Zipping up

This was a long and busy weekend.  Handsome had a friend in Tucson from Washington that he wanted to see and I had the sono-mock scheduled for Friday morning so we decided that Handsome would come with me to  the appointment and directly afterwards we would pick up the dogs and head to Tucson.  Once in Tucson we dropped the dogs off at my parents house and went and met my husband's friends (some other friends had also met up in Tucson) for drinks and lunch.  We went to Gentle Ben's which is not the best bar on University Blvd as their beer selection and food is decidedly average.  Afterwards we went to The Shelter on Grant and were the first people in the bar it opened at 3:00pm and we got there at 2:55pm.  It wasn't bad although I could have done without seeing the cockroach in the bathroom :)  They guys were all tired since they had basically been drinking for the past 2+ days so we dropped them off at their hotel and went back to the house.  I took a nap because the sono-mock really took it out of me.  We met up with the guys later and had dinner and drinks and then I decided to go home - I was exhausted - and told Handsome that he could call me and I would pick him up or he could take a taxi.  He decided to take a taxi and texted me at 2am that he was at the front door (he doesn't have a key). 

Saturday we relaxed - I woke up fairly early and spent the time talking to my parents and watching Desperado.  My husband slept in but finally got up for lunch and then we came back and took a nap for a couple hours.  We packed up our stuff and the dogs and made it back up to Phoenix by 8pm, went to Aunt Chilada's for dinner and then back home to watch Top Shot.  Today we got up fairly early so we could go out to the Sporting Clay range.  We were joined by some friends and I actually did pretty well today although my shoulder is a little sore.  While at station 12 we saw what appeared to be a bald eagle which was really cool and I wish I had been able to grab a picture.  Grocery shopping is done and my wonderful husband will be grilling bison burgers tonight for dinner!

I'm sure you are all wondering about the sono-mock and how that went, well even if you aren't I'll tell you.  It pretty much sucked, it wasn't the worst experience in my life or even the worst experience during our fertility challenge, but it wasn't fun.  Both Handsome and I were told to take antibiotics the night before and and breakfast the day of t he procedure.  I was also told to take 3 Advil before hand and come with a full bladder.  When we got to ARMS the nurse asked if my bladder was full, I told her it wasn't bursting but I could probably go to the bathroom.  After taking my vitals she gave me another glass of water to drink and this time by the time I was finished and the doctor called me in I REALLY needed to go. 

I was shown into the bathroom that connects to the examination room and undressed from the waist down.  While we waited my husband decided to use the bathroom which made me have to go even MORE!!!  Once in the room Dr. Moffitt inserted a speculum which is one of the worst things they are ALWAYS uncomfortable.  He asked what progesterone supplement I had been on and I told him Crinone.  He said there was residual and proceeded to remove it by what felt like scraping me clean with a spatula and seemed unnecessarily rough - not hurtful rough but a little fast and uncomfortable.  Then he tipped the table backwards so he would be able to see and guide the soft catheter for the mock transfer.  I thought that being tipped backwards would help my bladder but it made it worse and I kept fearing that I just wouldn't be able to hold it anymore - wouldn't that have been embarrassing.  The used gel and an ultrasound on my belly (of course pushing on my bladder) and it was good fun all around **sarcasm**  Finally he said I could go to the bathroom before the sonogram. 

When I came back an intern was going to try performing the sonogram.  I got back up on the table and again had to have a speculum.  Then she moved the tube into place.  I have gone through similar instances in the past so was ready for the cramping when she got it through the cervix and blew up the balloon.  They removed the speculum and inserted the vaginal ultrasound wand. Then they started to fill my uterus with saline which also caused some mild cramping but unfortunately the balloon had slipped and the saline was running out.  Nothing like feeling like you are wetting your pants to make you feel special.  They took out the wand and re-inserted the speculum - joy.  They had to reinsert the tube, she tried once more and when she couldn't get it Dr. Moffitt did it.  Because the balloon had slipped they decided to put it all the way into the uterus before blowing up the balloon which caused worse cramping.  Once it was in place they removed the speculum again and reinserted the wand. 

