1st IVF Cycle - The Outcome

I wasn't able to hold-off and not test. Husband was out of town and left to my own devices, of course I tested! The day before my beta, the home test was negative. The morning of my beta, it was also negative.
I went to the clinic for the blood draw and left still feeling a tad hopeful. My husband got home early that morning so we were together on the couch, waiting for the call.
It was Negative.
I was able to hold it together while on the call, and then hubby and I had a nice long, sobbing, stuffy-nosed cry. I had my husband call and text those who we had shared this process with to let them know. I think calling his mom was the hardest call to make.
The rest of the day we just hung out and didn't do much. I made dinner that night, chicken and dumplings, my comfort food.
I was at work the next day, focusing on work. Somehow, this major thing in our life just happened, and I'm able to function at work.
On Monday morning August 18th, the doctor called. He wants to sit down with us face-to-face and review our case. We're scheduled to see him this Thursday August 28th. I also made an appointment to see a psychologist. My first session is tomorrow, Tuesday, August 26th.
As for how the rest of my week went post negative news: I had a breakdown on Tuesday the 19th. My period started and I had to go to the store to get supplies. While at the store, I ran into no less than 3 pregnant women. That was a rough day.
On Wednesday August 20th, I woke up at about 4am with severe abdominal cramping, and the immediate urge to go to the bathroom. I had the chills and a low grade fever. I made it into work and dealt with the cramping and avoided the bathroom because I didn't eat anything all day. For added fun, had a splitting headache.
Ended up working from home for part of the day on Thursday, and again, didn't eat anything on Friday for fear of upsetting the tummy while at work.
By Sunday the 24th, I was marginally better. I still had the headaches though.
I've read online that estrogen withdrawal can cause headaches. I'll find out this Thursday if my stomach issues were directly tied to coming off of all medicines.
I'll post again after our discussion with our doctor. We will also be going over next steps.
I feel like seeing a psychologist is very important for my mental health. I need some tools to help weather this infertility storm. We're obviously devastated and need to work through all of these feelings.
Stay tuned...

From Trigger Shot to Retrieval to Transfer: Our Unexpected Adventure

Friday August 1^st: Follicles are finally looking like they should. I’ve been on stimulation medications since Sunday July 20^th, that’s 13 days of stimulation medication. Thought I would only be needing 8-10 days of medicine.  Four (self-pay) prescription refills later and here we are, Trigger day!

The clinic calls me to let me know to administer the trigger shot @ 6:30 PM exactly. A little air bubble here, a  little “ I think I can get more out of it, let me try again” there, and wham, bam, shot given at 6:33 PM.

Saturday August 2^nd: Bloodwork at clinic to make sure I gave myself the shot, and fess up and tell them about my time flub. Turns out a few minutes off is no big deal.  Blood work results confirmed I’m not an idiot and we’re set for Sunday 6:30 AM retrieval.  I’m told to arrive 30 minutes before procedure.  We relax Saturday night and watch a movie. Nothing to eat or drink after midnight.

Sunday August 3^rd: Retrieval! Traffic was a breeze seeing as we were on the road at 5:35 am on a Sunday. Hubby made his deposit at home since we live so close to the clinic. Less stress for him that way.
I had to pay separately for the anesthesia and I wished I could pay based on service received. I’m not new to anesthesia but this is the first time that the anesthesiologist made me bleed from the iv b/c some plastic cap wasn’t screwed on, and then didn’t use any lidocaine to prevent the anesthesia from burning as it entered my arm. I wanted to call her a devil woman, but I was too busy putting on a tough face and then I was out.  At least she didn’t mess that up.

Coming out of anesthesia was easy and I felt just a little tired. Probably because I woke up that morning at 4:45am. As for nerves, I wasn’t nervous at all until I walked into the doctors office. This was just one step in our journey to baby.

The report came in, and they got 14 eggs. Waa Hoo!

Went home and rested the entire day. Felt some cramping but Tylenol and a heating pad helped. Started taking the antibiotic doxycycline, a steroid, and tomorrow I start the progesterone gel suppository. Fun!

Monday August 4^th: Work from home. Pain not too bad in the morning. Clinic called and said of the 14 that were retrieved, 12 were mature, and they used ICSI on all of them, and 5 have fertilized. Not what I was hoping but we’re not out yet! We have 5 beautiful embryos.

