Wednesday, January 28, 2009

Busy Plans, Testing and Cycling Update

Thankfully this winter we have a lot of busy, fun plans. It is always nice to stay busy so that I don't constantly keep thinking about our cr*ppy IF. Here is our schedule:

January 10-15: Arizona to visit FIL and his wife
January 22-25: DH snowmobiling in Michigan
January 25-26: Colorado for one day work-up
January 29-February 1: I go scrapbooking
February 6-8: Northern Minnesota to visit friends
February 11-14: Nieces to stay at our house while my sister and her DH go to Las Vegas
February 19-20- DH goes to Ice Fishing contest in Wisconsin

I am really excited to go scrapbooking tomorrow. I am going with 15 other girls to a crafting retreat. I know about half of the people that will be there including my mom, sis and good friend, L. DH, DS, my dad, BIL and nieces are going to spend the weekend ice fishing on one of the local lakes. When us girls get back on Sunday we are going to meet up with the guys and kids at my parents house and watch the SuperBowl together. The guys are planning all of the food and cooking for us girls.

I heard back from my OB and she is able to perform the E-Tegrity test to check for the beta 3 integrin protein in my endometrial lining. I have to supply a couple of the things needed for the procedure and then ship it off to the outside lab myself.

I also called the local hospital today that has my serum in the freezer. I have to go there tomorrow to give them my doctor's orders and then they will take care of shipping my serum off to CO for me.

Dr. Schoolcraft said that all of our stuff would be current for one year. Although, I am almost certain that we will have to at least do the communicable disease blood work every six months as mandated by the FDA. I figured that if we for surely decide to cycle locally to finish out our warranty program that I would do the fresh cycle in March/April. If we have any frozen embryos from that cycle then I think we would be able to cycle again in June/July. If we fail both of these cycles then I am hoping that we would be able to do the egg retrieval at CCRM in November/December (I want the medical tax deduction in 2009!) and then do the CGH frozen transfer in winter 2010. Man, that seems like a long time way! Hopefully, it will be well the worth the wait!

Tuesday, January 27, 2009

CCRM Review

I apologize in advance for this being a long post. We got back late last night from CO and our work-up at CCRM. I was amazed at the size of the clinic and how many patients were there. Many of them were there, probably 8-10 couples, to also get their one day work-up done as well. Amazing and quite the testament to CCRM and how well-respected and known they are for being one of the top IF clinics!

So here was our day...

8:30- Meeting with Dr. Schoolcraft- We did a quick review of our IF history. He talked to us again about doing CGH, where they test all of our chomosomes. He said that with my age, my ability to produce lots of eggs (7 of which were "true" blasts on my cycle in August and he thought that their lab could get more blasts) and already carrying a child to term he thought that we would have no problem conceiving again. He said that he wished that all of his out of town patients had such great stats as I do. He also said that he is brutally honest and if he thought that we needed DE, DS or a GS that he would tell us that. He doesn't forsee us needing any of these. He did say that he would give us a 60% chance of success and if we do CGH he told us he was able to be "bold" in saying that we would have success in one cycle because of my age, egg producing capabilities and having L. He then said that I was an "interesting patient" because most of the couples that come to him from out of state he can look at their chart and know exactly what went wrong with their past failures. With us, he can't. He doesn't know why we have not had success. He was so nice and asked about L and told us that he wants to help us "give L a partner in crime".

9:00- Semen Analysis and Antibody Testing (ASAB) with Chromatin Assay- M had to give a sample to be sent off to South Dakota to check for DNA fragmentation and then CCRM likes to do their own SA to measure the motility, morphology, and count of sperm. I had to give a blood sample to check for antisperm antibodies. We will find out these results in the next couple of weeks and I will explain more then if anything is found.

9:30- Baseline Ultrasound and Doppler- I had an u/s to look at my uterus, lining and my ovaries. I have 6-8 resting follicles on each ovary. Now, I am not normally one to brag, but my ovaries rock!! That means that I have plenty of eggs to work with, so to speak. For those that don't know, when girls are born they are born with all of the eggs that their body will ever produce, wheras with guys they produce new sperm every 70-90 days. With having so many resting follicles I am not at risk for DOR (diminished ovarian reserve) which is another IF diagnosis. My lining was thin, but that was to be expected since AF just stopped. My uterus looked good, nothing abnormal. The doppler is done to check blood flow to the uterus. Good blood flow means that it is easier, per se, for my embryos to implant. The doppler was high, meaning that I have restricted blood flow to my uterus. To improve this I have to avoid caffeine and do electro-accupuncture while cycling.