This time when they started filling with the saline it started cramping again.  Handsome was great he held my hand and stroked my hair the entire time.  When ever a cramp would hit I would squeeze his hand and he would squeeze back.  I was really happy that he had come with me, I wouldn't want to go through it alone.  While they were performing the sonogram all of a sudden I had to stop Handsome for stroking my hair because I felt like I was either going to pass out or throw up.  I couldn't say anything because I was struggling not to do either.  Late, my husband said he kept waiting for me to go limp (pass out) but I didn't.  Finally they were done and I was able to sit up and felt much better.  I also went to the bathroom again which helped.  For the rest of the day I was achy and tired and anytime my bladder or bowel was full it made it worse, probably because it was pressing on my poor abused uterus.

The good news was they didn't find any tumors, polyps or fibroids that would prevent a pregnancy and nothing that needed surgical repair.  The only thing they saw was a small diverticulum which he said was too small for surgery and if they tried to correct it would probably just make the situation worse.  He said that if the blastocyst were to implant there it could be bad but that the chances of that happening are very small.  For those of you who don't know (i didn't) a "diverticulum (plural: diverticula) is medical or biological term for an outpouching of a hollow (or a fluid-filled) structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false." -Wikipedia.

Next on our agenda is our teaching visit where we get to give them bags and bags of money and they let us know about the medication and upcoming schedule. 

Miss Suzy Had a Steamboat
"Miss Suzy had a steamboat, the steam boat had a bell,
Miss Suzy went to heaven, the steamboat went to -
Hell-o operator please give me number nine
And if you disconnect me I'll cut off your -
Behind the fridgerator there lay a piece of glass,
Miss Suzy sat upon it and broker her little -
Ask me no more questions, I'll tell you no more lies,
The boys are in the bathroom, zipping up their -
flies are in the meadow, bees are in the park,
Miss Suzi and her boyfriend, are kissing in the
D. A. R. K., D. A. R. K., D. A. R. K.
Dark dark dark!"

Tick tock

I spoke to the financial lady on Monday and it was basically all the information she had previously given me.  I did ask if the sono-mock is covered by the $10K and she said no but that it is considered diagnostic so out insurance should most likely cover it.  CD1 was Monday as well so my sono-mock is scheduled for Friday.  Next Wednesday is our teaching visit and when the funds are due.  Keep your fingers crossed for us!

Everything seems to be happening so fast and although that is what I wanted and told ARMS we wanted it is moving so fast that it is a little scary.  I have asked Sparkles to create a workout plan that involves no up/down, twisting or strenuous movement of the abdomen.  When I have those ~20 follicles I don't want to damage my ovaries or fallopian tubes by bouncing them up and down or anything.  On the workout note, things have been going well; Mondays I do cardio, Tuesdays and Thursdays I do my Sparkles weight training plan sometimes combined with cardio, and Wednesdays I go to class.  I am feeling better physically and better emotionally since I am happier with my body.  Tonight I have class and we'll see what kind of fresh torture Sparkles has in store.  He has a new personal trainer that came to class - she's pretty quiet which is a big contrast to Sparkles.

I think Handsome and I have decided to transfer one blastocyst for our first cycle if we have multiple good quality blastocysts and then if it doesn't work we may transfer two for our second attempt.  Hopefully we won't need that second attempt and can keep those blastocysts waiting until we decide to have a second child.  With all that is happening I sometimes wish for a fairy godmother who could either make all this go away and make us pregnant naturally or could at least help with the expenses.  Handsome and I are lucky enough that we can afford the treatments and I realize that not everyone can say the same and that there are couples out there who can't afford these treatments without loans at absurd interest rates.  Sometimes it can be depressing because not only is it expensive but for every supporter there are plenty of naysayers out on the web and I find their reasoning uninformed, annoying, mean, and it makes me both sad and angry.

