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. 

Tuesday, September 19, 2017

Rosh Hashana 5778

As we get ready to bid this past year goodbye I think about the list of goals I set out for this summer after we found out the pregnancy wasn't progressing. If it had been a viable pregnancy I'd have been 25 weeks pregnant by now. As a way to move forward, I gave myself a list of things I wanted to accomplish by the time the summer was over. In my mind summer ended with Rosh Hashanah.

- Recover from D&C and period return
- Root canal
- Mole removed
- New bedroom furniture
- Second car
- Take a trip
- IVF6 and/or FET6
- New floors on first floor

Other than getting the floors redone, I've pretty much hit every item on that list! I was overly ambitious with regard to doing both an IVF and FET cycles. I didn't think it would take as long as it did to get my period and the first 2/3 of the summer was "wasted" waiting for it. It always feels like everything takes forever between cycles.

I never thought, when first starting this process, that I'd be looking down the barrel of a seventh IVF cycle before even having one child. In theory I know that we've had really good results so far and "it's only a matter of time before success" but in reality it feels like we've gotten the shitty end of the statistic stick every single time. It was statistically low to get a blighted ovum - only 20% of all pregnancies - yet it happened to us. Statistics don't care if you got pregnant naturally or if it was your fifth FET after five IVF cycles.  Statistically speaking, about 30% of embryos that fertilize on day 1 make it to blastocyst stage, yet we just experienced an overwhelmingly low 11% with our latest cycle. I could probably go on but what use is there in dwelling on the failures. I'd rather look at the positives.

So here are the positives. I got pregnant. I stayed pregnant the last time, even after I stopped all meds; it was only the D&C that got rid of the pregnancy because it wasn't viable, just a blighted ovum. We have a healthy embryo in the freezer. We have two other embryos we just sent for testing and we're still holding on some hope that at least one may come back healthy.

This cycle tested my stamina and perseverance more than any other cycle before it. Even knowing what I know now, it's hard to think about how many times we've gone through it; how many more times we may still go through it. I don't know what the future holds.

Last year  I was much more optimistic going into Rosh Hashana. My post was excited and happy. This year I'm burned out. I'm worried about what disappointment may be waiting for us. I believe, somewhere in the back of my mind, that this is still possible for us, but not in the same tangible way I used to. At this point it seems like having babies is what other people do. Getting and staying pregnant with a healthy baby is magical, like winning the lottery.


For this coming year I've set up new goals.

- Take a vacation. We planned to do a trip at the end of October. Now that Florida is supposedly zika-free we wanted to spend a few days on the beach. Hopefully there will still be a Florida after hurricane season. Our quick getaway to NY this weekend was such a boost. I'd forgotten what a refresher it is to get out of your own head and just get a change of scenery, even if it's just one night. We're definitely homebodies and don't like straying too far but I definitely need to keep in mind that we should get outside of our four walls more often.

- Reach a new goal weight. I've decided to continue my diet but less restrictively. I don't want to be
borderline anything anymore, and I know that any weight lost will be helpful in the long run for a potential pregnancy. I've set a goal number in mind, which is 21 lbs lower than what I weighed at last baseline.

- Decide about reno. I want a master bathroom. At this point the whole house belongs to us, but we're working really hard to build a family and God willing there will be little people potty training and bathing in the bathroom in the coming years. If nothing else it adds resale value to the house for when we sell it to afford more treatment :P  Seriously though, there are two options: renovate within the perimeter or add an addition. The addition is clearly the more expensive option but I'm curious by how much more. On one hand I don't want to take out debt unnecessarily. On the other hand what's more debt? I already owe hundreds of thousands on my mortgage, cars, and student loans.... may as well pile it up and enjoy life. My credit cards are clear and I like to keep it that way, if nothing else than as an emergency backup in case we need it for treatment. If a bank wants to lend me money to add a bathroom, who am I to argue? I'm slowly doing the research and finding out what it will entail. It may not happen overnight and that's ok.

- I only have one goal for fertility treatment: take home a baby. I'm not going to put a number on any IVF or FET cycles for the year because it's irrelevant. I hate setting a goal where the success depends on factors outside my control, but it is something we're aspiring to and spending the biggest chunk of our time doing so it goes on my list.

