WTF Appointment

SO yesterday I had my WTF appointment about why our IVF cycle failed.   We went in expecting the worst.  I really thought the RE was going to push donor eggs.  He’s brought them up before and I thought for sure, after only having 2 eggs fertilize, that he would bring them up again.

We walked in and it was standing room only.   The RE was in a chair and my husband and I had a chair but there were 2 med students standing and our nurse was in the room standing.  It made me really nervous.  Our doctor pretty much drew a diagram and explained everything to us.

We ended up with 9 eggs.  Of those 9 eggs only 5 of them were mature.   However, 2 of the eggs were close to being mature and did end up maturing in the lab. The other two were straight immature.   Of the 5 mature eggs, only 2 fertilized.  This could be due to quality, it could also be due to the fact that I had some endometriosis in the follicles.

So, the doctor basically thinks it was just bad luck.  The one embryo wasn’t good quality so they said that was typical.  The other looked good but 42% of embryos that look good have genetic issues and will not implant.

This is when I got a list of 3 choices.   The first choice was to keep the same protocol.   He immediately crossed that out and said it would be stupid to try the same protocol.   The second option was to learn from this previous cycle and try a new protocol.  The third option was donor eggs.  However, my doctor feels that even though my AMH is really crappy, my ovaries responded well to the Follistim and that I should try

Now that he knows how they react, he has a better idea of what to do.   Part of the problem was my estrogen level so we are going to do estrogen priming.  We will also be starting me with Lupron along with the estrogen instead of using Ganarelix.  Then he is going to crank up my Follistim dose.  The hope is that we will have more mature eggs and better quality eggs.

Let me tell you how I feel about this.   I feel good because it’s a plan and he thinks we can do this using my own eggs.  I also feel good because I can take a month or two off before starting again.

Now for the bad.  I’m scared to death.  This is probably our last ditch effort.  It’s the last one my insurance will pay for and we don’t have the money to go beyond insurance.  I’ve been a crying mess the last 2 weeks.   I can’t even imagine doing this all again in 2 months.  My butt is still itchy and sore.   I am up 5 pounds.  I don’t have much motivation to do anything and I’m worried about the future.

But here we are.   We can’t wait another year to do this all again.  For one reason, I turned 35 this week.  I’m not getting any younger.   My husband is older then I am.  Another reason is my AMH and FSH levels suck.   They aren’t going to get any better.    The doctor actually wanted me to go ahead and do this cycle late August/early September but that won’t work with my schedule.  My nurse says October will be better anyhow.  We will see.

So friends, I probably won’t be writing too much over the next month or so.  If I have some thoughts I’ll write them here.  If not, I’ll be back in September when things start heating up again.  I think for now I need a bit of a break from everything.   I’m stressed out, I’m sad, and I’m in a state where I don’t know what the future will hold for me.

National Infertility Awareness Week (NIAW)

Yesterday started National Infertility Awareness Week.   I so badly want to post status updates on my Facebook page, shout it out on Twitter, and shares quotes on my Pinterest page.   I think NIAW is such an important time because it teaches those who do not struggle with infertility about those of us who do.

Unfortunately, I am not “out” to my friends or family so I won’t be posting anywhere but here and on Twitter.   They don’t know about my daily struggles and don’t understand what it’s like to be blindsided with an unexpected pregnancy announcement.   They don’t understand that asking me when I’m going to have a baby is like punching me in the stomach.  But I can’t blame them, they don’t know any better.   They don’t know my struggle.

We’ve been on this crazy journey for almost 3 years now.  Three years ago this May I took my last birth control pill.   Two years ago this May I started charting and we really started trying.  One year ago this May we had 2 IUI’s behind us and were looking at IVF in the summer.

This year isn’t much different.   I’ve had 2 more IUI’s and am waiting for June for our second round of IVF.  Infertility isn’t pretty but it isn’t anything to be ashamed of.

This year’s theme for Infertility Awareness Week is You are not Alone.   You don’t know how true that is until you experience infertility.   I was surprised by how many of the women I talk to online, how many other bloggers, experience infertility.   I am currently on 3 chat boards with women just like me.  In fact, 1 in 8 couples experience infertility so why is it such a taboo topic?

Do you want to learn more about NIAW?  Go to the RESOLVE site and learn more about it and more about how you can educate others about infertility.

