Saturday, September 8, 2012

Timeline (IVF power post)

As time trudges forward, I am finding myself with so much to say, but no ability to say it. I don't know what that's about...too much at once, I suppose. Here's where we are now:

Tuesday was the 13-month anniversary of losing Aliya and Bennett. The actual day itself was so highly focused on IVF that neither of us really had any time to reflect, but I can say with assurety that between losing Roxy's calf the Thursday before and knowing that both 13 months had gone by and we were about to really kick this IVF into gear, I was feeling a lot of feelings. My manager asked me on Wednesday, the first day I was back in the office, how my long holiday weekend was, and did I have fun? All I could say was, "Um, well, I cried a lot." There isn't much fun to be had in my life in general, and certainly not that particular weekend.

On Tuesday, we spent six hours at University of Washington, and what an eventful and yet disjointed six hours that was. It started with Paul's appointment in the urology clinic, where he had to leave a sperm sample to be frozen as a back-up in case we need it after egg retrieval (like, if that day's sample doesn't fertilize anything). It's always good to have something in the bank, right?

After that (and we were about 45 minutes early, so that was a lot of sitting around), we headed over to the Roosevelt clinic for our other appointments. It was a little confusing as things didn't happen in the order we were told to expect, and everything got off to a late start, but really, it was all good. We met with the financial coordinator (who thought we had to pay cash for my saline-infused sonohystogram that day, which, um, NO!!!, and yeah, we don't have an extra $700 laying around for something we were told insurance would actually cover!), forked over the $622 for my mock transfer, and then waited some more, before being led into an exam room...where we waited. Not sure what got them so backed up, but it reminded us of Dr. M.'s office, and we laughed.

Dr. Z.'s nurse finally came in and went over the plan briefly before Dr. Z. came in. He did my mock transfer first, and that was really good. He talked us through everything he was doing and seeing, and made sure we could both see the screen and the titanium-tipped catheter in my uterus. He marked the test catheter so he knows exactly how far in to bend it 60 degrees (my cervix isn't straight) and then where to stop so our embryos land in exactly the perfect spot in there. Then he switched gears and did the SIS. It hurt, but it wasn't terrible. I had taken 600 mg of Tylenol beforehand as instructed. He was very happy with what he saw; no signs of any polyps or fibroids or scar tissue. He printed off two photos and asked me to give them to Dr. M. so he can see what a great job he did during my surgery. :)

After that, he took Paul across the hall for his exam while I dressed and headed down to the pharmacy to pick up my drugs. We weren't expecting to do this, but it turns out they want me to have my baseline monitoring done down here rather than making me come back to Seattle, but that meant I'd have to get my drugs this week. Oy. We weren't expecting to drop $1,133.54 on meds that day, but it turned out ok. I left with a brown paper grocery bag stuffed full of drugs (10 different ones for me and 1 for Paul), needles and syringes, and sharps containers.

So, here's the plan:

**I'm on 21 days of birth control pills, ending 9/19. The purpose of these is to keep my ovaries quiet so that I don't start developing a lead follicle. (For those of us with diminshed ovarian reserve, our internal chemistry - the workings of estrogen and follicle stimulating hormone, or FSH - is wonky, so the negative-feedback loop doesn't work right and our brains tell our system to make more FSH...which in turn causes follicle development to start right away. The last several ultrasounds I've had, there was a lead follicle already forming on cycle day 3. Sucks, man.)

**I will have my baseline estradiol (and progesterone?) bloodwork and an antral follicle ultrasound done on 9/19 at Dr. M.'s. This will allow Dr. Z. to fine tune my medication dosages (and, of course, give us a cancellation point if I have any cysts.)

**I will start my stims on 9/21 - 225 iU of Gonal-F and 150 iU of Menopur...get this, ALL subcutaneously!! (Cue the angels singing!) I can mix my Menopur myself and give myself both shots in the belly, under the skin, in the evening (yes, once a day!). No more big ass (pun intended) shots in the butt twice a day, and no more getting up, bleary-eyed, with Paul so he could give me those shots. Woohoo! Paul and I both also start a 10-day course of antibiotics this day.

**I'll have repeat bloodwork and another ultrasound done on 9/25, stim day 5, up at UW. My dosages will be adjusted as needed.

**I'll go up for bloodwork again on 9/27 and start my Cetrotide (antagonist, so I don't ovulate prematurely) and recombinant human growth hormone ("Saizen"), and will continue with the Gonal-F and Menopur.

**I'll probably have bloodwork daily.

**Trigger shot of hCG on 9/30, depending on how I respond to the stims, Cetrotide and Saizen. This shot is usually done late at night, so that egg retrieval happens near-exactly 36 hours later. The stims (except the rHGH) will stop this day.

**Bloodwork again on 10/1, and last dose of Saizen. We're to stay the night in Seattle this night.

** Egg retrieval on 10/2. I'm to start my second antibiotic and a steroid pill this day for 5 days.

**Fertilization report on 10/3, followed by the start of daily Crinone (progesterone).

**Start Estrace (estrogen) 10/6, three days post-retrieval. This day, too, the lab will suck a single cell out of each of our embryos and send the biopsies to a lab in San Francisco for genetic testing (PGD).

** The morning of 10/7, I pop a Valium 1-2 hours prior to transfer, we find out how many of our embryos had normal gene sequences, and one or two normal ones are transferred back into my uterus.