The common greeting this time of year is L'Shana Tova U'Metukah which translates "To a Good and Sweet Year" and the reason behind all the honey as symbolism for a sweet year ahead. It's difficult to go into the prayer season knowing that what we prayed for last year has not been answered. Still, we're still alive and therefore given another chance to get to it this year.

A prayer for something that has already happened is considered t'filat shav which is translated as "wasted prayer." Technically speaking, whatever our embryos are they are. We can't pray for them to change so even though we don't know the results some may say it's a wasted prayer to daven for them to be healthy and transferable. I disagree. I don't think there is such a thing as wasted prayer even if it's not answered the way I wanted.

So instead of harping on prayers that weren't answered last year, I will be channeling my energy on praying for healthy embryos and a successful transfer in the coming year. If you have a minute, any prayer you send up on our behalf would be appreciated.

Despite how burned out I feel with the latest blow, with a new year comes renewal and hope. Wishing all a year of flowering prosperity, a year of happiness and success, a year of fertility and calm, a year of abundance, health, and love, a year of peace and blessing.  L'Shana Tova!

Sunday, September 17, 2017

Gutted

Only two.

Got the final update on our embryos this morning and there were no additional ones that made it to blast. Our final count being sent for testing is two embryos. Knowing the odds of what it takes for them both to come back healthy I'm not holding my breath. I went into this cycle fully knowing that there's a chance it might be a bust. But when we got 28 eggs and 14 embryos on day 5, the chance for a bust seemed so slim. I knew not to be so excited about the high numbers. I knew we couldn't possibly get all of those. But two? Just two? WTH?????

Can't stop crying. So upset. Asked my doctor to call me. We'll see if he does. My husband is ready to call it quits on these people and move to the second clinic. I don't know what to do next. For now I have to go pack for this stupid trip.

So tired of this merry-go-round from hell. I just want to be done with this stage of life and be raising my babies. This is such a nightmare. The high's mess with your brain and make the low's that much worse. Burned out and sapped of any hope or faith right now.

Saturday, September 16, 2017

IVF 6: Recovery

First of all, milk of magnesia directions say a bm is expected within 1/2 to 6 hours. That did not happen. I considered taking a second dose but gave it until morning. It wasn't exactly what I was expecting but still better than nothing.

Second, we got an embryo update. They biopsied 2 embryos today. Just two. They said they're "still watching" the rest but I'm having a difficult time processing the number. I knew to expect attrition; I knew we would likely not biopsy all 14. But to go from Day 5 with 14 to Day 6 with only two biopsied felt like an enormous blow. I know that doesn't mean it's only two for this cycle for sure, but it might be. We only have a 25% chance per embryo for PGD results to come back favorable.

Of course I spiraled from being sad about low numbers to worrying that we may have to do this again to crying that this may never happen for us to just freaking out about what's the point of any of this. I just went through the worst recovery yet and the only thing that kept me going was thinking that we had lots of embryos and there was a chance we'd never have to go through this again. Now I'm not so sure. I'm still not sure.

I need to pull myself together because I have a long week ahead. We're going away for two days tomorrow for a family simcha in New York. I also need to get my act together for Rosh Hashanah: shopping, cooking, laundry, so much to do. People ask what they can do to help and I don't know what to tell them. I can't think ahead enough to know what to ask for.

After Shabbat I listened to the voicemail about the embryo update. As I was processing I got a text from my sister that they're expecting another baby. I'm really happy for her and I appreciate that she texted me early before showing or sharing with the rest of the family. Timing could have been better but it is what it is.

At this point the wind was knocked out of my sails and I'm having a hard time. If I could skip the family get together out of town I would. As it is I don't have anything to wear that doesn't make me look like I have a six-month belly.  As if I don't get enough comments as it is.

Until tomorrow... with whatever news it brings.

Friday, September 15, 2017

IVF 6: Follow up appointment

Yesterday the bloating and discomfort reached levels I couldn't handle so I called my nurse for help. She recommended a few things and said if it's not better in the afternoon to call her again. I called again in the afternoon to report no change and scheduled to come in this morning for an ultrasound. They saw fluid pockets in my belly and around the swollen ovaries but nothing that alarmed them enough to recommend a procedure to drain it.
 
