Schedule of Events!

We had our Plan of Care appointment yesterday.  This is where we got our entire “schedule of events” and instructions on medications.  It was a long appointment, but we got all of our questions answered and are very excited about the whole process!

To start, the “mock transfer” that they did turned out great.  Due to the healthy condition of my ovaries, I am going to be on the lowest dose of medications available, which means less money and less side effects (hopefully).  K’s “swimmers” were perfect - as usual - so they don’t anticipate any problems with fertilization. 

There were many consent forms to read and sign.  Do we agree to do IVF?  Do we understand it isn’t a guarantee?  I agree to use Lupron (more on that in a bit), even though the FDA hasn’t approved it for fertility.  What do we want to do with K’s back-up sample in the case of his death?  What do we want to do with the frozen Embryo’s in the case of my death?  His death?  Both our deaths?   Do we give them permission to do ICSI (manually inserting sperm into the egg) if the eggs don’t fertilize on their own?  There is a lot to consider and a lot of legal junk.  We took all that paperwork home to discuss and sign. 

Here’s a list of the medications I/we will be on:

Birth Control Pills (BCP’s):  These are to help control my cycle and to let my ovaries rest.

Lupron:  This inhibits the release of certain hormones by the pituitary gland, which may interfere with development of healthy, mature eggs.  It is actually only approved by the FDA for use in endometriosis (scars & cysts in the uterus & cervix), but it is the most commonly used medication for IVF cycles.  Lupron causes a false menopause, but the purpose of using it is so my doctor has total and complete control over my cycle.  She explained to us that my 'normal' cycle as we know it no longer exsits.  This is extremely important.

Bravelle & Menopur: both are a follicle stimulating hormone s(FSH) used to stimulate my ovaries to mature a bunch of follicles (pre-eggs). 

Progesterone: This is to keep the lining of my uterus nice and thick so the embryo’s have a soft spot to nuzzle into. 

Metformin: a common diabetic medication, but for me, it will help decrease the chance of miscarriage and gestational diabetes.

HCG: human chorionic gonadotropin.  Say that 3 times fast!  This is known as the “trigger shot”.  This shot will tell my ovaries to release all the mature follicles.

Pre-Natal Vitamins: this is pretty self-explanatory

Baby Aspirin: this is to keep any clots from forming

Doxycyline: Anti-biotic to keep everything nice & healthy around simple procedures

Medrol: Steroid to take after the retrieval since it is a fairly invasive procedure

Then we got our color-coded calendar for the next 6 weeks.  From now until 10/10, I just do my BCP’s and pre-natal vitamins. 

~On 10/11, we got to a shot class, medications in tow.  This will be to confirm that we know just the right amount of Lupron to use and how to administer it.  This is also the final day to pay.  We both start an antibiotic this day as well, and I start on baby aspirin, too.  I will still be on my BCP’s.  The pre-natal, BCP, antibiotic, baby aspirin, Lupron cycle continues for one week. 

~10/18 is the last day I take my BCP’s and 10/20 is the last day for our antibiotics.  I still continue on the Lupron, pre-natal and aspirin. 

~On 10/25, we go in for a baseline ultrasound to see how my ovaries are resting, how my uterine lining is doing and to do another shot class for the FSH shots, which start this day.  I also get a blood test this day to check my hormone levels.  I continue the Lupron shots, FSH shots x 2, pre-natal and aspirin through 10/29.  This is also the last day I am able to exercise and K’s last chance to get lucky for a bit. 

~10/30 leads to yet another blood-draw. 

~11/1 is when the fun truly begins.  I am still on all 3 injectible medications.  Now I go in for daily ultrasounds to see how large the follicles are and how thick my lining is.  Each day after this is touch & go depending on the results.  If they aren’t quite mature, I continue my shots and go in the next morning for another ultrasound. 

Right now, based on my ovaries’ previous response to medications, it is estimated that my trigger shot (HCG) will be done on 11/3.  It is very interesting how this part of the process works.  The trigger shot tells your ovaries to release all mature follicles (called eggs once they are released into the fallopian tubes).  In a normal person, your body naturally does this and you release 1 mature follicle.  After all my drugs, we are hoping to get 18-25 follicles.  Exactly 36 hours after the trigger shot, I will go in for the egg retrieval.   So, I will probably be told to do my trigger shot anywhere from 7:00pm to 1:00am on 11/3 so that the retrieval can be done during normal business hours on 11/5. 

