WTF!?! IVF!?! aka Our First Fertility Appointment

Thursday May 1^st, 2014 – WTF!?! IVF!?!  aka Our First Fertility Appointment!

Ever the planner, I was focused on all aspects of our appointment, down to the most frequent question all women ask themselves when preparing for an important meeting…What will I wear? My mother always said when you are feeling down, or unsure of yourself, at least look fabulous! I think there is some truth in that. I’ve had several days were I felt like crap inside, but I looked good on the outside.

With the printed New Patient paperwork in our hands and having decided on my newly dry-cleaned favorite maroon ankle pants, cream blouse and blue cardigan, we set out for our appointment.

I don’t think I've ever been as nervous for anything in my life as I was for this appointment.  My husband and I were driving separately because I had to go into work after the appointment for an important work meeting.

As we walked into the office, the front desk ladies knew who I was when we walked in. They were very welcoming. There goes those warm and fuzzies!

Because we live in one of the many states in these United States that does not offer coverage for Infertility treatment, I knew what we were in for. 
On a positive note, my insurance and my husbands covers the diagnosis of infertility. So many tests and procedures leading up to treatment are covered. Check your medical benefits policy to see if this is covered. If you have any questions about this topic, please e-mail me!

Our wait was very short, and a very pleasant nurse brought us in to take my blood pressure, height and weight, (she let me write it down because don't most women know their weight?) She then went over how the appointment would unfold. We would meet with Dr. C for about 20-30 minutes, then he would perform a baseline ultrasound and then another nurse would do our blood draws and collect urine sample, and we would meet with the financial counselor, and then the physician again if we had any additional questions.

Blood pressure was perfect: 120/80. I thought for sure it would be high because my nerves were going insane. Thank you empty stomach and 1/2 cup of coffee!
Suppose now is the time to tell you a little about me and my husband. We're both 33 years old and carry a little 'happy to be married' weight. My husband is 6'1" and built like a football player. And he has the most amazing hazel eyes. In the past few weeks we've really started to take our weight seriously, knowing what could lie ahead for us. Last year we both lost a bunch of weight, and over Christmas, Santa gave us a few extra LB's. I come from a large family and I always knew I wanted to be a mom. My husband is an only child and always wanted a large family. Win-Win!

The nurse then brought us into Dr. C's office and he was very calming. He got right into it. I was worried he would suggest trying to bring up my husbands sperm count and then several rounds of IUI before suggesting IVF. 

When I say I was worried, it's because we only have a certain amount of money to work with. Remember that retched job I mentioned? Yes, it was awful, but when I walked away from it, I left with enough stock for a rainy day or some fertility treatments. Dr. C said, 

"I like seeing patients like you. Young, with male factor. We'll see what's what with you and if everything looks good, we'll get you pregnant."

 I like this guy. He goes through our potential treatment plan and then gets into some science. Having done my fair share of research, I knew a lot about what he was speaking about. My husband was following because I gave him the Cliffnotes version of my findings. 

He said that IUI wouldn't work for us because we don't have much sperm to work with and our only option would be IVF using ICSI, which is Intra-cytoplasmic sperm injection. They can take a single sperm and inject it directly into the egg to fertilize it. Traditional IVF would have an egg in the petri-dish and then sperm would be added and one of the millions of normal sperm would make its way into the egg. ICSI does the fertilization for you. Science!

Next, we had the baseline vaginal ultrasound (u/s). I also have to mention that I've never had a male doctor as my lady doctor. So, there is a whole other layer to my nerves. But he's very professional, and makes me feel at ease. 

If you don't know what this kind of ultrasound is, please look it up. Be prepared.

After a quick peek around, Dr. C. immediately said that I had a polyp in my uterus. A uterine polyp can make it hard for an embryo to implant into the uterine wall, and should be removed. If we don't remove it, an embryo could attach to the polyp, and miscarriage is very likely. If my husband didn't have his issue, my issue would be a serious hindrance in achieving/maintaining pregnancy because of it's location. Right ovary looked good, and left ovary, 'looks even better!'

Doctor said we still had to check out my fallopian tubes. We would need to schedule surgery to remove the polyp and could do all of the other diagnostic tests at the time of the surgery.  

We then met with the nurse who told us about screening for cerebral palsy and an optional genetic test we could request by a company called counsyl. https://www.counsyl.com/ We decided to get this additional testing done because we have already come this far. I asked the nurse how many patients get this genetic testing done and she said, about 50/50.