They also asked me to get weighed and for a change I wasn't worried about the number being too high, if only to have some proof that I'm not faking it!  I weighed in wearing my heaviest and longest denim skirt because it's two sizes too big and literally the only thing that fits right now. How's this for irony: my weight was the same number as I had at baseline exactly three weeks ago, to the decimal point.
 
I learned a few things this recovery period:
  • Free water is bad. It collects and doesn't pass as easily. Doctor recommended electrolytes so lots of Gatorade.
  • Green leafy veg are good. Spinach is bad because of the iron.
  • Colace isn't all it's cracked up to be. It's a stool softener, not a laxative. Today doc recommended milk of magnesia. It's been two hours since taking it and still nothing. We'll see.
  • Potato chips are recommended! Salt? Starch? Don't remember the reasoning behind why they work, but they do.
  • Protein helps. After I spoke to the nurse yesterday morning she recommended upping protein intake so I had an omelette for lunch and this morning I saw a slight difference.
In embryo news, 14 are still growing. They need to biopsy them for PGD testing so they will give them another day or so to reach blast stage. I can't believe we're talking about double digit numbers right now. These are unprecedented numbers for us! I hope it bodes well for good numbers overall.

Shabbat shalom.

Wednesday, September 13, 2017

IVF 6: Embryo watch

Of the 28 eggs retrieved, 20 were mature, 18 fertilized. It's a ridiculously awesome number. We're cautiously thrilled and we know there's expected attrition.

I've been suffering from the worst post-retrieval symptoms I've ever had after an IVF cycle. The nausea didn't completely go away. I've been painfully gassy and constipated. It's hard to walk, it's hard to move, it's hard to breathe. My stomach is hard and tender to the touch. I remembered this from before but I don't remember it being this bad. I've been afraid to eat because I didn't want to add on more to it. I took some Colace today and hope it does something. I plan to call the clinic in the morning if it doesn't.

Today I was reflecting back to my husband about my pre-cycle jitters and hesitation. At the time I couldn't exactly pinpoint why I was anxious about another cycle. I chalked it up to just be burned out with fertility treatment. I realize now that this is what I was dreading. The shots are not terrible, the traffic and monitoring are manageable, even the retrieval itself and everything that led to it was tolerable. It's the pain and recovery that are so difficult for me.

It's been a difficult week. Work is so hectic. Friends and family are busy with their own lives with first weeks of school and getting ready for the holidays starting next week. I've been trying to not feel neglected by my support network. I know it's not personal, there's a lot going on. I hope I stop feeling crappy soon.

The new fall theme for the blog reminds me of this time last year. What a crazy 12 months until now. Hope the next 12 are better.

Sunday, September 10, 2017

IVF 6: Egg Retrieval

TL;DR version: 28 eggs. Stories in chronological order from Friday to Sunday.

There was a situation on Friday where there was stress for a bit because my follicles were large and there was a chance I'd need to trigger with Lupron, but they needed to see the blood levels before confirming. A Lupron trigger meant not only did I need to run to the pharmacy before they closed on Friday, but I'd also have to arrange for a ride on Shabbat to get bloodwork to see if it absorbed right. I waited on pins and needles all day and emailed my nurse around 1pm. She replied saying there was a machine issue and the bloods needed to be sent to another location (over an hour away) for processing so they won't get info until after 3pm. I got news around 4 pm that trigger will be with HCG so no need to run to the pharmacy and no need to come in on Saturday for bloodwork. Whew.

Trigger went fine on Friday night. The next step was Saturday meds. The antibiotic they usually prescribe is azithromycin which is one dose night before retrieval to help prevent infection. In the past, I've had severe GI issues with it (at first I called it the nervous-shits but then we discovered it was actually from the meds). So this time, I thought I was being clever by asking for a different antibiotic. Enter doxycycline. It's twice a day for five days. Supposedly a more mild medication and less intense on the GI tract. It had been a rough several weeks with the diet and shots - I was already nauseous. But as soon as I took the doxy the nausea reached a whole new level. On Saturday, I took the first dose of doxy in the morning and felt off the entire day. I threw up my coffee. I couldn't even keep water down. My appetite was non-existent but I knew I needed to get something in my system. I tried eating some dry crispix and kept it down for about 20 min but it came back up. Toward evening I tried having an apple and it stayed. I thought maybe the worst had past because I hadn't connected the dots with the doxy. Then I took the evening dose of doxy and it was an immediate reaction. I was again nauseous and so miserable. I thought maybe having some tea and crackers might help. I was willing to try anything and I knew I'd be skipping breakfast the next day. It was Saturday night and I didn't want to take another doxy on an empty stomach in the morning right before retrieval. I called the after-hours line for help. I told the nurse who called back that I have the azithro and that I just can't tolerate the doxy. I didn't want to overmedicate or have a weird combo reaction. She advised taking the azithro and if it comes back up, it comes back. She said they can give me anti-nausea meds in the IV in the morning.

