Doctor Interview #2: UNC

Last Thursday, we went to UNC to meet with one more doctor.  This would be our 4th RE.  Our 4th opinion. I went into the appointment thinking that Duke was at the top of my list and was worried that I wouldn’t give UNC enough of a chance.  But by the time we left, I was ready to hand over my embryos.

This doctor was a lot like the doctors at Duke, but she was more commanding and informative.  She was compassionate and educational.  Like Duke, she wants to dig deeper into my thyroid.  She also wants to check for any early diabetes markers since it does run in my family and can cause miscarriages.  She wants to recheck my clotting issues since my last test was over a year ago.  She wants to see if it’s getting worse or better, or even staying the same.  They also do mock transfers, where they simulate a transfer and make sure everything is going to run perfectly before the embryos are involved.  I love this for two reasons.  First, I like that they’re treating me like an individual.  I’m not in and out and done.  Secondly, I want to make sure the cramping I felt during the last transfer isn’t anything concerning.
Which brings me to the cramping I felt the entire time I was pregnant. Dr. T dismissed it and said it was nothing.  The doctors at Duke said it was probably the endometriosis and that there was nothing to be done about it. Dr. M said she’s rarely heard of that happening before.  She wouldn’t have dismissed it.  At the very least, she would have treated the pain just to keep my stress levels down.  Their clinic is so interested in helping patients with the emotional aspect of fertility treatments.  They have 2 therapists they use and recommend.  This doctor encourages patients to email her with questions.
And, first beta is just 9 days post transfer.  None of this 2 weeks nonsense.

She said our chances of getting pregnant (and staying pregnant) are good.  They would be higher if we had created our embryos with them (I’m sure most doctors think that though).  She’s the first doctor who told me that the silver lining in this last miscarriage was that I can get pregnant and produce good betas.  She didn’t say it that way, she was a lot more empathetic in the way she said it, but it’s what I’ve been looking for.  Something useful to come out of it.  Dr. B said something along the same lines about our first miscarriage and I remember it comforting me then as well.

UNC has put many of my fears and concerns about another transfer to bed.  I can’t control the outcome, but I think this next shot will be a good one.  We’re aiming for a June transfer depending on when my period decides to come back.  I go in tomorrow morning for thyroid, clotting, and diabetes blood work.

And how am I feeling overall?  I’m pushing through.  There are still days that I find myself watching the clock.  Watching the minutes tick by one by one as I wait for a decent time to go to bed.  Some days, I just want time to speed up and for the day to be over.  I’m not sure if I’m hoping the next day will be better or if I’m just hoping for a few short hours that my heart doesn’t hurt.

I’ve also been finding solace in the gym.  Go figure.  I started going two days after they told us my beta at dropped to 5.  I was honestly hoping it would jump start the bleeding.  I ran and ran and then came home and cried and cried.  But it helped.  A couple days later, after my muscles stopped aching, I went again and ran and ran.  I didn’t cry quite so much that day.  So I kept going, at least 3 times a week.  It’s been three weeks.  I’m starting to lose weight (in a good way) and I’m able to run a little farther and a little longer each time.  Some days, I find myself aching to go back to the gym to run even though I’d been there just that morning.  I’ve always hated running.  HATED.  But it’s comforting to run so hard that I just can’t focus on anything but breathing.  Like sleeping, it gives me a brief reprieve from having to think about what we’ve lost and what’s coming next.

36: IVF, Here We Come!

Today marks our 36th month of trying.  That’s 3 years.  I haven’t felt the need to discuss the past couple because it wasn’t like we were going to magically get pregnant naturally.  lol.

Anywho, we met Dr. T this evening.  It’s true what they say that everything seems to move a bit slower down south.  Our original appointment of 3:30 got pushed to 4:30 and we didn’t actually see him until 5.  He was, however, quick and efficient, less personable than Dr. B, but I don’t need a new friend.  I need a doctor who can perform a medical miracle.  I need a doctor who has found a way to combat OHSS and a doctor who tells me my chances of conceiving are close to 70%.  I need a doctor like Dr. T.

