Consult Outcome

I apologize for not posting sooner, but I've been trying to absorb the conversation from our consult. We really like Dr. Vitek, and the Rochester office is very nice. The 52 minute ride out was quiet, as we were both nervous as to what we would learn. Sadly, the 52 minute ride home was even quieter as we were both reflecting silently on what we heard.

In a nutshell, IVF is our only chance to conceive. The report from Buffalo regarding our HSG last June (after our tubal cannulation surgery in May) indicated that the tube filled with dye, but spillage at the distal end was not observed. This means that removing the polyp blocking the proximal end of the tube opened it up to allow the dye to flow through, but there is another blockage at the distal (ovary) end that is preventing the dye from spilling out. Therefore, the tube remains blocked. (We were told the surgery was successful and that the tube was unblocked. We've done three injectable IUI cycles since being told the tube is open. We also had a "chemical" pregnancy after the HSG. Dr. Vitek highly suspects that this was indeed a THIRD ectopic pregnancy that resolved itself early on.) There is no surgery to try to unblock a tube blocked at the distal end. We don't understand why we were told the tube was open when clearly it wasn't?!

Dr. Vitek also confirmed my suspicion that I have PCOS. During my 38 month stint in Buffalo, no one ever mentioned PCOS to me. I am reading a book on PCOS and am surprised at how the pieces of the puzzle are all coming together. High cholesterol, high testosterone, thinning scalp hair, weight gain/obesity, difficulty losing weight, skin tags, irregular periods, sleep apnea, depression and anxiety, excessive hair growth on face, and insulin resistance are some of the classic symptoms that I've never connected until now. I'm a classic case. Also, women with PCOS are more likely to develop heart disease, high blood pressure, diabetes and breast/endometrial cancer in their lifetime. So, it does have lifelong implications I need to be aware of and watch for.

Given our tubal issues and the need to do IVF, the PCOS shouldn't impact our attempts at conceiving. Although, I will be closely monitored to ensure I do not develop complications that can be related to PCOS (difficulty managing my thyroid disease, gestational diabetes, hypertension, etc) during pregnancy. I've been on Metformin for a little over a year, as this is a typical treatment for women with PCOS who are trying to conceive. Metformin can reduce insulin and androgen levels, lower lipid and triglyceride levels and promote normal ovarian function.

Rochester uses a Lupron protocol which they have a great deal of success with. Their SART reported success rates are higher than Buffalo. (We used the Antagonist protocol in Buffalo, and I welcome the chance to try something different.) We would not do ICSI as with our last IVF, of the 5 embryos ICSI'd, only 3 developed. Of our 5 that were inseminated, all 5 developed. Dr. Vitek feels that we do not need ICSI. (Oh, and our sperm quality is normal! Who knew that 5% normal morphology IS normal?!) Dr. Vitek reports that on average, it takes a couple 2.4 IVF tried to conceive. She said she feels very confident we will see success with our next cycle. While that is certainly nice to hear, I won't bet the house on it as I've heard it before.

Sadly, Rochester does not have financing or a payment plan. The money (approximately $7000) is due prior to the start of the cycle. For this reason, we are unable to do a cycle in Rochester right now. We are trying to figure things out. I don't know how we will be able to swing this, but if there is a way, my husband and I will surely find it. I am also trying to figure out ways I can bring in some extra money. I am going to open up my Etsy shop again. I am also going to start listing some things on ebay that I've been wanting to sell. I hope we are able to figure this out before the meds I have expire, as using the meds I have would save us $3000-$5000. Any suggestions for making some extra money in a hurry?!

In the meantime, I will continue to improve my diet. I am reading about PCOS friendly diets. I will continue to try to lose weight. And I will continue to hope and pray that we win the lottery or come across some extra money!

In other more boring news, I got my new enhanced license in the mail today. I really like my new picture. I was having a good hair day. :) And, I am now officially an organ donor. I also bought a few new pieces of clothing for school today. I don't have much that fits from last year since losing weight. I hated spending the money, but it was a necessity. I tried to buy timeless pieces that will carry me through different seasons as well. And everything was 40% off. (I still need to clean out my closet - Sherri, are you reading this?! I NEED your help!!) Also, I had my teeth cleaned today and remain cavity free! (I was worried as I've been having some extra sensitivity along the bottom right side. All is good though.)

As always, thanks for your continued support. We are lucky to have so many people who care.

Counting down...

I got a package in the mail the other day that Strong Fertility in Rochester must have put in the mail to me before I dropped my files off there Wednesday morning. It took exactly 52 minutes from my driveway to their door. The forms included in the package are ones I have already filled out and turned in. All I need to do is show up Tuesday and hear what they have to say and hopefully leave with my questions answered and a treatment plan in place! (I just finished going through my records with a fine tooth comb and have several questions prepared.)

The photo above is of the flyer about the doctor I will be seeing that the office sent me. While I will be consulting with Dr. Vitek, I have heard from several others who have been treated at Rochester that the doctors all work together to review patient cases and develop treatment plans. Surely multiple minds working together will be better than one!

