Thursday, October 19, 2017

Feeling good

I talked a lot about redoing our bedroom and it finally happened. I bought the furniture we liked at a Labor Day sale knowing it would take a while to ship and it finally arrived. It's spectacular!  The room is still a work in progress but I'm happy to report progress. Next up is lighting, decor, and accessories.

After seeing what the architect came up with, I've decided against renovating the house to add a master bathroom within the current perimeter. Either we'll finish off the basement or we'll do an addition upstairs (or maybe both eventually down the line). I don't want to have tiny rooms and teeny bathrooms and pay out the nose for it. So that's on hold for now.

I've been talking with my new nurse about our next cycle. I'm trying to schedule retrieval around my work schedule. Things are going to get hectic in the next several weeks so I want to see if we can work backwards from mid-December. That gives me enough time to get mentally prepared and enjoy a few more weeks of normalcy. It will also give me a chance to drop the extra holiday pounds.

I've been enjoying our non-treatment break so, so much. It feels amazing to just be regular without discomfort or pain or fluctuating hormones making me crazy. It's incredible to be able to hold my emotions, something really difficult while on medication. It's so nice to be able to plan a few days in advance because I don't have to assume I likely won't feel well.

On one hand I hate having to gear up to get into this again for IVF 7, knowing the hell coming up. I also hate the idea of all the shots coming up for whatever transfers we end up doing, along with all the side effects that come with it. On the other hand, feeling like this makes me happy to know that whatever treatment hell has in store, it's temporary. It will be over eventually. It's not forever. There's a light at the end of the tunnel. I can and will feel normal again, it's just a matter of time and a difficult chapter to get through. The mere idea of all this being "in the past" and having gotten to the other side is exciting.

Over the past few weeks there was a significant change in my attitude: I've been happy and hopeful. I have energy and a spring in my step. I'm not sure what specifically to attribute it to. The break and lack of meds is probably a big factor. I know that the holiday season was incredibly difficult where we were reminded of our childlessness non-stop. At shul, at family gatherings, at holiday celebrations - triggers were everywhere. Before Kol Hanearim this year at Simchat Torah our rabbi read this prayer specifically geared toward couples dealing with infertility. It was special and gut-wrenching at the same time.

So maybe we hit a new low regarding feeling sad that there was only one way to go, which is up. Regardless of the cause, I'm glad to be feeling good and more like myself, making decisions and taking chances on things I may not have otherwise. For the first time in a while I'm looking forward to what's ahead even thought it's still scary and out of my control.

Monday, October 16, 2017

Next

The last days of the holiday were nice. We were home for all the meals and socialized with friends and neighbors in the afternoons. We chilled, relaxed, overate. It was good.
 
The working plan now is a retrieval cycle in Nov/Dec, trip in January, transfer in February. Details to follow.
 

Monday, October 9, 2017

Sukkot

The first days of Sukkot were tough. Our sleepover guests were exhausting and demanded all of our time and energy. I wrote up a whole post of what was difficult about their stay, but even in an anonymous post on an a supposedly nameless blog, it's still the internet where everything is public and permanent. Suffice it to say it was a lot of work and most of it felt unappreciated.

I used shul as an escape, which kind of backfired because that's where all the ladies with pregnancy bellies hang out (apparently) with their beautiful cute little families. There were triggers everywhere.

Over the holiday I received an email from my nurse that she's moving to a new position. This was our third nurse. Even our nurses get to move on from this hellish journey. I'll be assigned to a new nurse once we let them know we're off our break and decide what we want to do next.

We still don't know what we want to do.  We've been enjoying just being a normal married couple, talking about other things. There are a few days we took off at the end of October to take a quick getaway but we're still undecided about where to go. Florida is our first choice but it's still unclear if they're completely zika-free. We also got the Israel-trip-bug again and we want to see if we can try to make a trip work for 2018. On one hand we want to give treatment the best chance possible and really believe it's priority. On the other hand it's an expensive trip and we're sick of the merry-go-round. I don't want to postpone any treatments because I feel my age ticking but I also don't want to feel like I let life slip by while waiting for results.

I know I'm not the best version of myself these days. I feel drained and exhausted. I feel like I'm surviving, not thriving. Just taking it one day at a time, one hour at a time. I want to make changes to help make things better. Maybe it is worth spending the money on an expensive trip to get change of scenery and a fresh outlook on life.