The nurse only took one vial for the counsyl testing, and about a million other for the diagnostic testing, (ok, maybe 7 or 8) and just one tube for my husband. 

Dr. C. stopped in to check-in on us, and I asked him about the spotting I've been having between cycles. He said, it's most likely because of the polyp. 

Next came the Financial Counselor...dun dun dun!

Our financial counselor was very knowledgeable and she was able to explain our options in a clear and concise way. I know she talks about this subject multiple times a day and still she had enthusiasm and took her time making sure we understood everything. I'm going to create another post just to talk about affording IVF.

The Beginning

I’d like to start at the beginning so I’ll try to bring you to present day as quickly as I can:

It was 2009, while working at the most retched job ever that I met my future husband. We have since moved on to better careers that offer excellent work-life balance and we’re better people for it.  I’ve never been one to like taking birth-control pills, so shortly after we were married in 2011, I said: Birth-Control, meet Trash-Can, Trash-Can, meet Birth-Control.

For the next few years, we were ‘sort-of’ careful.  It wouldn’t have been terrible if we got pregnant so we weren’t very concerned.

In May 2013 we decided we were ready to really have a go at it. Let’s get pregnant! I knew I would need to start by taking a prenatal vitamin well before getting pregnant. Vitamins are my sworn enemy, and most make me nauseated, so I had to find one that wouldn’t hurt my delicate stomach.
After consulting with one of my best girlfriends/new mom, I found that I like Rainbow Light Prenatal Vitamins. They are food-based, so gentler on my finicky tummy.

Prenatal Vitamin, Check! Now, for the neurotic/impatient woman’s tools for conception:

Period Tracker App
Fertility Friend App
Clear Blue Easy Fertility Monitor
Refills for Monitor
Basal Thermometer
Lots of Pregnancy Tests

Before you think I’m crazy, hear me out. I am a person who likes control. Need as much information available to me as possible.  When I’m interested in a subject, I like to know as much about that topic as possible. I’ll research the heck out of it. I’ve always been this way, and you may think I’m a little coo-coo but this is often a silent personality trait, and only those closest to me see this side, so please reserve your judgments J And if you’re just like me, nice to see you again my friend!

People that say, ‘Relax, it will happen’ may have had an easy time getting pregnant. Or, they think you really ARE crazy and they want you to relax. Either way, this path I headed down was going to change significantly over the next few months.

In my first few months of trying, it was exciting and new. In my research, I knew that it may take about a year, but odds were better if I knew more about my body and my cycles.

I only used the Fertility monitor for two months. I’m still hearing about that purchase from my husband. It was NOT cheap, and I never got the ‘Peak’ day that I was expecting to get. I later discovered that I should have been testing later in the morning at 11 or 12, or later afternoon at 3 or 4. NOWHERE in the directions did it mention that the best time to test is late morning. I liked the simplicity of it, but what I came to discover, you’re at the mercy of the monitor. So if you have a longer cycle, say 32 days or more, you will definitely feel like you are pissing away money by having to test on day 9.

After two mildly disappointing months, I moved on to another tool: Internet Cheapie Ovulation Predictor Kits (OPK’s). I could test when I wanted, and even twice a day. You have to read the lines and know when you have a positive reading, but they are pretty easy to use, and very affordable.  (I ordered almost all my conception ‘tools’ from Amazon.)

It was during this time that I was also charting. For some people charting is easy and becomes a part of their daily life.  For me, it was something I had to be mindful of. I would get so mad at myself if I got up out of bed in the morning and forgot to get my temp, or missed getting it at the same time every morning. Charting is also difficult if you travel a lot for work, or spend weekends away from home, which was our case, when we visited friends.

Looking back at my charting, I think it came and went in spurts. I was good one month, and then have an incomplete month the next month. Once I had a few months of ovulation certainty, I was able to start testing a few days before I thought I would ovulate and catch it every month.

The one method of tracking ovulation that I never got into was observing my cervix position. For any woman who does that, you’re a better woman than me.

I have to also mention that for about the last year and a ½ I began spotting between cycles. I’ll get into that more later.

As for my emotions, I never really broke down and cried until we were about six months in. I think I held myself together because my two closest friends each struggled to get pregnant and it took them a while, with one of them taking almost 3 years to get pregnant.

I don’t know what it was, but the despair hit me hard, and I was a wreck. Every woman who has been trying for a while will know what I mean and understand. It’s our secret society where our ritual is to cry in the bathroom while reaching for a tampon/pad with general lethargy to follow. I ruined an entire weekend by wallowing in sadness.