I'm so anxious for Tuesday, and relieved that my husband isn't giving me a hard time about going with me! (Those who know him know how much he HATES doctor offices. It is usually like pulling teeth to get him to go for that reason, not to mention that he is missing work to go and he HATES/NEVER misses work.)

OMFG...

So, I was able to obtain a copy of my records from the Buffalo office today. I don't even know where to start...

1. When I explained that I wanted ALL of my records copied, I was asked (in wht was definitely a very rude, "fuck-you" voice) if that included ALL my negative pregnancy tests!? My reply went something like this: "I don't need copies of negative pregnancy tests to remind me that I'm still childless after 3 years at this clinic."

2. I paid $.75/page for a grand total of $73.50 (98 pages). It seems to me that after 38 months (which includes countless IUI's, 2 surgeries, several diagnostic tests (HSG, etc.), blood work, 2 ectopic pregnancies, 1 chemical pregnancy, an IVF, etc.) there would be more to the file. They assured me it is all there. (Upon reviewing the file, there is definitely stuff missing. I think Rochester will get the idea with what is there, so I don't plan to pursue it unless necessary. If Rochester needs something, I will ask them to contact the Buffalo office.)

3. I went to a friend's house on the way home and took the file in to with me to look at it with her. It took me about 5 seconds to realize NOTHING was in any sort of order. It was literally as if they threw all the papers up in the air, let them land, and then shuffled them back into a pile. I am so ANGRY about this. I called Rochester and explained the situation. I told them I wanted to make things as easy as possible for them and that I would put everything in order if that was OK. Of course, the receptionist there told me that would be appreciated. She was very apologetic that my file was such a mess. My friend and I spent over an hour going through paper by paper and putting them into order. WHAT. A. MESS.

4. I do have several questions after glancing through the file that I will mark and ask Rochester Tuesday. (I made myself a copy of my file to refer to during the consult and to keep for future reference.)

One question is regarding our sperm quality. We have always been told our samples were good. However, in the file, the "normal" sperm never reached more than 6% in any given sample. 94-96% of our sperm in each sample was ABNORMAL? Is this normal?! I don't know what I don't know about sperm quality/morphology/etc., but I do plan to ask about it. It seems weird to me.

Another question is about my June 2011 HSG test I had done AFTER my surgery to unblock my remaining right tube. The report states that the dye did not spill out the tube. Doesn't that mean the tube was still blocked? This also makes me think the "chemical" pregnancy in September 2011 could have indeed been a third ectopic. So many questions...I hope Rochester will be able to answer them all and suggest a treatment plan to move forward.

5. I will drive my file to Rochester tomorrow morning with the paperwork I filled out for them so they have time to review my file before my consult Tuesday. I will continue to review my copy of the file at home and make a list of questions.

Sorry for the scattered post. My head is spinning after today...it took all my energy to even compose my thoughts enough to post this.

Oh, and I also demanded that Buffalo do my blood work today for the IUI. I'm not due until Thursday, but was going to go tomorrow since I will be away for work through Friday. After the aggravation to get my records, I didn't want to have to go back tomorrow morning. Once I get the "official" negative result tomorrow (they drew the blood this afternoon so it won't go out until tomorrow), I hope to be done with Buffalo. Up until this point in time, I always gave them the benefit of the doubt. Now, I'm bitter and ANGRY with them. I hope I never have to return there for treatment. I don't know that I could...

Consult moved up!!

Strong Fertility in Rochester has an opening for a consult next Tuesday morning. So, I moved my appointment up from October 9th! I'm glad I don't have to wait so long...

Now I just have to get my records from Buffalo to take there. Rochester would like my records prior to my appointment Tuesday at 8am so they have time to review my case. I have a feeling this will be tricky. 3+ years worth of medications (oral and injectables), 2 HSG tests,  2 sperm analyses, 2 ectopic pregnancies, emergency surgery when ectopic #2 ruptured, tubal cannulation surgery to unblock remaining tube, countless IUI's, a chemical pregnancy (could have been ectopic - not confirmed), and an IVF. I think that about sums up my existence for the past few years. That file is going to be THICK. And at .75 per page, I may go broke obtaining it. Not to mention I hope Buffalo doesn't give me a hard time about the time constraints. I'm filling out the records request tonight and hand delivering it to Buffalo first thing tomorrow morning.

Here's hoping Rochester will bring us our miracle baby we have been longing for...

12dpIUI

999 Reasons to LAUGH at Infertility

I would be ordering the "I-Just-Peed-on-a-Negative-Pregnancy-Test Frappuccino" today....

Migraines...

I'm 10dpIUI today, and I have had a migraine for 45 hours. I hope I don't sound whiny when I say THIS SUCKS. Could it be a sign of impending pregnancy? I sure hope so. That is the ONLY reason that would make this tolerable.

I also woke up with a huge canker sore on the side of my tongue. And I've been cramping since about 6dpIUI. I hate the mind games our bodies play with us...

Did you see that?!

Flying Pig via Etsy

Pigs flew over my house today....

You might be thinking at this point that I have gone mad. While that is certainly a plausible scenario, I assure you that is not the case. But it is possible that my husband has gone mad...