K takes one antibiotic the day prior to the retrieval, so that his fresh sample is healthy.  I will re-start an antibiotic and also start a steroid for the day of the retrieval.  This is because the egg retrieval is done with a needle that goes through the vaginal wall, directly into the fallopian tubes, where all the little eggs are floating around, just waiting to be snatched up.  Since the retrieval requires me to be in a twilight sleep, K will take me there, give his fresh sample while I am in the procedure, and then we’ll have a day of relaxation at home. 

And then we wait.  During this time, each healthy egg will be put in its own little dish (used to be test-tubes).  Then,  50,000 to 100,00 sperm will be put in EACH dish, and the fun begins again.  Friendly people in white lab coats will watch each egg to see if they fertilize and divide cells.  They will watch the eggs for 3 days.  After 3 days, if we have lots of healthy, mature, divided eggs, they will be considered viable embryo’s.  If we have some ‘average’ to ‘good’ embryo’s, they will be transferred on Day 3 to try and grow inside the uterus.  If we have a lot of ‘excellent’ embryo’s, they will wait until day 5 to let them get big & strong before they transfer. 

The estimated transfer date (ET) is currently 11/8 to 11/10.  They will take the embryo’s (1 to 3 max) and place them in my uterus.  Immediately after this, I will rest for 30 minutes in their office, completely laying down.  This is when the acupuncturist will come in and do another treatment.  Studies show that acupuncture done the day of the ET can increase success rates by 20%-50% and decrease miscarriages by 20%.  Plus, it is just so relaxing! 

The next two days are required “Couch Princess” days.  I get to lay around, eat lots of high-fat dairy foods (Ice Cream!!) and be waiting on hand and foot!  I think I’ll be bored pretty quickly, but K will be taking time off to keep me company, and we’ll probably rent every movie at Redbox!

8-10 days later, they will do a blood test for baseline results.  I won’t hear the results of this test, because there won’t be anything to compare them to.  Then, 8-10 days after that, we’ll do another test to see if it worked! 

I know that was a lot of information for us to process, so I’m sure all of my family and friends out there reading this have probably given up by now!  I will be updating you all each step of the way, but that was your crash-course into IVF (at least our IVF). 

I bought the medications today, and they will be delivered tomorrow to K’s bank.  I don’t think he will be quite prepared for the huge, refrigerated box of liquids, powders, creams, pills and syringes!  Thankfully, it wasn’t as much money as we were anticipating for medications, so that is a big bonus!

I go to the acupuncturist, Scott, tonight for my first consult and treatment.  I am very excited about this visit, as he has great reviews from friends, and is highly recommended by Dr. Slater.  Just talking to him on the phone to schedule my appointment made me feel less stressed!  So, I’ll update this about that visit tomorrow! 

3...2...1...

My body decided it wanted to join the team and cooperate for once.  Cycle day 1 yesterday, without any medications!  Of course, we were up in Cascade, in the middle of a 45 mile ATV ride.  I called my doctor's office & left a message for the nurse.  She happened to call me back when we were in the ONE spot that had service.  She said this is a good thing, to get my blood draw when I get back sometime and start on the Birth Control on day 3. 
The birth control is to give my body a nice rest.  Since BC makes your body think it is pregnant, it gives my ovaries a nice, long time to relax and not do any work.  I should be on it for right about 2 months, so things will be moving slowly for a while.  
In the mean time, here's a picture of the cute little cabin we were visiting when the nurse called me.

Step 1: The Consult

K and I scheduled a follow-up consult with Dr. Slater for the 1st of September. Since she hadn't seen us in 2 years, she needed to go over any changes in our medical history and the likes. 
Dr. Slater is very convinced that the appendix issue is the cause of my current problems. Since I'm on the Metformin and it has gotten my glucose/insulin ratio back to normal, that means the insulin resistance is 'cured'. I should be ovulating on my own. I am not. She said appendix issue has cause pelvic lesions, which is keeping me from ovulating. She said the fact that 3 previous IUI's did not work helps confirm this for her.

