. Homemade cookies, flowers and chocolate covered strawberries have appeared at our door. Offers for meals and hugs from co-workers have brightened our days. You have no idea how much your prayers, love and support mean to us. Thank you so much.

We'll have to take at least a month off from trying to get pregnant, maybe longer. It's always hard to take time off. It feels like we're wasting time, and after two years of trying to have a baby, that's a very frustrating feeling. However, we know deep down that we need to use this time to recover emotionally and physically. I have been on fertility drugs since June and my body has been through a lot this past month. I'm actually looking forward to a "no hormones added" cycle. We're hoping a mini vacation in March and our upcoming bathroom remodel will be fun distractions and will help the next month or two pass quickly.

Our meeting with Dr. D has been rescheduled for Monday, March 5. I'll post an update after that consult. Hopefully, we'll have a plan for moving forward that we feel good about.

Another Loss

It's been a really hard weekend for us.

On Friday I started having severe abdominal pain on my right side and my lower back. We immediately called our fertility doctor, but because I wasn't spotting he didn't think I was miscarrying. We had no idea what was wrong. We thought it could be a pulled muscle, a kidney stone, or appendicitis. When I started to vomit from the pain, Jeff decided to take me to the ER. Once there, we found out that I had several really large ovarian cysts, mostly on my right ovary that were causing all of my pain. These are a result of my stimulation medicine and are really nothing more than very large follicles filled with fluid. My biggest was 7cm. They are extremely painful, but will go away on their own. There really isn't any treatment for them except pain medication.

While we were at the ER they checked my HCG level and we were extremely saddened to hear that it had dropped from 1,900 on Monday to 1,500. We knew what that meant. We went back to our fertility doctor today and my HCG had dropped all the way to 330, and they confirmed that I am having another miscarriage. I do not have any bleeding yet, but because my hormones are dropping on their own, they suspect that it will come soon. According to my doctor, this has nothing to do with my ovarian cysts. He said that many people have cysts while they are pregnant and it should not have effected my pregnancy.

To say that we are sad, disappointed, and confused doesn't even begin to cover what we are feeling. We go back to meet with Dr. D on the 29th to discuss everything and hopefully decide how to move forward from here. Please continue to pray for us.

Exciting News!

WE'RE PREGNANT!!!!!!!!!!!!!!!!!!!!!

After what seemed like the longest week, our doctor told us the good news last Monday. I waited until today to post anything to be sure that my HCG levels (pregnancy hormone) were rising as they should be. In normal, healthy pregnancies HCG should double every 24-48 hours. The first time I was pregnant I had low, slow-rising HCG levels, which was our first indication that the baby wasn't developing normally and I would likely miscarry.  I wanted to be sure that wasn't the case again this time before I posted any news. I'm happy to say that my HCG increased from 153 to 1,948 over the past week. We go back for an ultrasound to (hopefully) confirm a heartbeat on February 29 at 8:30 and then I'll be released to my regular OB. In the meantime, I will continue taking 2 kinds of progesterone, estrogen and baby aspirin to support the pregnancy through the first trimester. Our due date is October 16.

We cannot express enough how much we have appreciated all of your prayers, emails, texts, phone calls,  and cards over the last few weeks. We have felt so loved and supported. Thank you so much! We ask that you continue to pray for a healthy pregnancy, as it is still very early. While we are sharing the news with family and close friends who have kept up with our IVF journey, we are not sharing the news publicly.  So no Facebook comments, please and thank you. :)

Longest week ever

Throughout this month everything had gone very smoothly and we had been asking ourselves when things were going to get hard. This week it finally got hard. Really, really hard. Through all the waiting it was difficult to stay optimistic. This past week felt like it would never end. We appreciate all the support from our friends and family. It was comforting to know we had so many people thinking about us.

Tomorrow we will have blood testing that will hopefully tell us we are pregnant and have healthy hormone levels. Having everyone's support through this process has been wonderful and we can't wait to tell you all if we get good news. However, we expect that we will need some time to process the results whether they are good or bad. Please know that we will tell you how things turned out as soon as we are ready.

Embyro, Meet Womb

                                                                                                                                                                                                                                                                                                                           

This morning we went to Dr D's for our scheduled embryo transfer. We were anxious because we didn't know how many embryos we would have remaining and still hadn't made a final decision on how many we would transfer. Once we arrived we got very good news. Of our 8 fertilized embryos, 6 were still viable. The cute grey blob you see above was the best one. The others are looking good but were not quite as advanced (likely because they weren't fertilized as quickly). Dr. D recommended based on our age and the quality of our embryos that we transfer only 1 but ultimately the decision was ours to do 1 or 2. Drum roll please....