Enter: Lupron Trigger Protocol.

In normal IVF, you take birth control for a couple weeks to settle everything down.  Then you move on to heavy injectables that stimulate the ovaries into creating ridiculous amounts of follicles (and therefore eggs).  You then use an hcg trigger to trigger ovulation.  Then you go in for your retrieval where the doctor sucks all of the eggs out of the follicles, combines them with some sperm in a lab, and transfers embryos back into you 3 to 5 days later.  Any leftover embryos are then frozen.

With Lupron Trigger Protocol, you still take birth control for a couple weeks and then move on to really heavy injectable to stimulate the ovaries.  Instead of triggering with an hcg injection, you trigger with…. a lupron injection.  It still causes ovulation, but it effectively squashes your estrogen and uterine lining.  The eggs are then fertilized and the resulting embryos are frozen.  During the next cycle, you take a couple low dose estrogen injections and then have a frozen embryo transfer (FET).

The reasoning for this is 1) The lupron trigger eliminates (or so Dr. T says) the chance of OHSS because it lower the estrogen.  We saw last summer than I react well to lupron.  We don’t need to be afraid of really beefing up my ovaries. Excellent. 2) Dr. T believes that the estrogen numbers with fresh transfers a couple days after a retrieval are too high for optimal embryo health.  I can see that.  Waiting until the following cycle allows him to create the perfect embryo environment.

This plan sounds awesome to me.  Every time I end up with OHSS they tell me that it will have no effect on our chances of conceiving, but I have a really hard time believing that.  I worry every time that it’s going to impact us because my body is angry and in pain and that can’t be conducive to baby making.

Lupron Trigger Protocol used to be done with fresh transfers until they realized that it didn’t work very well when it came to maintaining a pregnancy.  They’ve done a great job at tweaking it and the miscarriage rate is as good if not better than an hcg trigger fresh transfer.  Dr. T has put our chance of conceiving around 70%.  Dr. B had only given us a 40-50% chance.

Another excellent thing?  Because we’ll be able to push the meds and retrieval process so hard, we should end up with a good number of frozen embryos.  A frozen transfer with this clinic is only $1000.  That’s what we paid per IUI in Chicago.  We could end up with our entire family in one go.

So what’s going on in the meantime?  This month, Dr. T wants to schedule a saline ultrasound.  I’ve never had one.  I’m not looking forward to it.  😦  He also wants to do a couple other blood tests because a lot of my original tests from Dr. B are over a year old.

After that?  We’re ready to roll as soon as my period starts in January.  Wooo hooo!!

NC RE Questions.

Life in North Carolina, so far, is good.  It’s a little lonely, but I knew that would be the case for a while until we really started getting out there and making friends.  We’ve learned that most people in Durham are also transplants and because of that no one around here has a lot of family close by.  They say this makes making friends a bit easier than in other parts of the country.  I suppose time will tell. 🙂

We’re slowly starting to be able to navigate on our own.  But honestly? I don’t know how people got around in new places before gps.  I would be just terrified if I didn’t have my phone with me here.  I don’t think I would leave my house alone. Ever.

I joined a knitting group.  My first time was last week and the second will be tomorrow.  The ladies I met were great!  They were all a good 7 to 25 years older than me, but that’s ok.  Because of the whole infertility business, I feel that I don’t often fit in with women my age anymore and that’s fine with me.

At this point, I’ve decided I’m not going to join a Resolve support group.  I loved my group in Illinois, but it took a while to really build connections, and I’m really hoping I won’t be a member of the infertile community for much longer.  Plus, the closest group is 45 minutes away, which is a bummer.

Which brings me to…. Our new RE!  My first appointment with them is tomorrow at 3:30.  I’ve been putting a list of questions together over the past week or so.  I’m hoping to both get a good idea about what I can expect from him as well as let him know that I’m not interested in screwing around.  We have a $30,000 fertility coverage max and I plan to use it wisely.  If he can’t do what we need him to do, I won’t hesitate to find another Dr.