10:00- Nurse Consultation and Medication Teaching- We met with the nurse to go over their processes and procedures and to talk about medications. This was kind of a boring meeting because we went over a lot of the same info as we had to do at our local clinic. It was a "ins and outs" of IVF sort of meeting. Since we have done four cycles, we pretty much know what we are doing by now. She did give us information on how to get my cycle day 3 labs sent from my local hospital to CCRM and information on the E-tegrity Test. This test needs to be performed by someone local (I will be calling my OB today to see if they can do it) on 9-11 days past ovulation. I have to monitor my ovulation with an OPK and then schedule the test. They will go in and scrape my lining, just as I had done previously with the endometrial biopsy, and send my tissue to an outside lab. The test measures my beta 3 integrin. This protein is needed in my endometrial lining for implantation of my embryos to occur. I have heard that the treatment for this is be on Lupron for two months prior to your cycle. If my lining is found to be absent of this protein I will explain more. The nurse also told us that they collect two sperm samples prior to egg retrieval. One of them will be frozen in the event that a sample can not be given on the day of egg retrieval or if it is an "off day" with M's sperm. We have been wanting to do this at our local clinic, but they don't find it necessary. Since M's counts have been all over the board, we were really excited to know that they highly recommend doing a frozen sample in addition to a fresh sample on the day of egg retrieval.

12:00- Lunch break- Self- explanatory:)

12:30- Hysteroscopy- Dr. Schoolcraft performed this on me. Hysteroscopy is used to look inside of my uterine cavity with a fiber optic telescope. Once the telescope is inside, he inserted carbon dioxide into my uterus with a tiny little tube so that he could visualize it better. This test is done to see if I have any fibroids, polyps or adhesions. My uterine cavity came back normal. At this time, Dr. Schoolcraft mentioned the restricted blood flow to my uterus. He actually said that my "blood flow looked funky". He didn't seem concerned about it, but then talked to me about avoiding caffeine and doing electro-accupuncture.

1:00 Business Office- We met with the business office to go over the cost of everything. They estimate that the work-up is $3,600 (I haven't tallied my receipts yet, but I know this is a high estimate). For ONE IVF at CCRM, they estimate (depending on how many stim meds you need) that it will cost between $15,000-$18,000. ICSI will cost an additional $2,600. CGH will cost an additional $5,000. I will also have to pay someone locally to monitor me before we fly to CO on cycle day 6 and we will also have to pay for all travel arrangements. I am estimating that we will be somewhere around $30,000 for one cycle. Holding a baby in my arms: Priceless. The up side is that we will get a refund from our local clinic of $25,000 if we don't have success there (more on this later) or if we decide not to cycle there again.

1:30 Consent Review- We both had to agree and sign a bunch of documents that talked about things like what to do with our embryos in the event that M dies, I die, we get divorced, etc. The documents also informed us of the risks of doing IVF, consents to do assisted hatching ICSI and cyropreservation.

2:00- Blood draws- My poor, dear husband hates needles. He had to have two vials drawn for further testing and I had to have five vials drawn for further testing. I will explain more later if anything is found.

Finally, our appts were done! What a long day and one filled with a lot of wait time between appts. After we left there we started talking about everything and DH mentioned that we should maybe do our one last cycle at our local clinic. We initially signed up for their warranty program that guarantees us three fresh cycles and any resulting frozen cycles. So far, I have only done two fresh and the two resulting frozen cycles. DH asked ever so delicately if I would be happy doing only one more cycle at CCRM and then being completely done and not doing the last remaining cycle at our local clinic? He gently asked why I am so afraid to have potentially six failed cycles? I guess my answer is that I don't like to repeatedly feel like a failure. I know that we are young and we have a lot of factors on our side as Dr. Schoolcraft pointed out, but dang it, I just want a baby!

