Trigger shot done!

Well I went to bed about 10:30pm, and Paul woke me up at 12:05am to give me my HCG trigger shot (he hadn't gone to bed yet). So those eggies of mine should be ovulating at about noon tomorrow. They want to retrieve them prior to ovulation as it would be impossible to find them after they've left the follicles given they are microscopic in size. So I guess I technically had one injection today, LOL. But still that's better than 3 a day although intramuscular shots hurt more than subq ones do. My stomach is grateful though!

My prayer requests at this stage in the game would be that the Lord would:

1. Guide the doctor's hands tomorrow during the retrieval that as many of the mature eggs can be retrieved as possible with no other injury to me (ie. doesn't pierce an artery of mine with the needle or something like that!)
2. Guide those in the andrology lab as they select the sperm to use for the ICSI process.
3. Prevent me from developing OHSS which is certainly still a risk given the large quantity of follicles I have growing in my ovaries.
4. Enable the "correct" number of eggs to become embryos. Of course I am hoping it is in His will for me to become pregnant. If I do get pregnant the first try, (especially with twins or triplets) I will be hoping that we haven't frozen a large quantity of embryos. If I don't get pregnant the first time or only have one or two babies, we will do a frozen transfer later (sooner if I don't get pg than if I do obviously). However we don't want to have say 15 babies! Most people that I know haven't had ANY frozen embryos. If I get pregnant with the fresh transfer that's fine with me if we don't have any to freeze. I would never have any embyros destroyed so the other ethical option in my mind is to give any extra embyros up for adoption. That is NOT my preference however. So that is why I am praying that the Lord would direct the fertilization process and such so that just the right number of embyros are created (I have no clue how many is the "right" number for us but I know He does!).

Retrieval on Wednesday!

My E2 was 3,224 today so it was almost exactly double what it was on Saturday (which is my usual pattern to double every 2 days). Dr. Awad thinks that 25 of my follicles are mature. I am to have my HCG trigger tonight at midnight (what fun!) but then I get tomorrow off - NO SHOTS for the first day in 25 days. YAHOO! The shots will resume on Wednesday when I start the PIO shots. My retrieval is scheduled for Wednesday morning at 9:00am. So I really would appreciate LOTS of prayer on Wednesday for the retrieval and fertilization (ICSI) to go well.

Smells

I usually wear nail polish on my finger and toenails (toenails only in the months I am wearing sandals). I had read on the information sheet last month that you cannot wear nail polish the day of the ER. I remember back when I had surgeries years ago they said it was in part to be able to check the color under your nails (a way of seeing how you are doing physically). So I figured that was the reason, and I have been going w/o fingernail polish the last week or so. Today I decided to ask about toenails as mine are still painted. I was told that it's fine for them to be painted if they have been painted for awhile, but that I should not paint them OR remove the nail polish from them the morning of the ER. She said the reason is that eggs and embryos are very sensitive to smells. She said no one who is in the room with the eggs or embryos is allowed to wear lotions, perfumes, etc. She even said not to use a smelly kind of shampoo! They then told a story of how a few months ago the hospital put new mulch outside, but the smell wafted inside. She said the doctor contacted the hospital and was very upset that mulch was put outside during a week they were doing IVF (they have on and off weeks for IVF throughout the year). I guess probably no other treatment inside the hospital might be ruined due to mulch outside the hospital! So anyhow I guess I will leave my toenails "as is" and wait to repaint them until after the transfer. I sure don't want something to do ANYTHING that might hurt my eggs or our embryos! I think I'll tell Paul not to even wear deodorant that day just to be safe. The nurse did say - but we want you to bathe that morning. LOL I am guessing embies and eggs don't like BAD smells either, LOL. I was only going to post one photo a day, but I do have an appropriate photo for this post! My nieces expect me to paint their fingernails and toenails when I see them (which I am very happy to do!!!). So I will post a photo from May in which Susie is showing off her painted toenails (and her nails were also painted red).

Stimming day 11 u/s report

Well I had the phleb. use my left arm again as I wasn't sure if my right arm would cooperate again. Well if I need blood drawn again this week I'm offering my right arm as my left arm HURTS. I've had blood drawn 6 times in the last 12 days and 5 of those times from the left arm. I thought since that arm had "off" on Saturday and Sunday that it would be okay, but I was wrong. But maybe I am done having bloodwork for a few days??? I'll find out when the nurse calls me this afternoon.

Well my ultrasound was very painful (as my ovaries are SUPER DUPER tender) and very long as there were LOTS of follies to measure. She measured more than 30 follies. I know she measured 16 on the one ovary; I am not exactly sure how many on the other side, but I know it was more than 12. The ultrasound machine only allows you to record up to 12 follies per ovary so she had to make the machine think she did two separate ultrasounds as she needed more than 12 measurements per ovary. So I'd guesstimate she measured about 32 follies or so. A few of those (maybe 4?) were "small" (meaning only about 10mm). The biggest was 19mm. There were I'd say at least 5 follies between 17-19mm and quite a few in the 14-16mm range. My lining is thick enough (11mm), but I've only had a problem with a thin lining ONE time and that was on Clomid. My lining is always PLENTY thick enough on inj. I was a little nervous about the fact that I had more than 30 follies that were 10mm or greater, but I think the 10mm are too small to really "count." I hope so anyhow. I am still praying for a fresh transfer. My #s today again convince me my retrieval will be Wed AM, but I'll find that out for sure in a few hours.

