…Go!

Well, I’m officially off and running on this final FET.  My start-cycle visit was Monday.

Back in June when I had my saline-infusion sonogram (SIS), Dr. E noted that my ovaries looked as though I had “mild” PCOS.  The “string of pearls” of small cysts that are one of the criteria for PCOS were evident.  I was ovulating based on seeing LH surges and having regular periods, but I knew that in SIS I had the cycle before I conceived M without medical assistance, my ovaries had shown no signs of the “string of pearls”.  I dug out my notes from that time and put myself back on the same medication/supplement regimen with a couple small tweaks (prior to this, I had been using lower doses of the medications/supplements that seemed to get me ovulating but obviously hadn’t totally cleared my ovaries of the cysts).  I hoped that with three to four months, perhaps my ovaries would fall in line.  I figured even if we were using the final frozen embryo as opposed to trying to conceive without medical assistance, the more in-line my hormones got, the better the chance for a good outcome.

I’m happy to say that when the ultrasound tech scanned my ovaries Monday, there were none of the little cysts.  My ovaries looked like normal, healthy ovaries.  It’s interesting – I had wondered if the cycle where M came along was a fluke, but it appears that possibly with the right combination of medications, I may be able to put my PCOS into a sort of remission.  I don’t know if that’s reality, since getting proof would mean serial ultrasounds/blood draws, but it’s certainly hopeful.

I took my first del.estrogen shot Monday night, and that is the thickest medication I’ve ever seen.  As someone who has injected an awful lot of oil-based meds into my rear, that’s saying something.  Not much fun, but at least it’s small amounts of oil (0.3 mL per dose) and only every 4th day.  I started the dexa.methasone Monday night as well.  So far, I’ve been able to sleep (steroids tend to give me insomnia) but I’m only two doses in, so we’ll see.

Next ultrasound/bloodwork is scheduled for Oct. 17 with transfer now tentatively scheduled for Oct. 23.

Fingers crossed.

Advertisements

Ready, Set…

Last week, I called the RE’s office about a few assorted matters since the FET visits and meds should start fairly shortly (within the next week or so).  First up was my flu shot.  Due to my job, it’s not so much a question of if I’ll get exposed to influenza, it’s a matter of when.  As I’d read over the medication instructions again, it occurred to me that the steroids – designed to weaken the immune system to provide a better chance at implantation for the embryo – might cause my body not to form much of an immune response to the vaccination.

Based on my period-tracking app (which is fairly accurate for me), my cycle is set to commence this weekend, which also concerned me.  Weekends are the worst time to have to start things or call medical offices in general, not to mention I work on the weekends.  I wanted to make sure everything was squared away and I knew who to call and what to expect.

Turned out to be a good thing I checked in.  Dr. E confirmed that the flu shot did need to be obtained before I started the steroids and hopefully in enough time to give my immune system the time to build the antibodies.  That meant the day before leaving on a major trip I was calling pharmacies to see where I could get one.  The one that had vaccine was the one not in my insurance network, so I paid about $41 for something I usually get for free.  Add it onto my running infertility tab, I guess.  Better than getting sick later – if this cycle works, I’m on the steroids until I’m 8 weeks along, which puts me into December, aka flu season, based on the best information I have (the dark part of my mind is grumbling that this is ridiculously optimistic, why would I think this cycle is going to work at all?).

It also transpired that the local office isn’t staffed with a nurse on the weekends currently, just a lab tech and ultrasound tech, so start cycle visits have to go to the main office (around 2 hours away) on Saturday/Sunday.  “I can’t do that,” I said.  The nurse – who knows me well and was at the office through 2013-2014 when I was doing the majority of my cycles and IVF – said that since I know the protocol, can do my injections, and understand when to call if something gets strange, she could do my start cycle visit the week before my period is projected to start and then she’d leave word with the office that I could be seen locally for the ultrasound + blood work.

I’m not sure if I’m comforted by the fact that I knew to call in and check the finer details (because there’s always something) or a little unnerved that I’ve spent this much time doing ART.

Anyway, I had my start cycle visit Tuesday.  That went well, I nailed down the details of exactly which office to call at any point in the weekend if my period starts, and we mapped out as much of the cycle as possible based on my app.  At this point, it’s just a waiting game.

