Gametes In Love

The fertilization report is in! The phone rang this morning, ironically right at the moment that Hubs went to use the rest room. Believe me, this was one call I DIDN’T want to take. I was so worried I couldn’t handle the news if they were bad.

So here is where we stand: out of the 8 eggs, only 7 were mature. Initially we had planned to ICSI half and let the rest meet sperm and do what eggs and sperm do. However, because of the low mature count they ICSI’ed all 7. Of those, 5 fertilized. 5/7 isn’t bad! I was expecting 50% fertilization rate (out of the 8), so it’s 1 better overall. Did you keep up with my math there? ;p

Here’s what our embryos look like today!

With these numbers, we’re looking like a day 3 transfer. We’re hoping that at least 4 will survive to Tuesday, but we also want good quality so that they’ll stick. We won’t know how many make it or what their quality will be until Tuesday. Until then we have some more discussions to have: like if the quality isn’t fantastic how many we want to put back in. Before all this I thought at most I’d want to put in two, but given how unpredictable this process has been thus far, everything I expected has turned out differently.

This morning was one of the most stressful days so far. I woke up with so many questions: Did I ovulate by accident too early? What if all my follicles are duds and there’s no eggs in there? If there are 0, is there anything I could have done over this last month that would have changed that?
I also woke up with the worst cramps I’d had thus far. Not awful, but not great. They also got worse as the procedure got closer.

We showed up to find the parking lot empty and the office lobby empty. It was 7:30am: exactly when they told us to be there. Umn… Ok. So we sit, and we wait. At this point my husband proceeds to the bathroom to work on his…. contribution 🙂 Now this sample you can either work on in the clinic, or gather up at home, provided that you can deliver it within 45 minutes. He decided to do it in the clinic. Now… the clinic doesn’t have a fancy room with low lighting, a cozy couch and posters of hot models up there. It has clinical tile, fluorescent lighting and for good measure a few Playboys: yep, we frequently refer to it as “the bathroom”, complete with stalls and all.
Now… for those of you that haven’t had to provide “a sample” for clinical use, it comes with instructions. The instructions have fun statements like “please clean your hands and wash your penis”. As Hubs is telling me this I go, “So what did you do?” He says “Well, I couldn’t just walk up to the sink and dribble all over the place, so I suck it in the toilet and flushed!” Yep, my jaw just like yours dropped and my eyes bulged out. Then he started laughing and I realized this was one of his jokes.

Now while my man considering hygiene in the fancy sample room (and lamenting the article to photo ratio of Playboy), I was escorted to one of the consultation rooms to go over the rest of the paperwork. Then I had to slip into one of the sexy gowns that tied in the back. Over the next 30 minutes I listened to the nurses prep for the procedure, until my anesthesiologist came in to put in my IV. He was pretty good — no popped veins, which I’m infamous for. It’s funny how the moment your IV goes in your body immediately starts to feel a wave of cold. Apparently, that’s the saline.
The next part went pretty quickly. I was escorted to the surgical room and lied down on the table. At this point my body began to shiver uncontrollably. The room was cold, but I don’t know why all of a sudden I felt THAT cold. They kept putting heated blankets on me, and with each blanket I could hear my heart rate slow down (hearing the beeping in the background and all). As I looked up I saw a dragon fly mobile (kinda like the ones they put on babies’ cribs) hanging from the ceiling. It also had glow in the dark stars and cut outs of fairies. I was thinking to myself “Nestie dust” fairies (Nest.com reference here). As I sat there pondering this they turned off the lights. I don’t remember anything after that.

I woke up about 10. I was thinking “Woot! My ovaries don’t hurt anymore. But dang my uterus is sore”
Of course it is! They just took a needle and stuck me with it a few times on the inside. It feels like getting an immunization: you’re sore at the site for a bit afterwards.

So here’s how the procedure works: the needle is guided by an ultrasound and is connected to a glass tube. As it punctures each follicle it extracts the fluid within and the egg. Once the tube is filled up they take it to the lab, which pours out the contents in a Petri dish and starts counting.

