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Gearing up for IVF Cycle 2: The Follow-Up


Hello everyone. Oh my! I had no idea that it had been so long since I have posted. I sincerely apologize for not writing, but truth be told there hasn’t been much to write about. You were there via Instagram for the devastating blow of #BFN after the faint positive from the blue dye test. (Note to self: Never EVER use blue dye again). Then, there was the celebration of my ttc sisters who succeeded on their IVF journey. That was exciting and fun and sad at the same time. But I am still thrilled for them. Now, it’s back to reality.

I started birth control for IVF cycle number 2 on November 3rd. That tiny little sphere was basically my “here we go again world” war cry. And here we are taking it day by day. So what does today bring? Today brings intake. Yesterday was our follow-on What in the World (WITW) appointment.

 The news gave me a lot to think about.

The new pill regime begins

I talked to Dr. G and her response was the protocol worked beautifully. We produced 12 good quality eggs, 9 of which were mature. Four fertilized. Two eggs divided quite nicely. One was a beautiful blast, the other only slightly behind. They were implanted. One of the remaining stopped growing pretty quickly. The other actually looked like it was going to continue dividing. It was in the same stage as the slightly behind blastocyst when it stopped dividing as well. And nothing remained.

I asked if it was an egg issue, a sperm issue, or something else. And she explained that it could have been anything, but if she had to guess, she would have guessed S.’s sperm count. It was low. Really low. Much lower than it had been for the IUI and that was significantly less than 1M. When counting sperm per grid, S. only had 7 moving per grid. I’m linking this Mayo clinic page that breaks it down much better than I, but here’s my layman.

Sperm is looked at under the microscope to see how many normal sperm appear in squares on a grid pattern. If they use a big 4 corner squares gril, they are looking for a number x50K to determine sperm per ml. If done by 9 big squares grid, they are to look by x22K to determine sperm per ml. S. had 7 or 350K. A normal minimum is 5M and my husband (if I understood correctly) had 350K after sperm wash on the day of retrieval. 

Not exactly a great number

 All of that being said, Dr. G reminded me that it only takes one good sperm and one good egg for success. She also said that with counts this low the very DNA of the sperm can be affected and the embryos can stop developing if the pregnancy will not be viable or if there will be genetic issues. She suspects that is probably what happened to us despite the blastocyst and morula looking very good.

We’ve gone to one of the top specialists in the nation for male factor infertility and he said the S. had no findable issues. I think it’s time for a follow-up. Either way, we are pushing forward and I pray everything works out. I’m a couple of days away from ordering some of the meds and our community has been able to help with others. I am investing in no stress and just focusing on God.

We will conceive.


-K

ICSI Bound?

The last I wrote it was to tell you all that S. and I were taking a bit of a break from #TTC.  That didn't exactly last long.  We stopped purposely tracking and doing basal temps, but we both acknowledged that we would probably not have success with natural conception.  We already know that IUIs won't work with us, so we decided to visit our RE again and see if now was the time to try something else.

It most certainly was.  After talking with the doctor, asking tons of questions, and discussing what we hope to have occur, our RE would like for us to try for an Intra-cytoplasmic injection of ICSI. ICSI differs from traditional IVF in that a single sperm is injected directly into an egg, instead of fertilization taking place in a dish where many sperm are placed near an egg.  This is a preferred treatment for those who have a low sperm count and poor morphology like S. 

Now, we're on a fast track for everything. S. and I are filling out the paperwork for a fertility loan this week.  The cost for us, including medication, will be approx $26K.  Yep.  That's right.  $26K.  Our insurance won't cover anything EXCEPT blood work and initial lab work for diagnosing an issue with infertility.  Even though we already know what the issues are, we have to retest to make sure nothing has changed in the nine months that have passed since our last failed IUI.

That $26K seems so grossly unfair considering we are attempting to have life, but many insurances now cover termination of life.  The same comparison was made when S. and I adopted our daughter. It is just ridiculous the cost, but we are more than willing to move forward.

Assuming approval, the office has already began drafting protocol.  I will start birth control in September.  Then comes the constant monitoring and the ultrasound while on my cycle and all the fun things.  Egg retrieval and finally transfer will occur 6 weeks later in October. 

How crazy is that?  If everything goes as planned, in six weeks, I'll be looking for double lines on a plastic cartridge.  In ten months, we may be welcoming a new member to our family.

Here's to research, plans, and information.  Let's see what happens!!!

Follow-up week

It's been an interesting time since our start on this fertility journey.  Monday, S. made the all important specimen drop with about minutes to spare.  Why so close?  He had to traverse the region's traffic and construction cones to get to his drop point, but he made it and that's what counted.