Current Cycle Status

Content note: Final FET feelings + already present kids mentioned.

Well, this cycle is finally starting to become real.  I’ve been going back and forth with the RE’s office to start pricing out drugs and nail down the slippery little details that I’ve discovered can really derail things quickly.  I confirmed that they still open at the same time they used to, that now they do Sunday appointments in my city (it used to be that they only took Sunday checks about 1.5-2 hours away at the main office), and got copies of all the paperwork.  When my period starts this month, I’ll call, get the prescriptions, and order the drugs in preparation for next month, thus outlaying the first actual cash in this endeavor.

I’ve noticed that I’m starting to have a more reasonable reaction to the prices again.  Maybe it’s that I’ve been out of the ART world long enough or that we’ve spent money on other things in the meantime, but I’m keenly aware that what we are spending on this cycle is going to be right around what we paid for our entire upstairs flooring in a high end, water resistant laminate including installation.  I remember when I paid for the flooring and called Arthur to give him the final bill remarking that while it wasn’t cheap, it was about what we’d paid for FET cycle past and – salient point – we weren’t paying for a chance we’d get a floor, we were actually going to receive a floor.

That last sort of sums up the mixed feelings I have bidding farewell to the RE’s office and ART.  I’m really grateful for the fact that IVF brought us older daughter and also cognizant of the immense emotional and financial costs that went into all the cycles.  One of the things that’s hard about ART and IVF is that beyond picking a doctor/office/lab and following the protocol, there’s really very little I could control in the cycle.  I was at once expecting my first IVF to fail (because I’m a defensive pessimist) and also completely shocked when I miscarried (apparently there’s some underlying optimism there after all).  I’ve known for a long time – working in the medical field – that modern medicine as a whole is extraordinarily powerful in some ways/instances, but also falls badly short far more often than some of the glowing articles and incredible stories would have people realize.  Even knowing this, I found it hard to stack up the hopes I had with the grittier, less successful realities.

It’s the end of ART for us.  One way or the other.  I’m almost 37 and it’s time.  Whether or not we see if something breaks loose on our own if the cycle fails is something we’re very undecided on.  Met.formin really does appear to regulate my cycles but in my late 30s, other concerns such as higher miscarriage rates are starting to tick up (and that’s making the enormous presumption that I’d get pregnant at all – certainly not a given with my history).  I’m not going to lie, I have a little bit of the ache these days at the thought of being done, I’d really love it if the cycle worked out, but I can’t tell if that’s a deep, ongoing thing or if it’s happening because I’m immersed in getting ready to try to get pregnant with the FET and if the beta is negative will dissipate with some time.  Despite the occasional achiness, I’m grateful for where we are now.  I have no doubt that regardless of outcomes, life is going to go on and I believe it’s going to be good.

I Had Forgotten The Rules of RE Office Phone Tag…

microblog_mondays

Watched Pot Theorem: The more you stare at your cell phone after leaving a message, the less likely it is to ring.

Murphy’s Law of Returned Calls: The phone will ring once you have stopped watching/procrastinating and gotten into a project where you can’t reach the phone or a pen easily.

Public Places Corollary: The more public the space you are in when the return call comes, the more likely you are to have to discuss your menstrual cycle or reproductive organs in detail.

This post is a part of Microblog Mondays.  If you want more, head over to Stirrup Queens!  Thanks to Mel for originating and hosting.

Clear

microblog_mondays

I went for my saline infusion sonogram (SIS) today.  Walking into the building, I could feel my anxiety almost immediately ratchet up.  I mean, I think my RE’s great, the staff at the office has always been fantastic, but it’s the site of more than a few Really Bad Days so my body/mind seems to have a fairly automatic response to walking through the doors.

I checked in, waited, and was ushered through to the ultrasound room.  Changed.  Dr. E came in and, seeing my reader, asked what I was reading.  “Dr. Deirdre Cooper Owen’s book Medical Bondage, about James Marion Sims, the origins of American gynecology, and the way the use of Black enslaved women and Irish immigrant women as test subjects has influenced pervasive myths about pain tolerance and such that are still coming up today,” I responded*.

Never let it be said that I am not honest (and exceptionally bad at making small talk).

