Saturday, February 23, 2013

The March of the Pills

Our first appointment ALSO entailed getting started on our pre-IVF drug regimen.  They won't pull out the big guns until I start my next ovulatory period, but in the meantime, we're doing the following:

Both of us:

  • Ciprofloxacin - preventative antibiotic.  Even minor infections can dramatically decrease the chances of IVF success.

Just me:

  • Metronidazole - a special antibiotic JUST for the ole bat cave.  It comes with a three feet long applicator.  Fun.  Toilet acrobatics.
  • Baby Aspirin - increase bloodflow to the uterus and make sure that future home is super comfy and lush.
  • DHEA - a hormone supplement to support my production of estrogen and androgen.  Hopefully, this will make up for my egg reserves, which look like they ought to belong to an old lady.  All I know is I'm crying at especially poignant television commercials and breaking out with the acne of a 15 year old boy. 
  • Estradiol - basically, a synthetic estrogen.  Again, geriatric eggs. 

We also got some blood work done, basically to make sure we're not teeming with chlamydia and ebola (news flash: we're not).  Jake has to get his swimmers tested ONCE AGAIN, presumably so the lab techs can point and laugh at those poor little guys one last time.  I had to get my AMH and thyroid levels tested again, too.  AMH came back confirming the above mention egg problem.  Thyroid came back a little weird, but subsequent blood work ruled out the need for synthetic thyroid medication.

I'm now off of birth control and waiting for ovulation.  They want me to ovulate at least once before we get going on this, so I've been drowsily peeing on those ovulation predictor sticks every morning for about two weeks.  The big O is a tad elusive this month, which figures, since I normally ovulate like clockwork.  Side note, did you know you can actually urinate onto plastic incorrectly?  Because I am a princess and like my toilet routine to be as high tech as possible, I splurged on the more expensive DIGITAL ovulation predictor kit on my way home from our appointment.  Twice, TWICE, the message that appeared in the window was a picture of an arrow pointing to a booklet.  Thaaaat's right.  This pretentious piece of plastic told me to go back and read the directions as to how I might more efficiently or perfectly pee onto it.  Since going through a box of those with no coveted "smiley face" result, I have downgraded to the less persnickety but far more inscrutable CVS brand.  Now, I'm supposed to compare the density and pigment of two pink lines.  Who has time for this nonsense?

On a more grim note, being off birth control has been tough these past two weeks.  Why was someone infertile taking birth control, you may ask?  Well, endometriosis is an inflammatory condition that is triggered by the ebb and flow of hormones.  Staying on the pill kept everything nice and quiet for the last year, and I was able to get by with only a few advil and a couple of hours on the heating pad a night.  Now, it's a mental battle every day just dragging myself out of bed.  The pain makes me sleepy and depressed, neither of which I have time for right now.  Come on, ovulation!

If I have a legitimate cycle this month, we'll get started on stim drugs as soon as my period arrives, possibly the beginning of March (cue ecstatic squealing and clapping). If not, we'll have to wait yet another month, which, though I know is nothing in the grand scheme of things, will totally bum me out.

Sunday, February 17, 2013

Decisions, Decisions

Another thing we had to do at our appointment was sit down with our doctor and go over some very important decisions.  Some were easy to make.  Use ICSI?  Duh.  Freeze any leftover eggs?  Of course.    Assisted Hatching?  No need.  How many embryos to implant?  Hmmmm....

Okay, so for a woman of my age, here is the textbook recommendation.  If they are good quality embies, put back one.  If they are less than ideal, put back two.  The doctor explain that we could be more conservative and only put back one, regardless of quality, OR we could be more aggressive and put back two, regardless of quality.  With the former option, our chances of conceiving at all are lowered.  With the latter, our chance of conceiving twins as opposed to a singlet is 1 in 2.  Jake and I stared at each other awkwardly for a few minutes and debated in our usual, snarky, hyperbolic style.  "You know how I feel."  "No, you said you want to do what's best.  That's not clear here."  "I want to do what's most effective."  "Well, most effective isn't necessarily best.  Putting back five would be most effective!"  The doctor jumped in here to make sure we understood that nobody is cramming five embryos into a 30 year old.  She must have thought we were getting heated, because she handed over the form and told us to think about it over the next few weeks.  She was staying out of it.