I had 8 eggs! Now if you remember at my last ultrasound I had 9 mature follicles and a few stragglers. It is only 8 eggs, which isn’t a lot, but given the fact that I was preparing myself for 6 a few days ago, those two additional ones felt like a gift. Since there were so few, they’ll probably ICSI them all. I just hope they’re all mature enough to work.

So now we wait. Tomorrow between 8am and 9am they’ll call us with the fertilization report. These next 24 hours will be hard. At this point it is all out of our hands and there is literally NOTHING we can do. After the fertilization report we wait another 2 days, hoping the embryos survive to transfer.

And the chant now continues: “Fertilize, fertilize!”

Today is the day. Now is the time.

I’m sitting in the waiting area of the doc’s office while Wifey is probably knocked out on the table. Each time a door opens I quickly look up expecting to see a nurse coming towards me with info – my logical mind says “good news” but my emotional mind fears that it’s “bad news”.

Wifey gave me a task to do while waiting, create my holiday card list of names and addresses – as mind numbing as that is, I still can’t even focus on it. So hands jump to keyboard (you didn’t think I would arrive for a three hour wait without a laptop did you?) for the therapeutic release of a blog post.

News Flash – I just heard our RE’s voice in the hallway. She was just checking on any waiting patients before she “went to retrieval”. An hour after our check-in at the clinic and it sounds like the doc is heading to Retrieval. That’s a good sign – things are on schedule.

Back to earlier thoughts. I thought after the shots ended we would coast into the retrieval appointment. It was at that point that my mind fought off the negative thoughts – had I been giving the shots correctly, were we too flexible in the timing of the shots, did I really give 5 IU last night or was that 10 IU. I could also tell that Wifey was more uncomfortable – the noticeable cringe on her face when the cramps shot through her were more frequent, the stiff look when we hit a bump on the road. It made me appreciate the sacrifice she was going through for US.

As much as it seems like a selfish reason, I’m glad I gave all the shots and attended most of the doc visits because I feel a part of this process. Otherwise I think I may feel more like an ingredient in a recipe – “Please produce a sample. Now wait here.”

The clock ticks away. The procedure is probably starting now. In an hour, we’ll be on our way home. Then we’ll have the challenge of replacing any negative thoughts with hopeful ones while we wait for the fertilization report tomorrow morning.

Today was our last day of injections! We ended the evening with the trigger shot. Much like the name suggests this injection triggers ovulation. In two days, or 35 hours to be exact, I will be knocked out in a surgical room while our RE harvests my eggs.

My last ultrasound was also today. I have 9 follicles that the doctor is pleased with (16mm +): 1 straggler (~14mm), and two little munchkin ones (at about 8mm). I really wanted there to be more. I’ve even given my body little pep-talks. It’s actually more like a chant that I’ve been running in my head “grow eggies, grow!” And they’ve been growing: just not enough for the little ones to catch up.

I heard two statements at the appointment today that shot me through the heart:

1. In general, not all mature follicles have eggs inside: only about 2/3’s do. So here I’m thinking “Great, now our odds are even worse!”.
2. My uterine lining is on the thin side, which blows: thin lining equals lower chances of implantation. There are no supplements or drugs I can take at this point to improve that.

It just frustrates me that these two elements are so out of my control. I can will my eyes to blink and my fingers to type, but I can’t will my ovaries to evenly grow more than 10 follicles.

However, in good news, did I mention that tonight’s trigger shot was my last shot? In even BETTER news, it was subcutaneous!!! When we showed up at the trigger injection training last night I saw the nurse put on the big 1.5 inch needle on the syringe. I asked her if it was possible to trade in our 1.5” for a 1” as I heard they shorter ones hurt less. She looked at me perplexed and said: “this is just the mixing needle, the injection needle looks like this” and pointed to a short 0.5” one. “It’s subcutaneous”, she says. At that point I blurted out “I love you!” Ok, if you’re sitting back there thinking “What’s the big deal?” let me explain: trigger shots, typically using the drug HCG are intramuscular. Big needle goes in your bum and hurts… a lot. Our clinic’s protocol, however, is to use a different drug, Novarel, which is administered subcutaneously with a short needle in the fat of your belly. I know that belly shots sound yucky, but believe needle fearing me: they are a piece of cake.