So instead of fighting the nausea, I went to get rid of the night dose of doxy which I knew was going to bother me until it came up, and I didn't want to throw up the azithro. The apple and crackers came back up and, since there was nothing left, I was left dry-heaving on the toilet.  I felt a tiny bit better almost immediately. I was worried about taking the azithro on an empty stomach and I mean completely empty. My husband brought me some dry crispix and I ate a handful. It stayed down for 10 minutes so I took the azithro and hoped for the best.

I woke up several times in the night with my stomach churning in hunger. I was uncomfortable because of the azithro wreaking havoc on my system and I was still nauseous. I got dizzy in the shower and started dry-heaving again. Nothing came out. It took effort to gather myself long enough to take a few deep breaths and pull myself together. By the time I got to the retrieval I was ready for drugs. Pain killers, anti-nausea, whatever they were offering I was accepting. This is from someone who reconsiders Tylenol for a headache. The meds were heavenly. I didn't even care that the IV was bothering me. It was such a relief not to be nauseous.

Retrieval was uneventful and surprisingly smooth. Maybe I'm just used to the drill by now. There was no issue with my weight. I'd lost 6 lbs since baseline. My diet had a lot to do with it but it was also aided along by the nausea. I'm sure I gained some weight from the bloating so it may even be more. I was ready to do the retrieval without anesthesia - there was no way I was canceling the cycle for that but I'm very glad it didn't come down to that! Tomorrow we find out how many eggs were mature and fertilized.

Overall the cycle passed pretty quickly. I hope the wait to results passes quickly too.

Friday, September 8, 2017

IVF 6: Trigger

E2 came back at 2905 - just under the threshold for a Lupron trigger. HCG trigger tonight with retrieval on Sunday. Hoping for good things. Shabbat shalom!

IVF 6: Day 12

The good news is that we're very likely triggering tonight. Largest follicle measured at 26. The bad news is we're not out of the woods yet regarding coming in on Saturday. The reason is because, depending on my E2 levels, they may decide to trigger me with Lupron instead of HCG to prevent OHSS. I'm already feeling bloated and nauseous; I don't want to add any more and OHSS sounds like a nightmare. I gained 2 lbs in two days and I know it's not because of what I ate.

While we wait for results, I'm trying to figure out how to get a ride to the clinic. I've had two friends already offer, which is very sweet, but I can't accept a ride from someone who is Jewish, even if they are not observant and would likely be driving anyway. I have a few non-Jewish acquaintances but no one that I can rely on unquestionably. I don't want to have to stay in the hotel next door all Shabbat just for a 10 min bloodwork appointment. That would really suck.


Beside for arranging for a ride, if I do need to do a Lupron shot, I have to run to the specialty pharmacy to pick it up before Shabbat. I also have to work late today to get everything ready for a Monday event I'll be missing. I also have to shop and cook for Shabbat.

#pinsandneedles




Thursday, September 7, 2017

IVF 6: Day 11

I went in this morning for bloodwork and ultrasound. I mentioned to the doc doing my ultrasound that I've been exhausted. Her response was that it's normal but not much to do about it other than having an extra cup of coffee at 3pm. I wasn't really looking for a solution, but it was reassuring to hear it's an expected symptom which means it should go away when the cycle is over.

It will be down to the wire to see if trigger will be Friday or Saturday. Lead follicle measured at 19 and they like to see it at 21-22. If not triggering tomorrow I'll have to go in on Saturday for bloodwork, which means I'll have to find a friend to drive me. Very likely not going to go past Saturday. Good thing too because after tomorrow I'm out of meds.