I’m going to attach my list of questions.  If you have any thoughts about additional or follow-up questions, please let me know! 🙂

• What is your clinic’s overall cost per cycle?  Does this include medication?
• What is your yearly charge for freezing embryos?
  Is it covered under my insurance?
  How long until they are moved to long term storage?
• After reviewing my medical records, do you have any theories as to what the problem might be?  Is it more than just endo?
  –>Has he looked at my records before the appointment?
• How much experience do you have with IVF and endometriosis?
• Do you prefer a day 3 or day 5 transfer?  Why?
• How many embryos do you typically transfer? Why? (we want two transferred).
• What are your personal success rates?
• What do you think my chance of success is?
• Do you recommend genetic testing?
• Do you use ICSI? Why or why not?
• What do your retrieval and transfer protocols look like?
• Should I expect bed rest after transfer?
• What kind of medication protocol are you thinking about? Why?
• Do you use long term lupron to treat endometriosis? Why?
• How often will I get updates on my embryos before the transfer?
• Will you be doing my retrieval and transfer?
• How will you handle my past history of OHSS?
  At what point do you typically cancel a cycle?
  Is this based on ovary size or estrogen number?
• What is the protocol if I do get pregnant?
  How long do I see you?
  Do you have a recommended OB?

I know.  I’m a control freak.  It is what it is.  😉  I will update after tomorrow’s appointment.  Cross your fingers and say some prayers for us!

Clean House

Our house has been on the market for 3 1/2 days now and it’s 3rd showing is tonight.  I’m glad people are looking at it, I just really hope someone is interested in it.  I want someone to love our house as much as we love our house.  🙂  And I really want it to sell before we leave in 2 weeks.  

Because it’s been showing almost every night this week, I’ve been cleaning the entire house everyday.  I am so tired of cleaning.. 😉
BUT, I think, for the first time in almost 26 years, I finally understand how to keep my house clean and looking good.  I have a bad habit of letting the clutter and the animal hair and the dishes get out of control.  And then I try to tackle everything, get overwhelmed, and refuse to clean again for 2 weeks.  But, now that I’m going over everything daily, I’ve noticed that it’s a lot easier.  I spend less time cleaning because I’m cleaning more often.  I’m sure most of you (and my mom… Hi MOM!) are already aware of this cleaning phenomenon, but evidently I needed to experience it to understand it.  

On the flip side, I’m also afraid to use my house because I don’t want to have to re-clean something.  The dogs have been angels all week because I’m letting them sleep on our bed all day long so that in the evening when there’s a showing, I just have to fluff the duvet, throw on their leashes, and head to the car.  They think they’re getting away with something, but hey, it’s a win-win.

In other news, the NCCRM sent me the link to their online portal.  Yes. It’s online.  All of it.  I signed in, filled out our histories (and boy, there was a whole lot more than the last time I saw a new RE…), and hit “save”.  That was it.  It also shows future appointments, test results, instructions, medication, and more.  It’s awesome!  I don’t have most of my records from Dr. B’s because they only told you what you needed to know or asked for.  Now, I’ll have access to everything so I can obsess about it throughout every single piece of my cycle. 😉  But really, I’m excited to have a place to see and store all of that information.  I’ve got good feelings about this place!  My appointment is less than 4 weeks away and I can’t wait!

We leave 2 weeks from tomorrow!  I can’t believe the time is going so quickly! We’re using 2 containers from PackRat to ship our things down to North Carolina and our first one will be here on Monday.  I’m excited!  Now if only this house would sell…

IUI #6/3

I’m so over these injections.  Knowing that we’re almost done has not made doing them any easier.  One more gonal-f tonight and then a novarel tomorrow and then, cross your fingers, I’m done injecting hormones into my body.  YAY!

I went in for a follicle count and blood work today.  She found 5 follicles, but only one looked like it would be dominant.  I’m a little bummed out.  We decreased the meds in hopes that 6 follicles would go down to maybe 2 or 3 follicles, but it looks like one it is.  My estrogen came back at 374, so we definitely have 1 really solid follicle, maybe even a second by Friday.

