For women who are TTC, there are POASers and non-POASers. I am far in the non-POASer category, and, for the record, POAS stands for peeing on a stick, or taking home pregnancy tests (HPTs).
For completely irrational reasons that are common in an infertile's mind, I feel like it is not truly a BFN until I get my period, and I always hope beyond hope until that actually happens. Many of us, however, are POAS-aholics and begin testing almost right away.
When you trigger with an injection like Ovidrel, an HPT will test positive soon after the injection. Many women will "test out" the trigger by testing often and watching the positive result from the trigger fade, then begin testing for another positive to see if the cycle was effective. Many women will also begin testing as soon as possible.
I rarely test. Out of the thirty-some cycles that we have been TTC, I have tested for fewer than ten of them. HPTs are expensive and I just don't see the point for me. In the 2+ years that we have been TTC, I have never had a positive, not even a faint one that resulted in a chemical pregnancy. Besides the cost of the HPTs, I also have trouble facing the seemingly inevitable.
Even though I know that the result will most likely be a BFN, those few days at the end of the cycle when it really could happen, or you might be late are really exhilarating. Your mind races with thoughts like of course it is negative - so far you're 0 for 31, but then there is that other thought, why not now? There is always a possibility... and you start thinking about how deliriously happy you would be. And how you would tell your husband. And how you would tell your family. And how everyone at work would be so happy that it was finally your turn.
It is really the only time during the month that the negativity doesn't outweigh the positivity for whatever reason. And I love it. I don't know if it is my brain's natural way to keep me from completely losing hope, but it feels so good. And when the BFN comes, it hurts and it is devastating for a while, but I keep plugging along because in some strange way, I was always prepared.
This is pretty much where I am now. Right now, CD30 is coming to a close, and on the last three cycles of Femara, my period always started early, around CD26 or CD27. I'm getting that natural high of thinking that this might be real. But then I remember that we had to cancel our IUI this cycle and that I never even triggered. My cycle could be running longer because I never sped it up with triggering. And I never even had an IUI, so what am I thinking? But then that other part of the brain chimes in and insists that it is possible. Lately, there have been several unexpected BFPs on the boards, either on breaks or canceled cycles.
Despite my inner-conflict, my period will have to be days late for me to even consider testing. As long as there is no negative test, I can still hang on to hope, and that's really all I've got right now.
How many chicks do you know that have been to a scrapbooking convention and a tattoo convention in the same weekend? How many historians do you know that teach middle school science? I am a middle school teacher, metalhead and infertile wife just stuck here in the middle.
Wednesday, August 31, 2011
Thursday, August 25, 2011
This is what I mean by "roller coaster..."
So it looks like our journey with the research study will be just as much of a roller coaster ride as the rest of the infertility journey.
I left our meeting with Dr. C feeling somewhat better about all of my projected anxieties. He assured us that he would do everything in his power to make the study work for us given our location and work schedules. He said that he would try to set up our appointments at the Radnor location as early or as late as possible.
This morning, I got a follow-up call from the organizer of the study, a woman named Jean. She told me that, in fact, no one has ever participated in the study through the Radnor office and that Dr. C is still working on this, but that it is not a guarantee. Also new to me, she said that no matter what Dr. C is able to work out, the baseline ultrasound and two of the other eight monitoring appointments must be at the downtown office. The more she said, the more I could feel all of the stress coming back.
There is another issue that somewhat complicates matters, as much as I don't think that it should. Yesterday, I went into work because my new co-teacher asked me if I wouldn't mind giving her a hand with set-up and some of her questions about sixth grade. Within a few minutes of our chit-chat, she told me that she is ten weeks pregnant and due in March. I impressed myself with my response. There was no gutpunch feeling, no shocked stare or attempt to hold back tears; I simply congratulated her and moved on with the conversation. She got pregnant with her first child around the same time we started TTC and now she is expecting her second. She also told me that she is experiencing just about every pregnancy symptom there is and she feels like crap most days.
In my overview of middle school routines and scheduling, she was genuinely surprised and dismayed to hear that the schedule is now the same everyday and that there will no longer be days when we have preps first thing in the morning. I had heard before that she often left early for "childcare needs," but she was also planning on taking full advantage of the middle school schedule by coming in late when her young child or pregnancy required it.
Now there are two teachers in the room who need some flexibility in the schedule, and given the fact that she is already expecting and the reaction I got previously from the Head of School, I can't imagine that I will be the priority, especially given that I am the one who is a "seasoned veteran." Right now, I am preparing to begin a year in which I will have to train and support a new(-ish) teacher, just to have her leave in March. She is planning to return after 6-10 weeks, but several of our co-workers are trying to convince her to stay home for the rest of the year and the summer to be with her kids.
I have been told many times by many people that this treatment should be a priority and that I can't let these things stand in my way. It is just so much more complicated than that. I can't help but feel dedicated to my job and I really am passionate about teaching. I also have been given a fair amount of pressure and responsibility this year given that out of the six teachers in sixth grade this year, there are only two who have done this before, and I am certainly the more competent of the two. It is unfair that it works out like this, but I just can't see either of my bosses being very understanding when I tell them that I will be late eight days per month and that at least half of those days, I will be significantly late.
Basically, I see three options right now, none of which are particularly appealing to me right now:
1. Continue on with the study just hoping that we will be assigned to the Menopur group and that it will be logistically feasible.
2. Drop out of the study and make separate arrangements with our RE to try a few cycles with injectibles OOP.
3. Nothing. Take a break from treatment and just hope that hard work, scrimping and saving will bring us a little closer to IVF, maybe next summer.
In the car today, my husband offered full support for whatever decision I make, and I really appreciate that. I know many women would want to make the decision together, but he knows me and trusts me, and he also realizes that the nitty-gritty of this decision really comes down to work dynamics and personal issues that he really does not understand or even have to participate in. All I know for sure is that he is not ready to quit yet and that we're not even looking down the adoption road yet.
I feel really down today that all of this is happening at once and my personality does not jive well with feelings of powerlessness. I hate that life is throwing all of these obstacles in the way of our attempts to overcome the biggest obstacle of our lives. I hate the fact that at least one of these obstacles is based on my talent and dedication in my job and that I am, in effect, being punished for this. If I was less competent at my job and more willing to just stand up and neglect my responsibilities to do whatever treatment I want, I would probably be closer to a BFP right now, and that sucks. If I had chosen a different profession that was more financially rewarding, I would also probably be in a different position right now. Most of all, I really hate that infertility is making me second-guess myself and make choices that other people simply do not have to make.
I left our meeting with Dr. C feeling somewhat better about all of my projected anxieties. He assured us that he would do everything in his power to make the study work for us given our location and work schedules. He said that he would try to set up our appointments at the Radnor location as early or as late as possible.
This morning, I got a follow-up call from the organizer of the study, a woman named Jean. She told me that, in fact, no one has ever participated in the study through the Radnor office and that Dr. C is still working on this, but that it is not a guarantee. Also new to me, she said that no matter what Dr. C is able to work out, the baseline ultrasound and two of the other eight monitoring appointments must be at the downtown office. The more she said, the more I could feel all of the stress coming back.
There is another issue that somewhat complicates matters, as much as I don't think that it should. Yesterday, I went into work because my new co-teacher asked me if I wouldn't mind giving her a hand with set-up and some of her questions about sixth grade. Within a few minutes of our chit-chat, she told me that she is ten weeks pregnant and due in March. I impressed myself with my response. There was no gutpunch feeling, no shocked stare or attempt to hold back tears; I simply congratulated her and moved on with the conversation. She got pregnant with her first child around the same time we started TTC and now she is expecting her second. She also told me that she is experiencing just about every pregnancy symptom there is and she feels like crap most days.
In my overview of middle school routines and scheduling, she was genuinely surprised and dismayed to hear that the schedule is now the same everyday and that there will no longer be days when we have preps first thing in the morning. I had heard before that she often left early for "childcare needs," but she was also planning on taking full advantage of the middle school schedule by coming in late when her young child or pregnancy required it.
Now there are two teachers in the room who need some flexibility in the schedule, and given the fact that she is already expecting and the reaction I got previously from the Head of School, I can't imagine that I will be the priority, especially given that I am the one who is a "seasoned veteran." Right now, I am preparing to begin a year in which I will have to train and support a new(-ish) teacher, just to have her leave in March. She is planning to return after 6-10 weeks, but several of our co-workers are trying to convince her to stay home for the rest of the year and the summer to be with her kids.