DH explained that the next time we could cycle at either CCRM or locally would be in March and then if we have two more failures locally that we could go right to CCRM. He thinks that since we have completed the work-up that the stress will be off somewhat and that we know we are ready to go there in the event that we have failed all of our cycles locally. Not to mention too that we have already paid for one more fresh and any resulting frozen cycles locally with the warranty program. And whether we quit the warranty program now or we go through all three fresh cycles, we still get the same amount of money back -$25,000.

We also talked about the timing of everything too. DH will be going back to work in March (he is self-employed and works in construction and we shut down in the winter months in MN as it is too hard to dig with the ground being frozen) and the timing for cycling at CCRM in the spring is not good. We would prefer to cycle there in the winter months so that he doesn't have the stress of trying to conduct business long distance during his busiest time.

This all makes tons of sense to me. I know in my previous post I said that I wanted 2009 to be a defining year for us on whether or not we have another biological Angel. In thinking about this, I am not sure that I agree with that anymore. No matter when we decide to "give up" and if we don't have another Angel in the process, it will be difficult to say that our IF journey is over. So, why rush it? As Dr. Schoolcraft pointed out, if I am young, produce lots of eggs and have a child carried to term (things on my side), what is my hurry? Right now, time is on my side, so why don't I just take advantage of it and finish my cycles locally?

Of course, I may change my mind tomorrow, but it feels good to write this out and insert logic into my pea brain. DH has a good point and he is part of this journey too. I know that we have done things that neither of us ever thought we would be doing or would have had to do. And I know that I have been the one in the drivers seat pushing forward and calling the shots. So, for once, I think I will leave it up to DH and let him call the shots. After all, the shots I have been calling haven't been working and I feel like I need a break from being in charge:)

Friday, January 23, 2009

Fears of the Unknowns

I was driving down the road today and all of the sudden it hit me! We are flying to CO on Sunday for our work-up! In my mind I was thinking "Holy sh*t, I can't believe I am doing this. I am flying halfway across the country to have a baby!". I got butterflies in my stomach and then I started to panic. If we decide to cycle out there and we fail, I will be so utterly devastated. Even though CCRM is one of the best clinics, not everyone has success there. What if we cycle there and I have a worse response and don't produce as many follicles/eggs and our embryos end up being worse quality and none make it to blast for the CGH testing? I have always had great response and tons of blasts to choose from on our two fresh IVF cycles at our local clinic, but what if CCRM puts me on a different protocol and it just doesn't work for me? What if we do CGH and none of our embryos come back normal? What if we spend all of this money on ONE cycle and it fails? What if I leave there feeling my lowest of lows and still no baby to take home?

Of course I wouldn't go to CCRM with no hope. What would be the point? I do have hope that I will have another Angel. I do have hope that L will not be an only child. I do have hope that CCRM can get me pregnant. I do have hope. Ah, yes, that tricky little thing called "hope". On so many bright days it is my best friend. On so many dark days it is my worst enemy. Hope and I have a love-hate relationship.

I would like to think that 2009 will be the defining year for us. Either we will have another biological child or we will not have another biological child. But, how can I possibly think that way, in all reality? Unless I have a hysterectomy, as my fellow blogger Planet Davila pointed out (http://planetdavila.blogspot.com/2009/01/is-it-time-for-hysterectomy.html), then I will never completely lose "hope" that we will have another Angel.

And what if CCRM is not the magic for us that it is for so many others? What will we possibly do next? Will we give up our dream of expanding our family? Will we go through the lengthy process of adoption, as my fellow blogger A Miracle to Come, so thoughtfully wrote about (http://amiracletocome.blogspot.com/2009/01/adoption-thy-name-is2yw.html)? Will we look at donor egg, donor sperm, donor embryo, or surrogacy? Will we live with broken hearts for the rest of our lives? I mean, what will become of us, really? I just don't know. I sure wish I had answers to all things Unknown.

Thursday, January 22, 2009

Hello, Visitors!

A couple of weeks ago I added a visitor tracker at the bottom of the right side bar of my blog. Many people have told me that they have been reading my blog, but I wanted to know how many. I have had almost 400 visitors to my blog in the past couple of weeks! I realize that a lot of these are repeat visitors, but I am just surprised that so many have stopped by. I want to thank you all for reading my blog and listening to me ramble day after day about my cr*appy IF life. If you stop by and feel comfortable doing so, please say "hi" by leaving a comment. If you don't have an account all you have to do is type in the "encrypted" word and then click on Anonymous and your message should post. If you are having difficulties, please let me know through email (friends and family) or IVFC.