Slow moving

I have noticed that in the blogs I read I really enjoy the posts more when there are photos. Although they've been taking about 10 ultrasound photos each visit, they haven't given any copies to me so I can't share those with you. I don't know how interesting you would find photos of my follicles to be anyhow, LOL. You know you're walking slowly when a white haired gentleman at church who looks to be at least 70 years old passes you out as you are walking on the sidewalk leaving church. Yep, that's what happened to me today, LOL! I am walking at a snail's pace these days. I am also soooo thankful for my comfy couch at home! I was in sheer pain in Sunday School sitting on a metal folding chair. OUCH! The church pew was better than the chair but again more painful than my couch in my living room. My flute solo went well this morning although I couldn't hold the last note for as many measures as I was supposed to due to it being rather painful to take a deep breath that involved my diaphragm. This too shall pass (unless I get pg which might curtail my flute playing for a little bit). I am hoping that tomorrow morning will be my last belly shot and that the pressure in my ovaries will decrease after the retrieval on Wed. I figure they are going to retrieve about 2 years worth of eggs (considering the average woman ovulates 13 eggs a year). So my ovaries are definitely being overworked at the moment! I think tonight I am going to try sleeping on the recliner as I haven't slept well in bed the last couple of nights.

I am happy to report that my colleague, Michael, readily agreed to fill in for me on Wednesday evening if my ER ends up being Wednesday morning. He already filled in for me once last summer session when Paul and I had the "all day" RE appt. What a great friend he is!

E2 results

My E2 today was 1,612; Dr. Gell thought it "didn't go up much." 600 in one day isn't much?!? She was concerned when it went from 444 to 1,043 in 2 days but not from 1,043 to 1,612 in one day? I figured it would be at least 1,500. I know with inj/iui the highest they like to see it get is around 3,000. They have you cut your HCG dosage in 1/2 when it gets over 3,000, and if it gets over 3,500 they usually cancel. I speak from experience (both with cutting a HCG dosage as well as having a cycle cancelled). So I asked her what their limit was with ivf. She said 5,000. I think I'll be at 5,000 by Tuesday. So I am almost positive that my retrieval will be Wednesday morning. I doubt they'll put it off until Thursday morning, and Tuesday is definitely impossible if I am not triggering on Sunday night. I was hoping to have the ER on Tues or Thurs, but I guess that just means I need to find a substitute for myself for next Wednesday. If I have the ER on Wednesday then I hope I have a 3 day transfer as otherwise I'll also miss next Monday, and I'd really rather not miss 2 nights of class since the class only meets 12 times total!!! But it's out of my control. Given I only teach 2 nights a week it would have been possible to not need to miss any classes, but I guess now my hope is that I just miss ONE day. But if I need to miss 2 days then I will. I have to be on bedrest for 24 hours after the transfer, and I know I'll be too groggy from the narcotics and too sore to teach the night I have the retrieval.

So bottom line is I am staying at the same dosage until Monday morning, and that's when my next b/w and u/s check will be. Dr. Awad comes back Monday so he'll be making the decisions from here on out (Dr. Gell was making the decisions through phone consultations this week). It was good I got a refill as I will at the very least be using one of the Repronex vials that were in the refill Paul picked up for me on his way home from school. I am doubting I'll need any of the Follistim vial, but who knows for sure. I guess it's not impossible they'll have me wait until Tues night to trigger and have the ER on Thursday morning, but I would say I am 90% certain I'll be triggering Monday night and having the ER on Wednesday morning. Aside from my class on Wednesday night (August 1), I have kept my schedule completely free from July 31 to August 5.

The nurse said today that it's a double edged sword. The more eggs you have the higher your E2 goes, and more eggs can be really good. However a really high E2 or really high # of eggs also increases your chance of OHSS which they want to avoid. So here's my prayer request - I do NOT want this cycle to be cancelled. If my E2 gets too high OR I have too many eggs (more than 30), they will freeze any embryos we have 5 days after the retrieval and will do frozen embryo transfer in the future. The success rate with frozen embryos is not as high, that involves more shots, and involves more $$$ than having a fresh transfer next week will. So I really, really want to avoid OHSS and have a fresh transfer next week. If they thought I was really in danger they would have cut down my dose, so Dr. Gell must not be too concerned. She's also more aggressive. I think if Dr. Awad weren't on vacation he would have cut my dosage back some. My guess is that I'll have around 25 follicles on Monday. I feel like I'll be getting close to the 30 limit, but it's okay as long as I don't get to 31 or an E2 over 5,000. My only issue is that in the beginning they said TWELVE was the goal. I figure I'm going to have twice the "goal" which is why I don't understand the dosage decisions. I figured from the start I'd have a lot more than 12 when they started and kept me at 225iu a day. However, I believe God is in control so I am just trying to trust that it is all going as He has planned.

I'll post my next update on Monday morning! I greatly appreciate your prayers and comments on the blog that have let me know you are praying for me and cheering me on!!!

U/S report

Well first I have to share an answer to prayer. I was praying this morning that the phlebotomist would be able to get blood from my right arm (which no one has been able to do in many years although various ones have tried). I had to go to the outpatient lab at the hospital as the RE's office doesn't have a phlebotomist in on Saturdays. Going there involves walking up a very big hill, which normally wouldn't bother me but it was very painful today because of my tender ovaries. However that trip was well worth every painful step since she was able to draw blood from my right arm. YAHOOO!!!