Dr. E thankfully engaged the topic and so that’s a good bit of what we talked about while I had my SIS.

As far as results, things look fine.  My ovaries are mildly polycystic (the usual) and my uterus is clear.  Now I get to wait for September.

*It’s an excellent book so far – if a hard read – that absolutely deserves a serious discussion of its own.  I read about it on NPR’s Code Switch Book Club and picked it up because anything that talks about medical biases regarding race and sex, especially ones that effect perception of pain and treatment, is an extremely relevant read professionally and personally.  

This post is a part of Microblog Mondays – if you want to read more, head on over to Stirrup Queens.  Thanks to Mel for originating and hosting.

The Left Overs

microblog_mondays

Last week I finally bit the bullet and made what I plan to be the first in the final series of appointments with my RE, hopefully culminating in a final embryo transfer around early-mid October 2019.  I mean, my RE is a good doctor and I like him, but I truly won’t be sorry to see the end of treatments and the clinic and all the attendant stuff.  I’m looking forward to moving on and coming to end of the infertility journey.

One part of infertility, however, isn’t going to be over anytime soon.  The reason I wound up at a fertility clinic in the first place, PCOS, still factors into my life, health, and daily living.

This is one of the parts of infertility that I really hadn’t considered much when I was in the trenches, mostly because in the trenches, it’s a day-to-day, minute-to-minute battle.  At this point, however, I’ve got a bit of breathing room to consider the future and that future continues to include PCOS.

And PCOS…sucks.

Mostly, it raises my risk of diabetes along with a number of other conditions, which means monitoring and care to ensure that I remain as healthy as possible.  For me, this means a daily dose of met.formin.  While it doesn’t work for all PCOS women, for me, it’s a miracle drug.  When my second RE put me on it prior to my second fresh IVF cycle because at that point, we were throwing everything reasonably possible at the infertility, I noticed my cycles regulated a bit and we got better egg retrieval and embryos.  After I gave birth to my first daughter, I went back on it to attempt to control the PCOS and boost my milk production, then continued on it and was surprised when, over several months, my acne abated and my cycles regulated.  Because PCOS is one of the big wild card conditions of infertility (some PCOS women have a terrible time conceiving while others, surprisingly, don’t have much issue at all), we were overjoyed when this led to our second daughter.

I managed without met.formin until I stopped nursing/pumping for my second daughter, but at that point, the PCOS symptoms returned with a vengeance – acne, wonky cycles, the whole nine yards.  I called my OB/GYN who was fine with putting me back on the met.formin and things have calmed down since.

I’m fortunate when it comes to PCOS because I have a fairly reliable external indicator about whether or not the PCOS is under control: acne.  If I’m breaking out massively, generally, I have cysts on my ovaries and the attendant issues.  I’m also fortunate that (so far) I’ve been able to find treatments that abate the symptoms considerably.

Despite the fact that my OB/GYN is good and I can somewhat see how well controlled my PCOS is, I know that I need a good primary care provider, especially since I’ll be able to stop seeing my RE (who has helped with managing my PCOS and been my back-up with that for years now).  At the moment, I’m starting to work on searching for the right doctor.  PCOS isn’t ending just because my infertility is resolving.

This post is a part of Microblog Mondays.  If you want more, head over to Stirrup Queens’ blog!  Thanks to Mel for originating and hosting.

Thinking Through my IVF/RE Experiences: Part 2

This is the second part of my coming to terms with my IVF/infertility treatment experiences, picking up when I switched doctors.  Read Part One here.

I’ve written in a Q&A format, mostly because that seemed easier than trying to form this as one narrative piece.

What was the difference between the first and second RE?

I switched because my second RE was the doctor who “officially” diagnosed my miscarriage.  He was kind and compassionate through that awful moment and promised that he would *personally* talk to my OB/GYN to help arrange the D&C.  I was super surprised the next day when my OB/GYN told me that 2nd RE had, in fact, actually called and talked to OB/GYN.  It was probably one of the first times I’d been promised something in that office and it actually happened.

I mean, that was the biggest difference.  2nd RE actually followed through on his word consistently.