I have been told many times by many people that this treatment should be a priority and that I can't let these things stand in my way. It is just so much more complicated than that. I can't help but feel dedicated to my job and I really am passionate about teaching. I also have been given a fair amount of pressure and responsibility this year given that out of the six teachers in sixth grade this year, there are only two who have done this before, and I am certainly the more competent of the two. It is unfair that it works out like this, but I just can't see either of my bosses being very understanding when I tell them that I will be late eight days per month and that at least half of those days, I will be significantly late.
Basically, I see three options right now, none of which are particularly appealing to me right now:
1. Continue on with the study just hoping that we will be assigned to the Menopur group and that it will be logistically feasible.
2. Drop out of the study and make separate arrangements with our RE to try a few cycles with injectibles OOP.
3. Nothing. Take a break from treatment and just hope that hard work, scrimping and saving will bring us a little closer to IVF, maybe next summer.
In the car today, my husband offered full support for whatever decision I make, and I really appreciate that. I know many women would want to make the decision together, but he knows me and trusts me, and he also realizes that the nitty-gritty of this decision really comes down to work dynamics and personal issues that he really does not understand or even have to participate in. All I know for sure is that he is not ready to quit yet and that we're not even looking down the adoption road yet.
I feel really down today that all of this is happening at once and my personality does not jive well with feelings of powerlessness. I hate that life is throwing all of these obstacles in the way of our attempts to overcome the biggest obstacle of our lives. I hate the fact that at least one of these obstacles is based on my talent and dedication in my job and that I am, in effect, being punished for this. If I was less competent at my job and more willing to just stand up and neglect my responsibilities to do whatever treatment I want, I would probably be closer to a BFP right now, and that sucks. If I had chosen a different profession that was more financially rewarding, I would also probably be in a different position right now. Most of all, I really hate that infertility is making me second-guess myself and make choices that other people simply do not have to make.
Research Study Consultation
Luckily, this meeting with Dr. C alleviated many of my fears and anxieties about the study. As I have posted before, one of my major concerns was whether or not to bother cycling in the study if we were placed in the Clomid or Femara group. I was really going into the study hoping to be assigned to Menopur and stressing over the other two protocols.
In normal clinical practice, the patient is prescribed a low dosage of either Clomid or Femara, usually with two or three refills. If the three cycles with that medication and dosage do not achieve pregnancy, the RE can either change the dosage or the medication after a follow-up consultation. In our case, three rounds of low-dose Clomid did result in mature follicles, but they usually took at least fourteen days to mature instead of the ideal twelve and we always developed only one. Instead of adjusting the dosage of the Clomid, our RE opted to switch us over to Femara, also at a low dose. Obviously, this protocol was not successful either and only resulted in slowly-developing single follicles.
In this study, however, the dosages can be changed from one cycle to the next because I will be so closely monitored and because the medications are being provided right from the RE instead of through a pharmacy. Given that we only ever matured one follicle and that it took slightly longer than the typical response, Dr. C felt that we were excellent candidates for a dosage adjustment after the first cycle if we are placed in the Clomid or Femara group. This made me more confident and hopeful about trying these meds again.
In this study, the patients are monitored much more closely than during a typical IUI protocol. During each cycle, I usually need a baseline ultrasound and a blood draw on CD3, then a follow-up ultrasound of the maturing follicles on CD12 and usually again on CD14. In the study, there will be an additional ultrasound and blood draw (or two) and check-up in between the baseline and the CD12, then several check-ins after the IUI.
With all of this additional monitoring, I was worried that my schedule limitations might be even more problematic. Dr. C could not have been more accommodating regarding my schedule. He cannot guarantee that all of our appointments can be taken at the Radnor campus, but he is working hard to create a research team at the location. He also offered to talk to the board about scheduling monitoring appointments in the afternoon after I get out of work.
There are still some final considerations that must be determined before we are definitively accepted into the study, so we are simply awaiting a phone call to see if we are accepted. As much as I am still hoping to be placed in the Menopur group, it seems like there is still hope for success with Clomid and Femara through this study.
As for right now, we are not allowed to take any meds, as this would interfere with the study. It doesn't matter much anyway - we just had to cancel our fifth IUI and we are out of refills for a new cycle. It seems like with the coming of the new schoolyear and all of the stress it will most likely bring, this is the perfect time to take a break from treatments and try to focus on living carefree for a little while. Who knows, maybe I am overstressing about the changes at work and we will be settled and adjusted just in time for a new cycle in the study... Fingers crossed!
In normal clinical practice, the patient is prescribed a low dosage of either Clomid or Femara, usually with two or three refills. If the three cycles with that medication and dosage do not achieve pregnancy, the RE can either change the dosage or the medication after a follow-up consultation. In our case, three rounds of low-dose Clomid did result in mature follicles, but they usually took at least fourteen days to mature instead of the ideal twelve and we always developed only one. Instead of adjusting the dosage of the Clomid, our RE opted to switch us over to Femara, also at a low dose. Obviously, this protocol was not successful either and only resulted in slowly-developing single follicles.
In this study, however, the dosages can be changed from one cycle to the next because I will be so closely monitored and because the medications are being provided right from the RE instead of through a pharmacy. Given that we only ever matured one follicle and that it took slightly longer than the typical response, Dr. C felt that we were excellent candidates for a dosage adjustment after the first cycle if we are placed in the Clomid or Femara group. This made me more confident and hopeful about trying these meds again.
In this study, the patients are monitored much more closely than during a typical IUI protocol. During each cycle, I usually need a baseline ultrasound and a blood draw on CD3, then a follow-up ultrasound of the maturing follicles on CD12 and usually again on CD14. In the study, there will be an additional ultrasound and blood draw (or two) and check-up in between the baseline and the CD12, then several check-ins after the IUI.
With all of this additional monitoring, I was worried that my schedule limitations might be even more problematic. Dr. C could not have been more accommodating regarding my schedule. He cannot guarantee that all of our appointments can be taken at the Radnor campus, but he is working hard to create a research team at the location. He also offered to talk to the board about scheduling monitoring appointments in the afternoon after I get out of work.
There are still some final considerations that must be determined before we are definitively accepted into the study, so we are simply awaiting a phone call to see if we are accepted. As much as I am still hoping to be placed in the Menopur group, it seems like there is still hope for success with Clomid and Femara through this study.
As for right now, we are not allowed to take any meds, as this would interfere with the study. It doesn't matter much anyway - we just had to cancel our fifth IUI and we are out of refills for a new cycle. It seems like with the coming of the new schoolyear and all of the stress it will most likely bring, this is the perfect time to take a break from treatments and try to focus on living carefree for a little while. Who knows, maybe I am overstressing about the changes at work and we will be settled and adjusted just in time for a new cycle in the study... Fingers crossed!
Injectibles
Our eligibility meeting with the research doctor at Penn is scheduled for early Monday morning, but like most true IFers, I am already bracing myself for disappointment. Even though we have passed through the initial phone screening and they were able to answer all of my questions, there is still a chance that we will not be eligible for the study, and we will hopefully find out for sure during the meeting on Monday.
As I described in the previous post, there is a one-in-three chance that we will be placed in the Menopur group, so it is likely that we will be assigned to take either Clomid or Femara again. Last night, I discussed with C whether we or not we would like to continue with the study if we are assigned to the oral meds group, and he seems to want to try. He figures that any chance is just that, a chance, and we should take anything that is financially feasible before looking into IVF. I guess providing all of those "samples" for IUI is less traumatic than he lets on...
I also had to bring up a third option. If we are placed in an oral meds group, we can always back out of the study and talk to the RE about trying injectibles OOP. Even though she usually skips over injectibles after oral meds and moves on to IVF, I think that she would allow us to try it given our financial situation. We can't really afford to try a Menopur/Follistim/Gonal-F cycle OOP, but is is certainly more feasible than IVF and some creative budgeting could allow for it.
Like a typical IFer, I am getting ready for the eventual disappointment and trying to come up with a backup plan. Some might say that I am putting the cart ahead of the horse by over-analyzing each step and not waiting until I have real news and information from the eligibility meeting, but there is a reason for that. IF is one of those situations that is truly out of the sufferer's control. By constantly planning and making alternate arrangements, an IFer feels more in control of the situation and can bounce back from failure more quickly by moving on to Plan B. I hope that this study works out and allows us to try a new protocol without the pricetag in the thousands, but if it doesn't, it gives me some hope to know that we can potentially try an injectible cycle or two in the near future.