The u/s tech said I have 21 follicles between 10-15mm; so they all grew 2-3 mm since yesterday morning (when they were 7-13mm). A lot of the follicles were 13-14 mm today. The nurse said likely I'll come in on Monday morning for another b/w and u/s check and either trigger Monday or Tuesday night (which would mean having the retrieval on Wednesday or Thursday morning). She'll call me later today after they get my b/w results and she talks to Dr. Gell. So I'll post again after I hear from her.

Going in again tomorrow

My E2 was 1,040 so I was correct in my prediction (I predicted it would be around 1,000). So they don't want me to wait until Monday for my next b/w and u/s, but neither the u/s tech or Dr. Gell are available to do the u/s on Sunday. So I'm going in again at 8:00am tomorrow. She said to stay at the same dosage, but they didn't give an indication as to when the stimming might stop. So just to be safe I called in a refill today of the Repronex and Follistim. I only have to pay $20 altogether for those vials, and I figure it's better to be on the safe side.

I did ask the pharmacist to only give me one box of Follistim (the Rx was for 2 boxes), and she said "but you only have to pay $10 for 2 boxes." To which I responded that I don't need 1,200 more IU of Follistim! I mean I actually might already have enough at home, but just to be safe I wanted to get one more vial (600iu). Yes, I know I will pay $10 whether I get 600iu or 1,200iu, but my insurance is paying the rest! I am sure they'd rather pay $591 for one box rather than $1,182 for two! I told her there was no way I needed 1,200iu so please just refill the Rx with only 1 box. I should have done the same with the Repronex now that I think about it. I should have just asked for only 1 box of that also as again the Rx was for 2 boxes. Well at least a box of Repronex is "only" $324 (for 375iu). If I get pg and have left over meds I'll donate them to someone so they aren't wasted.

I hope my vein is up for more b/w tomorrow. It really hurt today. Normally it doesn't hurt at all, but #1 I am not as crazy about this phlebotomist as others I've had there in the past and #2 I've had blood drawn from that vein 4 times in the last 9 days. So tomorrow will mean 5 times in 10 days. We shall see if it cooperates or if they need to use my hand instead. My right arm just can't be used for drawing blood so I always offer the left arm.

In terms of adoption we assembled the profiles last night (took us an hour working on it together), and I mailed them to Cathy today. Well I'll post another update tomorrow after my next appt!

Ultrasound report

The u/s tech measured 19 follicles (9 on one side and 10 on the other). The biggest was 13mm and the smallest that she measured was 7mm. MOST of the 19 were around 10mm. So I have quite a few growing in there, but they're not big enough yet. I really hope these 19 get bigger and not any more than that, but my guess is I'm going to have over 20. I really hope it stays as close to 20 as possible as I really don't want to get anywhere near 30. I can't remember for sure what this clinic defines as "big enough." I think my first RE clinic wanted to see at least 16mm, and if I remember correctly, I think this clinic uses 18mm as the minimum. I am curious what my E2 was today; I will find out in a few hours. I will post again this afternoon once I get my E2 level and find out what my instructions are as to my dosages and when to go in next. Also, I need to know whether I'll need to refill my prescriptions or not. I have enough Repronex for two more days (will run out after my Sunday morning injection), and I have enough Follistim for three more days (probably run out after my Monday night injection presuming my dosage stayed the same which it might not). I was hoping this was all I'd need. Not because of the cost as if I need to refill both it will only cost $20 total (although the vials are worth hundreds of dollars each) but just because I'd like the stimming portion to be over sooner rather than later if possible.

I am definitely in pain. It's not pleasant to have 19 follicles growing on your ovaries! I feel very bloated. I think my walking/jogging days are over for awhile. Last night was the first night it was too painful to sleep on my sides. I knew that day would come from previous experiences. It's hard for me to fall asleep on my back though as I always sleep on my sides except when my ovaries are feeling like they're ready to pop with 10+ eggs. Well hopefully this pain will not be in vain.

30 more profiles

I talked to Cathy M last night about our profile. She had some minor changes here and there that she suggested. Some were changes to the text and others were suggestions like - lighten such and such photo or make it bigger. So I made some changes last night and the rest this morning. I had a few ideas on my own of changes like I took a photo of Paul with Fergie (the dog we are pet sitting this week), of a deer in our backyard this morning, and of a vase of stargazer lilies in our living room that are from my flowerbeds. The profile is now 12 pages long.

So I ran those off at Staples today (which cost about $200) and then bought some pink ribbon at Walmart that has a string of pearl intertwined. I think it's very pretty. So tonight Paul and I will have what is hopefully our LAST experience of assembly profiles (punching holes, stringing ribbon, signing our names on the last page). After tonight we will have assembled at least 180 profiles over the last 31 months (we have 30 to do tonight). Then I'll get those in the mail to Cathy tomorrow. She said she'll use these 30 up first and then if she runs out she'll switch to the first 10 we sent. I hope one of these 30 is "the one." I can send our profile as a PDF file to anyone who wants me to email it to them.