IVF #2 Consult

Yesterday morning I had my IVF consult with the RE.   He is new to the clinic where I go but he did do an ultrasound on me several months back.  When I walked into his office he told me we had to have a heart to heart.

He talked about my AMH being .26 and my FSH being 14.2.  He said that while the numbers weren’t great, they weren’t impossible either.  He also said based on my previous IVF response in August, just 6 months ago, he feels like we can produce some quality eggs.

He talked about his own IF journey.  It took he and his wife 8 years of going through IF before they had their children.  In fact, he didn’t go to medical school until after his children were born.  Because of the difficulty they had, he wanted to help others like him and so he went to med school to be an RE.   Pretty cool that he understands where we are coming from.

He explained that my options are to go for an aggressive IVF cycle as soon as possible or to use donor eggs.  I told him we weren’t ready for donor eggs so we are planning on an aggressive iVF cycle.  He wants to use a Lupron Flare protocol because of the DOR diagnosis I’m a candidate for low response.

We also discussed embryo biopsy.  Because of my low number of eggs left, the doctor would like us to have embryo biopsy done on the embryos we produce.   He can give us a 70% success rate if we do that.   It will look for chromosome pairs, genetic disorders, and will determine the gender of the baby.   I think it’s crazy that they can know the gender of the baby before placing it back in me.  I’m not sure if I could choose so I think we’ll tell him to just place the healthiest embryo.

The doctor told me he thinks I can produce eggs and is giving me a good shot.  I’m feeling much better then I was previously when I got the test results back.  He also gave me his email and his personal cell phone in case I have any questions for him.   While I still don’t feel great….I feel much better then I did last week and I know have some hope.

Bad Test Results

I haven’t posted in almost a week because I’ve been sad…and mad…and feeling hopeless.   After my IUI was cancelled on Saturday the RE wanted to take a look at my AMH level.   One year ago it was sitting pretty at 2.56.  That was a good number and my doctors were pleased.   At that time my FSH was around 9 which they said was fine as well.

When my FSH came back at 14.2 last week the doctor was worried.   FSH is what makes the follicles and pushes them to become a mature egg.   14.2 is a high number and they don’t like to see it.   Put that with the fact I only produced 1 follicle with the Letrozole this month and they were worried.

I was on pins and needles for 4 days waiting for my AMH results.  The nurse called on Wednesday and told me to call her back.  She didn’t leave the results on my voicemail so I knew something was wrong.

An AMH level of under 1 is low and concerning.  When I called her back she told me my level came in at .26.   It had drastically dropped in the past year.   .26 is considered significantly low and shows that I don’t have much time left to have a baby.  The nurse told me we need to look at IVF as soon as possible to get the best results.   the only high point of the conversation was that I responded well to stims in the past and as recently as January so they were hopefully if we go to IVF next cycle I’ll be ok.

I cried a lot that night.   I couldn’t handle it.   How was it that just this past summer they told me I had plenty of time left, not to rush?   I produced 22 eggs in August during my IVF cycle.   I was a champ.   Now, I’m worried I won’t even produce 5 eggs during my next, and quite possibly my last, IVF cycle.

We had already planned on doing IVF in April but I’ve been waivering because I have a lot going on at work in April.   With the new numbers in I don’t really care about work and what I’ll be missing.  They will have to get on without me because the time to do IVF is now, and I’m going for it.   The plan is early April though I’ll have to have some testing done prior to that.

So overall it’s been a bad week.   I’ve had trouble putting the numbers out of my head and don’t know what to do to make it any better.   I’ve had several people tell me I’m on until I hit .1 for AMH but sitting at .26 I’m not very far away from that.

IUI #5 Monitoring and Bad News

I went for monitoring this morning and was sure I was going to trigger today for IUI on Saturday.  This is how it always is with my IUI’s.

We got to the office late because the roads were crappy this morning.   As soon as I was there they took me back.   The RE looked on my right side and found 1 follicle at 15mm.   He looked on the left side and had a very difficult time finding my ovary.   It took he and a nurse a lot of pushing and pulling and poking but they found it.   No follicles at all.

This was concerning since for the last 4 IUI’s I’ve had 3 follicles.   He told me he wanted me to come back on Saturday for monitoring and possible IUI.   Boo.