As I described in the previous post, there is a one-in-three chance that we will be placed in the Menopur group, so it is likely that we will be assigned to take either Clomid or Femara again. Last night, I discussed with C whether we or not we would like to continue with the study if we are assigned to the oral meds group, and he seems to want to try. He figures that any chance is just that, a chance, and we should take anything that is financially feasible before looking into IVF. I guess providing all of those "samples" for IUI is less traumatic than he lets on...
I also had to bring up a third option. If we are placed in an oral meds group, we can always back out of the study and talk to the RE about trying injectibles OOP. Even though she usually skips over injectibles after oral meds and moves on to IVF, I think that she would allow us to try it given our financial situation. We can't really afford to try a Menopur/Follistim/Gonal-F cycle OOP, but is is certainly more feasible than IVF and some creative budgeting could allow for it.
Like a typical IFer, I am getting ready for the eventual disappointment and trying to come up with a backup plan. Some might say that I am putting the cart ahead of the horse by over-analyzing each step and not waiting until I have real news and information from the eligibility meeting, but there is a reason for that. IF is one of those situations that is truly out of the sufferer's control. By constantly planning and making alternate arrangements, an IFer feels more in control of the situation and can bounce back from failure more quickly by moving on to Plan B. I hope that this study works out and allows us to try a new protocol without the pricetag in the thousands, but if it doesn't, it gives me some hope to know that we can potentially try an injectible cycle or two in the near future.
This cycle was canceled...
...but I am hoping for new hope.
This month would have been my third cycle on Femara and sixth medicated cycle with IUI overall. When I went in for the CD12 ultrasound on Friday, there was only one lead follicle and it was pretty small, measuring only 16mm. Even after the two day recheck on CD14, it wasn't looking good and even the RE said that we would need "a lot of luck this time." Given the size of the follicle and that I wasn't feeling very "lucky," we canceled the IUI. I figured that there is no need to fork over the money for the trigger shot and IUI with only one rather skimpy follicle.
On a slightly lighter note, we made an appointment today to go over the terms of a study that Penn is offering. In the study, they are looking at the occurence of multiple gestations (i.e. twins, triplets, etc.) comparatively with Clomid, Femara and Menopur. Unfortunately, it is a blind study and the medication will be assigned randomly. Obviously, I would prefer to be in the Menopur group considering that this is the only one of the three medications that we have not tried already. It is also not covered by our insurance and is expensive, so this may be our only oppurtunity to try it. If we are assigned to the Clomid or Femara group, we will not know which medication we are receiving, and I am not overly optimistic considering that we have tried these before. (Even though the study is blind, the Menopur group will know because it is the only injectible medication of the three.)
According to the statistics originally given to us by our RE, injectible stims are only 5-10 percentage points higher in success rates than oral medications. She generally skips the injectible step because they are only marginally more effective, but significantly more expensive than the oral meds. I am very willing to try injectibles, however, if the cost is covered by the study.
I am trying to remain hopeful for the study, but I have a few concerns, mostly related to my return to work. Within two weeks, I will be back to work full-time and will have to work our fertility treatments around my work schedule.
In the past, the middle school has operated on a six-day rotating schedule so that I always taught the same number of classes per day, but the time of my free periods varied. In this schedule, I could often work my appointments around the class schedule so that in the 2010-2011 school year, I literally missed only two classes for RE appointments. This year, however, the schedule has been made static so that we will have the same classes each day at the same time. My most recent conversation with my boss indicated that my reading and math classes will be first thing in the morning each day, making it impossible for me to come in late too often. I will also be working with a new co-teacher this year who is only in her second year of teaching and first year of sixth grade. Last year, I worked with a seasoned veteran whom I could trust to take the lead when I needed her.
The study at Penn is also based out of their Philadelphia location instead of the Radnor satellite office that I have been visiting. The study coordinator said that she would try to accommodate me at Radnor whenever possible, but this may be an additional complication that hinders our ability to fully participate.
I am trying to remain hopeful for the study, but I can't help but think that it could have a negative impact on my work. Also, if it doesn't work and I have to move on to either IVF or adoption, I will have already set a bad precedent for needing time off.
A good friend at work once told me that "family always comes first, and right now fertility treatment is your family because it is the way to a family." As much as I believe this and want it to be true, I don't think that it will be as easy to work testing and monitoring into the schedule.
This month would have been my third cycle on Femara and sixth medicated cycle with IUI overall. When I went in for the CD12 ultrasound on Friday, there was only one lead follicle and it was pretty small, measuring only 16mm. Even after the two day recheck on CD14, it wasn't looking good and even the RE said that we would need "a lot of luck this time." Given the size of the follicle and that I wasn't feeling very "lucky," we canceled the IUI. I figured that there is no need to fork over the money for the trigger shot and IUI with only one rather skimpy follicle.
On a slightly lighter note, we made an appointment today to go over the terms of a study that Penn is offering. In the study, they are looking at the occurence of multiple gestations (i.e. twins, triplets, etc.) comparatively with Clomid, Femara and Menopur. Unfortunately, it is a blind study and the medication will be assigned randomly. Obviously, I would prefer to be in the Menopur group considering that this is the only one of the three medications that we have not tried already. It is also not covered by our insurance and is expensive, so this may be our only oppurtunity to try it. If we are assigned to the Clomid or Femara group, we will not know which medication we are receiving, and I am not overly optimistic considering that we have tried these before. (Even though the study is blind, the Menopur group will know because it is the only injectible medication of the three.)
According to the statistics originally given to us by our RE, injectible stims are only 5-10 percentage points higher in success rates than oral medications. She generally skips the injectible step because they are only marginally more effective, but significantly more expensive than the oral meds. I am very willing to try injectibles, however, if the cost is covered by the study.
I am trying to remain hopeful for the study, but I have a few concerns, mostly related to my return to work. Within two weeks, I will be back to work full-time and will have to work our fertility treatments around my work schedule.
In the past, the middle school has operated on a six-day rotating schedule so that I always taught the same number of classes per day, but the time of my free periods varied. In this schedule, I could often work my appointments around the class schedule so that in the 2010-2011 school year, I literally missed only two classes for RE appointments. This year, however, the schedule has been made static so that we will have the same classes each day at the same time. My most recent conversation with my boss indicated that my reading and math classes will be first thing in the morning each day, making it impossible for me to come in late too often. I will also be working with a new co-teacher this year who is only in her second year of teaching and first year of sixth grade. Last year, I worked with a seasoned veteran whom I could trust to take the lead when I needed her.
The study at Penn is also based out of their Philadelphia location instead of the Radnor satellite office that I have been visiting. The study coordinator said that she would try to accommodate me at Radnor whenever possible, but this may be an additional complication that hinders our ability to fully participate.
I am trying to remain hopeful for the study, but I can't help but think that it could have a negative impact on my work. Also, if it doesn't work and I have to move on to either IVF or adoption, I will have already set a bad precedent for needing time off.
A good friend at work once told me that "family always comes first, and right now fertility treatment is your family because it is the way to a family." As much as I believe this and want it to be true, I don't think that it will be as easy to work testing and monitoring into the schedule.
BFN
Well, it's all over for this cycle. This was our fifth medicated cycle and fourth IUI.
Usually, my cycles are like clockwork, but I started getting early spotting this cycle. I held out hope that the early and very light spotting may have been implantation bleeding, but I tested this morning (13dpIUI) and it was stark white - BFN.
I feel exasperated and tired, defeated and lonely.
I made reference in the past to discussing the costs of IVF, and I guess now is as good a time as any since it seems like we're getting very close to the end of the IUI road.
There are only fifteen states in the US that require insurance companies to offer fertility coverage and unfortunately, Pennsylvania is not one of them. Therefore, we will have to for all expenses out of pocket. Generally, clinics offer packages of IVF cycles, both fresh and frozen, but these prices do not include the cost of medications.
If we were to continue at Penn, where we have had all of our testing and IUIs, we would have a few options. A single cycle of fresh IVF without the cost of meds, it is around $11,000. Ideally, however, we would purchase a package of two fresh cycles and two frozen to increase our odds of success. This package is about $22,000. Another downside at Penn is that they may enforce a BMI requirement to even begin the process. While I have been working hard and exercising like crazy lately, it would be nice not to have a number looming over my head before we begin.
