Busy busy

Wow, the last few days have been fun...

• First, the entire family got sick.  It was book-ended with two middle of the night vomiting episodes Tuesday and Friday nights.  And in between my husband and I were trying to go through the motions while not feeling very well.  Unfortunately, I've been doing A LOT of laundry.  Yuck.
• I don't know what the deal is with these IVF meds, but after reading about triedandtrying's near disaster with her prescriptions, I followed up on my prescriptions and found out that the mail order pharmacy never received them.  The nurse told me that they must have been sent to a local pharmacy by mistake, but when I called them, they had no record of it either.  I made a few calls and ended up getting it switched to the local specialty pharmacy and picked everything up on Friday afternoon, so I'm good to go tomorrow night for day 1 of Lupron.
• The IVF Orientation was fine, although I was not feeling well.  Good thing I have enough experience with the needles; otherwise, I might have had more than one reason for my unsettled stomach!  And I didn't get a chance to use the orange.  Boo.  The nurse who taught the class was okay, but she really asserted her opinion on exercise.  She told the group that her advice is to back off exercise as soon as you decide to do IVF.  That really bothered me.  I just don't understand how and why doctors and nurses have such different advice on the same topic.

Onward and upward.  Lupron starts tomorrow night and my last day of BCPs is Friday.  I'm getting antsy and wish this cycle were shorter, but I guess in the long run a few days here and there is not a big deal.  I'm just ready to get the show on the road, but I'm sure that in two weeks when I start stimming, I will be nervous.  I just need to remember to take one day at a time....

Saline Sonohysterogram

Check!  Mark that off the list.  I had an ultrasound and SHG this morning and was pleased that it quick and painless.   Somehow I came across a few blog entries last night where women had unpleasant experiences so I was a bit worried that I was going to have a repeat of the HSG (which for me was a terrible experience with a med student who had terrible technique and a bad bedside manner).

At any rate, everything looks good.  The cyst is gone.  There are a good number of antral follicles (15 on the right, 11 on the left).  Uterus and lining look good.

I also had a chance to review my plan with my doctor and get her input on my desire to do the chromosomal screening followed by an eSET.  She agreed that it made sense, so I have a sense of peace that this is the right route for us.  I keep contemplating the scenario of not doing the screening and transferring two embryos, but my fear of twins keeps bringing me away from that.

Ironically, when I met with the nurse today to discuss PGD, she mentioned that she also did a screening when she went through IVF and only transferred one embryo...and ended up with identical twins.  :)  Ha.  I get it.  There is only so much a person can control!

Anyway, next up is the IVF orientation on Friday and I will offer an orange from our tree for sacrifice.

Moving along

I was going to post that I really have nothing to write about because nothing is happening, but I realized that things are actually moving along.  For example:  
- I'm dutifully taking the birth control pills 
- I received a nice big envelope in the mail with a bunch of consent forms to sign.  I read them and realized that I have some work to do!  I need to get some specific costs on certain procedures (ICSI, assisted hatching) as well as storage costs.  There was no information on PGD, so I have to call tomorrow morning and make sure that I set up the chromosomal testing (I was told that you can set it up and cancel at the last minute, but not the other way around).
- The nurse faxed in my prescriptions to the mail order pharmacy and I have been advised to be a "nag" to make sure they show up on time.  I'm not sure why she didn't use the local pharmacy I had used for my injectable IUI cycles, so I may just ask her to switch it back if it will make it less stressful.  Plus, for some reason, I get the Endometrin for free at the local pharmacy.  At any rate, Lupron injections begin a week from tomorrow so I have this week to take care of this.
- Saline sonohysterogram is scheduled for Wednesday morning.

On the exercise front, I've been diligent in squeezing runs in whenever I can.  My legs are getting nice and tired and I should be ready for a break on October 16th.  Now I just need to shape up my eating habits.

That's about all for now.  Everything else has been quiet and uneventful.  And now it's time to pick up the house and put away anything related to this cycle because my family is coming over for dinner.

ICLW

Welcome, ICLW.  I have recently decided to embark on my first IVF (this is a big deal for me) and am currently on BCPs and working out final scheduling details with the nurse at my clinic.

