Thursday, September 20, 2007

Back to Reality

We're back from our beach escape! One week in the Outer Banks is never, ever enough. Every year I ask myself if there's any humanly possible way that we could manage to stay for 2 weeks the next time we go. I've never taken 2 weeks off in a row - seems impossible but I know that there are some who swear by 2-week vacations.

The week before we left the mean weatherman was predicting rain for 6 of the 7 days we were to be there, and I was freaking out. However, beach weather is always fickle, and wouldn't you know we managed to somehow luck into perfect weather every single day! Never rained so much as a drop until Saturday morning as we were packing up the car to come home. Just how I like it!

We ate and drank sinfully, luxuriated in the sun, swam in ocean, pool, and hot tub, romped in the surf with our dog, played golf, went kayaking (Ok actually only R played golf or went kayaking, I concentrated on the luxuriating in the sun part), and drank many, many, many cocktails on a daily and nightly basis.

We also went on a lighthouse sightseeing mission one day towards the end of the week: we decided to drive the 130 miles from the northern most part of North Carolina's Outer Banks, where we were staying, all the way down south and across the ferry to Ocracoke Island. It took us all day, but we saw all four lighthouses most often associated with the Outer Banks: Currituck Light, Bodie Island Light, Cape Hatteras Light, and Ocracoke Light. It was quite an adventure!

Anyway, now that we're home, all I can do is pine away and wish we had never left the beach!!! Siiiiigghhh.....

Compounding my lack of enthusiasm for returning to reality, we came home to a leaking water pipe in our front yard. Actually, on the second day of our vacation, our neighbors called R's cell phone to report that they had seen a "small lake forming in our front yard" and they wondered if we'd like them to call the water authority to have our water turned off until we came home? Um, yeaaaah, that seems like a wise course of action! I began to fret over this lovely piece of information until R reminded me that there was absolutely NOTHING we could do about from North Carolina, and as such, we shouldn't ruin our entire week's vacation worrying pointlessly over it. He was right, and I tried to put it out of my mind for the rest of the week. (yeah right)

But, now we're REALLY back to reality, and the repair people are coming tomorrow morning to excavate the old pipe (all the way from the edge of our property at the street, through the yard, through R's perfectly manicured grass, through our borders with impatiens, otto luyken cherry laurels, hosta, etc.) and then install the new one.

Isn't it fun to spend $4,000 the weekend after you get back from your annual vacation? Especially when it's 2 weeks before you were supposed to spend $10,000 on your upcoming IVF cycle??

Given this state of affairs, R and I made the somewhat difficult decision last night to postpone our IVF cycle for at least a month. We'll need at least that long to determine how to scrounge up the necessary sack of money to proceed. It's really the only thing we can do. Having running water in the house is not exactly a luxury.

Sooooo, instead of starting the Lupron injections this Sunday, as I had been planning, I probably won't be starting them until sometime around Halloween. But golly gee, in the grand scheme of things, what's another month? We've already been at this for 35 months. Hell, might as well make it an even 3 years.

Tuesday, September 4, 2007

Just checking in....

Well, I have absolutely nothing of interest to report, but was feeling delinquent for not having posted anything lately!

We're just killing time until our vacation to the Outer Banks in NC next week. Woooo-hoooooo! So, hum drum, ho hum, bring on the beach vacation and accompanying cocktails! I'm soooooo ready for a vacation, I can't even tell you.

Did I tell you that my master plan of manipulating the birth control pills to time perfectly with the end of our vacation was foiled? Curses!! Dr. G said that I couldn't stay on the BCPs for 5 consecutive weeks, because the risk of over-suppression was too great - especially for a long-responder like me.

So, I have to take 2 whole months of pills. Boo hiss. Luckily the first pack ended last week, so I'm getting my blasted period out of the way this week. The good news is that I won't have to contend with a period whilst swimming in ocean, pool, or hot tub next week, nor will it cramp our opportunities for vacation er, romance. Thank God!

Bad news though, is that instead of being able to start stims IMMEDIATELY upon returning home from vaca, I'll have to wait an additional 3 weeks. You know that doesn't set well with my immediate gratification driven psyche, but what can I do?

I guess that does give us a stay of execution in terms of writing the enormous check to pay for this next round. So that's good.

Anyway, just wanted to say that I'm still here, and still keeping tabs on each of your blogs. Wishing all the best for each one of you!

Friday, August 17, 2007

Now what?

R and I have been going around and around the mulberry bush, as they say, on what action to take next in trying to start our family. After many days of soul searching and lots of knock-down, drag-out tearful conversations, I think we have finally have a mutually agreeable plan, at least for the very near future.