He then wanted to talk to me about my blood work from last week.  My FSH levels were back and he is very concerned that the number jumped from around 5 to 14.2 in just 6 months.   14.2 is very high and could mean I have DOR (diminished ovarian reserve).  He’s also worried because my ovaries didn’t produce how they normally do.

He ordered an AMH test to see what my levels are there.   I’m very worried they are going to come back low meaning a diagnosis of DOR.   This sucks as we are planning on IVF in April.  The RE is concerned as well because of my lack of response to Letrozole this time as well as my FSH numbers.

So, a bad day here.  Hopefully I’ll have more info on Saturday, though the AMH levels won’t be back in for 7 days.

My first RE appointment

Our first appointment with the RE was in February of 2014.   We had to drive 2 hours to get to the office so I had to take off work that day.   I had no idea what to expect.   I’d heard from others that I’d get blood work and maybe an ultrasound.

We walked in the doors and I was amazed by what I saw.  The entire waiting room was filled with women of all ages and several men as well.  I was shocked by the number of people in the office but I thought maybe it was a fluke.

Waiting for our names to be called took forever.  Finally a doctor came out and called my name.   My husband and I stood up and met our RE.   He was a middle aged man with a big smile.   He introduced himself to us and then took us to his office.

Once in the office he asked us to tell him about some of our history.   I went first and then my husband went.   The doctor then pulled out all of our blood work and my HSG and went over the results in detail with us.  As it turned out all of the tests were normal.  He then told us that we could continue trying on our own but since we’d already been trying on our own for a year the chances of us getting pregnant on our own were only around 5% per month.   That was a blow that made me pause.

I asked him about our test results.   If everything was normal what was going on?   He explained to me that 15% of the general population has infertility problems.   Of those 15%, he said that between 15-20% are unexplained infertility meaning that all of the tests come back negative and there is no real reason why we couldn’t get pregnant on our own.   I was crushed.   I thought going to the RE would tell us what was wrong and how to go forward.   Luckily, the doctor had a plan for us.

He basically gave us all of our options ranging from doing nothing to IVF (in vitro fertilization).  We could try a medication like Clomid and see if that worked.  We could do Clomid with IUI’s (intrauterine insemination).   We could do IUI’s with injectibles.  There was also the option to go straight to IVF though he warned me that if I had insurance I would probably have to wait and do a few other cycles first.

We talked through it and while we wanted to wait on our insurance, we decided that if all went well the next month we would start with an IUI.   The doctor reviewed that with us and we decided we would use Clomid and Bravelle (an injectible) on our first cycle.

I felt good having a plan though I was very, very scared.  I hated needles and couldn’t imagine giving myself an injection.   However, because of our ages, I wanted to do everything I could to have a baby now.

After meeting with the doctor we were taken into another room where we met with the financial counselor.   She asked us for our insurance information and then asked us a few questions.   She said she knew others with this insurance and most likely infertility would be covered.   She did caution us that normally insurance companies wanted 3 IUI’s before moving on to IVF.   She then said most companies wanted us to be trying for 2 years before moving on to IVF.

I was surprised by this and told her we had only been trying for a year.  She then asked if we had been preventing prior to that.  I told her I went off birth control pills in June 2012 and we didn’t use any other contraceptives.   She said in the mind of our insurance, we would be closing in on 2 years of trying.   She then let us know that while we wanted to do IUI next cycle, we needed to wait until the insurance came through otherwise they might not pay for it.  I told her I understood and then she left.

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The last person we met with that day would be the most important.  It was my nurse, Betsy.  She came in with a big smile on her face and introduced herself.   We talked a little bit and actually found out we went to rival high schools!  This may not seem like a big deal but where the doctor was located was more then 4 hours away from where we both lived as children and went to school.   Right there we had an instant connection.

Betsy gave us a lot of information.  She gave me her direct phone number and told me to call with any questions.   This was a surprise as most doctors offices don’t want to be bothered unless it’s something major.   I would learn in the next few months that Betsy would become invaluable to me and she really did mean I could call her anytime.   She would get back to me the same day and give me all the information I wanted whether it was something big or just something little.  It didn’t matter; she was there to help me through this journey.

We left the office feeling a bit shell shocked but also like we were moving in the right directions.   After months of feeling like something was wrong with us and there was nothing we could do, there finally was something for us to do.   Now we just had to wait and hope that our insurance came through.