Friday is IUI #6/3.  It will only be cycle day 11.  It’s rather early, but if follicles are ready, then they’re ready, right?

This seems to have gone fast, but the early IUI coupled with the fact that I’ve been done with a horrible cold since this past weekend is probably why.  I’ve heard it’s going around and with the huge number of different students I see on a daily basis, it’s not surprising that it got me.

What do I do when I’m sick?  Knit socks of course.  The socks that I started a couple weeks ago got finished up last night…

 

Find the pattern here.

You can also catch a glimpse of the new nursery floor and wall color in that picture.  I’ve been too sick and/or preoccupied to take good pictures of it so far.  I’ll get there eventually.  For now, I’d prefer to nap on my couch. 🙂

33: Next…

IUI #5 didn’t work.  The extra cysts and swelling made for a very painful Sunday afternoon.  I’m thankful for the left over Tylenol-3’s I have from my lap.  I knew I saved them for a reason…

I don’t know what comes next.  We’re moving forward with our very last IUI.  I told Dr. B’s nurse that I wanted to decrease the gonal-f from 112.5 to 75 units.  I know I made 5 follicles and 6 follicles the past two cycles, but they’ve been beating the hell out of me in the process.  I’m swollen and sore from the day after my IUI until a couple days after my period starts every month.  Thus far, it hasn’t been worth it.  This past cycle, I may have produced 6 follicles, but only a couple of them actually produced eggs.  So my question for her is: what’s the point?

She’s going to chat with him and let me know when I go in for my baseline ultrasound tomorrow morning.  I’m even less certain than last month that my ovaries are clear of cysts.  I’m actually hoping for a month of birth control.  I feel really run down.  I know I could just take a month off myself, but I don’t want to give the endometriosis any extra opportunity to grow back.  AND I’m afraid if I stop, I’ll never be able to start again.

We also had to schedule a consultation appointment with Dr. B for the end of October in case this IUI also doesn’t work.  She didn’t tell me what it was for, but I’m assuming he’s going to tell us that if we’re not interested in moving forward with IVF then he can’t help us.  Bummer.

Now how about some pictures?  My posts have been very infertility treatment heavy lately… Say ‘hello’ to WHAT I KNIT THIS SUMMER! 😉

 

I made these for a friend who is pregnant with twin girls via IVF.  She’s almost 36 weeks and I’m so excited!!  The booties are cotton and fleece.  Find the sweater pattern here.

 

This is for our neighbors who just had a baby girl.  We really lucked out in the neighbor department. 🙂  Pattern found here.

And this is for my mom’s best friend’s new grand daughter.  She saw the sweaters I made for the twins and asked if I’d make her a sweater and booties.  I was excited to try this one in green though.  It gives it a much different feel than the pink ones.

Needless to day, a lot of baby knitting going on.  Considering I don’t normally knit in the summer, I feel like a got a surprising amount done.  I haven’t knit anything for myself recently, but I did start a pair of socks on Sunday.  I haven’t finished a pair of socks in over a year and I miss freshly knitted socks on my feet! 🙂

Other than that, not a lot is going on.  I’m working as much as I can because I’m planning on needing a good chunk of savings to adopt a baby…  It’s been nice to be so distracted though, so I can’t complain.

More after tomorrow’s ultrasound.

 

4.5 Weeks to Go!

I know I’ve been noticeable absent over the past 5 weeks.  I’ve been just living and being.  While I definitely don’t feel 100%, I don’t feel as bad as I was expecting to at this stage in my lupron therapy.  I had my second injection 3.5 weeks ago, which means my 3rd and final injection is on Monday afternoon.  The hot flashes, headaches, general lack of energy, and epic lack of focus have been my main complaints.  I don’t find myself being too much more moody than normal, and if I am, it’s usually because I’m not feeling well.

I still feel astronomically better than I felt when I was taking clomid last summer and a fair amount better than I did before my lap in April.  And I think that is absolutely ridiculous.  I’m looking forward to getting the lupron out of my system and just being healthy for a while.