The Catholic church (which I am not a member of) thinks that IVF is sinful because it takes away from the intimacy of the sex act between spouses, there are fertilized embryos that may die, and it "deprives the fetus of familial bond" when they are fertilized in a test tube.  While marriage is for procreation they do admit that being infertile isn't inherently sinful - well thank you very much since infertility isn't a choice.  All of these points are easily countered and beneath me to argue.  Most insurance doesn't pay for infertility because having children is a choice, yes it is but being infertile isn't.  Sex is a choice yet insurance pays for viagra, smoking is a choice but insurance still pays for lung cancer treatments, I could go on...  Then you have the people who say - if you can't have kids you should adopt - I have nothing against adoption but if they think it is so great why don't THEY adopt?!  Also what many may not know if that the time and money involved in adoption can equal or outweigh that put into IVF especially if you want an infant.  One individual on a website said that DNA that can't reproduce shouldn't to help human evolution.  Um, excuse me but my DNA is fine I just have a condition that inhibits fertility.  Or there are people out there that say its because we are too old and we should listen to mother nature, now I will admit that I am 34 (which I don't think is that old) but we started trying when I was 31 which isn't old at all.  Ugh!  It just makes me mad that all these ignorant people are passing judgement on me when many of them have not suffered the same things and even if they did they still aren't me!  How about a little less judgement and a little more acceptance and support?  Well I will get off my soap box.  ttyl

Hickory Dickory Dock

"Hickory, dickory, dock, The mouse ran up the clock. The clock struck one, And down he run, Hickory, dickory, dock. "

Bigger Sword

So it appears that Handsome and I will need a stronger weapon to defeat our dragon, our nemesis, infertility.  We were very disappointed that our last UPT came back negative and have decided to move forward with IVF.  We made an appointment with ARMS and both went in to see Dr. Moffitt yesterday.  While there we had a blood drawn for our infectious disease screening and genetic testing, I had to give 3 vials and Handsome 2.  The genetic testing is to see if we are carriers of any genetic diseases that we could pass on if we both are carriers.  I also have a phone appointment to speak to the financial lady again. 

Here is the road map that Dr. Moffitt gave us:  Get the genetic tests and infectious disease screenings, then on CD1 start on birth control, once the bleeding has stopped I will have a sonohysterogram (SHG) and Mock embryo transfer - the SHG shows a clearer look at the uterus to see if there are any polyps or fibroids that need to be removed while the mock transfer allows them to map the cervix to better prepare for implantation.  We have a tentative start date of May 12th to start the gonadotropins (stimulation shots) and then 5/21 would be the beginning of the week that egg retrieval is anticipated.  Three to 5 days after egg retrieval will be the embryo transfer (5 days we are hoping for blastocysts) and then UPT 14 days after egg retrieval. 

Dr. Moffitt expects me to be a high responder so I will be put on an injectable progesterone afterwards to help reduce my chances of ovarian hyperstimulation syndrome.  He says that in someone who responds like me he would expect around 20 eggs to be retrieved.  The stimulation shots will be for 10 days and I will have to go in every day of those 10 days for blood tests and ultrasounds.  According to the numbers Dr. Moffit gave us couples like us have a 56.5% chance of getting pregnant and he expects that I will probably be on the higher end of that average.  That being said he strongly recommends that we transplant one blastocyst although it is up to us whether we transplant 1 or 2. 

Lets lay out some of the numbers.  I'll start with the financials.  For the Attain IVF program we had originally considered it costs 18K, not including medication, for two fresh cycles and two frozen (and you have to alternate them, I asked).  If we decide to pay as we go it would be $10K, not including medication, for the fresh cycle and $2.1K, not including medication, for the frozen.  Which would mean we would have to do two fresh cycles or one fresh cycle coupled with 4 frozen cycles to make it cost effective to use the attain program instead of paying as we go.  Now because I am a high responder and we have a high likely hood of getting pregnant 1st or 2nd time it makes more sense to pay as we go.  The second part of this is how many blastocysts to transfer.  Dr. Moffitt is hoping/expecting for 20 follicles by the time these get down to blastocysts there will be anywhere from 3 - 6 (on average).  Blastocysts are 5-6 day old embryos and typically have higher rates of pregnancy rates that 2-3 day old embryos so less are recommended for transplant. Below I talk about the numbers behind the transfer.