The top 4 things on my mind right now are:
1. Planning my schedule so I can exercise as much as possible in advance of the "no more vigorous exercise" cutoff listed on my IVF schedule on October 15
2. Gathering my thoughts on CCS (comprehensive chromosomal screening)
3. Working through the decision of single embryo transfer.
4. Wondering why I need to bring an orange to the IVF orientation class (for injection practice???)

Of course items 2 and 3 could drastically change next month when the cycle is underway, but I want to feel comfortable that I have the information I need to feel comfortable with the decision.

Thanks for stopping by....

The irony

Okay, so I know that this is nothing new and that many women doing IVF have had the same thoughts, but I can't seem to get over the irony of taking birth control pills. 

The last time I took a birth control pill was seven long years ago.  2005 was a long time ago!  Even my dog who is curled up next to me on the couch while I type this wasn't in our family then!  At that time my husband had already waited a year or maybe two for me to be ready "to give up my body" as I thought of it.  I had promised that after this triathlon season, I would be on board.  My logic for not pushing for one more year was that "you never know if you'll have trouble getting pregnant", so I didn't want to wait until I was nearing 35.  Maybe I did have a premonition.  Who knows.  I also had a close friend who was also going to start trying at the same time.  We talked about how fun it would be to be pregnant at the same time.  We would go for slow runs together the following spring and be on maternity leave together in the summer and fall.  It was a picture perfect plan.

So...on October 9th, 2005, I raced what I thought would be my last big race before babies and the next day I felt like I was throwing caution to the wind when I didn't start a new pack of pills.  I had no idea that what would follow would be months of irregular periods, diligent temping, and questionable ovulation.  And for my friend's part, she managed to get pregnant that November but miscarried a few weeks later. 

Since that last pack of bcp's seven years ago I have never prevented pregnancy...and I have never gotten pregnant without help.  My OB warned me that oftentimes women who had had trouble getting pregnant would then have a surprise pregnancy later.  Ha!  If only I could be so lucky.

When I reflect on this situation, I don't find bitterness in my heart, but more of a sense of disbelief that I am where I am.  I never thought that I would do IVF.  I don't feel like there should be anything wrong with me or my body.  And I certainly never thought I would be taking bcp's in an attempt to get pregnant. 

Go figure that this is my best shot.

Stockpiling

There are several things about IVF that I am not particularly looking forward to, but the one that will probably be the hardest is the exercise restriction.

I'm don't consider myself crazy or addicted to exercise, but I do like to get out and run at least 6 days a week.  I love to run.  It's calming for me.  It starts my day off right.  And I normally use it to ease my stress.  So I'm just a bit worried that I will be losing one of my most reliable stress-reducing outlets during this process.

I should count my blessings that my RE has been accommodating and said that I could swim (no flip turns) and bike (road, not mountain) while my ovaries are huge, but I'm still dreading the time away from running.

I have a plan.  In preparation for the next month, my goal is to get as much running in as possible and increase the intensity in an attempt to build up my fitness (and burn myself out?) so that maybe the first part of the break will be welcome.  There are some local races coming up and my gym at work has some classes that I really enjoy (and that kick my butt, leaving me sore for days!), so I will be getting my butt out there.

Then maybe I won't even notice when the stash of drugs and needles show up at my house....

Finally!

Finally, my month of waiting is over. Finally, it's CD1.  And finally, I have made a decision that I am happy with.

I decided to go with IVF. 

It became clear to us that we want to take our best shot at this sooner rather than later and not leave any cards on the table.  I do think that I could get pregnant with Clomid, but I don't know how long it will take.  At my age, I don't have the time to stay on this rollercoaster ride for very long.  I realize that the IVF may not be successful and that I may not have any embryos that make it to freeze, but I feel most comfortable with going all in and seeing what happens.

I called in to report CD1 this morning and by early afternoon received a tentative schedule:

BCPs: 9/18-10/5

Saline Sonohysterogram: 9/25
IVF training class: 9/28
Lupron injections begin: 10/1
Rest of injections begin: 10/12
Day 5 ultrasound: 10/16
Predicted Retrieval: 10/22
Predicted day 3 transfer: 10/25
Predicted day 5 transfer: 10/27

I'm ready.  Let's get the show on the road!