Thursday, September 28, 2017

Choices

The financial counselor that has screwed me over in the past is no longer there, thankfully. I took my questions directly to a supervisor to make sure I understood my options.

As we debate next steps whether to do IVF 7 or FET 6, I want to know exact numbers. What are the costs? What programs are available? Are we getting the biggest bang for our buck?

As I mentioned before, my clinic has several "Shared Risk" programs. One such program has the option of doing up to 6 fresh IVF and unlimited transfers from embryos from those cycles. They make you transfer every viable embryo from one IVF before doing a new cycle, up to six times. After six IVF cycles and all the transfers from those cycles have been transferred, if you don't have a take-home baby they refund 100% of the money (not meds, of course). Any embryos I have in the freezer right now wouldn't count toward the program. So while I can't count them in the "unlimited" transfers, they also won't hold us back from doing fresh IVFs. That's fine with me. Even though it includes everything except meds, it's a lot of money up front. There's also an additional fee if we want to do back-to-back cycles without transfers in between. Once you get a take-home baby the contract is complete, regardless of how many cycles you've done. Let's put a pin in that for a minute.

My insurance won't cover a fresh IVF as long as we have embryos in the freezer. Since we are interested in "preserving fertility," as they like to call it, we've opted to do fresh cycles even when there were transferable embryos in the freezer. At this point we have two embryos we can transfer (IVF 4, 4/16; IVF 6, 9/17).

I believe we overpaid for a combo IVF/FET which includes one transfer for every IVF in the global fee. I don't want to pay for the FET out of pocket; I want them to go get authorization for it from my insurance. Why should I pay for it if I still have benefit dollars I can use up? Insurance only denies coverage for IVF while there are still embryos in the freezer, but I still have coverage and the clinic should get authorization and use it!  For this last cycle I paid for a combo IVF/FET per the advice of the now-fired financial counselor. When I spoke to the manager I asked for a credit for the FET portion of the fee I paid. If we decide on a fresh IVF cycle, the credit will go toward a new cycle and I will only be charged for the IVF part of the global fee. If we decide to do a transfer, they will submit to insurance for authorization which they said they will as soon as they have a start date. How's that for fun?? I saved nearly $4,000 just for spending 15 minutes asking questions. Take that Geico.

While I feel like getting more embryos is the way to go, I'm not sure I feel that way for the right reasons. As long as they're in the freezer, they're safe and there's hope. In the past five transfers we've ended up with only disappointment and heartache so I hesitate to pick a transfer. I don't want to "waste" embryos. It's obviously flawed logic because if we don't transfer we have no chance at a pregnancy and baby which is the ultimate goal here. Embryos on their own are not babies. When we only had one in the freezer, the choice was easy: don't be left with nothing, keep retrieving. But now that there's more than one, does it make sense to keep doing IVF? I don't know anymore. The right path isn't clear when there's no guarantee one way or another.

In April 2016 when we got 3 healthy embryos to transfer from IVF 4, I thought it would be the last time we'd ever have to do a retrieval. Then this time in IVF 6 when we had 14 embryos on Day 5 I again thought we'd never have to do another retrieval but then only two made it to biopsy. Maybe I have to stop thinking that we're never going to need to do more retrievals. Then there's my age to consider and while I'm not old yet, at 33 the "advanced maternal age" of 35 is just around the corner. There's no way to know how my body will react to a pregnancy, if I ever get that lucky, and no way to know how many transfers it will take to get pregnant with number 2.


I've tried to focus on working on getting one baby at a time, but it's impossible not to think about the future. I know there are no guarantees, but with embryos in the freezer I would be a lot calmer to enjoy baby #1 before needing to rush back in and get started again to try for a sibling. I never thought there would be a specific number I have in mind of how many I need in the freezer before I feel comfortable transferring. I thought I'd be ok with having one. But now that there are two, I want to keep two. Knowing what I know now, I don't know if I'll ever feel content with anything regarding fertility treatment. There are just too many unknowns and things beyond our control.