I did quite a bit of shopping around to find a better price and I found Sher Institutes for Reproductive Medicine with offices in North Jersey and a new office opening in Bethlehem. At SIRM, we can purchase two fresh cycles and unlimited FETs for just over $15,000. In this package, SIRM will perform a fresh cycle and if it is not successful, they will do unlimited FETs until your supply of frozen embryos is exhausted, however, you are required to use all of the frozen embryos before they will allow you to move on to a second fresh cycle. Aside from the savings, SIRM also does not have a BMI requirement.
It is impossible to know how much the medications will cost until the consultation, the prescribing and ordering them from a distributor. There are so many protocols for IVF, we cannot know which medications we will be prescribed. According to SIRM, IVF meds usually run from $2500 to $9000. We hope that we would be on the lower end of this range given our age and our lack of a diagnosis, but there is no way to know until we are committed to the cycle.
Overall, we can expect to spend about $20,000 for IVF and that is an absolute impossibility for us. We would have to rely on help from our family, and this is also problematic. While my mom and my aunt are more than happy to help us, I am struggling with the emotional toll that might take on us, especially if the IVF package is not successful.
The weight of all this information and all of these choices is really affecting me today. I really hoped that IUIs would be answer for us, but it is looking more like it will not. I have many hesitations about both IVF and adoption and I feel so stuck.
Usually, my cycles are like clockwork, but I started getting early spotting this cycle. I held out hope that the early and very light spotting may have been implantation bleeding, but I tested this morning (13dpIUI) and it was stark white - BFN.
I feel exasperated and tired, defeated and lonely.
I made reference in the past to discussing the costs of IVF, and I guess now is as good a time as any since it seems like we're getting very close to the end of the IUI road.
There are only fifteen states in the US that require insurance companies to offer fertility coverage and unfortunately, Pennsylvania is not one of them. Therefore, we will have to for all expenses out of pocket. Generally, clinics offer packages of IVF cycles, both fresh and frozen, but these prices do not include the cost of medications.
If we were to continue at Penn, where we have had all of our testing and IUIs, we would have a few options. A single cycle of fresh IVF without the cost of meds, it is around $11,000. Ideally, however, we would purchase a package of two fresh cycles and two frozen to increase our odds of success. This package is about $22,000. Another downside at Penn is that they may enforce a BMI requirement to even begin the process. While I have been working hard and exercising like crazy lately, it would be nice not to have a number looming over my head before we begin.
I did quite a bit of shopping around to find a better price and I found Sher Institutes for Reproductive Medicine with offices in North Jersey and a new office opening in Bethlehem. At SIRM, we can purchase two fresh cycles and unlimited FETs for just over $15,000. In this package, SIRM will perform a fresh cycle and if it is not successful, they will do unlimited FETs until your supply of frozen embryos is exhausted, however, you are required to use all of the frozen embryos before they will allow you to move on to a second fresh cycle. Aside from the savings, SIRM also does not have a BMI requirement.
It is impossible to know how much the medications will cost until the consultation, the prescribing and ordering them from a distributor. There are so many protocols for IVF, we cannot know which medications we will be prescribed. According to SIRM, IVF meds usually run from $2500 to $9000. We hope that we would be on the lower end of this range given our age and our lack of a diagnosis, but there is no way to know until we are committed to the cycle.
Overall, we can expect to spend about $20,000 for IVF and that is an absolute impossibility for us. We would have to rely on help from our family, and this is also problematic. While my mom and my aunt are more than happy to help us, I am struggling with the emotional toll that might take on us, especially if the IVF package is not successful.
The weight of all this information and all of these choices is really affecting me today. I really hoped that IUIs would be answer for us, but it is looking more like it will not. I have many hesitations about both IVF and adoption and I feel so stuck.
A Word on Adoption
I have met countless friends and acquantances over the years who have thrown around the notion that they would like to adopt a child. These are always friends who have a few children of their own and they have a daydream of a multicultural family that satisfies their need for altruism.
OK, that sounded really negative. I certainly do not mean to degrade any family that grows through adoption and I have said many times that I think adoption is as beautiful and natural way to build a family as any other. However, I think that the vast majority of these people are doing just that - fantasizing and have no real understanding of what adoption entails.
Here comes the brutal honesty: I think many of my kind, caring and like-minded friends have caught a case of JPS - Jolie-Pitt Syndrome.
I think it is wonderful that my friends want to offer a new life to a child in need, but the cold hard fact is that they will probably never adopt. If they had any intention of adopting, then they wouldn't be throwing these stories around because they would know the harsh reality of real-life adopting.
Just from cruising the boards on TB, there are always stories of adoptions that occured through some miracle match-up and that cost less than the federal income tax credit for adoption. I am truly happy for those people. Unfortunately, the majority of adopters will not have this luck.
I can honestly say that if my phone rang tomorrow offering me an infant from anywhere in the world, I would be on the next plane. In reality, you must meet hundreds of criteria and have your entire life - personal and financial - scoured by an agency. You must have agents come to your home and assess it multiple times. You must make videos and brochures of yourself as a couple and "sell" yourselves to the birth mothers who are flicking through catalogs of other couples. This does not even include the financial aspect.
I have contacted a few women who achieved their adoptions more easily and for less money, but unfortunately for us, their adoptions were through religious organizations. While these are sometimes less costly, they have their own religious criteria that we certainly do not meet.
International adoptions are often more costly. Besides the placement fees and the payments for lawyers and court fees in two nations, you must travel to the country and pay for accommodations, sometimes for a few days, sometimes for a few weeks depending on the laws of that nation.
Perhaps I'm being overly sensitive, but as a possible future adopter, it breaks my heart when I hear couples with children throwing around the idea so lightly. They already have a family and this avenue would just be a bonus, an add-on.
I have seen several children come through my classroom who were adopted in addition to biological children. Sometimes, their families are beautifully completed by adoption, and other times, the situation turns out to be downright unhealthy. I have seen families with children already who adopt another child, close in age to the others, then they struggle with some of the issues and complications that can arise. The parents want to do right by the adopted child, but they also feel compelled to protect their biological children and they cannot help but compare them.
Obviously, these situations are not overly common, and perhaps my one experience with a particular young girl have clouded my judgement about these close-in-age adoptions. That does not change the fact, however, that every child deserves to be treasured by their parents, and some of these scenarios do not lend themselves to a healthy valuing of the child.
Either way, for reasons that only a childless couple can understand, it pains me to hear another family throwing it around as something that would be "nice to do." In addition, only a childless couple can understand the emotional roller coaster that the adoption process also entails. When a birth mother changes her mind, or when laws and logistics interfere with the process, I think it would be a lot easier to go home to an already happy, healthy family than back to that empty home with the empty "nursery" that as been taunting you for years.
As I have posted before, an infertile couple that goes forward with adoption may very well be the happiest family in the universe, but there was still that moment in time when they had to grieve the baby that never was.
Call me jaded and bitter, I don't care. I can't help but feel that jab, though, when I hear adoption thrown around as an easier option...
OK, that sounded really negative. I certainly do not mean to degrade any family that grows through adoption and I have said many times that I think adoption is as beautiful and natural way to build a family as any other. However, I think that the vast majority of these people are doing just that - fantasizing and have no real understanding of what adoption entails.
Here comes the brutal honesty: I think many of my kind, caring and like-minded friends have caught a case of JPS - Jolie-Pitt Syndrome.
I think it is wonderful that my friends want to offer a new life to a child in need, but the cold hard fact is that they will probably never adopt. If they had any intention of adopting, then they wouldn't be throwing these stories around because they would know the harsh reality of real-life adopting.
Just from cruising the boards on TB, there are always stories of adoptions that occured through some miracle match-up and that cost less than the federal income tax credit for adoption. I am truly happy for those people. Unfortunately, the majority of adopters will not have this luck.
I can honestly say that if my phone rang tomorrow offering me an infant from anywhere in the world, I would be on the next plane. In reality, you must meet hundreds of criteria and have your entire life - personal and financial - scoured by an agency. You must have agents come to your home and assess it multiple times. You must make videos and brochures of yourself as a couple and "sell" yourselves to the birth mothers who are flicking through catalogs of other couples. This does not even include the financial aspect.
I have contacted a few women who achieved their adoptions more easily and for less money, but unfortunately for us, their adoptions were through religious organizations. While these are sometimes less costly, they have their own religious criteria that we certainly do not meet.
International adoptions are often more costly. Besides the placement fees and the payments for lawyers and court fees in two nations, you must travel to the country and pay for accommodations, sometimes for a few days, sometimes for a few weeks depending on the laws of that nation.