Monday evening: pain seems to be worse tonight.  I’m a little sweaty and I have abdominal pain. I think it’s probably constipation and so I take some medicine, apply a heating pad and go lay down. Back to work the next day.

Tueday August 5^th: Wake up feeling much better. Clinic calls in the morning. 5 still hanging on, but one not looking so good. Has 30% fragmentation.  What's fragmentation? Think of it like a cookie, that's got a lot of crumbs. Not good in embryo world. But under 25% and it might still be ok. We’re still looking at 5 day transfer she says. I have (3) two cell embryos and one of those  has the 30% fragmentation, (1) three cell embryo with 20% fragmentation, and (1) four cell embryo.

Wednesday August 6^th: Clinic calls in the morning. Overnight we lost the three cell and 2 of the two cells. Have a nice looking 8 cell and a 4 cell with fragmentation remaining. My doctor wants to move up my transfer from day 5 to day 3 and transfer 2. This whole time we were thinking we would make it to day 5 and here we are, on day three being asked to transfer 2. This was never in our game plan. Would we be ok with twins? We have nothing left to freeze and so we would have to do this all over again anyway if it worked with one and so this way we would get our little miracles in one cycle. Hopefully.

So I have to call out of work and start chugging some water for the transfer. They want us in there @ 1030am for an 11am transfer.

No medicine is given for the transfer. After changing into the appropriate attire, and my husband in a one-size-fits-all except for him gown, we meet with the surgical nurse, the embryologist, and the doctor before going back for the procedure. I get a picture of the embryos. The 8 cell looks textbook perfect, and the four cell has some catching up and some fragmentation (15-20%)

As we’re in the procedure room waiting on the transfer, our little 4 cell became a 6 cell and was looking better. It’s over before just as soon as it began, and I have to lay on the table for 10 minutes. With a full bladder. So I’m laying on the table, crying because I know that the embryos are now inside of me, and having to pee so bad. My husband finds this adorable somehow.

As we’re leaving the clinic's parking lot, he says, you know, I really hope it’s twins, so we can forever tease them about who was the embryo slacker. I love my husband.

We get home, and it’s 2 days of bed rest for this girl.

I’m officially in the Two Week Wait and PUPO (Pregnant Until Proven Otherwise).  It’s not really two weeks, it’s actually only 11 days. Beta test is Sunday August 17th.  I’m not looking for pregnancy symptoms because I’ve been pumped full of all kinds of drugs. In addition to the progesterone, I’m also taking estrogen tablets.

I've been listening to some women who have done this a few times and I'm going to take their advice. I’m going to enjoy this time, and speak to my belly, “grow babies grow!” and know that I’m the furthest I’ve ever been in our years of trying to get pregnant.

Have a great weekend!

 

Medication Update

Worried that meds will hurt? Menopur burns a touch, but then you get used to it. Ganirelex/Cetrotide you can definitely feel for the first few days, made my skin blotchy as well. And then you get used to it. On my last night of Cetrotide, it didn’t burn or get blotchy. I think my belly was so full of meds it didn’t matter!

As for the HCG shot, that was the only one that I got even the slightest bruise from, and was sensitive the next day.

Great tip from my nurse: Since the HCG shot is timed, get the darn thing ready 15 minutes before you need it. Unlike the menopur, it takes about 5 minutes for the solution to dissolve the powder.

My IVF Calendar of Events

Hello Again!@

I wanted my next post to be of substance. Here’s what I’ve been up to!

Attached is my calendar so far.  Before I get into the process, I wanted to tell you all about how the administration went down. Husband mixed first days meds and I tried to inject but I chickened out. So for the next shot, I prep everything, and he injects. He has a small issue with removing the needle from my skin, he sort of catches my skin, so this morning I let him inject me, and then I pulled it out. Works much better that way.

A few things unexpectedly happened in the last 9 days. On my first visit to check my progress (Wednesday July 24^th, day 4 of stims), the doctor didn’t notice much movement and so he increased my meds from Menopur 75 IU to 150 IU, and increased Gonal-F from 300 U to 375 U.

