Not So Pretty

Yesterday I had an appointment to make sure the birth control pills are suppressing my ovaries. Lan (the coordinating nurse) was out of town so they were running late and we had to sit there waiting for over an hour. I didn't think I was going to make it back home in time to get Sawyer off the bus. This is where living an hour away from the center can be problematic. Finally Dr. A was ready to see us, and everything looked good. I'm suppressed (in more ways than one now, haha) and the cyst is shrinking. The hormones are doing their job, beyond just making me really really cranky! I got the go ahead to start Lupron, 20 units a day.

Eric came with me to the appointment because we also had to sign our consent forms. The forms give basic medical information about the various procedures and their risks, as well as the risks of pregnancy. You sign off on those, I guess so you can't later sue the center if things go wrong. Then you have to decide what will happen to any leftover embryos. Since we only have 3 it's not likely that we'll have any left, but we're thinking ahead to fresh cycles in the future where that is a possibility. They take you through every possible scenario - for instance, if your husband dies, what do you want to do with the embryos? If you die but your husband's still alive? What if you both die? Or what if you get divorced? Yeah, all really fun to think about. For each scenario there are several options - donate to another couple, donate to research, store indefinitely, or discard. So we made all those decisions and signed off on them with the notary, Carol at the front desk - who by the way is hilarious. (Our decisions: If I die, discard; if Eric dies, discard; if we both die, donate to another couple; divorce, discard. I would rather donate to research, but Eric is not comfortable with that.)

Then we discussed our embryos and how many we should transfer. This part was pretty discouraging, because after reviewing the images taken 7 years ago, Dr. A said "They are...not so pretty...no offense." (To which I wanted to respond, "Hey buddy, tell YOUR embryos to look in a mirror sometime!") Last time we did IVF we used the best 2 embryos to transfer, which was obviously a good choice because it got us Sawyer. Unfortunately the ones we left behind are much lower quality, and will likely be even worse after thawing (the thawing process can sometimes damage embryos; interestingly, the amount of time they have been frozen is irrelevant.) Two are blastocycts, but not expanded, and one is a morula, which is not great at all.

We are doing assisted hatching, which could help, and the fact that we've had a positive result in the past works in our favor. But still, Dr. A gives us about a 20% chance with these embryos and told us to be prepared for a negative result. Which is kind of funny, because that's already the way I've been feeling about this cycle. I'm prepared for it not to work. But we are still going to give it our all, because we both feel strongly about giving these embryos a chance. As far as how many, we decided to go ahead and transfer all three - since they are lower quality the chances of all three implanting are "zero to minuscule...it would be an absolute miracle." So I feel good about that.

I also asked how likely it is that things will go according to schedule and he said "Extremely likely...98% chance." REs are really good at speaking in percentages.  So I need to reschedule Sawyer's opthamologist appointment that's the same day as embryo transfer.

Next step: I stop birth control pills on Tuesday, go in for another ultrasound on Friday and start Estrace that day if everything looks good.

I'm Only In It For The Drugs

I'm on a lot of medications right now. Like, a LOT. Here's the list (full disclosure: I have to look at my list on my iPhone to remember them all.)

-levothyroxine (for hypothyroid)
-metformin (for PCOS)
-bromocriptine (for elevated prolactin, probably also related to PCOS)
-birth control pills (part of FET cycle)
-prenatal vitamins (doesn't hurt to be prepared)
-vitamin D (because I am always pasty white)
-baby aspirin (increase blood flow to uterus)
-Lovenox (to prevent blood clots, since I am "blessed" with Factor V Leiden and MTHFR.)

The last one is what is causing all the trouble, and not just because it stings like a mofo. My insurance doesn't seem to want to cover it. At first they would let my pharmacy fill it, but only 6 syringes at a time. With a $10 copay, that's actually pretty reasonable compared to the out of pocket price (at least ten times that amount, even for the generic, which explains their reluctance to pay for it.) It was just kind of a bother to make such frequent trips to Target. Then last time when I tried to fill it I got rejected - they now will only give me 6 syringes every 23 days. Which is pretty useless since I need to take it daily or I could, you know, die from a pulmonary embolism. (Also, 23 days? Why not 20? Or 30? Or 42? Who came up with 23?) I've talked to several customer service reps who have been about as useless as their current Lovenox policy. It's supposed to be a straightforward process: have my doctor call them and tell them I need to take it every day, but that's happened twice already and for some reason that hasn't been enough to change it. Thankfully my hematologist had some samples in the office and she let me have enough to cover me for the next few days while we battle things out.

Watch out Cigna. I'm willing to fight for a long time to earn the privilege of not dying of a blood clot.

Scheduled

Big news today - well, not Osama Bin Laden-big, but infertility saga big. I'm scheduled! All the preliminary testing is done and we are officially cycling, gearing up for the big FET.

Here's the rundown, for anyone interested in such things (and for my future reference - I can't even count the number of times I've gone back to posts about our first IVF to remind myself of what happened.)

5/9 - Baseline sonogram & bloodwork. Begin birth control pills and Lovenox injections*. (Done.) The sonogram didn't go quite as expected since we found that I have a large ovarian cyst, but the bcps should shrink it down. We hope.

5/27 - Sonogram. Begin taking Lupron, 20 units a day (sub-q injections.)

5/30 - last birth control pill

6/3 - Sonogram & bloodwork. Begin Estrace (not sure yet if it will be in pill or suppository form,  but the important thing is it's NOT an injection!) Reduce Lupron to 10 units a day.

6/7 - Start doxycycline (antibiotic) 100 mg, 2x day for 15 days. Eric takes it for 10 days.

6/10 - Sonogram & bloodwork. 

6/16 - Sonogram & bloodwork.

6/17 - Begin progesterone. Suppositories, not PIO injections. Hallelujah! With Sawyer I did PIO shots for something like 16 weeks, and I had nerve pain in my butt for a good two years after. I hear the suppositories are messy, but hey, I'm a mom, I can deal with messy.

6/22 - Embryo transfer.

7/1 - Beta test.

The last half of the schedule is extremely tentative and there's almost no chance everything will actually occur on those days, since it all depends on my body's reaction to the drugs. And if there's anything we know by now, it's that my body is unpredictable these days.

I've been on the phone all day scheduling appointments and ordering medications - from two different mail-order pharmacies, since apparently Village is out of Lupron. It was pretty funny talking to the lady at Freedom Drug, which we used for our last IVF in 2004. When she verified my address the one she had was 3 moves ago. It's funny how many things change if you just wait 7 years.



*I've been doing the Lovenox injections for 5 days and I'm already running out of non-bruised skin on my belly. And it really hurts, every time. How did I do this for nine months?