The crux of our difference in perspectives is this: R is tired of watching his wife go through endless days and nights of shots and doctor's visits and emotional highs and lows. He is worried about the emotional (and physical) toll that 6 future cycles of IVF (if we sign up for Shared Risk) might have on my emotional well-being, on my very personality. He's ready for us to be parents, now. He is interested in pursuing something that offers certainty and security in terms of an outcome. He is frustrated by the unpredictability of IVF. When considering the prospect of spending over $20 thousand dollars, I think he feels much better about signing up for something that has a 100% chance of putting a baby in our arms at the end of it.

I, on the other hand, am clinging desperately to the idea of having another chance at a biological child, and pursuing that opportunity as quickly as possible. It's the only thought that keeps me from being well and truly 'depressed', as a matter of fact. I'm just not ready to let that dream go. I feel really desperate and out of control; I'm not sure how to change or channel these feelings.

Our endless and frustratingly circular conversations over the last week stemmed from the fact that I'm scared out of my wits that we are heading down a path that will breed resentment in the future. If R feels we should abandon treatment and pursue adoption, and I go along with that, will I wake up 10 years from now resenting that I didn't "try harder" or insist on further opportunities to try for a biological child? If I want to sink a huge amount of our money and our time into 6 further IVF cycles, to the tune of $22K, will R resent me when monthly financial decisions are impacted as a result of this expenditure? Or, if all 6 cycles fail, and the money has been refunded to us, will R resent the fact that we've then "wasted" potentially 18 - 24 months and we're at the starting gate to adoption at ages 39 and 41, respectively?

Bless R, for he is unbelievably supportive and open minded and kept reiterating that in spite of his opinion about being ready to move on to adoption, he respects the fact that it's my body, and will support whatever I want to do next - more treatment or otherwise. Ack! Why didn't I rejoice in this response? Because I want to come up with a plan that makes both of us happy and leaves no room for questioning or second-guessing or resentment at any point in the future. And that is IMPOSSIBLE. There is NO GOOD ANSWER to this dilemma.

From a financial standpoint, we've decided that we simply cannot afford to shell out the full amount required for Shared Risk right now. In the spring when we both receive our annual work bonuses, we could conceivably fund a $20K payment - either for a Shared Risk IVF treatment plan, or for adoption. But not until then.

However, we have almost $4,000 worth of insurance coverage left. If we did one more cycle in the pay-as-you-go format, after adding in all the "extra" treatment options Dr. G recommended (ICSI, Assisted Hatching, etc.) we'd need to come up with about $7K (not including the drugs, of course.)

I almost come out of my skin contemplating the idea of waiting for almost 9 months to try again. 9 months is a lot of time to "waste" when you are trying to get pregnant, especially when you are about to turn 37.

Ultimately we've decided to come up with $7K and try again as soon as we get back from our beach vacation. I'm on BCPs now, so if all goes as planned, I'll likely be starting stims around the middle of September.

I don't know what we'll do if this cycle fails. Wait until spring to try to find $22K (in addition to the $7K we just blew)? Abandon treatment and begin pursuing adoption? I don't know. But I've accepted that I can't make decisions right now based on what may or may not happen in the future. We can only make one decision at a time, based on the current situation and circumstances. At this moment, doing another pay-as-we-go cycle seems like the next right step. Maybe I will second guess this decision. Maybe not.

I'm scared to death that it won't work, again. I'm terrified to think that this could be our last attempt at a biological child. Right now I'm trying very hard to "relax" (yeah right), and am hoping to enjoy our vacation in a few weeks.

Sunday, August 12, 2007

Syringes and needles and vials, oh my!



Late last week I decided that I was tired of paying for the little miniature Sharps containers the pharmacy keeps sending me, so I decided that in order to reuse them, I would empty all the full ones I have (yeah, I'm stockpiling full Sharps containers, and I know I have a problem) and put the contents into a recently emptied extra-giant sized laundry detergent container.



So, I dragged all of my bursting-at-the-seams Sharps containers into my kitchen and dumped everything out onto my kitchen counter. (Yes, I know that seems sort of unsanitary, but I reasoned that I could bleach the kitchen counter afterwards...) Anyway, the more I dumped, the more morbidly fascinated I became. I felt a perverse sense of accomplishment looking at all of those spent vials of medication and used needles. (Yes, I know I'm cracked.)



Soon I found myself carefully sorting through the contents, almost feverishly piling syringes on one side, needles on another....



This, I thought, is what hundreds of needle pokes looks like. This is what ONE IUI and ONE IVF looks like. This is what thousands of dollars worth of drugs looks like.


And above, you can see for yourself what it looked like.


For the as yet uninitiated, clockwise from the top left: Empty vials of Menopur, progesterone in oil, and hCG; empty Follistim Pen cartridges; used Lupron needles; used needles; used Follistim Pen needle caps; and used syringes.