Went back to clinic on Friday (day 6 of stims) and there was some movement, but not what they wanted to see. Good thing was that I was responding, bad news is, not fast enough. Increased Gonal-F to 450. Kept menopur the same.  This was a little boggling to the doctor since all of my diagnostic testing showed I would be a great responder to medication.

Third visit to clinic was Sunday July 27^th, (Day 8 of stims) Now we’re cooking! Got a print out of my follicle growth. Doctor saw 12 follicles, 5 on right and 7 on left. Reviewed BW and that night I introduce another Menopur and the Cetrotide. Cetrotide makes my skin warm and I can really feel the medicine.
Last night was a little tough because there were 3 shots. I survived though.

Was instructed on Monday July 28^th to add a third Menopur in the AM, keep Gonal-F at 450U in PM and take another Cetrotide. I go back tomorrow for another check on follicle growth. Tomorrow will be day 10 of stims. I will also be out of medicine tomorrow night.

Good thing though is that the pharmacy I selected has overnight, free shipping, and delivers on Saturdays.

I’ve spent an additional $1923.00 in medication so far. I don’t even blink when I place the re-orders. I’m committed now so this is just a drop in the bucket.

I’ll post more information as things happen. Hope you are all having a good week! :)

Show Me the Money!: Part Deux - IVF Meds Cost

Hello Again!

The below information shows pricing for IVF medications from 4 different pharmacies. If you would like to know the names of them, please message me and I would be happy to go over them with you.

No one will use all of the medicine below.  For the antagonist IVF protocol it will break down like this:

Bravelle OR Gonal-F  OR Follistim
Menopur
Ganerelix OR Cetrotide
HCG Trigger Shot

Will also need to be on Birth Control Pills (BCP) for about 14 days, an antibiotic, and a few other oral medications that will be taken at various times during the cycle. In addition to that, will be taking progesterone.  I’m hoping the oral medication prescriptions are covered. I know the BCP’s will be covered at 100% thanks to Health Care Reform.

 This post will mainly focus on the injectables since I’m out of pocket for all of the those costs.

Drug Name	Pharmacy A	Pharmacy B	Pharmacy C	Pharmacy D
Bravelle (40 vials)	$2,272.02	$2,156.00	price not provided	$2,249.99
Gonal-F (3) 900 IU pen	$4,860.00	$2,664.00	$2,664.00	$4,815.57
Follistim (3) 900 IU pen	price not provided	price not provided	price not provided	$2,343.00
Menopur (10 vials)	$758.00	$739.00	$759.00	$739.50
Cetrotide (5 vials)	$472.50	$472.50	$472.50	$559.65
Ganirelix (5 vials)	price not provided	$724.50	price not provided	$580.50
Trigger Shot (name varies)	$84.75	109.90	$89.90	$91.95
Needles  (30)	$11.39	included	$15.00	included
Syringes (30)	$15.33	included	$15.00	included
Shipping	free	free	free	free

 

After price shopping and applying discounts (captured below) I will take the follow medications:

Gonal-F redi-ject pen 3 pens each containing 900 IU’s (international units)
Menopur- 10 vials each containing 75 IU’s
Cetrotide- .25mg (5 of these)
HCG Trigger shot – 1 shot (10,000U)

Discounts:

Heart+ card: Can be obtained from your physician’s office. There is a $10 enrollment charge which is handled at the pharmacy level. Discounts apply to Bravelle, Menopur, Endometrin, and Novarel.

Go-Direct Savings: Mail-In Rebate for $10 off every 75 IU’s of Gonal-F and $10 off every .25 mg of Cetrotide. Obtainable if you go to HERE.

Will also have to take progesterone.  It can be administered via injection or vaginally. Both methods have their drawbacks and advantages. My clinic recommends the latter.

I also asked my RE about any sample medications they have available that patients have returned to the clinic. They are going to give me about $200 worth of Crinone 8%.  Should get me through until I find out I’m pregnant (fingers crossed!). Then my insurance may cover it after that.