However, with a few minutes left to ourselves while waiting for our next meeting with the IVF nurse, we knew our decision: the aggressive course, two embryos, high possibility for twins.  Essentially, we just know that we'll regret it terribly if we don't conceive after only putting back one.  From that moment on, we've been sort of deliriously giggling and joking about how crazy our future life with twins will be.  Jake's been peering, with wrinkled forehead, into his cramped backseat, trying to picture TWO carseats shoved into that tiny M3.  I've been mentally rehearsing trying to get from the parking garage in our future Dallas high-rise to the apartment door with two infants and a single sack of groceries.  When we talk about signing up for insurance at his law firm, he'll say, "Well, it's cheap for me but more expensive when I add you and..." "The TWINS," I finish.  And we both crack up and whimper a little simultaneously.

Dear Lord, one will REALLY suffice, but I promise I'll be gracious if you double our pleasure.

Saturday, February 16, 2013

Good Things Come to Those Who Wait...and Wait

It's finally happening.  Nearly 5 years after we started trying to conceive, three years after we were told unequivocally that we had no chance of conceiving naturally, after two surgeries on my endometriosis, over a year after applying for our scholarship through INCIID, 6 months after we raised $3,000 for their organization, WE'RE FINALLY GETTING STARTED!!!!!!!!!

I want to again thank all of our family and friends who donated to INCIID on our behalf.  We are truly blessed with an incredible network of support.  Many couples navigate IVF in private, keeping the dates and details to themselves.  This makes a lot of sense, of course, because, when things go wrong, you don't want to have to share THAT news with everyone.  While this sort of privacy is appealing, we know our journey will be a slightly different one.  We've made this project a public one from the start, and you are all a part of this process.  You've a right to know what we're doing and how we're progressing.  Additionally, there are so many people whose faces screw up with concentration and wonder whenever I speak about this procedure in broad terms.  I have gotten the distinct impression that people are deeply curious about how this whole thing works.  If you're not in that camp, read no further.  But if you're like 90% of Americans and delight in all things voyeuristic, do enjoy.

INCIID matched us with the Reproductive Medicine and Surgery Center of Virginia, pretty much the most ideal match we could have had.  The clinic is only a little over an hour away, and we are familiar with our doctor since she did our official scholarship testing, as well as performed my most recent hysterosalpingogram (running fluid through the fallopian tubes under x-ray to see if they work) and laparoscopy (minimally invasive surgery to look around the pelvic region).  The latter had been performed last April for the purpose of cleaning up my endometrial adhesions and removing my blocked (and therefore toxic) fallopian tube.  She managed to open up the tube during surgery, doing exactly what two previous doctors had attempted to do three other times.  As a result, I have two working tubes and a new hero.

We had our first appointment on Tuesday, and it was a doozy!  Not difficult, just a lot of new information and decisions.  First, we did a practice run of the egg transfer, basically mapping out the size and shape and tilt of my uterus so there are no surprises on the day of the real thing.  The most amusing thing has to do with the ultrasound, which they move on the top of the belly to guide the catheter.  Now, between the surface of your skin and the uterus is your bladder, so they basically use it as a window to look through.  The bigger the window, the better the view, right?  Consequently, I was told to come with a full bladder.  The appointment was at three, so I made sure I used the restroom for the last time at lunch and spent the second half of the day sipping water.  By the time I got there I was rather uncomfortable and proudly told the nurse when asked, "Oh, yes.  VERY full bladder."  Well, apparently in egg transfer world, "full" has a totally different meaning.  They were looking for ready-to-burst; I was told to aim for twice as full on transfer day.  I wonder how many women have had "accidents" in that waiting room.

After the trial run transfer was a saline ultrasound, basically just a look-see around the uterus and ovaries to make sure there are no polyps or cysts that should be treated before we proceed.  My lady-junk got rave reviews, and the procedure was a breeze.  This ship is ready for boarding!

More on our first appointment in the next entry...