Perhaps I'm being overly sensitive, but as a possible future adopter, it breaks my heart when I hear couples with children throwing around the idea so lightly. They already have a family and this avenue would just be a bonus, an add-on.
I have seen several children come through my classroom who were adopted in addition to biological children. Sometimes, their families are beautifully completed by adoption, and other times, the situation turns out to be downright unhealthy. I have seen families with children already who adopt another child, close in age to the others, then they struggle with some of the issues and complications that can arise. The parents want to do right by the adopted child, but they also feel compelled to protect their biological children and they cannot help but compare them.
Obviously, these situations are not overly common, and perhaps my one experience with a particular young girl have clouded my judgement about these close-in-age adoptions. That does not change the fact, however, that every child deserves to be treasured by their parents, and some of these scenarios do not lend themselves to a healthy valuing of the child.
Either way, for reasons that only a childless couple can understand, it pains me to hear another family throwing it around as something that would be "nice to do." In addition, only a childless couple can understand the emotional roller coaster that the adoption process also entails. When a birth mother changes her mind, or when laws and logistics interfere with the process, I think it would be a lot easier to go home to an already happy, healthy family than back to that empty home with the empty "nursery" that as been taunting you for years.
As I have posted before, an infertile couple that goes forward with adoption may very well be the happiest family in the universe, but there was still that moment in time when they had to grieve the baby that never was.
Call me jaded and bitter, I don't care. I can't help but feel that jab, though, when I hear adoption thrown around as an easier option...
The Line in the Sand
So far, the biggest conflict between my husband (C) and I has been where to draw the "line in the sand." We are both completely committed to being parents. We both feel that being childless is absolutely not an option. What varies between us, however, is at what point the pursuit of a biological child ends and the pursuit of parenthood by any means necessary becomes the path. Unfortunately, as more family members have become a part of our infertility journey, the more alone I am on my line.
My husband is willing to go to any lengths necessary to have a biological child. He would love to have a child now, as a matter of fact, we expected to have a one-and-a-half-year-old by now, but he is also fine with it taking many months or years. He wants to continue with our covered IUIs, but he also wants to try IVF and FETs as much as possible. He is open to adoption, but considers it a last resort and has several conditions on it.
I, on the other hand, am more open to adoption and have some real hesitations about IVF. I am happy to continue with the IUIs that are covered under insurance, but at a certain point, it is becoming obvious that IUIs are not going to work. So far, we have never been pregnant. We are very fortunate to have never miscarried, but I don't know how I would handle it. Frankly, the thought terrifies me. I am also very reluctant to go through all of that treatment, bedrest, and all of that money if it doesn't work. The idea of paying monthly bills or flushing out family savings accounts for unsucessful IVF treatments gives me a lump in my throat and nearly makes me sick.
Now that several members of my family are aware of our infertility, they have become somewhat involved in the decision making process. While they are very supportive, it has surprised me how much they have come down on the side of further treatment. They would certainly support us and help us with an adoption, but they also believe that we should try IVF, and that we (or more likely my husband) will regret it if we do not try.
We are in complete agreement on a few fronts, however. We both agree that donor sperm (DS) and donor eggs (DE) are out of the question. Many couples feel a strong desire to go through the process of pregnancy, but we do not feel strongly enough to use DE or DS. While experiencing pregnancy would be wonderful, we both agreed that if the child is not biologically ours, we might as well adopt.
Overall, as difficult as the journey has been for the both of us, no one, not even C, can understand the apprehensions I have about going forward with IVF. No one else has to experience it in the same way that I do, and no one has to deal with potential loss or guilt like I do. As much as I value the opinions of my husband and my family, their experience with a failed IVF will not be anything like mine. Even though I am alone here next to my line in the sand, it will be me who feels it most when the decision is finally made.
My husband is willing to go to any lengths necessary to have a biological child. He would love to have a child now, as a matter of fact, we expected to have a one-and-a-half-year-old by now, but he is also fine with it taking many months or years. He wants to continue with our covered IUIs, but he also wants to try IVF and FETs as much as possible. He is open to adoption, but considers it a last resort and has several conditions on it.
I, on the other hand, am more open to adoption and have some real hesitations about IVF. I am happy to continue with the IUIs that are covered under insurance, but at a certain point, it is becoming obvious that IUIs are not going to work. So far, we have never been pregnant. We are very fortunate to have never miscarried, but I don't know how I would handle it. Frankly, the thought terrifies me. I am also very reluctant to go through all of that treatment, bedrest, and all of that money if it doesn't work. The idea of paying monthly bills or flushing out family savings accounts for unsucessful IVF treatments gives me a lump in my throat and nearly makes me sick.
Now that several members of my family are aware of our infertility, they have become somewhat involved in the decision making process. While they are very supportive, it has surprised me how much they have come down on the side of further treatment. They would certainly support us and help us with an adoption, but they also believe that we should try IVF, and that we (or more likely my husband) will regret it if we do not try.
We are in complete agreement on a few fronts, however. We both agree that donor sperm (DS) and donor eggs (DE) are out of the question. Many couples feel a strong desire to go through the process of pregnancy, but we do not feel strongly enough to use DE or DS. While experiencing pregnancy would be wonderful, we both agreed that if the child is not biologically ours, we might as well adopt.
Overall, as difficult as the journey has been for the both of us, no one, not even C, can understand the apprehensions I have about going forward with IVF. No one else has to experience it in the same way that I do, and no one has to deal with potential loss or guilt like I do. As much as I value the opinions of my husband and my family, their experience with a failed IVF will not be anything like mine. Even though I am alone here next to my line in the sand, it will be me who feels it most when the decision is finally made.
One Infertile's Epiphanies
Lots of people think that they understand how you feel, or they think that they can sympathize, but infertility is really a singular experience that cannot be fully understood by anyone unless they have experienced it. Here are my reasons why it is such a unique experience, as well as some thoughts that have probably never occured to a fertile individual.
1. At every stage in your life, you had at least a vague idea of what the future held. We don't.
No matter what I have gone through in my life, there has always been some clarity of what the future held, at least in the short term. Large and small, I always had some notion or feeling about what would happen. For the first time in my life, I feel blindsided and completely unaware of what to expect. I no longer have "a feeling" anymore of what will happen or a vision of what my future and my family will look like. For me, that was and continues to be a strange revelation.
2. If we adopt, we will love that child more than anything in this world, but we will still grieve the child we never had.
Long before I knew that I would have fertility problems, I always considered adopting and believed that it was as beautiful and natural a way to build a family as pregnancy. As reality set in, however, I had to accept that this was not financially feasible for us and that my husband deeply wanted his own biological child. No matter how realistic you are with yourself while trying to conceive, you cannot help but imagine your life with that child. As a matter of fact, you might not actually be ready for a baby if you do not constantly consider that baby's life once it arrives.
If you are like me, that child has a name and he/she has outfits, trips to the beach, birthday parties, and red hair with green eyes. Even though I have never conceived and never miscarried, that baby exists to me and it exists to my husband. While I truly believe that we can be a happy family through adoption, others need to understand that as much as I may love that child, I did lose a baby in the process. Part of the whole experience of infertility is to privately grieve a loss that others cannot understand.
3. An infertile couple is under the care of doctors and nurses with constant monitoring. If they can't get me pregnant, your advice certainly will not.
When people with children (and even people without children) offer advice about how to conceive, they almost always just mean to be helpful, hopeful and supportive. That, however, is not the way that it feels to the recipient of said advice.
If you tell me that I should have a few martinis and relax, or suggest positions and pomegranite juice, you are not only not making sense, but you are placing the "blame" back on that person. Many infertile couples may even interpret that as taunting and insensitive because you are explaining how easily it happened for you. Believe me, advice is not the kind of support that someone in this position needs.
4. If you tell me that "God has a plan," you may as well brace yourself for a throat punch.
Because you might just get one. First of all, if you know me and my husband at all, you know that we are not religious. Quite the opposite, in fact. Newsflash: we lived together for years before we got married; we dated for eight years before we got married and you're crazy if you think we "waited" for marriage; and my husband plays in a thrash metal band. Hello?
Besides the obvious eye roll from both of us, God-fearing or not, this is an incredibly hurtful thing to say. Basically, you are telling me that God doesn't want us to have children. If I had any other medical condition, would you tell me then that "God had a plan?" I don't recall anyone telling my friend with diabetes that "God had a plan," or that "God had a plan" when my aunt became paralyzed. Unfortunately, religion has become intertwined with fertility treatment, but that doesn't mean it has to be in your conversation with me.