We quickly decided we would only transfer 1 embryo. Dr. D said that he expects most of the 5 remaining will continue developing and be able to be frozen for later use. We will hear tomorrow how many fully developed and were frozen. If this cycle doesn't work we will skip a cycle and then be able to thaw an embryo for another shot in 2 months. Dr D's success rates suggest that we have a 53% chance that this cycle work. If it doesn't his success rate after thawing our frozen embryos is 50% per cycle.

After deciding on a single embryo we moved along to the procedure room as the staff prepared for our transfer. They did a test run with the catheter to make sure everything was in the right place and avoid any surprises. Then they loaded the catheter with our little embryo and injected it into my uterus. Once the catheter is removed, the walls of the uterus collapse around the embryo preventing it from escaping. If all goes well, the embryo will hatch from its protective shell today and implant into the uterine lining as early as tomorrow.

After the procedure we had a quick meeting with Dr D. He told us that he didn't like to give anyone false hope, but that hope was important and so far everything had gone as well as possible. It is a little surreal at this point to think we could finally be pregnant but we are excited and hopeful. We return in 8 days for a pregnancy test. Thank you for all the calls, texts and good wishes this past week. Keep hoping for the best this week!

Now We Wait

Our doctor called this morning to update us on our eggs. We were excited to hear that 8 out of the 10 eggs fertilized. The other 2 were not mature eggs, so it wasn't surprising that they didn't fertilize. We were also excited to learn that my eggs fertilized naturally when mixed with Jeff's sperm and they didn't have to use ICSI, which is a procedure where they manually insert the sperm into the egg.

Now we wait. We wait for our embryo transfer on Sunday morning at 9:00. Then we wait 8 long days for my pregnancy test on February 6th. And in the words of Tom Petty, "The waiting is the hardest part."

Retrieve and Conceive

Laura is still under the influence of sedatives and not permitted to blog.  This message is brought to you by her sperm donor.

Today's procedure went well and was quicker than expected.  We arrived at Dr D's at 8:00 and were at home with chick-fila biscuits in our stomach and the real housewives of beverly hills on the tv by 10:30.  Laura has had a little bit of cramping and is a bit drowsy but otherwise is doing well.

During the procedure Dr D. was able to reach both ovaries and managed to retrieve 10 eggs.  There were 14 follicles that appeared to be mature but 4 didn't make it.  3 things could have happened with those 4 follicles 1) they never actually had an egg inside  2) the egg escaped into Laura's body when they drained the follicular fluid away  3) The egg was destroyed during the retrieval process. 

We were a little disappointed with the number of eggs because only a third of successfully retrieved eggs are likely to make it through the fertilization process and the next 5 days to become a blastocyst and be available for transfer.  Dr D was slightly disappointed (they usually get around 80% of mature follicles which would have given us 12) but still expects we will have several blastocysts and maybe even enough to freeze 1 or 2 for later use.

We will get a call tomorrow morning letting us know how many eggs were successfully fertilized.  Dr D said the number of fertilized eggs is a better predictor of how many healthy embryos we will ultimately have so hopefully what we lost in the retrieval will be made up in the fertilization stage.  We most likely will transfer our embryo(s) Sunday morning.  Keep us and our growing embryos in your thoughts and prayers this week.

No More Shots!

I had my final ultrasound and blood work done this morning and everything looked good. My follicles are definitely growing. Most of them were in the 15-19 mm range, so they scheduled my egg retrieval for Tuesday morning at 8:30 am. That means I'm done with all of my follicle stimulating medications (injections)! I do have one final shot to take tonight at 8:30 pm. It's an HCG trigger shot that induces ovulation and is taken 36 hours prior to retrieval. After that, NO MORE SHOTS!

I will be under IV sedation for the retrieval, which is pretty quick procedure. While I'm having the retrieval done, Jeff will go back and collect a "sample." :) They'll fertilize my eggs with his sperm and we should get a call the next day telling us how many of the eggs they collected were able to be fertilized. Our embryo transfer will be 5 days later on Sunday, January 29.

We would appreciate your prayers over the next week. Please pray that the egg retrieval goes smoothly, that my eggs can be fertilized, and that they develop into healthy embryos in the days that follow.

Quick Update: Round 2

I went back to the doctor for another round of blood work and an ultrasound today. I had 19 measureable follicles in all. Everything continues to look good! Most of my follciles were between 13-15mm, so they still need a few more days before my eggs will be mature enough to retrieve. My estradiol level was close to 1,000 so I'm cutting back on my medicine from 4 vials to 3.

I'll go back on Sunday morning for another quick ultrasound and more blood work, and possibly again on Monday. Right now I know that I'll take my HCG trigger shot to induce ovulation either on Sunday or Monday night and will have my egg retrieval 36 hours later, on Tuesday or Wednesday. It all depends on how things look on Sunday morning.