Altogether we have now spent $10,000 on adoption in 2007 (between Ukraine and domestic newborn adoption) plus over $8K on IVF. It's a bit overwhelming for me the penny pincher! (just ask my dad to tell the story of when he gave me $$ to spend at summer camp, LOL) I know kids are expensive once you have them, but I never dreamed I'd spend over $30K just trying to have or adopt one, but we've already spent that much and will spend a lot more if we actually get matched with a birthmother or do ever travel to Ukraine. 2007 has definitely been the year of spending the most on adoption and fertility treatments. We spent $10K in 2004 on adoption but only about $4K total on adoption in 2005 & 2006. People are always quick to point out the adoption tax credit. Well...you only get that (especially for int'l adoptions) if you actually complete the adoption. So if we don't ever adopt from Ukraine, we'll never get a tax credit for the thousands we spent creating that first dossier that wasn't able to be submitted before it expired. And if we stick with our plan of me becoming a stay-at-home mom after we adopt, we probably won't be able to claim much if any of a tax credit over the 5 years you have to claim it as Paul will make very little as a FT grad student so we won't owe much if anything in taxes to the IRS so again no way of claiming the credit. Bottom line is that if we do adopt or get pg from IVF that child will be worth every tiny penny we spent trying to become parents, and I am thankful that the Lord has provided me with a job that has enabled us to come up with the money for these expenses the last 4 years. Of course we cannot keep spending money at this pace toward our efforts to try to become parents, so I am also glad that there is one free option out there - adopting from the foster care system. It's nice that there is a free option so that even those with very limited incomes are able to adopt even if they couldn't afford int'l or other adoption options.

Well I'll let you know tomorrow how I make out at the doctor. Tomorrow we should start to get an idea of how many eggs they might be able to retrieve from me next week.

E2 results today

I just called the nurse, and she said my E2 was 444 today. They are pleased with that so they don't want to change my dosages. I will have my next b/w and u/s on Friday morning. I bet my E2 will be over 1,000 on Friday. Keep in mind that in a "normal" cycle a woman's E2 peaks at about 150-200 around ovulation (for just one follicle). So having an E2 of 444 about 1 week before ovulation is much higher than "normal" but of course they want your E2 to be MUCH higher than normal with IVF if they hope you have at least 12 mature follicles. So anyhow so far so good although I am not feeling that great today. Off to work I go!

U/S report

Well I had b/w and an u/s this morning. I will get the b/w results in 3-4 hours as well as the instructions as to when to come in next (probably Friday) and what dosage my meds should be the next couple of days. The u/s was done by an u/s tech since Dr. A is away. I could tell she was struggling to find my left ovary, and I said to her - my left ovary is always hard to find. She laughed and said I must have done this a lot if I know that about myself, LOL. She said well your left ovary isn't THAT hard to find (compared to some other patients). But it is harder to find than my right ovary. I figure I've had at least 60 u/s in the past 4 years. Well the good news is that the follie sizes are right on track. I have lots of them on both ovaries but none are huge yet - which is good. Sometimes that can be a problem with IVF that a few take off and grow much faster than the rest. My biggest follies were 9 or 10mm on both ovaries. I can tell quite a few are growing though as I am feeling a lot of pressure on both ovaries. She only measured about 6-7 follicles, but I could see many more on the screen. The nurse will give the b/w and u/s results to Dr. Gell (in Wilkes Barre) and she'll then make the decisions as far as my dosages as well as when I should come in next.

I emailed Cathy M last night to make sure she got our package that I mailed on July 7 as I hadn't heard from her since. She called back while I was out last night, and when I called her back about 8:15pm (she's in CA so it was only 5:15 there) she was on the other line and said she'd call me back tomorrow. She did email me though and said that overall she really liked our profiles and just had some minor suggestions of changes to make before we make the next set of 30 profiles. She said she's been really busy - lots of babies born lately (which is good!). She had one born Saturday, another born yesterday, etc. and even two on the same day within the last 2 weeks. I told her we were pet sitting this week (Paul's nephew's hamster, Bubba, and Paul's parents' dog, Fergie), and we are going to take pictures of Paul with Fergie and replace the picture of Paul playing chess in the profile since likely a young woman will relate more to a dog than chess. Also, Paul and I had talked about going miniature golfing this weekend so maybe I'll have him take one of me holding my golf club and might replace one of my photos with that shot. So anyhow we'll make a few changes (hopefully for the better) before we run off the next 30 copies of the profile. But I was pleased that she thought our profile was "quite good" (to use her words).

In the grand scheme of things this is a MINOR prayer request, but I have been praying that if possible my egg retrieval next week could be on any day except for Monday or Wednesday. By the size of my follies today I am sure it won't be Monday. If I can have it on Tuesday or Thursday (which are very likely possibilites - I doubt it would be later than that), then I wouldn't have to miss any school. Of course I will miss school if necessary, but my class only meets a grand total of 12 times (3 hours and 20 minutes each time) this summer so missing one class is a bigger deal than normal. Again in the big picture this is really not very important, but I figure it doesn't hurt to ask! I'll post again later today after I get my b/w results.

So far, so good

My E2 was at 166 today (compared to 22 on Thursday morning). Dr. Awad is on vacation this week; so they called Dr. Gell to discuss my # with her. I did one cycle with her (last summer). She is pleased with my progress - not too little and not too much. So they are keeping my dosage the same. I will go in Wednesday morning for bloodwork and an ultrasound. At this clinic the RE's usually do the u/s, but it will be done by an u/s tech since Dr. A is away (and he's the only RE as his partner left about a year ago and his new partner doesn't start until September). The pressure is already starting to build. I can tell my ovaries are BUSY!!!