Our egg retrieval is scheduled for Saturday morning. I’ll fill you guys in when the anesthesia wears off. Meanwhile, please chant with me “Grow eggies, grow!” and throw in a “Fertilize, fertilize!” chorus line for good measure. More on that Saturday!

So this week-end is when they’ll harvest my eggs. Right now we’re shooting for Saturday, but it could be as early as Friday: it all depends on how well my follicles are progressing. We find out the day of the retrieval tomorrow.

At my last appointment (yesterday), I had 10 maturing follicles, each measuring b/w 9 to 12 millimeters. By the time we’re done they’re supposed to each be about 18mm. I don’t know about you, but that boggles my mind: I can’t believe that a single egg, which is the size of a pin head requires 18mm of living room. Apparently these suckers like to live large. No wonder I’ve been gaining half a pound of weight a day!

To be honest, I’m a little disappointed with the total number of follicles. There are 10 good ones, and two smaller ones that my RE doubts will mature enough in time for the retrieval. Even she said she was surprised that for my age and diagnosis I had just 10. I was really hoping for 12-15. I’ve had one of my stimulating meds increased twice now, which is why I’m kind of down on the whole thing. I was really hoping my body would respond better. I know that stimulating my ovaries is kind of a guessing game: too little meds and you get nothing, too much and you over-hyper stimulate and bad things happen. However, att the end of the day, it’s an odds game, which is why I was hoping for a few more XX players. Of the eggs that are retrieved not all are mature enough to be fertilized. THEN not all DO fertilize. THEN of those that DO fertilize, some don’t make it past the first day. I’m just worried that there won’t be enough to make it to at least the 3rd day to go back 🙁 I’m told that ultimately the day of the retrieval is when we find out the final egg count because there are some that can’t be seen on the ultrasound. I’d like to think that will be the case so I’m staying hopeful we’ll get at least 12 good ones out there.

Have I told you about the ultrasound equipment yet? I don’t think I have. Well, you know those little wands that you see in the movies that they rub over pregnant ladies’ bellies? Yeah, that’s not it! This is something that they put literally up where the sun don’t shine. It makes sense since they need to see in there up close and personal, but it’s hard to take seriously a piece of equipment that requires a condom and some lube whenever we meet. I giggle on the inside each time I see it. It’s attached to a camera that shows on a monitor what’s going on inside. It took hubs and me literally 5 ultrasounds to finally make sense of what we’re seeing. Imagine watching a black and white TV after hours where there’s nothing but static. Then the doctor starts talking about and pointing at some black dots. It’s nothing BUT black dots. How they can tell an early follicle from a pixel is beyond me. Now that they’re finally getting bigger, I am starting to develop some comprehension.

I am definitely starting to feel different though. I don’t know if it’s the meds or some psychosomatic conditions but:

• my sense of smell is really heightened
• I feel a nauseous at some weird times of the day
• my cramps are getting sharper daily
• I SWEAR I can feel my ovaries when I press down on my lower abdomen and feel something lumpy down there!
• I feel kinda bloated. Walking, driving over bumps and standing for prolonged periods of time definitely jiggle my insides
• I’d like to think I’m maintaining a good attitude, but my temper is certainly shorter

Despite all these things I fell very fortunate so far. I’ve been reading the stories of other people going through IVF and I think I have it pretty easy in comparison. Hopefully this isn’t a “no pain, no gain” scenario, where the rate of success is in direct correlation to the discomfort of the process.
Its times like this that I like to look back on all the things I’m thankful for:

• the fact that Hubs and I are on the same page with our treatment and we never had any major disagreements on how far we’re willing to go for a baby
• a kick ass manager who is supportive of what we’re going through and lets me have the time off for all these appointments and recovery
• moving to a new clinic which so far, knock on wood, has kept the process pretty stress-free
• a new medication protocol which calls for short needles for all but one of the meds (the trigger shot)
• no routine blood drawing. Given my fear of needles, this has been pretty nice.
• a group of resources (family, friends and Nesties) that support and listen or have gone through this process and answer each one of my tedious questions

Ok, enough cheesiness.