I also appreciated the fact that 2nd RE wasn’t nearly as uncomfortable with the really strong emotions that come with IVF as 1st RE (2nd RE was a lot younger than 1st RE, so I wonder if that played a role).  After my ectopic/miscarriage (following my FET), I walked in for the follow up appointment loaded for bear, so to speak.  I cried for pretty much an hour plus, and I really appreciate that he didn’t try to cut me off or tell me that it was okay, we could try again.  He told me that it made total sense that I was upset, that we did need to take a break at this point.  Also, he was in favor of limiting the number of IVFs – 3 fresh was his personal max in my situation, and as he put it, that was only if we wanted to go that far at all.  It was helpful to hear that he wasn’t advocating for more and more and more and that it was okay to say enough.  In that follow-up, we decided we’d do one more round of fresh IVF, but if that failed, we were probably done.  He supported that decision.

2nd RE also was willing to try things that helped me get through.  I asked, prior to my FET, if my embryos could be grown out to blastocyst stage (they were frozen at 3-day) prior to transfer – and if they couldn’t get that far, then at least I’d be spared the 2 week wait.  Even though this wasn’t clinic protocol, he was fine with that.  He also would call me personally if things were changing/not going well/etc.

Did things go perfectly after that?

No, I mean, there were still communication issues at times between staff in the clinic, but it was better.

What helped?

I mean, honestly, it’s amazing how far listening and basic compassion goes.  Don’t sell false hope.  Follow through on your promises.  Keep in communication with patients.  Respect limits and boundaries.  None of this is reinventing the wheel – it’s stuff clinicians should be doing.  Unfortunately, it’s time consuming, and I think this is where problems come up.  My clinic offered a complimentary session with an infertility counselor with IVF, but it’s not really enough.  It’s not something that can be entirely outsourced – the doctors and staff at clinics have to be involved.

One thing 2nd RE did that I found helpful was that he gave me his personal work email – the one that went directly to him.  Funny enough, I never wound up using it.  But it took a HUGE load off me mentally to know that if I had one of those questions that wasn’t serious enough to call the on-call physician at 2am but was bothering me, I could send an email.  It also helped to know I could contact him using my own words and not have to rely on someone else passing the message along.

Also, when 2nd RE had bad or mixed news, he would sit down with us – I mean, physically, sit down.  I know this sounds sort of strange, but it helped because he wasn’t sort of “standing over” us and could make eye contact that way.

What are some thoughts on clinics and the experience?

I think one thing I would say to infertility clinics/staff is that even a single failed cycle, whether that’s IVF, IUI, whatever, can represent an enormous loss to the patient.  It’s time lost, emotional endurance lost, and as crass as it feels to mention money, it can be a big financial loss.  I mean, a single cycle of IUI or TI with injected fertility meds for me cost around $800-$2500, plus the time and emotion that goes into it.  Even clom.id or fem.ara, with timed intercourse, while cheaper, still ran about $150-$300 including the ultrasounds.  That’s not impossible, but it’s not an inconsiderable expense either.  By the time my husband and I got through infertility treatments, we had spent >$40,000.  For perspective, we spent about as much on a down payment for a 4-bedroom house + some new furniture + some new flooring.  We don’t live in a super expensive area, admittedly, but it’s still a boggling comparison.  Having a cycle fail doesn’t just mean all the emotional losses (which are considerable as well) but also a sickening amount of money and financial stability in many cases.

I was really grateful when the fertility clinic I used took down all the baby collages that patients could see.  I’m fine with clinics having stuff like that in strictly staff-only areas, but I remember really clearly passing the “baby board” with my miscarried fetus still hanging out in my uterus and feeling like someone had kicked me in the face.  I did not find it “hopeful” or helpful to have those out.  It made me feel like a defective failure.

It would also be nice to see “success” and “failure” re-defined when it comes to infertility.  I’m not a “success” because I had kids – I have absolutely no idea how I managed to pull that one out.  In other words, it’s not because I did something “right” or “wrong”, it’s just how things worked out.  Likewise, I wasn’t a failure when my cycles weren’t working and I miscarried twice in a row.  I would love to see clinics be much more mindful of patients as whole human beings who have intrinsic worth and dignity regardless of whether or not they have children.  I view success – when it comes to infertility – to be comprised of having a life one considers full and meaningful no matter what that looks like.  Basically, coming out on the other side is a huge victory.