Originally I thought that if we had a 50% chance with one blastocyst that it would mean with two blastocysts we would have a 75% chance of getting pregnant with at least one baby and a 25% chance of twins.  However much of what I have read says this may not be so.  A 2009 study showed that for fresh cycles the pregnancy rate (PR) was similar but that the live birth rate (LBR) was higher at 42.5 vs 28.4; however this study is about day 2-3 embryos and not blastocysts.  Another website for a different ART facility says that for women under age 35 (still me for a short while) with good quality blastocysts (hopefully) that an implantation rate(IR or PR) is 90%.  However they say that for this patient population (hopefully me) they will get pregnant with however many blastocysts are transferred.  They see that one blastocyst transfer reduced IR by 6% (so 84%) but two blastocysts have a multiple gestation rate of 40%, while one has only a 3-4% of twins or higher.  An article for TIME says that transferring a single fresh embryo followed by subsequent thawed embryos may be as effective as implanting multiple embryos at once.  This looks at a time period from 1995 - 1999.  They say that for each egg retrieval the overall pregnancy rate was 38% for single embryo transfer and 33% for multiple egg transfer.  At a Stanford fertility clinic using blastocyst transfer they saw that success rates were on par if not higher for single transfers.  Another study from 2010 showed that for single blastocyst transfer the IR was 60.9 - 70.5%, pregnancy rate was 60.9-76% and multiple pregnancy rates (MPR) was 0-3.2%.  They also note that couples who elected single blastocysts transfer were typically younger, has had a prior birth, had not had unsuccessful IVF treatment, and had multiple blastocyst able to be cryopreserved - we fit 3 of those criteria.  This article mainly focused on the fact that single blastocysts transfers were similar in IR and PR rates at double blastocysts transfer but much lower in MPR.  The last article I have shows that a double blastocyst transfer has similar viable pregnancy rate (PR) as triple blastocyst transfer - 62% vs 58%.  It also says that the chance of MPR was 39% for double blastocyst transfer vs 79% for triple.

A quick summary is that however it might feel, more is NOT better.  IR and PR seem to be similar between SBT (single blastocyst transfer) and DBT(double blastocyst transfer) and the DBT has an average of 40% ending up in multiple gestation (ie twins).  According to some studies and sites the delivery costs for twins is four times higher than singletons (although our insurance pays for all of that).  There are also health risks associated with twins - I will only lay out risks for fraternal twins since identical could happen either way and most twins from DBT are fraternal.  60% of the time twins are premature and end up in the NICU.  Twins are 5 - 7 times more likely to die during infancy, one twin in 27 will die in infancy compared to one in 135 in singletons.  They are more likely to suffer from cerebral palsy (7.4% vs 2%).  As the mother I am more at risk for gestational diabetes (twice as likely), placenta problems, heart problems (13X) and preeclampsia ( 1 in 3 chance) with twins than with singleton.

So we haven't decide yet whether to for single (SBT) or double (DBT) blastocyst transfer.  This is of course assuming we have multiple goo quality blastocysts.  So anyone out there have an opinion, feedback or advice?  Should we do one or two?


The Two Brothers
"Whosoever empties the cups will become the strongest man on earth, and will be able to wield the sword which is buried before the threshold of the door." The huntsman did not drink, but went out and sought for the sword in the ground, but was unable to move it from its place. Then he went in and emptied the cups, and now he was strong enough to take up the sword, and his hand could quite easily wield it.
Grimm, Jacob; Grimm, Wilhelm; Charles River Editors; Taylor, Edgar (2011-11-29). The Complete Brothers Grimm's Fairy Tales (Illustrated) (Kindle Locations 4278-4281). Unknown. Kindle Edition.

Falling Down

Negative.  I think i was worse this time because both Handsome and I had such high hopes (and if you know my husband you know how rare it is for him to get his opes up or be optimistic).  We are both truly depressed and feel like nothing works.  I have left a message on the ARMS Nurse Line letting them know that the UPT was negative and that we would like to start IVF as soon as possible.