**On 10/16, I will go back up to the office for a beta (blood pregnancy test), to find out whether or not all of this worked.

The dates are subject to slight change after 9/27, since everything depends on how my body responds to the protocol. Also, there are several points at which this could end in cancellation:

1) I don't respond to stims and we cancel prior to egg retrieval (we'd get a partial refund here).
2) We make it through egg retrieval and no healthy eggs are retrieved, or none fertilize via ICSI.
3) We do have fertilization, but none make it 3-day biopsy.
4) We do make it to biopsy, but none are normal, so none are transferred back.

I honestly almost expect one of these to happen (especially #1, given my history), so I'm definitely not getting my hopes up about any of this.

We had tons of questions about all of these processes, and thankfully had everything answered. I had to sign a shit-ton of disclosures and consent forms (this is surgery, after all), and go over the lab order for eggs and embryos with Dr. Z. Have I mentioned before that we love him?! Swoon! (Paul and I later learned that we each told him - unbeknownst to the other - what a pleasure it is to work with him and how wonderful his staff is!)

The coolest thing is that Dr. Z. had a fabulous solution to our dilemma of not wanting to know the sex of our embryos after PGD. (Apparently, we are in the minority...most people want to know, and some want to transfer a specific sex, or want to have a boy first, etc., but as I pointed out to Dr. Z., most people probably haven't lost one of each and only want a LIVING's selfish to choose sex when alive and breathing is the most important thing!) So, if we end up with more than one healthy embryo after PGD, they will do a random number assignment for transfer. If we were to transfer more than one (which we apparently can still choose to do, but he doesn't recommend it to help avoid twins again, although one can still split into two after transfer), then he'd transfer healthy odd-numbered embryos (say, #1 and #5, if #3 was unhealthy). If we only have two, then we'd either transfer just #1 and freeze the other, or transfer both (and have nothing in the bank). We're both really happy with this suggestion.

It's really hard to have an appropriate measure of hope when, 59 cycles later, my brain is in full self-protection mode. So many times it's felt like having hopes (not even expectations, just hopes!) has led to self-hatred as everything fell apart. I did peek ahead, because I can't help myself, and noticed that if this cycle works, not only will I be 14 weeks pregnant during the week of Christmas (how's that for a mind fuck?), but I'd likely be in the middle or tail-end of bedrest post-preventative cerclage. Huh. (Oh, and this would be a June baby, the most popular birth month in Paul's family.) I have both of these observations in my brain, but I refuse to write them - even in pencil, as I've done so many times in the past almost 5 years - in my dayplanner. Less to erase...and be pissed at myself for. To be honest, once I am pregnant I'm not sure how much I'll be willing to write down, but don't worry, I'll be hyper-aware of 13 weeks (2nd trimester), 14 weeks (OMG!), 24 weeks (earliest viability), 28 weeks (high viability), and then every week past then. Breathe...breathe...breathe...


  1. I didn't realize how much went into IVF. I know that it was a lot of medication, but didn't know the rest of it.

    I have my fingers crossed for you that eveything works with this cycle and you don't ever have to go through all of this ever again.

    By the way, if you get a BFP, have you decided if you're going to share with your blog stalkers? Now that I have the timeline I'm going to be going crazy in anticipation :)


    1. Hi Gabrielle! Yes, I will be sharing real-time. My husband spilled the beans right out of the gate last time and can't be trusted, so I will take all the mystery (and power) out of that news by announcing it myself, right up front. I can't handle the thought of reliving that particular bad point in our marriage.

  2. Wow Amy! This is so much to digest! And the cost of everything is so crazy (I just can't help, but wish you were able to spend it on Aliya and Bennett), but I know this is the next step. Will be stalking your blog like crazy over this timeline...and probably texting you too ;) I had a calendar for m that I wrote in every day that I was pregnant and I never filled in the dates for more than a week at a time even in the third trimester...we be crazy! That's how it goes though!
    Ps I got a temp job next to your office, maybe we could meet for lunch one day!

  3. It's interesting to see the timeline... I really hope that at Xmas you'll be hitting that 14 month mark... And that, come June... Well, you know the rest. Thinking and hoping this cycle works out. :)

  4. I am so glad you posted all of the details. I imagine you want to do everything you can to protect your heart from getting your hopes up too high, but the fact that you are moving forward is so hopeful, and it's a wonderful thing. You guys have already demonstrated what wonderful parents you are, in the way you love the twins and in the fact that you continue to move forward thoughtfully as you try to expand your family. I know just how you feel about the planner, but I hope so much that you have another June birthday to look forward to.

  5. Hi honey~
    That is an intense timeline. So much to do but in a way it's nice to have it all outlined probably. I'll be thinking good thoughts and checking frequently for updates! I REALLY hope everything goes as planned. I'm sure it's hard to get your hopes up as a protection measure but hopefully.... Love you!

  6. What a great plan and great medical professionals you are working with. I am really happy for you! Just keep your head down, do what you need to do in following your protocol and you will be at retreiveal before you know it.

    Good luck Amy!

  7. Best of luck to you - I know this will work out with the most POSITIVE outcome. I am on a weight loss journey now to do my first (and probably only) IVF. $15,000 is a lot to pony up, but here's hoping that we both get a baby in our arms and in our homes in 2013. :) I haven't even talked to my OB about a cerclage but I am pretty much going to demand it.


What are your thoughts?