OUCH!

Well yesterday morning Paul gave me the Lupron on the left side (side that doesn't have bruises) and it was painless. Then he gave me the Repronex on my right side and it REALLY hurt - the area immediately got red and swollen. Thankfully the Follistim last night was painless. I have never been bothered by Follistim injections.

So this morning I asked him to give me the Repronex on my left side in case that might make it less painful. So first he went to give me the Lupron on my right side. I screamed and so he removed the needle before giving me the med. It still got red and swollen. He didn't think the needle had gone in at all, but when he saw the skin reaction I had he believed me it had gone in some. So then he switched to my left side which is usually my good side and for some reason it hurt a lot on that side as did the Repronex. So I ended up with three areas on my tummy that were red and puffy. I have no idea why the Lupron hurt so much today. This was day 16 of Lupron and most days it hasn't hurt. The nurse had warned me about the Repronex. She said they prefer to prescribe Menopur because it causes significantly fewer injection site reactions than Repronex does, but she said some insurance companies only pay for Repronex. I guess that must be why they gave me an Rx for Repronex rather than Menopur. It was really bad this morning. After the third stab (really the second injection) I was crying. All three spots were really hurting. I think both Paul and I are going to be a bit gun shy tomorrow morning. Thankfully I know the shot tonight will NOT hurt. I've had about 60 Follistim injections over the past 3 years, and they never hurt anywhere near as badly as the two hurt this morning. I'm going to try icing the areas tomorrow before the injections to see if that helps. Plus I will remind myself that I have 2 days done and probably about 8 more days at most to go. Scary thing is everyone says the PIO shots are the most painful of all, and I haven't had any of those yet. Oh well this will all be SO worth it if we see a heartbeat on an ultrasound in a few weeks.

Green Light!

Well today I had my baseline u/s and b/w. Basically they want to make sure you don't have any cysts. I got the "all clear" from the u/s, and my E2 was only 22 which is VERY low. And very low is very good! It won't be low for long though, lol. I just hope it doesn't go TOO high (meaning TOO many follies are developing). Tomorrow morning I will decrease my Lupron to 10iu (I have done 20iu the past 14 days), and I will also have 75iu of Repronex tomorrow morning. Tomorrow night I'll start taking 150iu of Follistim. I will do those same amounts on Saturday and Sunday as well as Monday morning (3 shots a day for about the next 10 days or so). Then I will have bloodwork done Monday morning. My dosages might be modified depending on how high my E2 is on Monday.

I am very glad they are going to monitor me after only 3 days of stimming as I am nervous that this might be too much. I was on 225iu a day once before and the cycle was cancelled. They normally start IVF patients on 300iu so they have already backed down in light of my previous track record. Dr. A feels that 225iu will be fine this time since I am still on Lupron and that is supposed to tone down my response a little. Anyhow I am very glad I'll have b/w on Monday morning so they can lower my dosage if needed before things get out of control. Then I'll probably go back on Wednesday for b/w and also an u/s. So tomorrow starts the main part of the IVF process. This part will likely take about 2 weeks (my egg retrieval will likely be around August 1). So I really covet your prayers each step of the way!!!

Earlier this week I emailed Cathy Harris to let her know that we weren't updating our dossier. I knew we wouldn't get back $1,500 of the money we paid her/Valentina, but I was hoping we'd get the other $1,000 back which was called a "prepayment." I thought we might get that part back since our dossier wasn't submitted etc. She told me it cost $1,500 to get the dossier translated and certified which has already been done. She encouraged me to create a 2nd dossier and suggested ways for doing it more inexpensively (such as only apostilling one dossier instead of two which would save $360). I had figured it would cost about $1,200 to update the dossier. She is estimating we could cut that down to $600. I asked if we would have to pay the $1,500 again, and she said she would try to work a deal with Valentina. She said maybe Valentina would waive the translation fee for the new dossier, and we would only pay an additional $1,000 to the SDA as an expiditing fee to get our dossier in ASAP. She's saying if we got a new dossier to Valentina in 4-6 weeks that Valentina would submit ours in September (through us paying this extra $1,000 "fee"), and we would have our SDA appointment in early December. December would be an ideal time to travel in light of me not missing work (and thus not getting docked say $10K in pay) and Paul not missing classes.

There's a tiny part of me that is tempted as in some ways this seems a more "sure" thing than IVF or domestic newborn adoption, but of course I was told before our first dossier would definitely be submitted by June at the latest. And that obviously didn't happen so I guess none of these options are "sure" things. Paul just wants to stick with domestic newborn and IVF. So I guess for now that's what we'll do. I am sure I don't want to pay the $1,000 fee until we know if the IVF worked or not. But we'll know if it worked in 4 weeks or less. So I am thinking maybe a compromise would be to pay the $43 for the child abuse and criminal record clearances so that IF we decided to do a second dossier we could do it quickly. Those are the documents which take the longest to get. The child abuse clearances are just for the social worker so she'll write an addendum for our home study. The criminal record checks are for her AND our dossier. Well I'll talk about it with Paul tonight, but I think this is a reasonable plan as we're only investing $43 to enable us to have the OPTION to send a dossier to UA in late August and possibly travel there in December. If I get pregnant I am certain we wouldn't send a dossier, but if the IVF doesn't work and we don't have any frozen embyros, maybe we'll revist this if we could truly travel in between the fall and spring semesters. I would still want to adopt a baby through Cathy M as we won't get a baby from UA if we go there, and I really want to parent at least ONE child from as close to newborn as possible. And I truly don't ever expect Lifetime to come through, but I'd love to be wrong about that!