"Rock a bye Baby"
"Rock a bye Baby in the tree top,
When the wind blows the cradle will rock,
When the bough breaks the cradle will fall
And down will come baby, cradle and all"

Patience

Handsome and I went down to Tucson again this weekend.  I love Tucson and love visiting our families but three weeks in a row is enough!  A friend of my husband's is coming into town in a week and a half so we may be going back down two weekends from now but at least we'll get to stay home next weekend.  I get to test on Wednesday, so for anyone who does NOT want to know the results, don't look at that post.  I will try to post by that evening after work.  I got the UPTs today at the grocery store and it was hard not to test this evening.  It is four days before my test date and while the box says you can test up to five days early the uncertainty is too much.  If I were to test early and get a positive result I would have the fear that the triggershot was still in my system giving me a false positive or that I have a chemical pregnancy (where the egg doesn't implant or doesn't develop properly but indicates positive early but you still get your period and a negative pregnancy test when testing on time) so I would have to retest Wednesday and wouldn't want to have my hopes up only to be dashed if I am not pregnant.  If the test was negative today there is still uncertainty so I would still test Wednesday but would be bummed until then.  I just need to call on my patience and wait three more days and stay positive.  I feel very positive - I told Handsome that we would have twins - a girl and a boy - and that I had already decided on the names.  Knowing how funny life is I'll probably have triplets and have to come up with another name, or two boys or two girls and have to think up more names of the appropriate gender.  ttyl

"Patience"
"Patience is a virtue,
Virtue is a grace,
Grace is a little girl,
with a dirty face"

Head, shoulders, knees and toes

Today is the halfway point until I can test.  I am scared and excited and doing my best to stay positive.  Bremen is feeling much better and we have reduced the aspirin he is taking and trying to keep him calm so he doesn't re-injure himself before he is fuly healed.  Heidel has been somewhat jealous of all the extra attention he has gotten due to his shoulder so we are trying to give her acknowledgement as well.  Last week was my last week with Sparkles :( but class is starting up again this week so I will be taking that and I will be following the exercise cards he set up for me.  I figure about once a month, when I need it, I will buy a session with him to make sure I continue to improve.  Well this is a short note about a lot of little things but I wanted to check in. TTYL

"Head, shoulders, knees and toes, knees and toes
Head, shoulders, knees and toes, knees and toes
Eyes and ears and mouth and nose
Head, shoulders, knees and toes, knees and toes"

Little Bunny Foo Foo

Had a wonderful long weekend!  Unfortunately Handsome wasn't off Friday so it was a normal weekend for him but I had Friday, Good Friday, off so I was able to do some shopping and also stop in on my friend Beth to visit her and her new son.  He is adorable even if he is still only eating, sleeping and pooping.  Hopefully that is what Handsome and I have to look forward to.  After visiting with her for a few hours on Friday I then went to the salon so I would look good for the wedding we went to on Saturday.  My husband got home a little bit late on Friday so we didn't get to leave for Tucson until a little after 7pm.  Once we got to Tucson and unloaded the luggage and the dogs we went to Zinburger for dinner (I LOVE their Kobe beef burger with goat cheese - I love goat cheese).  Saturday I got up early and went shopping with Mom and then to P.F. Chang's for lunch with Handsome.  The wedding, for our friend Casey and his beautiful bride Laura, started at 4pm at La Mariposa.  It was sweet and went quickly and then while the wedding party was getting their pictures taken there were lawn games for the rest of us.  Handsome and I joined two other couples to play Croquet, I had never played before but had a great time.  Afterwards was dinner, dancing, and conversation.  This was the wedding that I told you called for "smart casual" attire which Handsome and I decided meant 1960s mad men.  We may have been some of the most dressed up people there but Handsome was the talk of the wedding - everyone loved his hat!  And to think, he wasn't going to wear it but I convinced him to.  Isn't he handsome?!  And I think I looked pretty good too.