We got results earlier than we anticipated, which meant that we could still decide to not skip a month. I wasn't so happy with taking a break. If we decide we want to do IVF I want to get it over with. But I recognize that we still need to live our lives. It's been non-stop for over two years.  We just need a break to be normal for a few weeks. Not be depressed, not be niddah, not feel nauseous, not be in pain or uncomfortable. We're aiming to do a small vacation end of October and that would've needed to get rescheduled if we restarted treatment earlier. In addition, my coworker who is now on maternity leave will not be back before December and I know there will be a lot of slack to pick up while she's out.

Back to the Shared Risk program, I don't think I'm going to want to do more than two back-to-back IVF cycles in a row. Maybe after the break we can do one more (at a reduced fee based on my conversation with the manager and the newfound credit on our account) and then start transferring. A transfer would be easier and if it fails we can always do the fresh IVF after.

If this journey has taught me anything it's that there are no guarantees and there are no wrong choices. If we do a transfer and it works then we have a baby and we've won. If we do a retrieval and get more embryos to transfer then we've won. We already know either one of those can fail, or worse start out hopeful and then crush our hearts. We've been there done that: high embryo counts that never develop into blasts; pregnancy that took but ended as a blighted ovum. So I don't know what the right path is; I can only hope that the one we choose leads us to our ultimate goal of having a family.

Just thinking. I don't have the answers, but these are the choices.


G'mar chatima tova.

Wednesday, September 27, 2017

One

It only takes one! 

We got PGD results back and of the two embryos we sent out, one came back healthy. Amazing!!! We had very low hope that anything would come back from this cycle and we're surprised and incredibly grateful that it wasn't a complete bust as we feared.

We're still debating between a fresh ivf and a transfer, but this gives us options. I have more to say about cost but another time. For now, it's a small sigh of relief: a high on this journey's roller coaster.

Tuesday, September 26, 2017

So what now?

Our next step is to decide whether to do another fresh IVF or to do a transfer. The next steps depend on the PGD results of the embryos we just sent out. I don't have high hopes, and I'll still be crushed if they're not transferable, but we still have to give it a chance to come back before deciding.

So for now we're doing nothing. Above all else I'm trying to fight the panic that missing a cycle won't matter in the long scheme of things. While I want to keep trying, I recognize the value in a much-needed break, so that's what we're doing right now. Giving a chance for the results to come in will let us make an informed, strategic decision moving forward. In the meantime I'm enjoying feeling good physically: no fatigue, no stomach issues, no headaches.

Timeline-wise, I don't know how we can do a transfer before January. Specifically because if we do another IVF we have to wait until after the holidays to start, so we're looking at a November IVF, and then the weeks of recovery. Before a transfer they still require several weeks of birth control and then they close the lab for cleaning the last week of December. It's only September but it seems impossible to fit everything in this fall. We'll see.

Our clinic has a shared risk program in which they offer up to six fresh IVF cycles for one fee. It doesn't include medication, but does include cryopreservation and unlimited FETs for any embryos from these cycles. They guarantee a full refund of the IVF fee if you don't take home a baby. The drawback is that they make you use all viable embryos before doing another IVF, so no banking. In addition, once you take home a baby the contract has been completed so it's a gamble because you may pay more for one cycle if it works the first time.

Why didn't we do this in the beginning? Honestly because it never occurred to us we'd still be doing this after so many cycles. I've said it before: I was sure IVF would work the first time. Every failure wasn't just a disappointment; it was also a huge surprise. We were also adamant about banking embryos for the future although now I'm reconsidering that part and just want to see one baby to start.

Pros of another IVF now:
- Banking embryos
- I'm still young enough to be a good responder
- I don't have toddlers at home during recovery

Cons:
- Expensive
- Painful recovery
- Delaying potential pregnancy

Pros of FET now:
- Potential pregnancy
- Less recovery, no time off work
- No added expense

Cons:
- If it doesn't work we're back to sq 1
- Back on a ton of meds: some painful (PIO), some bitter (anti-inflammatory), some bruising (blood thinners)

I haven't been able to read other blogs. I stopped participating in some groups on fb. It takes a lot of effort to answer emails and texts, and I have to fight the urge to ignore the phone when people call to check in. I used to find others' good news in fertility treatment uplifting but lately it causes me to retreat into a darkness that makes it hard to believe it will ever happen for us. Reading bad news makes me relive our own disappointments. I feel like a bad friend but I don't know how else to protect myself. I don't engage in small talk because everything feels like a trigger. Being on guard all the time is exhausting and isolating. Hopefully this too shall pass.