Previous to his drop off, I'd given blood for the diagnostic tests.  If my memory serves, my blood was tested for uteinizing hormone (LH), estradiol (E2), AMH, prolactin, testosterone (T), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating. I promise I'm going to look those up at some juncture because everyone of those sound like Greek to me.  S. swears the phlebotomists took four vials, but it was only two for me.

I went back in to the RE's office for a transvaginal ultrasound for the doctors to view my uterine cavity and ovaries.  I've had ultrasounds before, but this was the first one I've had where I was on my cycle. Yes, you actually have your cycle and have a wand covered with a lubricated condom inserted  vaginally so doctors can get a clear picture of what exactly your body is doing.

Mine appeared to be functioning well.  I had several large size follicles (that I later learned were an indication of impending ovulation) that were the appropriate sizes for releasing an egg.  The sonographer was very pleasant and, despite my having a tilted uterus, didn't cause me much discomfort at all.  The entire appointment for my ultrasound and blood work appointment was less than 15 minutes.  They are so efficient!

So now I'm in a waiting game until next week where I attend my HSG.  I am more than a little nervous about that one.  I'm told they [the sonographers/nurses] shoot die in your tubes and it can be painful.  Even the nurse warned me to make sure I take some pain meds before hand.  Yikes!!!

I hope we come up with great answers about conception when all of this is done.  But it is most certainly worth it!




Our Initial Consult

Today was our first consultation with our Reproductive Endocrinologist (RE).  I wasn't nervous because I honestly had no idea what to expect.  I didn't know if we were going to go in and they would already have a suggested "do it this way" guide or if we would get a bunch of shrugged shoulders. Fortunately for us, we received peace.

From the moment we entered the facility, we were put at ease.  The staff was all courteous and everyone greeted us with a smile.  We turned in our pre-filled paperwork listing how long we'd been trying to conceive, my pregnancy history, our sexual history, etc.  Shortly after arriving, I was called into the back to get the ever dreaded weigh in and height.  Nothing out of range, but I was not happy to see that I had re-acquired that pesky ten that I'd lost last summer.  And then, S. (hubby) and I waited.

In about ten minutes, we were called into the back office and met with our RE who was one of the most professional, warm, and engaging woman I've ever met.  I could understand why her reviews were so high.  She went over our forms including my Ob/Gyn records, asked us some follow-on questions, answered our questions, and then immediately discussed what they [the facility] would do to get to the bottom of why we couldn't conceive on out own.

She ordered a full blood panel including STD tests and an Hysterosalpingogram (HSG) for me.  She ordered the same panel for S. and a sperm analysis for him as well.  She answered our questions regarding how much IUIs cost versus IVFs and the options that were associated with each and then introduced us to our personal nurse, A. who would be helping us on our journey.

She gave us a folder with step by step instructions for everything that we'd discussed and information of how and when to have the HSG done.  We left her office feeling pleased that we had a plan and a direction.  I stopped by the front desk and made an appointment for the HSG and a follow-up appointment to return.  S. made an appointment for specimen drop off.  We were/are officially in business.

Here are a few of the questions we asked our RE.  I got the list from Medicinenet.com.  I didn't ask all of these questions, but some were pretty relevant to our needs:

  1. If the reason for my infertility is unclear, what diagnostic tests do you recommend? What is the likelihood that each of these tests will establish a diagnosis? Are there any risks associated with the testing? Does my partner need additional testing?
  2. What type of treatment would you recommend trying first? Does this treatment involve surgery, medications, or both? What are the risks of treatment?
  3. In your practice, how often does this treatment result in pregnancy? (Be sure to determine whether your doctor is talking about pregnancy rates or live-birth rates when discussing specific treatments so you can make adequate comparisons. For example, a treatment may have a 30% pregnancy rate per cycle but only a 25% live-birth rate due to early miscarriages.)
  4. Are less-invasive or more conservative treatments available? How do these compare with your recommended treatment in terms of risks and success rates?
  5. How many cycles of treatment would you recommend before trying another option? Do you recommend skipping a menstrual cycle between treatment cycles?
  6. Are there any lifestyle modifications that might help my condition and increase my chances of getting pregnant?
  7. (If this is an acceptable option for you) Would you recommend treatments using donor eggs and/or sperm? Does your clinic or practice offer these options?
  8. What is my prognosis? In your opinion, how likely is fertility treatment to be successful for me? (While no doctor can give you an exact answer to this question, taking into account your personal medical information and age, your doctor's past experiences may allow him or her to roughly estimate whether you will have an average, below-average, or above-average chance of success).
  9. What does treatment cost? Does my insurance cover any of the medications, hospital charges, or doctor's visits? If I must pay out-of-pocket, do you offer any special payment plans?
REFERENCE: MescapeReference. Infertility.Medically Reviewed by a Doctor on 9/12/2014