As women, we’re taught at a young age that getting pregnant is very easy. A boy can look at you the wrong way and BAM you’re pregnant. Obviously, that isn't true, but it sets you up with unreasonable expectations when you ARE trying to get pregnant.

It was also around this time, that my dear husband started to take this whole process more seriously and was on-board with Operation: Get me pregnant! It really helps that I married an amazing man.

After about 10 months of working hard I began thinking about next steps. I know that checking out the woman is a much more complicated process, but having your husband checked is easier.

Much to my surprise, my husband bought one of those test at-home kits.  He didn't tell me he purchased it because I would probably ask too many questions. He tested a few days later and it came up negative.  I know that other reviewers state that even if it’s a faint line, it’s a positive. There was no line.

I don’t hold much stock in those tests but knew we should go ahead and get a real semen analysis (S.A.).
Most people might wonder where to get this kind of test done, do I go to my regular doctor first, or a urologist? I work in the insurance business and sometimes my knowledge base helps when it comes to personal matters. You have to be careful about scheduling a urology appointment for your significant other. Some don’t do semen analysis. Or you may have to do a consult first, then go to some lab, then go see doctor again for results. I.Don’t.Think.So!

Thankfully, we both have PPO plans, and do not need referrals for services. I suggested that my husband go to his primary doctor and have him write a script for the S.A. We live in a major metropolis and so I took a look at the large hospitals because most have labs on site. After a phone call, I scheduled an appointment at the andrology lab and hubby just had to bring the script with him. (Insurance covered the test. I’ll get into that fun topic in a later post.)

Script in hand, my husband made his deposit one rainy day in April 2014. Within 24 hours we got the preliminary results, with a detailed report being sent to the family physician within 10 days. We didn’t get a detailed report 10 days later. The preliminary report was all we were going to get. In the box where it read ‘Sperm Count (>15 X 10-6/mL)’ the technician wrote: ‘See Comment’:

Severe Oligospermia, 4/4 non-motile sperm seen in fresh sample.

WTF? Aren’t there supposed to millions of those little guys? 4!?! FOUR? 4.0.

OK. Now we’re getting serious. I was coming up on 12 months of trying, and my annual gynecologist appointment was coming up where I would tell her we tried for a year, and now what?

My gynecologist, or my lady doctor, as my husband calls her, is part of large network of physicians and hospitals. After doing my research, I knew I didn't want to go to the fertility clinic associated with that network. I’m sure she would refer me to them.

Sometimes, I need to be reigned in, as I can get ahead of myself, and for that, my awesome husband allows me to bounce ideas off of him. My lady doctor appointment is scheduled for May 8, 2014. It was after his fateful results that I started looking into fertility doctors. I didn’t want to wait when I knew we needed more information.

Where does one start? Well, I ended up here: http://www.sart.org/find_frm.html

Here, you can see fertility clinic outcomes for IVF in your area. They don’t report things like IUI or other techniques, just IVF results. It’s a good jumping off point. A word of warning though: take the results with a grain of salt. With any statistical reporting, outcomes can be manipulated.  For example, some clinics might have high live birth rates because they may only work with couples that they know they can help make a baby.

Another thing I did was look up each clinic I was interested in. View the website, check for reviews. Again, take reviews at face value. What prompts someone to post a review? Either a very negative experience, or a very positive one. There are many in-between experiences that we never hear from.

I researched the doctors in the practice. I also looked up where they were located. If you end up in the IVF boat, you will need to determine if its location will work for you. Can you get to your appointments and then head into work within a reasonable amount of time? Check out the clinics operating hours, do they have early morning appointments and evening appointments? Do they have multiple locations? Will you been seen by a physician at your visits or by a nurse?

I decided on a clinic that has several experts in Reproductive Endocrinology (RE), has a lot of face time with the physician, was close to my work, and had great hours. I also got the warm and fuzzies when researching the provider. You will need to do what’s right for you, especially if you are paying out of pocket. 

Welcome!

Welcome to my blog! After much deliberation, I decided it was important for me to journal my experience with Infertility. God knows I’ve spent a lot of time trolling the internet for information on everything from Pre-Conception, Diet & Exercise, Recipes, Charting, Ovulation, to Infertility that I felt the need to share my journey so if there is someone out there like me - it might help! Plus, I sort of like being held accountable to document this time in my life and what better way to be held accountable than to put it on the internet!

My personal disclaimer: Any recipe or products I share with you are because I’ve tried them and loved them (or hated) and I’m not being paid to promote anything.