Well again please pray about the IVF - that just the right amount of follicles will develop and that I won't get anywhere near having OHSS. Thanks!!

In a holding pattern

Well I *could* have gone in for my baseline appointment today and started the additional shots tomorrow, but when I spoke with the RE nurse on the phone on Saturday she said it's fine to keep my appointment for Thursday even though it means my FSH shots won't be starting until cd7, and they usually start earlier than that. She said I am in a holding pattern on the Lupron and can be left there as long as they want. Humph. I wanted to say would YOU want to have three extra days of shots for "no good reason"???? But I decided it wasn't worth fighting a battle to get my appointment moved up just to avoid three extra Lupron shots. She said "but you need to be on Lupron for at least 10 days." Well today was the 11th shot so no worries there! Then she said well you can be on it for weeks - it doesn't hurt to be on it longer than the minimum. My tummy begs to differ with "it doesn't hurt." I've got quite a collection of little bruises already! But I am trying to just go with the flow so I didn't persist and just let it go. Paul was actually the one I think ready to call the nurse this morning and ask her to move up my appointment, LOL! Paul said I am not an airplane and don't need to be in holding pattern! :-) He started giving me the shots a couple of days ago, and I do like that better. I'll do the Follistim ones myself, but I think I'll have him do all the others.

So anyhow Thursday morning I will have my baseline bloodwork (will refer to it as b/w in the future) and ultrasound (u/s). Then Friday I will add one shot of Follistim in the morning and one shot of Repronex in the evening to my routine and will continue the morning Lupron shot as well. That will likely continue for about 10 days (plus or minus a day or two). I am happy to say though that I've been feeling pretty good lately. I had a headache on Thursday and Sunday but I think that was more from driving in and out of NYC not the Lupron, LOL! I did take a nap on Friday, but I haven't had one since then. So I am thankful that my "menopause" symptoms haven't been too severe (no hot flashes yet!).

I haven't heard from Cathy yet. I assume she received our 10 profiles last week in the mail. I am anxious to hear her thoughts. We'll make the changes she suggests and then make 30 more (as she wants 40 total of the first batch).

Naps

Well I took a nap again today (90 minutes just like Sunday). So I am not back to "normal." But there was a big difference. I woke up, and after I ate dinner then I had my full energy back and was able to function normally (and still am alert now at 9:30pm!). On Sunday I was still exhausted and "in a fog" even after the nap. So I think I need to get over the idea that "I don't take naps." I remember in college my roommates would all take a nap on Sunday afternoons. And Paul likes a nap now and then. Well I guess it's okay if while on Lupron I am a nap taker, LOL! I just hope some of my other usual preferences don't change - like please let me never lose my love of chocolate, LOL! Just kidding. I would definitely give up chocolate if it would help me get pregnant!

Fog is lifting!

Well I thank those of you who have been praying for me the last couple of days. I was truly concerned about teaching my class last night. My idea in the afternoon was that maybe I should drink Mt. Dew or something like that a little before the class. I almost never drink soda or coffee so if I do have any caffeine then it really effects me since my body isn't accustomed to having it regularly. Well I didn't need any caffeine. Around 3pm or so I woke up yesterday (meaning I no longer felt at any moment I might fall asleep). And I felt fine for class last night! In fact, the ironic thing was that one student came up to me after class (it was the first night of class so it was my first time meeting these students) and she said "boy you're just bundle of energy!" I laughed and she asked me why I laughed and I said you would never believe how tired and sleepy I was all day and how nervous I was that I would be alert for class tonight. What immediately him me then was "oh ye of little faith!" I mean I was praying that I would be alert and asking others to pray - didn't I think God could answer that prayer? Well He did! I had my usual energy level and also didn't feel like my mind was in a fog like I had for most of the day on Sunday and Monday. PTL!

And I am happy to report that today I haven't had a nap yet, lol!!! I went walking with a friend at 8am near church and then had ladies Bible study at 9:15 and then had lunch with the youth pastor to discuss a new tutoring ministry the church is thinking of starting, and I haven't felt the "fog" sensation at all nor have I felt weepy either! I am still a little more tired than usual. However the difference is right now I feel like "hmmm a nap sounds good" (which is NOT a usual thing for me to think as I usually only nap a couple of times a year) whereas the last two days it was "I think it's impossible for me to stay awake." So I am very glad. Maybe just having the Lupron is making it easier (no more bcp) or maybe my body is adjusting to the Lupron. Anyhow my energy is coming back. I surely wouldn't mind if my energy came back 100% (so I didn't even have the feeling of craving a nap), but I can function much better with the amount of energy I have today so this is "doable".

My tummy still doesn't like the shots though. The injection site got all puffy and red right away this morning. I have noticed that the right side of my belly reacts worse than the left side so I'm going to try giving all my shots on the left side the next few days to see if that helps. A few of the ladies in Bible study were nurses so I asked them for some tips and they gave me some good ideas also. Really a minor side effect in the grand scheme of things...