My coworker is on baby-watch and people keep coming up to me and asking me if there's any news. It's bad enough they keep asking; it's worse that when I say no they then go on about their own birth story. I don't know how to escape it. I feel like telling them my situation would just exacerbate the situation and make it horribly awkward, extending the issue longer than this particular news.

I can only hope that this is a temporary mood dip. On Sunday my husband and I watched the movie Collateral Beauty with Will Smith. At first I saw the trailer and thought it was too sad. But after watching the movie, the plot resonated with me. Even in the face of the most awful tragedy (losing a child), there is life after death. I'm the kind of person who needs the plot to wrap up at the end with a neat little bow with a happy ending. Even though the tragedy didn't reverse itself, the main character relearns to see the beauty and meaning in life after tragedy. The movie did a lot to life my mood. Partly it was removing my head from my own churning thoughts, but it was also because it made me take a second look at our journey. In the back of my mind I still want to believe we may have a happy ending - that it might still work for us. Hope is both my fuel and my downfall. 

Sunday, September 24, 2017

RH recap

For the first set of yom tov I made 8 lbs of challah, 4 lb brisket, 4 lbs meatballs, multiple kugels (zucchini, potato, onion), honey cakes, sesame cakes, deli rolls, 4 lbs of stuffed chicken, fish, and salads. I have to figure out what's gone and needs to be replenished for next set of holiday. My husband's family is coming in for first days of sukkot, so I have to think of what to make. 

We had a good mix of social time and home time. When there's a three-day yom tov our guideline is 2 meals out, 2 meals with guests, and 2 meals alone which is a balance that works for us with our different personalities. For this particular set, we were out two meals, one potluck with neighbors, hosting one, and home for two. It worked out well and we were both happy. 

Over the holiday I got caught off guard with my period coming early. My trigger shot was on Friday night two weeks ago. For some reason I assumed it would start on Saturday. I don't know why that mattered when but I basically got caught unprepared. I didn't have anything in the house: fresh out of tampons or even pads. I could have gone to a neighbor or walked to a family member. It was day 1 of a three day YT and there was a long stretch before I'd see the inside of a store. I had an idea: I remembered that after every IVF procedure I'd get a little baggie from the clinic with a disposable heating pack, the pain killers prescription, contact sheet for emergencies, and a yellow little pad.  This is what the clinic offers: those old-fashioned Always-brand diaper pads in the yellow liners (aka medium). It's the worst but they have to offer something and I bet they offer this so people don't steal them from the rooms and bathrooms. Anyway, turns out I had 5 from saving the little baggies from previous cycles. Turned out to be a lifesaver. It wasn't my first choice but I preferred that than missing shul or going around the neighborhood to my pregnant neighbors asking for tampons. As soon as Shabbat was over my husband went to the drug store and saved the day. 

Shul ended about 1:25 pm both days. This year we went to the shul around the corner which was very convenient. Shul was over 1:25, we were home by 1:30. There were assigned seats and the women's section was completely full. The first day the person sitting next to me didn't show up so I had plenty of elbow room. The second day my seat neighbor came and it felt too claustrophobic to stay put so I moved to the back and stood. I couldn't handle being so squished for a long period of time. I get that they try to accommodate everyone who wants to attend. They're currently fundraising to expand the building. 

Davening was good. The chazzan was just ok. The differences between ashkenaz and sefard davening is significant even though it's mainly a similar davening so I missed the songs I grew up with. The davening itself was very emotional for me. Following my unprepared theme, I brought no tissues. I sobbed silently in my corner and just let the tears fall. Eventually the nose situation became an emergency and I asked the people behind me to pass a tissue (since I was trapped in my corner due to the sheer volume of people). I came better prepared the next day and with moving to the back of the room I had the windowsill to put things down.

Overall it was a nice holiday albeit a little long. With my period here I have to think about the next steps but it's too soon and with the holidays in full swing maybe we'll just take the cycle off. That gives us at least a little time to get results of the embryos from this last cycle. 

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