So bloodwork results came back and definitely not triggering tonight. I go back tomorrow morning for day 12 monitoring.

I've stalled on my diet. Even though I'm still eating within my limited calories, I'm bloated and I think the weight loss is being replaced with bloat and fluid so they cancel each other out on the scale. I broke protocol and had an egg+cheese bagel this morning. I was so full it held me til lunch when I had coffee and an apple. The mild nausea keeps my appetite quiet. Drinking water is a chore but I force it down because if I get dehydrated my veins get flat which makes it difficult to get blood every day.

Hopefully only a few more days of this madness.

Wednesday, September 6, 2017

IVF 6: Day 10

I've been feeling bloated and tired. I came home from work at lunch to try to squeeze in a power nap but there was too much pressure to fall asleep and I was worried I'd sleep through the alarm. So it didn't happen. I don't feel myself being constantly tired and distracted. I also have a headache more often than not, some permanent low-grade nausea, and I think some fluid in my ear that's making me dizzy. I don't want to play this anymore. Ready to not be on shots anymore.

We finally pulled the trigger on two things that have been in the works for a while. First, we got a second car. Hooray! We found a 2015 fully-loaded car with only 12,000 miles on it but the 2017 new car in same make and model turned out to be the better deal because of all the incentives and better APR.

Second, I finally ordered new bedroom furniture. It's not getting delivered until mid-October. The exact model I wanted was on sale for Labor Day. When I saw that delivery was so far out I considered doing some more research and looking for something else that was available now, but I love the furniture I chose and didn't want to settle for something less. We had this furniture so long, what's another 6 weeks. I'm happy I didn't rush it. Excited!

Tuesday, September 5, 2017

IVF 6: Day 9

Suddenly it's day 9. Monitoring this morning was delightfully uneventful.

I've been so tired it feels like maybe I missed part of this cycle. Maybe the meds are fresh and super potent? Maybe my diet is preventing the meds from getting diluted? I don't know what's causing it but I feel like things are progressing faster this time. I've been feeling sluggish and out of it. At any point today I could have put my head down on my desk and fallen asleep. Part of the exhaustion is that we're short a staff person at work and I've been picking up a lot of slack for that empty position while they interview.

I was a weird sort of exhausted-awake and felt like my eyeballs were too big for their sockets. As I typed this out I realized I've mentioned that symptom before, and lo and behold I sure did. I also found my Tips and Suggestions post I wrote a while back which is also helpful to keep in mind. Sometimes I forget things between cycles and it helps to have it all written out. Maybe when I'm not so tired I'll add more to it.

So day 12 is on Friday. I kind of hope we trigger then so that retrieval can be on Sunday. In the past I've triggered on day 14 but since things are moving slightly faster this time maybe it can happen. I'm kind of ready to get the recovery part started. I know recovery from retrieval will be painful and uncomfortable for a few days and I want it over with. I go back for bloodwork and ultrasound on Thursday.

Sunday, September 3, 2017

IVF 6: Day 7

Monitoring this morning took a while but was overall uneventful. One stick for blood. Total wait time was 50 min, normal for weekends especially around a holiday. Follicles are growing: largest at 12 and I'm starting Cetrotide in the morning. Progressing faster than previous cycles so maybe I'll stim less time? We'll see.

Color: S'il vous plait
I went to get my mani/pedi this morning and got Essie's s'il vous plait on both hands and toes. I got a new girl - I don't mind trying new people, I'll give most people a shot. Pro is that she didn't nick me but cons is that she had trouble coloring in the lines and I had to fix it at home. I'll stick to my regular girl next time.

I've been exhausted the past few days. Friday night I fell asleep at 8:30 pm and slept until 6:00 am. This morning I had to wake up early for monitoring and fell asleep in the afternoon for an hour nap. I've been parched but drinking water takes so much effort. I know I need to keep drinking, but ugh.

I had a weird incident this evening. We went out to dinner with friends. Knowing we'd be eating out I saved up nearly all my calories for this evening. I had a half cup of cottage for breakfast and a bowl of cereal for lunch (total of 350ish calories). I ate what I would normally eat when we went out, but I also included snapple and tasted from all the extra dishes ordered for the table. We got a piece of chocolate cake to share among the entire group, so just a sweet bite at the end. As I was eating the cake I started to feel woozy. My hearing got dim and I felt like I was going to pass out. My husband looked at me and asked if I was ok. I wasn't - I felt terrible. I went with a friend to the ladies room and splashed some cold water on my face. I didn't know if I had to go to the bathroom or throw up, I just didn't feel right. As I walked around I started to feel better. I went back to the table but the place was crowded and I left the table twice more to walk around. The more time passed the better I felt.