5. Once we have been deemed infertile, our ability to become parents is largely a financial issue, and that really hurts.
Currently, only 15 states mandate health insurance coverage for infertility treament, and Pennsylvania is not one of them. Even under the mandated plans, there are usually lifetime caps on the amount of care available, or a prior diagnosis of infertility can be considered a pre-existing condition, thus limiting eligibility.
Our specific costs will be discussed in a later post, but it is worth noting what the average costs are for family building. For each IUI, there are at least 2-3 ultrasounds, plus the IUI itself and the costs of medication, totalling well over $1000. An average IVF cycle is almost $10,000, not including the medications, which could be anywhere from $2500-$9000. Finally, adoption also runs in the $10,000s, ranging from $10,000 to $40,000, and the process can be filled with as many dead-ends, broken hearts and disappointments as TTC.
Not only does it break our hearts that we are having so much difficulty having a child, but that we have to take on second jobs, scrimp and save, and finance loans just compounds the issue. All of this to achieve something that is free to everyone else. Often, the treatments do not work, yet we are getting monthly bills or replenishing a savings account for the costs.
6. We did everything right.
It may not be the most rational thought process in the world, but what sometimes hurts the most about infertility is the stark unfairness of it all. Everytime we see unwanted pregnancies, unfit parents, and callous parenting, it is like a knife in our hearts. Sometimes I just sit in the house that I bought for my future children in the amazing school district with the backyard and empty bedrooms and I can't help but feel hurt and resentful. We planned and saved and worked to build for a family that we cannot have.
One of the first and most important stages of infertility is learning to accept and live with this great unfairness. For some, it takes only a few weeks to move on, but for others, it takes many months or years, or maybe even never.
1. At every stage in your life, you had at least a vague idea of what the future held. We don't.
No matter what I have gone through in my life, there has always been some clarity of what the future held, at least in the short term. Large and small, I always had some notion or feeling about what would happen. For the first time in my life, I feel blindsided and completely unaware of what to expect. I no longer have "a feeling" anymore of what will happen or a vision of what my future and my family will look like. For me, that was and continues to be a strange revelation.
2. If we adopt, we will love that child more than anything in this world, but we will still grieve the child we never had.
Long before I knew that I would have fertility problems, I always considered adopting and believed that it was as beautiful and natural a way to build a family as pregnancy. As reality set in, however, I had to accept that this was not financially feasible for us and that my husband deeply wanted his own biological child. No matter how realistic you are with yourself while trying to conceive, you cannot help but imagine your life with that child. As a matter of fact, you might not actually be ready for a baby if you do not constantly consider that baby's life once it arrives.
If you are like me, that child has a name and he/she has outfits, trips to the beach, birthday parties, and red hair with green eyes. Even though I have never conceived and never miscarried, that baby exists to me and it exists to my husband. While I truly believe that we can be a happy family through adoption, others need to understand that as much as I may love that child, I did lose a baby in the process. Part of the whole experience of infertility is to privately grieve a loss that others cannot understand.
3. An infertile couple is under the care of doctors and nurses with constant monitoring. If they can't get me pregnant, your advice certainly will not.
When people with children (and even people without children) offer advice about how to conceive, they almost always just mean to be helpful, hopeful and supportive. That, however, is not the way that it feels to the recipient of said advice.
If you tell me that I should have a few martinis and relax, or suggest positions and pomegranite juice, you are not only not making sense, but you are placing the "blame" back on that person. Many infertile couples may even interpret that as taunting and insensitive because you are explaining how easily it happened for you. Believe me, advice is not the kind of support that someone in this position needs.
4. If you tell me that "God has a plan," you may as well brace yourself for a throat punch.
Because you might just get one. First of all, if you know me and my husband at all, you know that we are not religious. Quite the opposite, in fact. Newsflash: we lived together for years before we got married; we dated for eight years before we got married and you're crazy if you think we "waited" for marriage; and my husband plays in a thrash metal band. Hello?
Besides the obvious eye roll from both of us, God-fearing or not, this is an incredibly hurtful thing to say. Basically, you are telling me that God doesn't want us to have children. If I had any other medical condition, would you tell me then that "God had a plan?" I don't recall anyone telling my friend with diabetes that "God had a plan," or that "God had a plan" when my aunt became paralyzed. Unfortunately, religion has become intertwined with fertility treatment, but that doesn't mean it has to be in your conversation with me.
5. Once we have been deemed infertile, our ability to become parents is largely a financial issue, and that really hurts.
Currently, only 15 states mandate health insurance coverage for infertility treament, and Pennsylvania is not one of them. Even under the mandated plans, there are usually lifetime caps on the amount of care available, or a prior diagnosis of infertility can be considered a pre-existing condition, thus limiting eligibility.
Our specific costs will be discussed in a later post, but it is worth noting what the average costs are for family building. For each IUI, there are at least 2-3 ultrasounds, plus the IUI itself and the costs of medication, totalling well over $1000. An average IVF cycle is almost $10,000, not including the medications, which could be anywhere from $2500-$9000. Finally, adoption also runs in the $10,000s, ranging from $10,000 to $40,000, and the process can be filled with as many dead-ends, broken hearts and disappointments as TTC.
Not only does it break our hearts that we are having so much difficulty having a child, but that we have to take on second jobs, scrimp and save, and finance loans just compounds the issue. All of this to achieve something that is free to everyone else. Often, the treatments do not work, yet we are getting monthly bills or replenishing a savings account for the costs.
6. We did everything right.
It may not be the most rational thought process in the world, but what sometimes hurts the most about infertility is the stark unfairness of it all. Everytime we see unwanted pregnancies, unfit parents, and callous parenting, it is like a knife in our hearts. Sometimes I just sit in the house that I bought for my future children in the amazing school district with the backyard and empty bedrooms and I can't help but feel hurt and resentful. We planned and saved and worked to build for a family that we cannot have.
One of the first and most important stages of infertility is learning to accept and live with this great unfairness. For some, it takes only a few weeks to move on, but for others, it takes many months or years, or maybe even never.
Officially in the 2ww...
To veterans of fertility treatment, the "2ww" is the two-week wait after treatment until one can test.
This morning, I had my fourth IUI on my fifth medicated cycle. This is our second cycle with Femara, but for the first cycle, we had to cancel the IUI for personal reasons (and a lack of the Ovidrel injection).
At the CD12 ultrasound, they were able to see one mature follicle, relatively large in size. My RE opted to let me go for one more day, then trigger the next day. I triggered on Monday night and scheduled the IUI for this morning.
On our initial SA, there were no problems with my husband's sperm count or quality, but the count and quality have been less consistent with each IUI. During our second IUI, the on-call RE performed the IUI at the Center City location and came into the exam room announcing, "So, your husband has a low sperm count?" I replied, "Um, no." Her response, "Well, he does today." Gee, thanks for your sensitivity, lady. On that day, his count was around 17 million with lower motility.
Luckily, today, the initial count was around 50 million with 51% motility. After washing, we had 45 million with 91% motility, and the RE seemed pretty pleased with these numbers. Also, the IUI was uneventful and went well, so I am trying to remain hopeful.
I have done a lot of research into IVF and adoption options in the past few weeks and it has been humbling and upsetting. I will go over the specifics in a separate post, but even the best scenarios seem nearly impossible. I am trying to remain hopeful for these IUIs because they may be our last shot for a long time...
This morning, I had my fourth IUI on my fifth medicated cycle. This is our second cycle with Femara, but for the first cycle, we had to cancel the IUI for personal reasons (and a lack of the Ovidrel injection).
At the CD12 ultrasound, they were able to see one mature follicle, relatively large in size. My RE opted to let me go for one more day, then trigger the next day. I triggered on Monday night and scheduled the IUI for this morning.
On our initial SA, there were no problems with my husband's sperm count or quality, but the count and quality have been less consistent with each IUI. During our second IUI, the on-call RE performed the IUI at the Center City location and came into the exam room announcing, "So, your husband has a low sperm count?" I replied, "Um, no." Her response, "Well, he does today." Gee, thanks for your sensitivity, lady. On that day, his count was around 17 million with lower motility.
Luckily, today, the initial count was around 50 million with 51% motility. After washing, we had 45 million with 91% motility, and the RE seemed pretty pleased with these numbers. Also, the IUI was uneventful and went well, so I am trying to remain hopeful.