So here is my cost break-down:

Drug Name	Pharmacy B	Pharmacy B with Discounts Applied)
Gonal-F (3) 900 IU pen	$2,664.00	$2,304.00
Menopur (10 vials)	$739.00	$739.00
Cetrotide (5 vials)	$472.50	$422.50
Trigger Shot (name varies)	$109.90	$88.90
Needles  (30)	included	included
Syringes (30)	included	included
Shipping	free	free
Additional Savings		($100) on orders over $2,000
Total before Savings	$3,985.40
Total with Savings		$3454.40

 

 Here is the final cost between all 4 pharmacies:

Pharmacy A	Pharmacy B	Pharmacy C	Pharmacy D
$3,613.99	$3454.40	$3,605.40	$3,434.10

 

Pharmacy D was less expensive by about $20.00 and I would have to use Follistim, and spend $25 on a savings card that would be in the form of a gift certificate.  I liked the responsiveness of Pharmacy B over Pharmacy D too. Also, the amount cost is for 10 days’ worth of medications.  I only got a 10 day supply of medicine so if I need to add 2 more days worth, I want to work with a company that has great customer service.

So that’s it! Please let me know if you have any questions, and good luck! J

Testing, Testing, 1, 2, 3!

Hello Again!
Wanted to wait to post again until I had more information, and I have loads!
I had my 'Polypectomy, Hysterosalpingogram (HSG), Hysteroscopy, and Possible D&C' on Wednesday June 18th. I can recall what was done because I had to tell everyone who touched my chart what was happening. I know it's for liability reasons, but part of me thinks hospital staff are dumb because I have to tell them what's going on.


If you're in my boat, there is nothing to worry about because you will be knocked out.


The night before, no food or drink after midnight. Had to report at 9am. No make-up and no contacts. To heck with that! A little powder never hurt anyone!
The admitting nurse for same day surgery takes my weight, blood pressure and pulse. All 3 are a little elevated and two of them are because I'm just a wee bit nervous.


My doctor visits with me and tells me that there is another case ahead of me but wouldn't be more than an hour. My husband sits and waits with me, but does more pacing than waiting. He was a little nervous too, I just didn't call him out on it.


I get wheeled into the surgical area, and it's freezing! They should really give people something before they roll them in that area because without my glasses I see blobs of people and objects and it's a little unnerving.


One of the guys that's fiddling with my IV is chewing spearmint gum, trying to make jokes with me. I have a perma-grin because that's what I do when I'm nervous.


He said, "You should feel more relaxed now." I said, "I don't think my IV is hooked up right because I'm still just as nervous."  About 10 seconds later, the room gets even more fuzzy and I'm out.


I wake up in recovery and a very pleasant nurse is trying to get me to stay awake. I just want to sleep. I was up most of the night before and so this is the perfect time for a nap.


Doctor comes in short time later. "You did great. Got the polyp, sending for biopsy, everything else looked great, however your tubes seized when the die was injected."


OOH! Left out something major. Before the day of surgery, you will have to insert a pill up yonder to help soften your cervix, makes the process for doctor and you much easier. I can see how this would definitely matter if you weren't under general anesthesia. And stock up on some pads because you will bleed.
Back to recovery...


What happened to me was called bilateral spasms of my fallopian tubes which can happen. It's not necessary, but if the doctor were to repeat this test, my results would come back normal. He said that when the testing is done again on other patients, normally tubes would be open about 80% of the time. I'm ok with that.


I got the results back yesterday that my polyp was benign, which is what he thought it was. So I'm all set! All my tests are done, I'm in great shape.
We also got the news that my husbands most recent sample was 300,000 little guys. We were ecstatic! He will have to produce another sample when we do the egg retrieval, but just for good measure.


I'm expecting my cycle to start in the very beginning of July. I have my surgical follow-up with the doctor Tuesday July 1st. Will also have to go back to the doctors office on the 3rd day of my next cycle.
And the appointment I'm most looking forward to: My IVF nurse consult.
I've already got a list of meds I'll need to take, and I priced them from four different pharmacies. I will create a post just about IVF meds.
During my IVF nurse consult, she will go over my medications list and my own personal IVF calendar. She will also go over how to self-administer the medications, or Husband-assist the medications.


So many appointments! Before all the craziness starts my hubby and I are taking a little mini-vaca. Well he's working at a convention, I'm going to take advantage of the pool and channel my relaxed self because I haven't seen her in a while.


Hope you are all well. Check back in a few days for my medication pricing post.
Have a great rest of your week! :)

My Stats - FSH, AMH and other tests

Hello and Happy Monday!