I'm still feeling pretty good--no mood swings, headaches, or hot flashes, but I'm very bloated and feeling lots of pressure in my abdomen. It kind of feels like someone is blowing up a balloon inside me. This is a normal side effect from the medication, since my ovaries are swollen from growing so many follicles. It doesn't feel great, but I really can't complain!

Quick Update

The shots are going well so far. I'm not really experiencing any side effects, other than a little soreness around the injection site. I went in to my doctor's office this morning for a quick check up. They did some blood work and I had my first ultrasound. The ultrasound showed about 12-14 follicles on each ovary, 7-8 of which were measurable (between 6-10mm). According to my IVF coordinator, everything looked good! I got the results of my blood work back this afternoon and my Estradiol level was good, so the doctor is going to keep my dosage of Bravelle and Menopur (injections) the same. No need to cut back or add more--I'm right where I should be. My progesterone level was 0.8, which was perfect since they like it to be below 2. That means my body is not trying to ovulate. For now we'll just keep doing what we've been doing and I'll head back to the doctor on Friday morning for my next check-up.

One Car Seat or Two?

We knew when we started this process that we would have to make lots of tough decisions. The one we're wrestling with right now is whether to transfer one or two embryos.  When IVF became a real possibility for us, we talked about how many babies we were comfortable having. We both agreed that we felt comfortable transferring two embryos. The possibility of twins became very real for us. We kind of just assumed that if you had more than one to transfer, that's what you did. It makes sense, right? If you're taking on the financial burden of IVF and putting yourself through so much physical and emotional stress, why not make sure you have the best chances possible? One would think that two embryos versus one would double your pregnancy chances. But that's where we were wrong. It's just not that cut and dry.

At Dr. D's office, there is a 53% pregnancy success rate from transferring one embryo. (Our pregnancy chances are closer to 65% based on our ages and my AMH level). If he transfers two, the couple's chances for pregnancy is about 60%, with a 44% chance for twins. A 7% difference in pregnancy rates? That's all? We were really surprised.It seems to us like this data means that either IVF will work for you, or it won't. Transferring more than one embryo doesn't really make much difference (if you're under 40).

The hardest part about all of this, is that we don't get to consult with our doctors about their recommendations until the day of the embryo transfer. There are only 5 days between the egg retrieval and the transfer, and during those 5 days our embryos will change every day. Some of the eggs they retrieve won't be mature enough to fertilize. After fertilization, some may grow and develop beautifully, while others may not. It's impossible to know how many embryos you have, and of the ones that you have, how many are high quality until day 5. Our IVF counselor told us that it's like playing a game of "What If?" to try to decide now. The scenarios are endless. We'll just have to wait and see.

The one thing we do need to consider, is that our doctor thinks we will have more embryos than we'll need for one cycle. When showing his chart of statistics at our orientation, we learned that we fall into the category of patients that have an average of 16 eggs retrieved, 11 that become embryos, and 5-6 that make it to the blastocyst stage (day 5). That means it is likely that we will have some left for freezing, which makes the decision even harder. If we only have two, the decision's easy--put them both in and hope for twins. But if we have 5, do we really need to transfer more than one? Is it worth the chance of a high-risk, multiple birth pregnancy for only 7%, if you have embryos left that can be frozen and used later.

Right now I change my mind daily, maybe even hourly. It's such an overwhelming decision. How will we decide? I'm hoping the right choice is obvious when we go in for our transfer, but Jeff says that's wishful thinking. We've still got a few weeks to think about it and my prayer is that we'll know what to do when the time comes.

Let's Get It Started

It's a busy week for us! Last night we had our orientation at Dr. D's office with the other couples who are doing IVF this month. Today I had my baseline ultrasound, mock transfer and medicine teaching class. Friday we start stimulation via injections!

Our orientation last night was very interesting. Dr. D took us through an IVF cycle from start to finish, explaining each of the steps and procedures. He talked for about 45 minutes and shared a few videos with us. We got to watch an egg retrieval, see how the eggs are fertilized though ICSI (intracytoplasmic sperm injection--a fancy way of saying they insert the sperm into the egg) and view an embryo transfer. All of the videos showed our doctors and were shot in our office, which I thought was neat. He showed us lots of statistics and pregnancy rates based on AMH levels. You may remember that I had my AMH level checked when I did blood work at my first appointment. AMH is an indicator of egg quality and egg reserve. Mine was 2.96, which according to our doctor is very good. This put us in the category with the highest pregnancy rates, which made us feel really good!  After Dr. D's presentation we "signed on the dotted line" so to speak, and hit the road to go watch the Tar Heels play basketball!