Wednesday, January 21, 2009

Remembering Myles and Cycle Day 3 lab

Please take a moment today to help me remember Myles. He was born one year ago today and is a little Angel whose life was far too short. My dear friend, Niki, is his very wonderful Mommy. I met Niki on IVFC and she also goes to the same local clinic as I do. We have met IRL and she is an amazing person whose spirit shines through. Please take a look at her blog and remember her sweet little boy with me. She has a video montage of Myles's life on the right side bar of her blog, if you wish to view it. http://myjourneytomylesandbeyond.blogspot.com/

I went to the local hospital today to get my cycle day 3 labs drawn. They agreed to draw my blood and turn it into serum and then store it in their freezer. When I get back from CCRM next week I have to bring my orders from Dr. Scool.craft to the hospital along with the shipping kit and they will send it to CCRM for me. Once CCRM gets the serum, they will test it in their own lab. Woohoo! I am so happy that they were able to do this for me without the doctor's official orders. They are literally saving us a whole month in getting started to cycle at CCRM, if that is what we decide to do.

Monday, January 19, 2009

AF Update and Karotyping Results

AF arrived bright and early this morning! I am so glad I didn't take Pro.vera to induce AF. I would probably still be waiting for her to arrive. I called CCRM this morning to confirm our appointment for next Monday, January 26!!

I also asked for the instructions on what needs to be done to draw my cycle day 3 labs before going to CO. They are not legally supposed to give me any instructions since I am not technically their patient until we go there next Monday. She did tell me that if I could find someone to draw my blood for me that they need 2 tubes of serum and that it needs to be frozen and then I can put it in a cooler and bring it on the plane with me. If we wait until next month to do it then we won't be able to start stimmining until March and then we will be in CO when M starts back up to work this spring, which will be really inconvenient. If we could stim and do the ER in late February/early March it would just work out a whole lot better. Tomorrow I will start calling my two OB offices and the local hospital to see if they can do this for me without official orders from CCRM. If not, we will just have to wait to get the official orders from CCRM on Monday and then have it done next month and send it to CCRM for testing.

I also received a phone call from my local RE today that M does NOT have a balanced translocation. Now that he has been tested, I will be going in tomorrow morning to have my blood drawn to get tested for a balanced translocation. If my clinic would have just let us both be tested at the same time, that would have been way more convenient.

It's been a productive day, that is for sure. I have booked our flights, hotel and car rental and I am just about to call my Dad to confirm that he will take L while we are gone. I should feel relieved that everything is coming together, but somehow I am feeling a bit stressed out. Hopefully this will all be worth it in the end and I will be holding a baby in my arms soon. The "what ifs", "what should have beens" and "if onlys" are already starting to pile up.

Sunday, January 18, 2009

Spotting and Karotyping

Well, I think that AF is on her way! I have been spotting all day today, which is not entirely abnormal for me. When I first started spotting this morning I was practically giddy! I have not been this excited for AF to arrive since before I was married (and, yes, Mom, I did have "fun" before I was married). Hopefully I will wake up tomorrow and she will be here in full force.

To prepare for our trip to CO next Sunday-Monday, I looked at airline prices today. They are really reasonable and less than we paid to go to AZ last week. We will only be there one night and we plan on staying at the least expensive place that CCRM listed on the area informational sheet that was sent out with my packet. When we go down there next week, we plan on looking at some of the other hotels listed so that we can figure out where we want to stay for our extended trip if we cycle there.

Today we were at my parents house and my dad just had surgery on Thursday. He had a bone spur on his foot that broke and was having tons of pain. He told us that he could take L when we travel to CO next week. What a relief! I was already trying to figure out what to do with him since all of the people I trust to take him work on Mondays.

I also called my local RE on Friday to ask if they had received the results of the karotyping for a balanced translocation on DH. It has been five weeks and they have not received the results back yet. They originally told me that it takes a "couple" of weeks to receive the results. I asked the nurse if she could follow-up on it and let me know on Monday. I am expecting a phone call back from them tomorrow. If it turns out that M does not have a balanced translocation, then I will be tested.

Things are starting to roll along, finally.