This morning, he gave me my PIO shot!!! MY husband, the man who has a serious fear of needles stuck a huge needle in my ass! AND he did a great job. I didn't even feel it. (He did freak out a tad when he saw how long the needle was, but he quickly recovered and was able to carry out the mission!)

This is a huge relief for me. I don't have to scramble to find someone to the shot now when my friend Lori goes away next week.

Today, I feel so lucky to have my husband in my corner. This is an emotionally trying and exhausting journey, and at times I've felt very alone. But today, I feel like I can conquer the world!

Kissing Ovaries...

We had our IUI this morning. It went well. While my husband's sample wasn't as "abundant" as it has been in the past due to spillage during collection, the motility was still right in the range it always is. 67% motility.

I started the Estrace (estrogen) this morning and will take it twice a day. I start the PIO (progesterone in oil) injections in the morning. Once again, my dear friend Lori is administering that injection because it seems my husband may never get over his fear of needles.

The ultrasound right before the procedure revealed that my ovaries are so full that they are "kissing". When I heard the nurse say "kissing ovaries", naturally I laughed out loud. After composing myself, I pictured my ovaries strolling hand in hand through the park, sharing a special, intimate kiss. Sweet and innocent, no?! Well, unfortunately having kissing ovaries isn't as sweet as it sounds. It is painful. I want my ovaries to be back where they belong, baking and releasing eggs in their own, separate areas of my abdomen.

I go back for blood work to check my progesterone level next Tuesday, and hCg (pregnancy) bloodwork Wednesday, August 22nd. Fingers crossed!

Lupron trigger and IUI....

I had my ultrasound and blood work this morning. All of my 30+ follicles are continuing to grow. In an effort to save this cycle from being canceled and preventing OHSS (ovarian hyperstimulation syndrome), we will trigger with Lupron tonight and go for an IUI Tuesday morning. We are triggering and moving forward with IUI despite the high chance of multiples. (It is likely I will ovulate 6-8 mature eggs from my right side Tuesday.)

From what I understand, lupron works by suppressing the pituitary gland's ability to produce LH, which causes ovulation. So why would I use this for ovulation if it suppresses ovulation? It has to do with lowering the risk of developing OHSS. In a natural ovulation cycle using no drugs, the follicle develops over about 2 weeks, and then a strong surge in LH causes ovulation. While Lupron causes the pituitary to cease LH secretion, in the first 1-2 days of Lupron use, there is a strong release of LH. It is this strong release of LH that makes Lupron great as an hCG substitute for the trigger shot. The quick surge results in a very short blast of LH, which could take place over 1-2 hours. This is very similar to the body’s LH surge that takes place in a natural cycle. After that, the LH has left the system, ovulation occurs 36 hours later, and ovarian stimulation stops. hCG, on the other hand, stays in the body for days, even up to 2 weeks. All of this time, hCG stimulates and stimulates the ovaries, which is too much for ovaries that have released many eggs.

So, why give an hCG instead of a LH injection? For IUI and IVF, hCG is often used as opposed to LH because hCG is easier to make and cheaper than LH, and hCG works just as well. The molecules of hcg and LH are very similar and act in similar ways.

One down side to lupron is that, in very small percentage of cases, it may not cause ovulation. This is a rare occurrence and is more likely to happen in women who are hypothalamic, i.e. they do not get regular ovulation due to exercise, dieting or some other factor. In these cases, there is no LH in the pituitary for Lupron to trigger.

Another detail of Lupron use as a trigger is that for luteal support, progesterone and estrogen are supplemented. The ovaries just shut down after Lupron use, and therefore estrogen and progesterone are produced in very low quantities. Typically progesterone is prescribed post IVF, and when using Lupron, estrogen is also prescribed. Daily, I will inject PIO (progesterone in oil) in my butt. The estrogen is simply a pill taken orally twice per day. I used PIO after my IVF, but I've never used Estrace (estrogen).

I feel good about this cycle again as I've said all along that you can't do the same thing over and over and expect different results. Changing things up this cycle leaves me with renewed hope.

As for the risk of multiples, we will cross that bridge if and when we get there. Right now we have our hopes set on this cycle working and resulting in a viable pregnancy, and ultimately, a take home baby.

Coasting...

At my ultrasound this morning, 30 follicles measured between 12 and 15. The right side had 16, and the left 14. (For comparison - in my IVF cycle in January, we only had 12 total eggs retrieved.) 30 follicles is too many for an IUI cycle. Even taking into consideration that I don't have a left tube, 16 follicles on the right is still too many to risk IUI. The doctor is "coasting" me tonight, which means I am to take NO medication. I go back in the morning for bloodwork and ultrasound. (I've read online that coasting for more than 1-2 days can negatively impact egg quality. I've also read that coasting does not decrease chances of implantation occurring.) I will talk more with the doctor tomorrow morning about what he thinks we should do. Cancel? Convert to IVF? Coast another day and see if we can pull off an IUI?

I am feeling pain from having so many follicles. It pretty much hurts when I breathe, laugh, cough and move. As always, I will endure all of this if it means having a chance at pregnancy. As I have so many times before, I am hoping and praying this works out. I've worked so hard to get to this point and waited so long....