Today I had my baseline ultrasound, which went well. Dr. D said my uterus and ovaries looked good! While I was in the exam room, he did a mock embryo transfer. Basically he just wanted to use the speculum and catheter that he'll use the day of the transfer to make sure that there were no problems inserting it into my cervix. The mock transfer gives them information about the shape and size of my cervix to ensure the real transfer goes smoothly. It took about 5 minutes. When I finished up in the exam room, I went down the hall to meet with our IVF coordinator to go over all of my medications and how to use them. Since we've done injections before, it was mostly review. However, I'm taking more medications than last time, so it was good to learn about the ones that are new to me.

As far as my injections go, I have 4 vials of medicine that I'll have to inject each night.  The good news is that all 4 vials can go into one syringe, so I'll only have to get one shot a day! My next appointment will be for an ultrasound next Tuesday, January 17 to check in on my follicle growth.

Thank you for continuing to check in our progress and for all of the love and support you send our way! We're so blessed to have such wonderful friends and family.

Our Medicine Is Here!

Here it is! I wonder if the UPS man had to make two trips. This seems a little excessive to me!

And this, my friends, is what $4,500 of medication looks like. Luckily, our insurance covers most of these medications. Our total copay was $327.86. Thank God for good insurance! 

Suppressing My Cycle

While I'm still taking birth control pills through January 8, the first medication I'll start is the Synarel nasal spray. Beginning January 3, I will spray this nasal spray into alternating nostrils twice a day and will continue it until the night of my Ovidrel trigger shot. Synarel suppresses ovulation. I start it while I'm still on birth control pills to ensure that when I stop the pills my body does not start selecting follicles for ovulation. That would prevent me from making lots of follicles and eggs for retrieval. 

Stimulation

I'll start stimulation on January 13 by taking daily injections of Bravelle and Menapur. Right now my protocol is for 3 vials of Bravelle and 1 of Menapur each evening, but that could change after my first ultrasound which is scheduled for January 17. Hopefully these drugs will make me produce lots and lots of eggs!

Ovulation, Egg Retrieval and Embryo Transfer

When my doctor determines that my follicles (with an egg in each one) are mature, I'll stop stimulation and take my Ovidrel shot to trigger ovulation. My egg retrieval will be scheduled for 36 hours after I take my  trigger shot. I'll start a Z-Pack of antibiotics the day after my Ovidrel shot to prevent infection from the egg retrieval. The day after my egg retrieval I'll start a medication called Medrol. It is a small dose steroid that prevents the body from rejecting the embryos that will hopefully be transfered 5 days after the retrieval. I'll also take a baby aspirin each day (not pictured).

Implantation Support

After the transfer I will take several medications to help support the implantation of our transfered embryos. I'll wear a Vivelle dot, which is an estrogen patch. I'll also take Prometrium and Crinone, which are progesterone supplements. 

Now that we've got the goods, we're just waiting for our orientation on January 10 and our ultrasound, mock transfer, and medication teaching class on January 11! It's finally starting to seem real. :)

Protocol

Our IVF Stimulation Protocol is here!!!

On Your Mark...Get Set...

Well, we're not getting our wish for a Christmas baby this year. Our round of injectable treatments were not successful, so we'll be moving forward with IVF after the holidays. While it's disappointing, it was expected.

I've talked with our IVF coordinator several times this week to get our ducks in a row for our January IVF cycle--and I must say, I'm getting excited! Here's what we know so far:

• I will take birth control this Saturday through January 8. 
• We will attend a mandatory IVF orientation meeting on January 10 with the other couples doing IVF this month. Our doctor will talk for about an hour about the process and we'll have a question/answer session at the end.
• We will start our injections on January 13. They will monitor my follicle growth every few days and that will determine how long I will take the injections. It will probably be about 8-12 days.
• I'll have my egg retrieval sometime the week of January 21-27 (depending on how quickly my follicles grow) and an embryo transfer 5 days later. 
• As soon as I send in our $100 deposit, our spot will be secured for next month's cycle. Then I'll get a packet of information that will include my personal protocol.

I'm glad to have a general idea about how the next six weeks are going to go. We both know there can be all kinds of hiccups and problems that could pop up along the way and change our course of action, but it's comforting to me to have a plan. (That would definitely be the J part of my ISFJ personality coming out, right Aunt Marilyn?)

January is going to be a whirlwind for sure. But for the next few weeks we get to enjoy the Christmas season, spend time with friends and family, and celebrate the arrival of a new year. Adios 2011. I'm not so sad to see you go. Cheers to baby making in 2012!

Well, That Was Fast

 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.

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!

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: 

• most effective option (50-60% chance per cycle)
• more control over potential multiples (we can choose how many embryos are transfered

Cons:

• 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!