What have I been up to lately?  We’ve had lots of house guests who have kept me nice and busy.  Jeremy’s aunt and cousin came for a few days at the end of May and his brother and his brother’s girlfriend were here visiting over this past weekend.  Getting ready for and spending time with everyone has been a huge help in making these past 8 weeks fly by.

We also put up our fence!  We had a little bit of help from one of our neighbors and Jeremy’s dad, but we put the whole thing up mostly on our own.  It’s not perfect, but it has made for some very happy hounds. We still need to trim the posts down.  It looks a little ridiculous right now.  It’s been so nice to have them out with me while I garden.

Speaking of gardening, I’ve put so many new flowers into my garden and a lot of the older ones are blooming.  It’s just beautiful!

I’ve been waging war against both the bunnies and the slugs, and for the moment I think I might actually be winning.  Lots of plants have been eaten right down to the ground, but I’m crossing my fingers they come back now.  My wildflower patch has just started blooming, so I’m expecting some beautiful pictures in the coming weeks.

I started teaching last week and it has already proved to be an experience.  It’s only 3 hours of actual teaching per day, but that on top of the lesson planning and grading AND the theory of writing class I’m taking AND the lupron has me feeling pretty run down at the end of the week day.  But, I love my students.  I’m especially fond of the 9th graders.  I hear most teachers hate teaching the younger high school students, but I just love them. They leave me with a smile on my face almost every day. 🙂

I have few other projects to share as well as an update on how our due date day went, but I’ll leave that for another post. I’ve got papers to grade! YIKES!

I’m getting antsy for these next 4 weeks to be over!!

29: 3 more months

We saw Dr. B today.  We were expecting him to fill us in on what kind of IUI we’re doing next, give us some pretty pictures, and send us on our happy way.

OF COURSE, that didn’t happen.  He has decided there’s a good chance that there may be more endometriosis lurking under the surface and he only gave us a window of 1 to 2 months before it comes back.  His solution?  Lupron.  For 3 months.  He thinks that will give me a 1 to 2 year window of being relatively endometriosis free.  What is lupron?  It’s an injection that shuts your reproductive system down to allow the endometriosis to heal.  It’s a whole lot like menopause.  It’s also used to treat cancer.  

I wanted to start crying right then and there.  While it might be an effective way to treat endometriosis, I’ve heard nothing but bad things about the side effects.  All I can think of is how completely horrible I felt when I was taking Clomid last year.  This will probably be worse.

He made the case that my quality of life will improve significantly if the lupron can successfully eliminate the endometriosis symptoms I’ve been living with.  It’s pretty impossible to argue against that.  It’s true.  I always feel bad, something always hurts, and I’m always just exhausted.  But this drug scares the bejeezus out of me.  Googling it brings up nothing but horror stories.  However, I know women who have taken it and, other than some God awful symptoms, been fine afterwards.

So we told him if our insurance will cover it, we’ll do it.  What else can we do?  I trust Dr. B.  I know that he knows what he’s talking about.  I made him promise me an IUI right away after we’re done with it.  No natural cycle.  This needs to be over.  I’m going to hot flash my way through this summer… again..  fml.

And so, I will be more than halfway to 26 by the time we start trying again and close to halfway to 27 before we have a baby at this point.  Our earliest due date?  One year from now.  I would like to start drinking heavily now….

Also, the birds who live in my yard are very fertile.  A-holes…

That Escalated Quickly..

Why yes, Ron Burgundy, yes it did. 😉

I went in for monitoring this morning for my day 14 follicle check.  It was the first check of this cycle and I really wasn’t sure what we’d find since we haven’t been babysitting my follicles like we normally do.  After drawing 7 VIALS OF BLOOD for my autoimmune workup, I headed over to the ultrasound room where we found one very adorable 19 mm follicle sitting pretty on my right ovary.  Not as big as last month, but not a bad size at all.  While they said it depended on how my blood work came back, they were planning on a Friday morning IUI.  Good thing too because my novarel hasn’t come in the mail yet.