Planning for next time

So I managed to get in to see Dr. G this past Friday. He called me on Tuesday evening, the day I got the beta results. He said that he was very sorry that this cycle didn't work, and suggested that we get together as soon as possible to talk about what we could do differently the next time. He suggested meeting on Friday at 2pm, and of course I readily accepted. What a saint.

He recommended several changes for next time: he thinks we should try to shorten my stim as much as we can, bearing in mind that I'm prone to hyperstimulation. Apparently the vast majority of patients have stim somewhere between 9 and 14 days long. Mine was 20. He wants to see if we can shorten it down to around 10-12. He believes that the long stim MAY have resulted in some of my eggs being post-mature. He thinks that may have contributed to our poor fertilization rate. The plan for next time will be to start me off right away with the highest dose of Follistim that I was on last time - 225ius. He'll watch my E2 level closely, and if it takes off immediately and looks like we're headed for hyperstimulation, then we'll immediately back down the dose. But if all goes well, we'll hit the old ovaries with the higher doses right away and see if we can get them to perform in a shorter time period. The hope is also to get more eggs this time around. Dr. G said 14 was great, but 20 would be better.

All 14 eggs they retrieved this time were mature. He said that was great, and was a sign of good egg quality. Of those 14, only 11 fertilized, and 6 of them fertilized abnormally. I'm sure I learned this in some long forgotten biology class, but when the sperm fertilizes the egg, the newly formed embryo is supposed to "kick out" the extra set of chromosomes. In 6 of our embryos, that didn't happen, and so they had 3 pairs of pro nuclei present. Dr. G explained that this could EITHER be caused by more than one sperm entering the egg, OR it could be an egg quality issue. He thinks it was the latter, in this cycle, but he thinks the quality issue can be attributed to the post-mature state of some of my eggs due to the long stim - NOT an overall age-related egg quality issue. So, his second suggestion, to eliminate any possibility of having more than one sperm enter each egg next time, is to do ICSI (for anyone not familiar, Intra Cytoplasmic Sperm Injection).

His third suggestion is to perform Assisted Hatching on our embryos next time around. He explained that this COULD be the reason that our gorgeous, 8-celled, compacting embryo didn't implant this time around. Perhaps it had a little trouble hatching in time to implant?Interestingly, Dr. G explained that although studies have shown no measurable benefit of performing Assisted Hatching on embryos of couples undergoing their first IVF cycle, the data does show that it helps in subsequent cycles. So, I guess his theory is that we might as well give them as much help as we can, and apparently with their embryologist's sophisticated and practiced techniques, there is little danger of harming the embryos when they "chip" away part of the "shell" or zona pelucida before the transfer.

I think it is really mind blowing - all of these procedures they can perform (ICSI, Assisted Hatching, etc.) on these tiny few-celled embryos. I can't imagine being the embryologist responsible for inserting a single sperm into a single egg cell?!?!?! It's almost like science fiction.

What's even more remarkable, in my opinion, is that "natural" conception and subsequent birth ever happens at all!! Every star and planet has to be aligned and every cell in your body and your partner's has to do EXACTLY what it is supposed to do at exactly the right time in exactly the right way......when you think of all the things that can go wrong, it makes you wonder how we managed not to go extinct before the advent of medical intervention! The deeper my knowledge of fertility issues, the more I'm convinced that every child is indeed a true miracle.

So, anyhoo, now the big freakin' question is how the frick we're going to pay to continue with this shit. We only have about $3,000 worth of insurance coverage left. If you add in all the costs of the "extras" Dr. G recommends next time around, we'd have to cough up about $10K to pay for a single cycle. (Plus, we'd have to pay $2,500 for a subsequent frozen cycle, should we be so lucky as to end up with embryos to freeze, of course.) By contrast, $22K would buy us 6 further attempts and/or a guarantee of our money back. We've been talking about it, and we're leaning toward Shared Risk as the logical choice. But $22K is a significant amount of money - do we finance it with a personal loan? Should we borrow from our 401K plans? Should we borrow against the equity in our home? Honestly?...We don't really want to do any of those things, but at some point we're going to have to make a decision and move forward.....

As luck would have it, Friday when I met with Dr. G also happened to be the day that my period showed up. So, he told me I could go ahead and start the BCPs if I wanted to. No pressure though - he said we could "manipulate" the pills in order to start the Lupron whenever I wanted to. We're going to the beach the second week of September, and there's no way in hell I want to be dealing with either a period or Lupron shots while I'm on vacation. I intend to be blind drunk the entire time. So, at this point I'm thinking we may be ready to start the Lupron around the 3rd week of September. We'll see. I guess it depends on how long it takes us to figure out the financial part of the equation.

