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!

P.S.

The only "glitch" in speeding things up was that they usually do a day 3 FSH blood test 18 days before starting the Lupron. Well first of all today is day 7 and secondly I am on the pill so they can't do the FSH test while I'm on the pill. Even if we had waited until July to start, I would still have wanted to stay on the pill because otherwise it would be very hard to predict when I would be 7 days past ovulation. The success rates are much better when the FSH is less than 10 on day 3. If the FSH is higher then it usually means you are harder to stimulate (won't have many follicles). If it's between 10-20 they still will consider IVF as long as you know your chances are much less for pregnancy particularly as you get closer to 20. They never do IVF if your FSH is greater than 20 unless it's with donated eggs. So she tried to see if I had my FSH tested before. I knew I had, but she couldn't find any record of it. The other clinic used to test FSH on day 3 at the start of every inj cycle so I (falsely) assumed this clinic did as well. Turns out they were only tracking my E2 at that point. Well she consented to starting the IVF without knowing what my FSH level is, especially when Dr. Awad was so confident that understimulation is not a concern in my case. I just dug through my medical records and found three FSH results - 5.4 in May 2003 (not sure what day of the cycle that was), 4.4 on March 2, 2004 (day 3), and 6.63 on July 12, 2004 (day 3). So although my FSH has likely increased some in the last 3 years (it goes up as you get older), I feel confident it's still less than 10 since it was between 4 and 7 in 2003-2004. I will show her these records on July 5.

IVF update

Well our appointments only last 4 hours and 15 minutes rather than the full 5 hours projected. One other couple was there with us for our initial training with the nurse at 9am, and they still had appointments left to complete after we left so it definitely does take 5 hours for some couples. I didn't really learn much during the "class" we took with the other couple; the only things I learned were as follows:

• They usually won't do an ER if you have less than 4 follicles (I have no worries about that as I have always stimulated very easily) and the most they will allow is 30.
• If you have more than 30 then they will still retrieve the eggs, but they will not do a fresh transfer (just a frozen transfer later) due to the risk of OHSS.
• The ideal number they are aiming for is 12 follicles. I feel I could easily have 12 follicles, and I am glad to know that is what they are aiming for (rather than say 30).
• As for the 3 day vs. 5 day transfer, if you have more than 10 embryos (and they said typically 75% of eggs are fertilized the traditional way when they put 500,000 sperm in the petri dish with each egg, and about 50% of the eggs are fertilized when they inject one sperm into an egg which is called ICSI and costs more $$) then they will do a 5 day transfer (at the blastocyst stage).
• If you have nine or fewer embryos then they do a 3 day transfer and any embryos that are still alive at day 5 are frozen at the blastocyst stage (as the thaw rate for embryos frozen at the 3 day stage is only about 50% compared to about 100% at the 5 day stage).
• They strongly discourage only transferring one embryo. They recommend two, but will allow a couple to transfer three at the most. If we have three embryos I want to transfer three. I know there's a 14% chance for triplets and 28% chance for twins, but I also know the chance of getting pregnant at all is higher and I'm okay with twins or triplets.

The mock transfer and hysterosonogram were VERY painful in my opinion. As in tears rolling down my face painful while I squeezed the living daylight out of Paul's hand. They said it would hurt a little (as the uterus doesn't like having objects thrusted into it), but I would not define this as a "little." The doctor said #1 my cervix is tighter than "normal" (I was told that with my first IUI in 2004) and #2 my uterus is titled a little to the left so he said having to put the catheter at a sharp angle made it more painful. Well it's over. I will be under sedation with the retrieval and the transfer won't be as painful as this was. So he said the worst is over in terms of most painful procedure. I had taken Advil prior to the HSG in 2003 as the doctor in Allentown recommended (dye through the fallopian tubes test); I wish they had suggested I do that prior to this test as I think it might have helped decrease the pain and cramping.

Well the doctor was surprsied I was on the pill (not a good thing to do if you're trying to get pregnant, lol), but I told him I only started it a few days ago just in preparation for IVF as sometimes my cycles are very long (although not lately but still I never know for sure what might happen). So anyhow he said that in light of that I didn't need to wait until August to get started. He said to ask the nurse if I could start the Lupron in July. So she checked her calendar and said if we started the "usual" day (21) it would be too late as then my ER would be falling during their first "down" week in August, but she said when you're on the pill you don't have to wait until day 21 (since I won't be ovulating); she said you can start on day 14. So over the last week I went from #1 being told the ER must be schedule 3 months in advance (ie. late Sept at the earliest) to #2 on Monday being told oh yes I could have it the last week of August (2 months in advance) to today being told I can have it the last week of July (5 weeks in advance). Yikes!!! But this is good news. It means that everything will be done LONG before school starts in the fall. Presuming we aren't on strike (I hope not but will find out in the next 3 days) I will be teaching Mon/Wed pm from July 9- Aug 15. So those teaching times do not interfere At All with doctor appointments. The only possible glitch is VBS which I teach in the mornings the week of July 16 but that shouldn't pose a problem as I'll just need one appt that week (July 19) and I can schedule it for like 8:00am long before VBS starts that morning.