It's been a few hours since and I feel totally fine. I think it was a significant spike in blood sugar that I didn't expect. I definitely overdid it on the eating and I think it shocked my system after the strict diet for the past few weeks. I have to be more careful about managing my calories better. Once the retrieval is behind us I'll continue the diet but a lot less strictly. I can't imagine this is healthy and I definitely don't want a repeat.

I'm hoping for a Sunday retrieval which means trigger on Friday. If numbers continue to progress as quickly we may not make it that far. I hope it's not a Saturday retrieval but if it is, then it is. Can't do anything about it. Friday retrieval would also be good. Better, actually, so I can have the weekend to recover. I go back on Tuesday so we'll see how things are progressing.

Friday, September 1, 2017

Freedom pharm saga

In July I did my due diligence and called several pharmacies to price out the medication for our upcoming cycle. Knowing we'd be paying out of pocket, I wanted to make sure we'd get the best discounts available. I called Freedom and got a price quote of x.

When I called again two weeks later the price changed to x + $2,000 for the same quantities. That's a huge difference. At that point it was to close to the cycle start and I needed the medication, so I lowered the dosage to be able to pay that day which came out to x + $1100 and asked to speak to a supervisor. I asked the supervisor to look into this because it was wrong to have been quoted so differently. I had prepared for x and suddenly there was a huge price increase, wtf. I was assured that it would get looked into and she would call me back. That was Friday, two weeks ago.

If you know anything about Freedom it's that their hold music/message is the most annoying thing on the planet. It seems that they got caught with an overload of calls these past two weeks because hold times have been insane - upward of 20 minutes. I was calling during breaks, between meetings, at lunchtime, in the evening. Sometimes I would sit on hold for 15 minutes before needing to hang up and get on with my day.

The incident happened on a Friday. I connected with someone Tuesday who assured me someone would call back, no one did. I connected again on Thursday and got the same empty promise. On Friday last week I sent an email to the help address I found on their website, no answer. On Monday of this week I called again and directly asked to speak to a supervisor. I spoke to someone who asked me for a few days to look into the matter and promised to call me back by Wed evening. She assured and reassured me multiple times that she would call back. She did not.

By Thursday morning, yesterday, I was so frustrated and fed up. I was also starting to worry because I was getting ready to order refills and I was out the $1100  from the earlier quote. My original order was never completed since I had to reduce quantities and I was going to run out medication soon. I was especially feeling a sense of urgency because of the holiday weekend coming up when they don't send out shipments.

I called again first thing Thursday morning, hoping to bypass the wait times. No, still a 10 min hold before anyone picked up. Once again I had to go through my whole story because every time I call someone new picks up the phone. The rep transferred me to the head honcho, everyone's supervisor. I went through the story with her too. She was reading the copious notes on my account while I talked. She said she needs to listen to the calls and get back to me. She promised that she will call back and I told her I want to believe her but have been burned before. She gave me her name and extension and reassured me that she will make this right.

Long story short, she did call back. She explained the original misunderstanding between the July quote and the actual order date. She refunded a portion of the original order amount and took my refill order to be delivered today. I asked her how I can avoid this saga in the future - I don't want to have to go through this again. IVF cycles are stressful enough. She said it was an issue on their end, especially with all those supervisors promising to call back and not following through. I didn't want to get anyone in trouble but that's really not right. Don't promise to call back if you don't intend to. She also gave me the concierge number to call in the future to bypass the hold times.

All in all it's still painful to pay so much money out of pocket and have to go through IVF so many times as it is. The least they could do is make the process of getting meds a little easier, especially since they're solely a fertility meds pharm! I'm glad this situation is over but it was a stressful two weeks trying to get it resolved. They say they pride themselves on their tradition of excellent customer service so it's a shame a few bad apples ruin that reputation. If you're ever having an issue with them, feel free to message me for the concierge or head honcho's extensions.

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