What else?

Oh, yeah – I’ve decided to participate in one of the Stanford studies and donate my immature eggs and embryos that don’t survive for research. About a year and a half ago I really wanted to do this, but decided against it until we have kids. Now I can and am feeling pretty positive about it. I knew that I (personally) wasn’t going to find a cure for cancer, but if I can contribute in even a small “cell” way to the research towards eliminating some terminal or debilitating diseases, I feel like I’ve done my part.

So that’s my very LOONG entry for today. Here’s hoping that we’ll have a few more eggs pop-up tomorrow!

Ok, I’m exaggerating a little, but I really do have bruises! We started the injections about almost two weeks ago.

I gotta say they’re not nearly as bad as I thought! The anticipation of the first shot was worse than how it actually felt. I think I cried a little on my walk up the stairs for my first shot. I’d like to think that I took it like a champ though. It also helps that the man administering my shots is pretty good at it 🙂

Bruises still happen though: I haven’t figured out why. For awhile I thought it was related to the needle hitting a blood vessel, but there’ve been times I’d bleed a little and no bruise and other times I’ll get a nice blue shiner the next day. So if you have any tips, please share.

I like the ramp up of the meds. Starting with one shot a day and then progressing to 3 has been pretty good. I take one in the morning now before leaving for work, and 2 at night. I also do them on my sides — I can’t come to terms with doing them in my stomach. I’m running out of room though, so I might have to brave it. We have another week on this regimen, before they take my eggies out.

That’s about it otherwise though — not much to share so far. I expect the unpleasantries to begin next week. You might here some more wining then.

I want to take a second and thank everyone of you that’s posted and is rooting for us. It’s so nice to have your support!

Our meds arrived today! At about 10:30am my doorbell rang and in came this box. I had to take a picture because it’s hard to appreciate just how many, many, many, many syringes I’m about to get intimate with.

Here you see said ginormous box. I had to put a water bottle by it for reference. Inside it were all the goodies you see in the following picture. All those little baggies? That’s needles and syringes baby! Are you jealous yet? Taking inventory was an experience to be sure.

So my first shot is tonight. We get to practice what we learned in class today.

The class was interesting. There were about 8 hopeful women attending. It’s strange to attend a class that reveals something so personal with others you’ve never met before. I say this as I’m writing a blog, so I get the hypocrisy, but at least this is somewhat faceless, and I don’t have to see recollection of personal pain in your eyes.

I was honestly surprised that there were only 3 guys there. For us, knowing what a baby I am when it comes to needles, HIM not coming was NOT an option. He is the one who will give me the shots every day — so you bet he’ll be piercing that orange (it’s what we had to practice on first) over and over!

The first hour was spent going over the process, what the medications were and why they were used, all the good stuff. Then came the part with the needles. Apparently I didn’t have to say anything out loud about not liking those things. The guy who sat across the table from me just saw me cringe each time the nurse poked at her orange. Then he made fun of me. Jokes on him though: his wife’s reaction truly wasn’t much better!

The needles actually aren’t too scary looking. They’re only about half an inch long. The scariest needle, which is an inch and a half is a mixing needle. So for now, I’m feeling brave…. for now. Ask me later when I’m licking my wound.

[Happy dance][Happy dance][Happy dance]!!!

Over the last two days we’ve had two separate appointments with Stanford: one for the sonohystogram (SHG) and a second for a cycle planning and financial overview. I was not thrilled about the test (more on this later), but I was really nervous about the financial talk.