Sunday we went for lunch with my in-laws.  We went to a beautiful buffet at La Paloma for Easter lunch although if we had known how expensive it was we probably would have told his parents not to bother.  They paid and I felt bad that it was $50 per person!  The food was excellent though and it was good to see them.  We will be back down next weekend for Handsome's brother's birthday.  Heidel loved going in the car and is excited that now that the weather is warming up there are lizards to chase.  Poor Bremen seems to have hurt is left shoulder.  There is no injury or swelling so we think he might have bruised or pulled something.  We are giving him baby aspirin to help with the pain and if he doesn't feel better soon we will take him to the vet to have him checked out. TTYL.

I don't know any Easter nursery rhymes, faerie tales or poems so...

"Little bunny Foo Foo,

Hoppin' through the forest,

scoopin' up the field mice

and boppin' them on the head"

Money Have I None

So as you may know from a previous post or from Facebook I recently started a new job (about a month ago).  I took a week off between jobs, we have had two IUI procedures, we had to pay for Handsome's application to the Colorado Bar, buy clothes and presents for a wedding, and for my first paycheck my new employer pays a week behind so it was only for one week; needless to say we are at the bare bones of our savings account.  We have other assets in stocks and such but want tot try and stay away from that if at all necessary.  The good news is that we both get paid tomorrow and we should start to be able to replenish our savings.

Yesterday was our second IUI and we feel really positive about this one.  As I mentioned on Sunday we had 5 eggs and unlike last time these were much more uniform in size (last time we had one that was ready and two that were quite a bit behind), and the increased number ups our chances.  In addition, they typically hope for at least 5 million for sperm count and my stud of a husband had 356 million!  In the picture below you can see how the sample and implements are set up for the IUI. 

So in the blue grid you can see a vial of sterile water (vial furthest away) which the nurse uses to clean/rinse the tube that delivers the sperm which is in the second vial (nearest vial).  I have also put a closeup of the tube below although it is still in its packaging so I don't know what you can make out.  The nurse sucks up the water and then injects it into the sink then she sucks up the sperm and threads the tube through my cervix to inject it into my uterus.  I went over this procedure in a previous post so won't reiterate.

For now we are staying positive, Handsome will put his hand on my belly and say "Goooo Babies!" and lift his hand up almost like you do in a team huddle when you say go team.  I'll start the crinone on Saturday and will test on the 18th.  Until then keep you fingers crossed and keep me in your thoughts :)

Hey, Ho, Nobody Home
"Hey, ho, nobody home,
meat nor drink nor money have I none,
still I will be merry,
hey, ho, nobody home."

Five by Five

Sorry it has been so long since I last posted.  Sometimes I don't think anyone reads or cares about this blog but it makes me feel better to talk about this trial that Handsome and I have gone through so I will continue putting my thoughts and feelings out there on the void of the internet.  We are trying the combination superovulation and insemination this cycle and I took Clomid cycle days 3 - 7 and I had follistim injections on CD3, 4, 6, and 8 (in 125, 100, 75 and 75 dosage respectively).  Today was day 10 and I went in for my mid-cycle ultrasound (we went in early because my body seems to grow the follicles so quickly).  My right ovary had been very busy and there were well over 6 follicles but most were to small to amount to anything so we will continue on with insemination.  I will be triggering Monday at 11pm if my OPK, ovulation predictor kit, is negative; if my OPK is positive we will not do the trigger shot.  Wednesday morning my husband will go in early to leave a sample and I will have a mid-morning appointment for insemination.  If my OPK is positive tomorrow we will move up the insemination to Tuesday.  The nurse that I performed my ultrasound believes that if we trigger tomorrow we will have 5 good follicles.  I am feeling very positive and happy because the follicles were much more uniform in size this time and we have 5 instead of 3 eggs. :)  So turns out that this April Fool's day is pretty good for us and no tricks.

(pictures- from http://www.timandheike.com/)

The Ants Go Marching
The ants go marching five by five, hurrah, hurrah
The ants go marching five by five, hurrah, hurrah
The ants go marching five by five,
The little one stops to take a dive
And they all go marching down to the ground
To get out of the rain,