Getting sleepy again

Well I slept 10 hours last night and woke up feeling energetic (yeah!) so I quickly started to get some work done just in case that energy would be short-lived. Well a few minutes ago I started to feel like I could go take a nap, and I've only been up for a little over 2 hours! After I started to feel that way I looked at the clock and sure enough about the same amount of time since the shot has passed just like yesterday when I started to feel sleepy and weepy. I just did a search online and read that "estrogen hormones regulate the level of cortisol (hormone responsible for tiredness). If estrogen level drops, cortisol will be uncontrolled producing to crashing fatigue." Yikes. I have not had a hot flash before so maybe I am wrong to feel this way, but right now I'd rather have a hot flash than feel like I just want to crawl back into bed at 9:15am. I am a morning person. This is the time of day when I am usually the MOST productive. Well one thing I can say is I am very glad I am doing IVF in the summer while I am only teaching ONE class (two days a week). I can't imagine trying to teach four classes a day with this little energy. Well I would appreciate prayers that tonight I'll be alert and have more energy than I do right now as I am teaching from 5:00-8:20 tonight. I have so much more sympathy for women going through menopause. It's just not fun!!! Well maybe tomorrow it will be better. Maybe it's the combination of bcp plus Lupron that's making me feel this way. Today was my last bcp so I'm going to hope I will feel better tomorrow when I'm only on Lupron.

On an unrelated note, I am curious why so many cancer drugs are used for infertility? Lupron is a chemotherapy drug. It says "oncology" right on my box. The first fertility med I ever took was Tamoxifen which is primarily (almost exclusively) used to treat breast cancer. Other RE's use Femera, Arimidex, or Letrozole which are also most frequently used for breast cancer. And I was given methotrexate (another chemotherapy drug) for my ectopic pregnancy on July 5, 2005. Now that had to be a far more potent drug as the nurse had to wear this special outfit to administer it to me whereas that's not necessary for Lupron. Well I had better keep getting some work done even though I feel my brain is going to sleep on me. I didn't get anything done yesterday because I felt like I was in a fog, and I can't afford to not get any work done two days in a row.

Feeling icky...

Well part way through Sunday School I felt so badly I wasn't sure I was going to make it through church. I had an awful headache and was feeling dizzy and also very weepy. I felt like I might burst into tears although I couldn't think of anything that was bothering me so I figured that at least the weepiness was definitely hormonally induced. I am not positive, but these could all be side effects from the Lupron. I've had 3 shots of it so far. Maybe my body doesn't like having my pituitary gland desensitized! I read a list of 10 common side effects of Lupron, and I have had 7 of the 10 so far (no hot flashes yet though, lol). I definitely have "irritation at the injection site". My tummy is soooo itchy where I have stabbed myself. I came home and took a 90 minute nap. I generally take about 2 naps a year; so that was significant for me. Especially as I got 9 hours of sleep last night so it wasn't like I was sleep deprived. Fatigue is one of the side effects. Well who knows maybe I just have a bug or something and maybe the only true side effects I've had are "mood alteration" and "irritation at injection site." I am positive the fact I feel like bawling is hormonally induced. Maybe it's the combination of the pill + Lupron. Tomorrow is my last day of the pill.

Paul looked at me like I was crazy when he saw I was about to start sobbing right before I fell asleep this afternoon. He said, "I thought you said you aren't upset???" I guess it's hard for a guy to understand the effect hormonal changes can have on a woman's emotions. I know in past inj/iui cycles my estrogen has been over 3,000 whereas in an unmedicated cycle a woman might peak at 200 (or less!). So when your hormones are more than 10 times what they are "supposed" to be it has an effect on your emotions!!! In my case right now my estrogen levels are being lowered not raised. Well I hope I feel better tomorrow, but if I don't, and I do get pregnant in a few weeks, it will all be WELL worth it. Well even though it's only 8:30pm, I am going to head to bed (and this is early even for me, lol!).

Pharmacy bill today

Well the total cost of the prescriptions Paul picked up for me today was $2,178.62, and I am very thankful that the amount we needed to pay toward that was $130.27. Whew... thank you Lord for a good prescription program! And the bill would have only been $30.27 if I had already paid my $100 deductible for the year! The doctor authorized refills on most of the prescriptions, but I doubt I'll need them since I at least with inj/iui have stimulated very easily, but if I do need to refill them it will not cost us much at all. I was given 75 syringes today plus many needles for the Follistim pen. I'm going to be using a LOT of needles over the next 6 weeks (and the progesterone shots will continue longer if I become pregnant).

RE appointment

Well we had our appointment today. It could have been done in 5 minutes, but we were actually there for 90 minutes+. First we signed the consent forms with the doctor such as if we freeze any embryos what do we want to do if Paul dies or if I die or if we both die, etc. Based on Paul's test last week Dr. Awad said we need to do ICSI as Paul had 3% strict morphology and normal is 14% or greater. I just did a little searching on the internet and read on a few sites that with a strict morphology of less than 4% IVF rarely ever works if ICSI isn't used. So really this is a "no brainer" so to speak. The RE said this explains why I wasn't getting pregnant from the IUIs. I guess I should have taken them more seriously when they kept pushing IVF. I kept thinking it was better to do inj/iui as it costs less than 10% of what IVF does, but if not even regular IVF would have gotten me pregnant then really those inj/iui cycles were a total waste, but that's water under the bridge now anyhow. ICSI costs an extra $550, but in our case it could likely be the most important process of the IVF in terms of whether a pregnancy is achieved or not.