I have done a lot of research into IVF and adoption options in the past few weeks and it has been humbling and upsetting. I will go over the specifics in a separate post, but even the best scenarios seem nearly impossible. I am trying to remain hopeful for these IUIs because they may be our last shot for a long time...
Beginning
Please note: I started this blog two months ago, but I am moving it to this location so that it can be public and anonymous. All of the old posts from the original blog have been moved here, so the date for all of these entries will be Thursday, August 25, 2011, even though they were created throughout July and August.
Though I would like to create posts on this blog about a variety of things, many of the posts will be about our journey through infertility. Anyone who knows me knows that I am a talker and I express almost every thought that comes into my head, but this process has been a little different. It isn't a privacy issue or one about embarassment, it is just painful and difficult to express to those who have never experienced it. This first post will briefly describe what our journey has been so far and how we got to be here.
My husband and I are high school sweethearts and have been in a relationship since we were sixteen. After I finished college and graduate school and he finished automotive school, we both were officially employed in late 2006. He had been working as a driver, then a technician at the same dealership for a few years and I landed my first teaching job in October of 2006. Within months, we moved in together for the first time when we were 22. We lived in that little one-bedroom apartment for two years and it was in that apartment that we were engaged.
It is worth noting that we are far from traditional and were perfectly happy with our living arrangement. We began looking to buy a house in 2008 and finally purchased our little house in November. When we purchased our home, however, and when we decided to get married, it was all with family in mind. We would have happily lived together for years if we did not believe that we were ready for children, but we wanted to start a family and we bought our little dream house and got married in order to do so.
Even before we married, we gave a brief shot at trying to conceive in March of 2009. Call it naivete, but I was born on Christmas Day and I thought that I would love to have a Christmas baby. We tried somewhat casually in March and officially stopped "preventing" that Spring. We were married in June of 2009 and immediately began actively trying. In June, July and August, we were only just beginning to learn about ovulation prediction kits (OPKs) and charting, so we made a more informed and intentional attempt in the fall, hoping for a summer baby.
Looking back, I feel like I was naive to think that I could plan for a particular season. I hoped that if I couldn't have my Christmas baby, at least we could have a summer baby so that I could be home with the infant for as much time as possible before returning to work in September for the new school year. I also hoped that I would miss as little paid time as possible and avoid using disability insurance and maternity leave. Once we went through the three-month window of the fall without conception, we discussed it and decided to continue trying to conceive (TTC) indefinitely, regardless of the projected due date. I remind myself, however, that many couples can plan their pregnancies and that there was no way I could have known that we would have this experience.
I cannot remember exactly when the internet became a major part of our journey, but I know that I stumbled on The Bump website through it's connection with The Knot, which I used extensively for planning the wedding. Through The Bump (TB), I discovered basal temperature charting and ovulation predictor calendars, as well as all sorts of specialized vocabulary and information for TTC. I also discovered one piece of information that changed my life - that infertility is defined by the inability to achieve pregnancy in one year of TTC. I'm not sure what I thought infertility was before, but within a few weeks of finding out this information, I would be in this group without ever really considering the possibility.
On TB, there are 40+ message boards for women of all degrees of pregnancy, motherhood or TTC to communicate with each other and exchange information and support. In "lurking" on the infertility boards, I realized that I suddenly fit in this definition and that I should seek help relatively soon to make sure that there wasn't a larger problem preventing us from conceiving. In the late summer of 2010, I decided to pursue help.
Of all of the phone calls and conversations I have had in this journey, the first one was probably the most difficult. I called my primary care physician and made an appointment to seek a referral. After a brief conversation about my overall health, I had to explain to my doctor why I was there. It was totally nervewracking. I explained to the male doctor that my husband and I had been trying to conceive for over a year and we would like a referral to the fertility care center at a nearby medical complex.
For many reasons, my husband and I decided that, at this early point, we would keep our troubles private. So many people have so many opinions about assisted reproductive technology (ART) and we had no real answers at this point.
Over the next few weeks, my husband and I went through the typical battery of fertility tests: the semen analysis (SA), uterine ultrasound, hysterosalpingogram (HSG) and blood tests. During the SA, the doctors analyze the sample for not only count, but also the quality and motility of the sperm. In the ultrasound, they analyze the shape, structure and lining of the uterus to detect any abnormalities, cysts, fibroids, or other issues. Finally, during the HSG, the doctors conduct an x-ray after flushing the uterus with a dye solution to detect any blockages in the tubes from the ovary to the uterus. In our case, all of our tests came back normal.
In all couples who seek fertility treatment, roughly one-third of couples find themselves in this same "unexplained" category. Therefore, it is not uncommon for all of the tests to come back normal even after a year or more of TTC with no success. While it was comforting to find that there were no immediate problems, such as male factor infertility (MFI), polycystic ovary syndrome (PCOS) or anatomical abnormalities, the "unexplained" diagnosis can lead to more anguish than any other.
When a couple is diagnosed as suffering from unexplained infertility, the potential for conflict, overanalysis of behavior and internalizing is enormous. When no underlying problem can be found, conjecture about possible causes are thrown around and it is difficult to avoid resentment or tension in the couple's relationship. In our case, this tension-causing and self-punishing factor was my weight.
I have struggled my whole life with my weight and I completely understand the implications that it has for my health. It is very difficult for me to lose weight, much less to keep it off for an extended period of time. When the fertility doctor (reproductive endocrinologist, RE) mentioned it, however, my heart sank and I immediately began to worry about pressure from others and potential tension between me and my husband.
The facts that I have been able to find are that weight may delay fertility, it can affect egg quality, and it comes with increased risk of gestational diabetes (GD), but the facts are vague and many doctors disagree on the actual effects. So here I am, stuck in the middle of this. It's difficult to know that losing weight will certainly be among the hardest things I have ever done in my life, but it also may not improve my chances of having a baby. I am also so afraid that it may mean that people might judge me for it or begin watching and monitoring everything that I do and eat. It's not a nice place to be. It's just too easy to blame weight and ignore any other issues that may not have been discovered yet.
So this is pretty much where we stand now. There is no real way to test the quality of my eggs or evaluate some other factors without going ahead with in-vitro fertilization (IVF). Currently, we are in the midst of our fifth interuterine insemination (IUI), the first three with Clomid and the last two with Femara.
Clomid and Femara are intended to increase the signals that the brain sends to the ovaries to develop more follicles of better quality. The hope is that after taking Clomid or Femara, the ovary(ies) will produce 1-3 mature eggs for fertilization, or follicles. Depending on the dosage of the medication and the protocol, these drugs are typically taken for five days on the third through seventh day of the cycle (CD3-7) or the fourth through eighth day (CD4-8). On the twelfth day (CD12), an ultrasound is performed to see how the follicle(s) have grown and progressed. If there are more than 2-3 follicles, the cycle will typically be canceled to avoid a high-risk multiple pregnancy. If the follicles are of the appropriate size and appear mature, the patient typically "triggers" ovulation that evening with a subcutaneous injection, such as Ovidrel. Thiry-six hours later, the IUI is performed at the doctor's office.
So far, on every cycle, we have developed one follicle and it has never been fully mature on CD12. Each time, I have had to go back on CD14 for another ultrasound before I got the approval to trigger.
The IUI itself is a simple procedure and seems to be far more traumatic for my husband than for me. Earlier in the morning, the male partner must produce a "sample," either at home or in the doctor's office. If it is collected at home, it must be transported quickly to the office for a process called "washing." Once the sample is dropped off and paperwork signed, the sample goes through a process that concentrates the sperm into a tiny sample of higher-motility and higher-quality. There is about an hour window between the sample drop-off and the IUI, so it takes up a good chunk of the morning.
During the IUI, the RE simply transfers the sample with a catheter, theoretically bringing the highest quality sample exactly to the tube to improve chances of fertilization and implantation. The process itself is usually painless, but I have experienced some pretty intense cramping after the fact, ranging from oh-that-hurts-a-little to doubled-over-in-pain-and-running-back-to-the-car-in-the-Walmart-parking-lot.
Because we are on our fifth IUI and most REs typically do six, we are beginning to consider the very likely possibility that IUI will not be the path to a baby for us. While it is possible to do IUIs with a more aggressive protocol of injectible ovary stimulation medications, these are very expensive and only marginally more successful than oral medications.
If these next IUIs do not work, the next logical step in treatment is IVF. There are many pitfalls here, however, not least of which being financial. We really cannot afford to do IVF out of pocket, so our only option is to buy packages of IVFs and frozen embryo transfers (FETs) with a fertility finance company.