It went wonderfully! It was smooth, to the point, the insurance coordinator had done all her homework — I was just waiting for “the catch” and it never came!!!! Our IVF cycle will pretty much be 100% covered by our insurance (except for the $500 deductible), and one of the meds. Boy is this a night and day difference over 2 weeks ago! I feel that I can finally relax and get started with the program.

The SHG test was tons better than the HSG. It didn’t feel good by any means, but it wasn’t nearly as bad as the other one. HE came with me and pretty much held my hand through it. Since there’s no x-rays this time he could watch (the monitor that is) and ask questions. It was sweet and gave me a nice little view over what the next 10 months (hopefully) will be like.

WARNING: This next paragraph can be a little graphic. Skip ahead if you don’t want to know what an SHG feels like.

…So, I’ve been trying to think of a way to explain the feeling of this (SHG) test. The best I could come up with is if someone shoved a syringe up your nasal cavity and expanded a balloon while on the inside and just kept blowing it up. Then they fill it up with water until you feel more pressure. You feel pressure and its weird, and you don’t like it and yet you can’t make it stop. If this scares anyone, sorry — it’s just the best way to explain it. The best part is being told to “relax” as this is happening. I don’t know about you, but having 2 people shoving stuff in your nether-regions while feeling this discomfort doesn’t exactly make me able to relax.

SO… ONTO THE GOOD STUFF.

Our new cycle isn’t too far off from the old one:

• We do injection training this Friday. I think it’s 3 hours long because they spend half of it teaching the partner how to lasso the patient and then submit them into a syringe inducing position. At least I hope they’ll cover that because I think we’ll need it in our house. I HATE needles! I can’t say that enough. The nurse today was suggesting that HE drop some dimes on the ground and as I lean to pick them up he shove the medicine in my tutcus. I’m a cheap date, but some dimes? Come on — he’ll need to do better than dimes!
• Our first injection is also on Friday.
• We’ll extract the eggies the first week-end of December (around the 8th), and we’ll put them back around 3 days later (probably the 11th).
• First pregnancy test will be 2 weeks after the egg retrieval. So week-end right before Christmas.

Oh, in other cool news, we can ask for pictures of the embryos before they’re inserted. I’m so looking forward to showing off our little dots to you!

So that’s that. We’re off to read, initial and sign a small mound of paperwork (in triplicate). Our unused embryos will have a living will of their own. Who’da thunk it?

Today was our appointment with Stanford. It went well! I’m excited (as I’m about to share), but also cautiously optimistic.

I miss our old doctor. I don’t think that will change, but I think we got REALLY lucky with her. The bond with had with her is one you rarely come across in a Dr-Patient relationship.

However, our new doctor is nice and we like her. She’s straight forward, not afraid to quote research and seems to be inline with our communication style and treatment preference. She sounded a little nervous when she walked in, but I have a good feeling about her. Everyone speaks highly of her, so I have confidence. By the way, if I haven’t mentioned it already, the new doctor used to work with FPNC (the old clinic). She’s now just practicing at Stanford. I think this is actually a bonus for us, because she has the background of where we come from.

I don’t know what I expected of this meeting to be honest. I guess I though it would be just an intro to rehash our history and roughly talk about our options. Then meet with some other people and then return to go over cycle planning. I thought that getting to a cycle planning stage would take at least a week.

Well, it’s definitely moving a lot quicker than I expected (which trust me, is good). Since all of our records were transfered over, and she knew FPNC’s protocol, we covered some of the basics and jumped straight into planning. We are going to go for an IVF round. Since I’ve been on the pill for almost two weeks now, we can do the sonohysterogram and catheter check at any time and start the Lupron as soon as next week-end. I go in for those tests on Monday, then on Tuesday we meet with them to go over the cycle details and go over financials. The financials are where things fell apart last time, so I’m cautiously optimistic this place will work for us. I still haven’t bought the cow yet. After getting burned once, I’m not so ready to get too excited yet.