Meeting with the RE

So it's now Tuesday night, AF is looking imminent (no miracle natural baby for me!) and I still don't have a final decision. 
The meeting went well...but I still don't have an answer.  I first spoke with a med student to provide some background information.  She asked what our timeline was, which threw me for a loop because originally my husband and I had discussed that we didn't want to go much longer than the end of the year, but that seemed so soon, so I said 6 months...

A few minutes later my doctor walked in and said "So we have six months to get you pregnant!".  Eek!  She started out by talking about IVF.  She talked about the process, made a comment that we would need to be careful about dosage since I am very sensitive to the medication, said she didn't think we didn't need to worry about ICSI, and then said that one decision we would need to make is how many embryos we would want to transfer.  I said I only wanted to do one.  I hope I have the strength to stick by this decision.  She was not against that knowing my history with pre-eclampsia and the potential problems I could have with twins.  She said that she had done SETs on 39 year old women before (I don't think it's very common at all), but if I did this, I might want to consider CCS so that we could know that we were transferring a chromosomally normal blast.  This wasn't something I had on my radar so it was good to discuss. 

We talked a little bit about timing and whether I'd be able to fit an FET in before the end of the year.  We concluded that it would be close...

I then asked for her thoughts on Clomid.  She was also open to this option and didn't think that waiting until January before doing IVF would impact my egg supply or my chances for getting pregnant.  We discussed that we know that I can get pregnant with Clomid, but it's definitely an unknown because you don't know what's failing and how long it will take before we have a successful cycle.  She then suggested that we could do Clomid with IUI until the end of the year and then get on BCPs in December to queue up to start IVF after the holidays. 

After talking through the logistics a bit more, she was actually leaning towards this option.  We have a vacation to Hawaii planned in early November and she was concerned that I wouldn't enjoy the vacation as much as I should because I would still be recovering from the cycle. It's definitely a consideration, but on the other hand, I think it would be nice to be on vacation and away from work during that time.

So...what am I going to do?  I'm still not sure.  There are definitely pro's and con's to each approach and each has its own appeal.  After talking it over with my husband, I realized that it's important for me to make my best effort to get pregnant before the end of the year, so I'm working out in my mind whether or not three Clomid cycles beats out one IVF cycle.  I even drew up a decision tree (I know, I know, but clearly nothing else is making the decision clear to me!).  I can't really figure out what I'm looking at in terms of probability of success for a single cycle for Clomid, or even IVF.  What do you think?  15%?  10%  for Clomid?  I checked SART and the IVF success rate for my clinic for my age is really low, so I'm not sure what to think about this data. I wanted to put a 30% chance of success on the IVF, but that is not consistent with what the data shows.

I think my last step is to send her a message and get her take on chance of success for each path and go from there.  She's put in the order for both Clomid and for IVF, so I just need to call in for CD 1 and have an answer ready when the nurse asks if I'm reporting CD1 for IUI or IVF.  I don't have much time.  Thank goodness!

Final Decision

Oops, life has taken over all of my attention this week, so I forgot to update on the nurse phone tag situation.  A different nurse eventually called me back last Friday and while we were talking, it became pretty clear that I wasn't going to come to any final conclusion by talking with her.  We decided that the best plan was for me to meet with my doctor to discuss options, weigh the pros and cons, and come to a decision together.

I wanted to meet with her before next AF (wouldn't that just suck if I couldn't see her before then?) which is due late next week, so the nurse put in a request with the scheduling people and now I have an appointment tomorrow afternoon.

I have been fully consumed with family this week so I haven't had a chance to prepare for tomorrow's meeting, but I think I have it all in my mind and just need to organize my thoughts so we can walk through the options and get her perspective on the best way to proceed. 

I expect to have some clarity tomorrow.  Finally.

IV-F?

While we were out of town this weekend, we had dinner with some friends who went through maybe five IVFs several years ago and eventually got pregnant with twins using donor eggs. 
When we walked into their house, we were greeted by their two dogs Rusty and Ivy.  We were petting the dogs a bit later in the evening when the wife explained that Ivy joined their family after their first IVF failed and she was actually named IV (they left off the F for failure!).  It's amazing the things you learn at dinner parties....

I thought this was cute and funny, but I realize that it's only cute because they were eventually successful and now they have two healthy 5 year old boys.  I can't imagine what would have happened if their final attempt had not been successful.  Would they always look at their dog and think about what could have been?

They say that infertility can stay with you forever.  I guess this is just another example of how people handle it.