Over the coming months, we will be researching our options and "shopping" REs to find the most reasonably priced options with the best care and success rates. We are also looking into adoption and we plan to attend informational meetings to gauge whether or not this option is for us.
Though I would like to create posts on this blog about a variety of things, many of the posts will be about our journey through infertility. Anyone who knows me knows that I am a talker and I express almost every thought that comes into my head, but this process has been a little different. It isn't a privacy issue or one about embarassment, it is just painful and difficult to express to those who have never experienced it. This first post will briefly describe what our journey has been so far and how we got to be here.
My husband and I are high school sweethearts and have been in a relationship since we were sixteen. After I finished college and graduate school and he finished automotive school, we both were officially employed in late 2006. He had been working as a driver, then a technician at the same dealership for a few years and I landed my first teaching job in October of 2006. Within months, we moved in together for the first time when we were 22. We lived in that little one-bedroom apartment for two years and it was in that apartment that we were engaged.
It is worth noting that we are far from traditional and were perfectly happy with our living arrangement. We began looking to buy a house in 2008 and finally purchased our little house in November. When we purchased our home, however, and when we decided to get married, it was all with family in mind. We would have happily lived together for years if we did not believe that we were ready for children, but we wanted to start a family and we bought our little dream house and got married in order to do so.
Even before we married, we gave a brief shot at trying to conceive in March of 2009. Call it naivete, but I was born on Christmas Day and I thought that I would love to have a Christmas baby. We tried somewhat casually in March and officially stopped "preventing" that Spring. We were married in June of 2009 and immediately began actively trying. In June, July and August, we were only just beginning to learn about ovulation prediction kits (OPKs) and charting, so we made a more informed and intentional attempt in the fall, hoping for a summer baby.
Looking back, I feel like I was naive to think that I could plan for a particular season. I hoped that if I couldn't have my Christmas baby, at least we could have a summer baby so that I could be home with the infant for as much time as possible before returning to work in September for the new school year. I also hoped that I would miss as little paid time as possible and avoid using disability insurance and maternity leave. Once we went through the three-month window of the fall without conception, we discussed it and decided to continue trying to conceive (TTC) indefinitely, regardless of the projected due date. I remind myself, however, that many couples can plan their pregnancies and that there was no way I could have known that we would have this experience.
I cannot remember exactly when the internet became a major part of our journey, but I know that I stumbled on The Bump website through it's connection with The Knot, which I used extensively for planning the wedding. Through The Bump (TB), I discovered basal temperature charting and ovulation predictor calendars, as well as all sorts of specialized vocabulary and information for TTC. I also discovered one piece of information that changed my life - that infertility is defined by the inability to achieve pregnancy in one year of TTC. I'm not sure what I thought infertility was before, but within a few weeks of finding out this information, I would be in this group without ever really considering the possibility.
On TB, there are 40+ message boards for women of all degrees of pregnancy, motherhood or TTC to communicate with each other and exchange information and support. In "lurking" on the infertility boards, I realized that I suddenly fit in this definition and that I should seek help relatively soon to make sure that there wasn't a larger problem preventing us from conceiving. In the late summer of 2010, I decided to pursue help.
Of all of the phone calls and conversations I have had in this journey, the first one was probably the most difficult. I called my primary care physician and made an appointment to seek a referral. After a brief conversation about my overall health, I had to explain to my doctor why I was there. It was totally nervewracking. I explained to the male doctor that my husband and I had been trying to conceive for over a year and we would like a referral to the fertility care center at a nearby medical complex.
For many reasons, my husband and I decided that, at this early point, we would keep our troubles private. So many people have so many opinions about assisted reproductive technology (ART) and we had no real answers at this point.
Over the next few weeks, my husband and I went through the typical battery of fertility tests: the semen analysis (SA), uterine ultrasound, hysterosalpingogram (HSG) and blood tests. During the SA, the doctors analyze the sample for not only count, but also the quality and motility of the sperm. In the ultrasound, they analyze the shape, structure and lining of the uterus to detect any abnormalities, cysts, fibroids, or other issues. Finally, during the HSG, the doctors conduct an x-ray after flushing the uterus with a dye solution to detect any blockages in the tubes from the ovary to the uterus. In our case, all of our tests came back normal.
In all couples who seek fertility treatment, roughly one-third of couples find themselves in this same "unexplained" category. Therefore, it is not uncommon for all of the tests to come back normal even after a year or more of TTC with no success. While it was comforting to find that there were no immediate problems, such as male factor infertility (MFI), polycystic ovary syndrome (PCOS) or anatomical abnormalities, the "unexplained" diagnosis can lead to more anguish than any other.
When a couple is diagnosed as suffering from unexplained infertility, the potential for conflict, overanalysis of behavior and internalizing is enormous. When no underlying problem can be found, conjecture about possible causes are thrown around and it is difficult to avoid resentment or tension in the couple's relationship. In our case, this tension-causing and self-punishing factor was my weight.
I have struggled my whole life with my weight and I completely understand the implications that it has for my health. It is very difficult for me to lose weight, much less to keep it off for an extended period of time. When the fertility doctor (reproductive endocrinologist, RE) mentioned it, however, my heart sank and I immediately began to worry about pressure from others and potential tension between me and my husband.
The facts that I have been able to find are that weight may delay fertility, it can affect egg quality, and it comes with increased risk of gestational diabetes (GD), but the facts are vague and many doctors disagree on the actual effects. So here I am, stuck in the middle of this. It's difficult to know that losing weight will certainly be among the hardest things I have ever done in my life, but it also may not improve my chances of having a baby. I am also so afraid that it may mean that people might judge me for it or begin watching and monitoring everything that I do and eat. It's not a nice place to be. It's just too easy to blame weight and ignore any other issues that may not have been discovered yet.
So this is pretty much where we stand now. There is no real way to test the quality of my eggs or evaluate some other factors without going ahead with in-vitro fertilization (IVF). Currently, we are in the midst of our fifth interuterine insemination (IUI), the first three with Clomid and the last two with Femara.
Clomid and Femara are intended to increase the signals that the brain sends to the ovaries to develop more follicles of better quality. The hope is that after taking Clomid or Femara, the ovary(ies) will produce 1-3 mature eggs for fertilization, or follicles. Depending on the dosage of the medication and the protocol, these drugs are typically taken for five days on the third through seventh day of the cycle (CD3-7) or the fourth through eighth day (CD4-8). On the twelfth day (CD12), an ultrasound is performed to see how the follicle(s) have grown and progressed. If there are more than 2-3 follicles, the cycle will typically be canceled to avoid a high-risk multiple pregnancy. If the follicles are of the appropriate size and appear mature, the patient typically "triggers" ovulation that evening with a subcutaneous injection, such as Ovidrel. Thiry-six hours later, the IUI is performed at the doctor's office.
So far, on every cycle, we have developed one follicle and it has never been fully mature on CD12. Each time, I have had to go back on CD14 for another ultrasound before I got the approval to trigger.
The IUI itself is a simple procedure and seems to be far more traumatic for my husband than for me. Earlier in the morning, the male partner must produce a "sample," either at home or in the doctor's office. If it is collected at home, it must be transported quickly to the office for a process called "washing." Once the sample is dropped off and paperwork signed, the sample goes through a process that concentrates the sperm into a tiny sample of higher-motility and higher-quality. There is about an hour window between the sample drop-off and the IUI, so it takes up a good chunk of the morning.
During the IUI, the RE simply transfers the sample with a catheter, theoretically bringing the highest quality sample exactly to the tube to improve chances of fertilization and implantation. The process itself is usually painless, but I have experienced some pretty intense cramping after the fact, ranging from oh-that-hurts-a-little to doubled-over-in-pain-and-running-back-to-the-car-in-the-Walmart-parking-lot.
Because we are on our fifth IUI and most REs typically do six, we are beginning to consider the very likely possibility that IUI will not be the path to a baby for us. While it is possible to do IUIs with a more aggressive protocol of injectible ovary stimulation medications, these are very expensive and only marginally more successful than oral medications.
If these next IUIs do not work, the next logical step in treatment is IVF. There are many pitfalls here, however, not least of which being financial. We really cannot afford to do IVF out of pocket, so our only option is to buy packages of IVFs and frozen embryo transfers (FETs) with a fertility finance company.
Over the coming months, we will be researching our options and "shopping" REs to find the most reasonably priced options with the best care and success rates. We are also looking into adoption and we plan to attend informational meetings to gauge whether or not this option is for us.
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