Just kidding.  My estrogen came back at 243 with a Lh of 36.  That follicle is ready to go.  Like now.  So we’re heading back bright and early tomorrow morning for IUI #3.  I’m crossing my fingers that UPS doesn’t drop the ball and that my novarel will be here soon.  I have two syringes full of ovidrel in my fridge just in case, but Dr. B is finding his patients are having better success with… intramuscular injections… Oi… My rear end hurts just thinking about what’s in store for it later this evening.

My awesome older sister has volunteered to stab that bad boy in for me since Jeremy can’t guarantee me he won’t choke halfway through.  I appreciate his honestly because.. ow… Although I do secretly wonder if she’s looking forward to stabbing a needle an inch into my butt.  It’s something everyone has secretly dreamed of doing to their siblings, right?  😉  Either way, it’s getting done.  It’s science. 😉

Come on, IUI #3, we’re rooting for you!!

RE Hand Holding.

We met with Dr. B today for the first time since August.  I felt really silly for scheduling this appointment because I didn’t know what I wanted him to tell me.  Well, I do — I wanted him to tell me that everything was fine and for him to really mean it.  But I knew I wasn’t going to get that.  I just knew that I’ve felt so in the dark and so frazzled about what comes next.  You can only do so many IUIs… and then what?

So we sat down with him and before we said anything, he brought up digging deeper to find out what is really wrong with me.  He mentioned the baby we lost in October — he’s the first person in that office to acknowledge that it really was a baby.  He was happy that we had gotten pregnant because it suggests that we could get pregnant again.  But he wondered if there was something going on with either my uterine lining or my antibodies that might be making this more difficult than we originally though.

He threw out two options for the next two steps.  First, he wants to do a autoimmune disorder workup to see if something in my body is attacking embryos.  We’re doing that tomorrow morning when I go in for monitoring. If it comes back positive, we start treating it and go from there.  If it comes back negative, we wait and see if this next IUI works.  If it results in a normal pregnancy, we’re done and everyone lives happily ever after.  If it fails, he’s recommending a laparoscopic surgery to check for endometriosis.  While I don’t have a ton of the symptoms that go along with endo, I do have some, and he told us that many women with endometriosis don’t have any symptoms.  If he finds surface endometriosis during the lap, he’ll clean it up and we should be ready to go for real.  If it’s deep, he’ll clean up what he can and then recommend a couple months of lupron, which pretty much shuts down my reproductive system and sends me into early menopause while my body heals.

He gave this all some thought and definitely had a lot more information for us about endometriosis than an autoimmune problem, so I’m wondering if he’s leaning that way and just doesn’t want to go through with the lap if he doesn’t have to.  I’m thankful for that.  While I know a lap isn’t that big of a deal, it’s still surgery and it’s still scary.  But we want answers and if this is the only way we can get them, then I’m willing.

We did chat with him about what the chiropractor said about a previous pelvis injury pinching nerves and other connections off to my reproductive organs.  He disagrees with their diagnosis and actually thinks the endometriosis (“if it’s there” he says) is pinching and affecting nerves and connections towards my back and is therefore causing my low back and hip pain.  He thinks working with them is just alleviating some of the endo symptoms rather than healing injuries like the chiropractors think.  So we have two doctors with two opposing views.  It’s very much a “which came first?” scenario.  In the end, it doesn’t matter.  I’ll continue with the chiropractors and undergo a lap if needed.  We’ll find out who’s right and deal with the outcome when we get there.

Overall, I’m so glad we went to this appointment.  I forgot how much I love Dr. B.  He never once made me feel like my feelings weren’t justified or that he wasn’t interested in getting to the bottom of this.  We have a hardcore plan in place that will most likely solidify my membership in the infertility club. 😉  I feel taken care of and again I feel like someone other than us is invested in this outcome.  Maybe it’s a little hand holding too, but I’m ok with that.

Monitoring tomorrow morning to decide if our 3rd IUI will be on Thursday or Friday.  My ovaries are sore, so hopefully we have a big, beautiful follicle. 🙂