I knew that the RE we had worked with off and on since 2004 retired a year ago. I had been seen by other REs along the way, but for both ivf cycles he was the main one I worked with. The woman who was the ivf nurse during both of our previous ivf cycles (2007 and 2009) also had left the clinic. The woman who is now the ivf nurse was a nurse there previously, so Joan was one familiar face. My favorite nurse, Denise, also left a couple of months ago, and the receptionist I had worked with for several years left two weeks ago. The phlebotomist was another familiar face, and she actually remembered my name. It's a bit frightening to think a phlebotomist has seen me enough to know my name, even when she hasn't seen me for more than two years! The new RE seems nice. He has interesting taste in clothing, lol! His socks, shirt, and pants each had pattern (stripes, plaid, etc.) and none of them matched although they were all in similar colors. Well as long as he's a good RE, who cares about his taste in clothing. :-) His accent makes me think she's from Africa. It was a bit difficult for me to understand his English at times, but I'm sure after a few appointments that won't be an issue.
The protocol has also changed. They don't use Lupron any more. When the nurse told me this, I wanted to say "let's not mess with success." The protocol was almost identical the last two times. They said now they use Antagon, and those shots don't start until part way through the stimming. When I got home I did a search online, I felt much better about it. In fact, I think my clinic was a bit slow in making the switch. The previous RE was in his 70's and maybe he wasn't exactly "cutting edge," although I am not complaining as the "old" methods worked just fine. Also, they don't use PIO shots any more. These were the MOST painful. They use Prometrium three times a day. I've been on that before in an oral manner, but these aren't taken orally. I find it rather ironic because I've already been on Crinone (during the ectopic pregnancy), suppositories, and PIO shots. This will be my fourth way of having progesterone support following ovulation. As long as it's equally as effective, I'm all in favor of fewer shots. The PIO shots lasted for weeks if a pregnancy occured. Dr. A did let me switch to suppositories a bit sooner during my pregnancy with Ian than he did with my pregnancy with Nadia. The RE said that the protocol will again be changing in a few years. Evidently it's already changed in Europe and now more recently in Canada, but it takes longer to get meds approved in the US. He said this new medicine gets it down to one shot a day for ivf (whereas it's currently two a day not counting the Antagon). What I tried to remind myself when I was feeling uncertain about all these changes (in personnel and the protocol) is that GOD is the giver of life. If He wants us to have another baby, it won't matter if I'm on Lupron or Antagon, Prometrium or PIO. He's in control. If our family is complete, it doesn't matter what medications I'm on, I won't give birth again.
I had said all along that I was hoping to do the retrieval around January 3. In previous phone conversations, they were fine with that. Today I found out that the lab (the part that deals with the embryos) will be closed from December 19 through January 7th. I wasn't able to do the SHG or mock transfer today because they like that to be around day 7-10 of your cycle. In the past I had gone on the pill so that could be done at this appointment, but this RE doesn't prefer women to be on the pill first. So I can't do the other tests until next month. The timing of when I would likely get AF in December did not work with the down time of the lab. If I didn't use any bcp, I would end up needing to wait until early February to start stimmming. So the nurse did get permission from the RE for me to go on the pill once AF arrives in November. If I go on it, I have to be on it for at least 2 weeks. How long I'm on it will depend on when AF shows and when we decide we want to start stimming. The nurse mapped out a plan that had me starting to stim one of the first days of December, which is about right if we make it to a blastocyst transfer. I told the RE that if we have more than 3 embryos, I want to wait for a blastocyst transfer since we're 0/1 for embryo transfers and 2/2 with blastocyst transfers. He was fine with that. If I conceived, my EDD would be 9/4/2012.
The biggest downside of doing everything in December is that I can't claim any of the expenses toward our medical FSA like I was hoping to do. This means the ivf will cost $700 more than originally planned (as I was counting on using money that would have gone towards taxes/medicare for the ivf). Also, since I have a propensity for giving birth prematurely, I was trying to have the EDD be a few weeks later so that if I am still working I could use 8 full weeks of sick leave for the first time. I didn't get any paid leave for my first c-section and only 3 weeks for my second c-section because they were born in between semesters. The upside of doing it earlier than planned is that the ivf won't interfere with our plans to travel to MD for Christmas, like I thought it might with our original schedule. Also, if the ivf results in a pregnancy, I would receive the best gift possible on Christmas day - a bfp. If I am not teaching next semester, then it doesn't matter one iota when the EDD is, and it actually will be better to start earlier as PSU's insurance only allows for 2 ultrasounds during the pregnancy. It would be better to still be on the Blue Shield insurance during the early stages of the pregnancy (if I get a BFP) as we'll still have that insurance through the middle of January.
If I truly waited until early February to start the stimming (no bcp), then I wouldn't be due until October 16, which would mean I'd need to start teaching FT the first part of the fall semester (if I'm still employed). That would not be good at all. Another option we didn't discuss with the nurse today that occured to me after we left was that possibly I could go on the bcp in November and be on it an extended period of time so that I wouldn't start stimming until the end of December so that my ER and ET wouldn't occur until after January 7. The EDD would be about 9-30 in that scenario. It's really hard to know which is the better timing without even knowing if I am teaching next semester or not. The Dean emailed me today that she'll bring my request to the President. Hopefully I'll find out in the next 10 days or so before I talk with the ivf nurse again. If I am going to be unemployed soon, then I definitely want to start the ivf sooner rather than later. If I'm still going to be employed, then maybe it's better to wait until after January 7th to do the retrieval. What do you think? Of course part of me is just itching to get started (the emotional not the logical side which analyzes the financial factors).
As for the exam, the RE mentioned I had a fibroid. He didn't say much about it, and in hindsight I wish I had asked him more about it. No one ever mentioned that before to my recollection. I'll be asking him or the nurse about it the next time I'm there. If we go with the earlier time frame, then another RE (whom I have seen before) will be overseeing part of my stimming because he'll be at a conference for a few days right during the time the nurse thinks I'll be stimming. If any of you know about fibroids, should I be concerned about this in relation to ivf?
We were there just a few minutes shy of 3 hours. I was hoping it would be 2 hours at the most since we didn't attend a class this time around. If no waiting was involved, it would have taken about 1 hour (talking with the nurse, talking with the doctor, my exam, our bloodwork, signing paperwork, and Paul giving his specimen). We both brought books so I got to read a little, and we also enjoyed some time chatting. Such a romantic date. :-) Actually, it was special. I found myself overflowing with gratitude that we're able to try for one more miracle. Paul won't have to give me any shots this time because they'll all be in the belly (subcutaneous). He'll only have to go to two more appointments (retrieval and transfer), and he's only a spectator at the transfer. I am also very grateful to Paul's parents who watched our kids at McDonald's for a little more than 3 hours. They made great use of the playland! We thought all that running around would have worn Ian out, but he only took a 20 minute nap.
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