So, our only option is In-Vitro Fertility, or IVF. It is a long process, starting this month.  They only do IVF cycles every other month, so we would be on the November cycle.  She feels we have a 65-70% chance of success from IVF, with a 40% chance of twins. 
We both had to get some blood drawn at the appointment to make sure we haven't contracted any diseases in the past two years.  K, hater of needles, nearly passed out from the simple blood draw.  That will give me some joking ammunition for a while!

We talked with the financial counselor and got to the nitty-gritty of it all.  She broke down each cost for each procedure, and gave us an estimate for the medications.  I won't get into the details here, but let's just say it isn't cheap. 

We talked about it ourselves and with our wonderful families.  After much discussion, and the full support of the families, we decided it is now or never!  I'm not getting any younger at 31 and the price only goes up with each year as the success rate goes down. 

I called Janna, the IVF coordinator, today to let her know that we are ready to rock and roll.  She is out for the day, and probably out the whole weekend, though they may be open on Monday.  So, this weekend, K and I are going up to Cascade for a relaxing weekend with some friends before the real fun begins. 

This is a long process.  Even though the actual procedure is not until November, the process starts in about a week.  I will update this as time goes on so everyone can follow the progress with us. 

I hope everyone enjoys the ride!!

Let's Start from the Beginning

I'll give everyone a little background on the road so far.  When I was 14, my appendix burst and it was burst for 5 days before we knew it.  I had to have a few surgeries, spent 10 days in the hospital and got to miss a whole bunch of school. All for a useless part of my anatomy. For those that don't know, when you appendix bursts, it leaks poison into your body continuously, which is one of the reasons it is so deadly. The surgeon said it was one of the worst infections he had ever seen. I recovered fully from this without any residual problems...or so we thought.


Fast forward to the near present.  While living in Carson City, my OBGYN, Dr. Tomita, diagnosed me with Poly Cystic Ovarian Syndrome (PCOS).  The name of the condition comes from the appearance of the ovaries in most women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).  The main symptoms of PCOS include infrequent menstrual periods, excess hair growth, acne and obesity.  Thank you Mayo Clinic for the accurate description*.  Another condition that normally goes hand-in-hand with PCOS is insulin resistance.  This is not diabetes, but rather your insulin/glucose ratio is off kilter.  Since insulin is a hormone, it is affected by PCOS. Basically, I don't ovulate like normal women.  If there isn't a little egg to fertilize, there is no baby.  The only time this is a problem, is when you are trying to get pregnant.
There is your medical school training for the day.


We did all the normal 'easy' treatments for PCOS.  It cannot be cured, but you can manage the side-effects enough to go around it.  I went on Metformin, which is a diabetic medication, but is used for the insulin resistance.  I went on Clomid for 7 months, which forces ovulation.  We did a hysterosalpingogram, which basically looks at the tubes and the uterus.  Nothing worked.  I was referred to Dr. Faulk, a "reproductive endocrinologist", otherwise known as a fertility specialist.  However, we moved to Idaho in early 2008, so I wasn't able to see him.  When we got to Idaho, I established care with Dr. Rice.  Dr. Rice performed an intra-uterine insemination (IUI) procedure in May 2008.  This is fondly known as the "turkey baster".  I won't go into the specifics, but all the conditions were perfect.  It failed.  She decided to refer me to Dr. Slater.  Dr. Slater, it turns out, is Dr. Faulk's partner!  What a small world.  We had our consult with Dr. Slater and she noted the appendix issue in my chart.  She thought we should try a couple more IUI's with some more aggressive medications.  Medication, shots, ultrasounds, more shots and the procedure within 2 week time.  Then wait 2 weeks for the results.  Then start all over again.  We did two more procedures that summer, and both failed. 
In August of 2008, my dear Nonni passed away, which was incredibly hard for me.  At that point, K and I decided to take a break from living life in 2-week increments.  It was emotionally breaking and financially not very feasible any longer.  While we didn't realize that our break would be this long, here we are. 

Read on for the current fun!