I asked Dr. Awad about assisted hatching. He said they only do it if #1 the woman is age 39 or greater, #2 if the woman's FSH is greater than 10, and/or if #3 one IVF cycle has already been done and was unsuccessful. Since I don't fall in any of those three categories, he does not recommend assisted hatching. So we didn't sign a consent form for that.

The nurse gave me my Leuprolide kits (enough for 28 days although I think I'll be on it a few days less than that). She said the insurance counts this as a medical expense not an RX? Maybe because it's usually thought of first as a cancer drug? I have no idea if they were giving it to me for free (I think the total cost would be about $350) or if they're billing my insurance. I start those shots tomorrow and will have overlap with the pill. My last day of taking the pill is to be Monday (they wanted 4 days of overlap). My new cycle should start in about 10 days. My next appointment is July 19. I will have to miss VBS that morning. I will have bloodwork and an ultrasound that day, and July 20 I will add two more injections to my daily routine. At that point it will be Lupron and Follistim in the morning and Repronex (or was it Menopur?) in the evenings. I think they're starting me at 150iu of Follistim and 75iu of Repronex. I questionned this since 125iu seemed to be my maximum in the past (to stay away from OHSS), but Dr. Awad said that the Lupron should cause me to have a milder response. Their normal protocol is 150iu in the morning and evening so he did cut back the evening dose at least. Dr. Awad was always the more conservative of the two; so I am going to trust his judgment that he's not trying to have me produce say 30 eggs.

Paul actually is hoping I start having hot flashes this weekend; he said maybe then we'll agree on what temperature to set the air conditioning at, LOL! I think he's right I think the only times we might agree are when I am pregnant (if that ever happens) and post menopause as certainly at this stage in life we do NOT agree. He is always much warmer than me. We dropped off the prescriptions for the other medications, and Paul is going to stop buy tonight on the way home and pick them up as the pharmacy didn't have everything we needed but was getting a shipment this afternoon. Thankfully I think our bill will only be about $100, and it will only be that high because I haven't had any prescriptions yet in 2007 and that's my deductible. But truly it is a blessing to pay only $100 as I am sure the total bill for all the meds he's picking up today totals in the thousands of dollars.

I'll probably post again later today after my conversation with Cathy about the profile. I thank you those of you who I emailed it to who gave me some feedback. I spent many, many, many hours on it yesterday - pretty much the entire day.

Fourth of July

Well it turns out Cathy left a message for me at work yesterday. I need to let her know that home is generally the easier place to reach me on the phone. I wonder when she called? I left work about 4pm and checked my voicemail before I left. She wants to discuss the profile we used with Lifetime. So I will try calling her tomorrow (I assume she's taking today off). I actually planned on working on our profile some today based on the samples she sent.

A couple of weeks ago a friend (who is in her mid-sixties and she retired as the principal of the Christian school when I became the new principal there in 1996) emailed me asking me if I had considered acupuncture. Her husband has found help from an acupuncturist for his sciatica. She gave me his name, phone, and address. So I have been mulling it over in my mind. Over the years I have read several articles in medical journals which have reported that acupuncture can raise the success rate of IVF, and some women I have known online have told me their RE has suggested they do acupuncture in conjunction with IVF (my friend said her husband's acupuncturist is working with a fertility doctor at a hospital down in Reading). So I finally thought - it's worth a try. The amount of $$ it will cost is SO small in comparison to what we're paying the RE, and if it might help, then it's $$ well spent. SO I did some searching and asked a couple of people around here for recommendations, and finally I picked someone (much closer than Reading).

So July 17 I am going for my first ever acunpuncture appointment. I truly never thought I'd do acupuncture, but I also never thought I'd do IVF. Her first available appt was the afternoon of July 12 and we are headed to Long Island that weekend. She said she's done as few as 2 treatments for a woman with IVF (the day of or right before the transfer and then a few days after the transfer). However she's also done as much as 3 months of treatments (once a week) in preparation for IVF (if the couple has already done one transfer and the first didn't work). She said if we don't have much time (which we won't since we have to wait 2 weeks for the first appt as she's going on a trip to CA in between now and then) we can do more than one treatment a week. We shall see... but at least I think I'll go for 4 treatments from July 17 til after the transfer. She says she often does treatment on the husband as well in preparation for IVF (can help with his count, motility, and morphology she said), but Paul is not open to the idea at this point. So for IVF #1 we'll just stick with only me doing acupuncture. And maybe just maybe IVF #1 will work and more extensive acupuncture for either of us will not be given consideration.

Tomorrow is our next RE appt, and I start the Lupron shots on Friday. The timing of tomorrow's appointment is a little ironic. It was July 5, 2005 when I was given shots of methotrexate (chemo) to end the ectopic pregnancy, and now on July 5, 2007 I am having an appointment on how to have Lupron and Progesterone shots for IVF (I've already had lots of FSH and HCG shots so I don't need to be trained on those).

I haven't heard a response from Lifetime as far as the email I sent on Monday. So I am trying to just consider that a firmly closed door. I don't want to expend any more emotional energy in that direction. I won't write or call them again (unless they give us an extension). I just get too worked up about it. So in my mind Ukraine and Lifetime are closed doors. I am praying that either IVF and/or adopting through Cathy will lead to us becoming parents sometime in the next year or so!