Sooooo, I'm still obviously very disappointed that we're not currently pregnant. But, thanks to the upbringing of my two wonderful parents I'm a fairly resilient person. I think I'm over the bulk of rage and bitterness that swept over me for most of last week. It's not the end of the world, for pete's sake. It's just another failed cycle. It sucks, but we'll try again, that's all. The way I figure - if no one is dying, then it's a pretty good goddamn day. Losing a parent to cancer has a way of helping to put life's trials into perspective. This is hard. Really hard. But R and I are still here, still putting one foot in front of the other, still loving and laughing and enjoying each other and dreaming of the future. I keep trying to focus on my innumerable blessings, and that really seems to help.

Tuesday, August 7, 2007

Negative

As expected. Still didn't make the news any easier to hear.

I feel like an empty shell. Metaphorically, emotionally, physically.....My heart feels permanently broken. But I know it isn't.

And in spite of being just SO fucking sick and tired of all of this shit, all I really want to focus on is trying again. I don't want to hear - oh you should just take some time and grieve and think and reflect, blah, blah, blah. No, I'm all out of patience. I'm all done with taking breaks and wasting precious time. I'll be 37 in 3 months. I want to start another cycle now. Today. This very instant! That's the only thing that would make me feel any better. Plowing ahead.

So you can imagine how I wanted to leap through the phone and strangle the receptionist when she told me in a semi-snotty tone that the earliest I could get in to see Dr. G to talk about what went wrong and what we can do next is August 31. There's no WAY I'm waiting an entire month. I emailed my nurse and begged her to cram me into Dr. G's schedule anywhere she could. I would meet him in the parking lot, call him on his cell phone while he's sitting in beltway traffic, meet him at 6am,9pm, the middle of the flippin' night, whatever it takes, just get me an appointment sooner than a month away!

I thought I had prepared myself and all I would feel today is more anger, more bitterness. Interestingly, I mostly feel sad and sorry for myself right now. Not angry, so much. More pitifully disappointed. I bet more of the lovely rage I've been experiencing will be back tomorrow though.

I also don't feel like "talking this out" with any of my best friends like I usually do. The only person I want to talk to is R, and he won't be home from work for another couple of hours.

What is there to say anyway? This sucks. That about sums it up.

Sunday, August 5, 2007

Hope's on her way out

Well, it's 13 days past my 3 day transfer, which translates to 16dpo, and nary a second line has been spotted. I think it's safe to say at this point that it's all over but the cryin'. It's been more than enough time to have seen a positive result from an HPT, but of course I'll go for the official blood pregnancy test on Tuesday.

My rage has sort of ebbed and flowed this week. I have good moments and bad. Today I had a pitiful trip to the grocery store - is it me or are there more pregnant bellies and mother-child parades per square foot at the grocery store than any other place on earth? Except for maybe, Disney World??? I was overcome and swiping tears off of my face in the frozen food aisle. I'm sure the other shoppers thought I was a wackjob.

But, I'm still glad I've handled things the way that I have - testing everyday so that there was a gradual and incremental grieving period happening each day. I still maintain that I couldn't have handled letting hope blossom and grow stronger and stronger for two whole weeks, having more and more fantasies about being pregnant, and then have it all crushed with one phone call. It's too much suspense, too much build-up, too much riding on that one call that I'd surely hyperventilate or pass out or scream or all of the above. As it is, knowing full well that Tuesday's news will be negative - I STILL don't think I can bring myself to answer the phone when the nurse calls. I decided a long time ago that I was going to let it go to voicemail, so I wouldn't have to make any conversation or say anything at all to the nurse.

I'm sure that Tuesday will still be very difficult, but I think, I hope, I've already processed a lot of my anger and sorrow over the loss of this cycle - which, I feel compelled to iterate, is just a nicer way of saying that our two embryos, our two maybe-babies have died. So, maybe I'm fooling myself, but I don't think I'll completely lose it when I get the news. I could be wrong I guess.

One small glimmer of an idea that is helping me to move on already, is that I just figured out that we may not have to make the big Shared Risk $20+ K payment immediately in order to continue treatment after this. I remembered that we should have at least a few thousand left of insurance coverage, since we didn't need to use anything towards freezing any embryos this cycle. So, I'm pretty sure that to do another cycle we would only need to come up with $4K or so, which is much less daunting than coming up with $20K. So that gives me hope that we can IMMEDIATELY start a new cycle and try again.

After 3 years of this, that's the only thing that makes me feel any better, is the idea that we can pick ourselves up, dust ourselves off, and try again immediately. I think part of the dread I was feeling about possibly failing this time around had to do with the knowledge that we'd likely have to wait for 6 months while we tried to scrounge up the money for shared risk.

I have to say though, I'm just really fucking tired of being patient. I've been patient for 3 years now. I'm sooooooooooo tired of this! What an understatement! It makes me want to jump out a window. The fact that we want this with every fiber of our very beings and there is not ONE thing I can do to exert any control over when it will happen. And in the meantime, I just have to roll with every punch, and keep waiting. Patiently. What choice do we have?