So that’s the summary: in effect we’re about a week behind where we would have been with FPNC’s schedule.

In other, serendipitous news, as we were driving down to the appointment (I’m not kidding — we were halfway to Palo Alto) we got a call from the old clinic. It was their Chief Financial Officer who wanted to speak with us about what happened two week ago. For some further clarity from my last post, the woman who told us to move to a different clinic was not the CFO. She was someone that reported to her. She had however called the CFO on her mobile, while she was on the phone with us and then told us to move to a different clinic. This left us with the impression that this was per the CFO recommendation. It wasn’t as it turns out, but the end result was the same: we were encouragd to leave the practice. Anyway, the woman sounded nice and sympathetic. I didn’t speak to her myself, but heard the whole conversation over HIS mobile. In summary, she apologized for what had happened, and offered to work with us and make-up for our experience if we chose to go back to them. So I feel a little bit better about them. We won’t go back to them at this point, as they’re still not covered by our insurance company, but if things don’t work for us on the only round we do get expensed, it’s good to know we have options. I’m also hoping, that they’ll change some of the information they communicate in their information sessions: if our rough experience helps another couple not have to go through the same anguish we did, I’ll feel better.

So that’s it for now. Not too much new info to share, I suppose. There’ll be lots more next week. I promise!

For every step forward it feels like we’ve been taking two steps back. We’re so far back, in fact, that we’re now at the beginning.

We spoke with FPNC’s contract negotiator today. She, as the one fully knowledgeable of what has been agreed with our insurance carrier, had the final say of valid information. During this conversation we confirmed the worst case scenario: the clinic’s major procedures are out of network for us, they will not be certified, and the clinic has no plan in the near term to seek coverage for their lab and surgical room facilities through any insurance carrier.

Then they proceeded to tell us that one of their former physicians is now working with Stanford Fertility Center, and they would like to recommend that we work with them and that they would be happy to transfer our records and initiate our appointments with them. We didn’t ask for this – they asked us to do this… in effect firing us as their patients.

The part that sucks is that we LOVE our doctor. She has been simply wonderful and I dread having to start the process over with the unknown of another physician. It’s hard to find someone that you ‘click with’ the way we did with her. We have not concretely ended our relationship with FPNC, but we’ve had to put an immediate halt on all procedures with them. For all I know, we could end up in the same scenario with Stanford. Given, however, the money involved it is worthwhile to at least investigate that option.

Since then I’ve called the cycle scheduling admin and had to cancel my upcoming SHG test as well as the injection training. I figured that the clinic that would be performing the IVF treatment should be the one conducting this test.
We also had a good chat with our physician as well. We explained the situation, she was very sympathetic and she’ll look into this whole situation on her end as well (esp. the part where the contract negotiators are encouraging her patients to leave the practice).

So that’s where we are: back to the beginning. We thankfully at least know what our diagnosis is, and what the methods of treatment are. Otherwise everything gets asked all over again: What are all the procedures that we’ll undergo? Who will be billed for each procedure and why? Is each facility performing each procedure in network with our insurance company?

I’m remarkably at peace with all this: maybe it just hasn’t hit me yet.

Meanwhile I’m going to remain on the pill. I figure at least this way we’re in a little more control over my cycles and can decide when to start a procedure, than just waiting for nature and having a bunch more rushed conversations.

A few good things have come out of this: for one, I can continue working with my personal trainer. I’ve been on a good track so far: I’ve lost 5 lbs, two inches off my waistline and an inch from each of my thighs. I can keep at it: being healthier will only bring on a healthier pregnancy (I hope). For another, we’ve had a remarkable outcry of support from friends and family. One of HIS friends works with Aetna and has been so generous in donating his time in helping us get us answers from the inside. All of our friends/family have extended us many shoulders to lean on. I’m also learning a great deal from the many experiences from other families in similar situations on the Nest.com. It’s truly an online support group.
I feel very fortunate to have all these in my life right now.

Our first appointment with Stanford is Nov. 9th. That’s two weeks away. See you then!