AF finally reared her ugly head but this time I was excited to see her. This cycle was long for me (38 days), so it made things hard, just waiting for her to arrive. However, since she was late, I was able to schedule my hysteroscopy, polypectomy, and Hysterosalpingogram (HSG) for Wednesday, June 18th. You cannot be ovulating for these tests.


My AMH test was just a blood test and that was done on my first visit. I didn't get the results until recently because I wanted to call the RE and say my period arrived, let's schedule things, and by the way, what's my AMH. Maybe it's my way of being less neurotic.


Anywho, my AMH is 3.6 ng/ml. What is AMH you ask? I've been spending a lot of time on this site ( Click Here ) but I've pasted some of that information below for your convenience.
 
"The table below has AMH interpretation guidelines from the fertility literature and from our experience. Do not get carried away with the cutoff values shown here. For example, the difference between a 0.9 and a 1.1 ng/ml test result puts a woman in a "different box" in this table - but there is very little real difference in fertility potential. In reality, it is a continuum - and not something that categorizes well.

Interpretation (women under age 35)	AMH Blood Level
High (often PCOS)	Over 4.0 ng/ml
Normal	1.5 - 4.0 ng/ml
Low Normal Range	1.0 - 1.5 ng/ml
Low	0.5 - 1.0 ng/ml
Very Low	Less than 0.5 ng/ml

Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. In general, having more eggs with IVF gives a higher success rate."




However, checking your AMH is just one part to finding out how well you will respond to an IVF cycle. The other test is the FSH 3 day test. Again, please Click Here for more information on the FSH levels.

"Why does your RE measure the FSH level on day 3?

By measuring a woman's baseline FSH on day 3 of the cycle (we do it on day 2, 3, or 4), we get an indication as to whether she has normal "ovarian reserve". We are looking at how hard her body needs to "step on the gas" early in the menstrual cycle to get a follicle growing. Therefore, if the baseline FSH is elevated the ovarian reserve (how many eggs are left) is reduced (sometimes the egg quality is also reduced)."

Day 3 FSH level	FSH interpretation for DPC Immulite assay
Less than 9	Normal FSH level. Expect a good response to ovarian stimulation.
9 - 11	Fair.  Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
11- 15	Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
15 - 20	Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle count is an important variable.
Over 20	This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.

My FSH level came in at 4.9. I felt like a scored an A+ on a test!


The doctor also performed an ultrasound to see how many follicles I had in each ovary. My right side is not that great of a performer, coming in at 6 follicles. The left side fared much better with 12 follicles. The doctor didn't make any comments about the follicle amounts. She wasn't my normal doctor and I was going to get the complete results from my visit in a few hours so I didn't ask her.


It's kind of awkward having the ultrasound done on Day 3 of your cycle, but the doctor was a complete professional and the nurse was great too. My husband was in the room with us and he was quite the gentleman.


They only took one vial of blood this time. I've captured the rest of my results below. Not sure why they run a beta test (for pregnancy?) but they did.


Estrogen: 43.1
Progesterone: 0.4
Beta: Negative (duh!)
FSH: 4.9
LH 2.49
AMH: 3.6
Right Ovary: 6 Follicles
Left Ovary: 12 follicles


These results will tell my doctor what kinds of medications I will need and the amounts or if you prefer fancy words, my IVF medication protocol.


I go back to the RE on Thursday June 12th for my pre-operative blood work. Then, I'll have my surgery the following Wednesday, June 18th.


I've heard stories from women who have said that the HSG or the Hysteroscopy is uncomfortable. Because I'm having a uterine polyp removed, I'll be under general anesthesia so all of those other tests will be performed while I'm under, which is fine by me! The Doctor will also perform the mock transfer at that time as well. It's going to be a big day for me (well reproductively) on June 18th.


One big question is looming in my brain right now...will the RE want to start my IVF cycle at my next cycle start or wait a cycle?
I wonder if I need that extra time to heal. He's not doing a D&C to remove the polyp, so my lining should be unaffected but I just don't know.
I'm going to ask him on the 12th when I have my pre-op blood work done. I'll keep you posted and let you know.


Please message me if you have any questions or leave me a comment. Have a great week everyone! :)