So here's what the timeline is looking like:

1. July 5 Paul and I go back to meet with the doctor to sign consent forms and to be trained on all the shots I will be taking (which won't be hard as we've already done two of the kinds already)
2. July 6 I will start the Lupron shots (daily) which will sort of make my body think it's in menopause (in other words I might have hot flashes and such)
3. July 19(or so) I will come in for an ultrasound and labwork and soon after that will start two more types of injections (one in the morning and one in the evening) in addition to the Lupron
4. August 2(or so) I will have the egg retrieval

So I ask for prayer:

1. For me emotionally throughout this whole rollercoaster ride experience especially as my body is being pumped with high doses of hormones.
2. For me physically (such as that I not get OHSS or an ectopic pregnancy).
3. If it's the Lord's will, that I would give birth to a baby (or babies!) in April 2008.
4. That just the right amount of embryos would be created (not that we will destroy any "extras," we would give them up for adoption if we felt we already had as many kids as we could "handle," but I'd rather not be in that situation).

Nurse called back

Well Alice Ann called me back this morning, and she said that if my next cycle begins around July 17 then yes I could have a late August egg retrieval. My calculations were correct. You do not have to schedule it 3 months in advance. Now this wouldn't have been possible if I hadn't started the pill on Saturday, although my body has been fairly cooperative lately on its own (32-33 days). So we will keep our 5 hour appt for Thursday. There is still time to change my mind if for example our dossier is submitted in Ukraine today or next Monday. The insurance will pay for these tests so although we'll be paying $8,200 up front on Thursday, really if I change my mind we'll get all our money back. Actually the shots probably won't start until early August so in reality I have another month to make SURE I want to do this. But I want to keep this appointment for Thursday to keep that option open. If I was ever going to do IVF, now would be the time (meaning in the summer rather than during the fall or spring semester when I teach three mornings a week).

Another website

The last few years I've always used the CDC website to look up the stats on different clinics that do IVF. Well I found another one today - http://www.sart.org/find_frm.html. And this one is now reporting data from 2005. It makes sense they can't report 2006 yet as someone could have gotten pg from IVF near the end of 2006, and you wouldn't know yet if it qualified as a "live birth." Anyhow the clinic I am planning to use definitely had better numbers in 2005 than 2004 - https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=2158. For those under the age of 35, almost half (47.6%) of those who made it to retrieval (25% of the cycles were cancelled) resulted in live birth. So although the % of attempts to live birth was 35.7 for under 35 it's nice to know that those who made it to retrieval had a decent chance of making it to live birth. They also had better succes with those ages 38-42 that year (4 out of 14). I know if we keep the appt on Thursday they will give us the data for 2006 as well as 2007 so far. Well hopefully Alice Ann's answer to my the question I left on her voicemail today will help us figure out what to do. Part of me says okay...I'll do it...it's worth the try.... and part of me says "no, I just can't bring myself to go through with it." So please pray for wisdom!!!

Having second thoughts

Well all the reasons I have for the past 4 years been unwilling to do ivf have again been running through my mind the past couple of days; we started our first fertility treatments 4 years ago and that was the first time we discussed what we were and were not willing to do. And ivf was in the summer of 2003 on our "no" list. Just a few weeks ago I was wanting a break, and I guess emotionally that's still where I am. Although the thought of being pg thrills me to pieces, the thought of going through all those shots and procedures is totally overwhelming. I haven't done ivf before, but having done inj 7 times (with 5 iui's), I have a pretty good idea of what this will entail physically and emotionally (and financially one try will cost 3 times more than all 7 inj tries put together cost).

The CDC reports the IVF success rates for every clinic in the US. Unfortunately the info is always delayed so the most current stats they have are for 2004. The clinic we were planning to use that year did 37 cycles with women under 35 of which 11 resulted in a live birth, 10 between 35-37 (that's me!) of which 3 resulted in a live birth, and 9 for women 38-42 (no pregnancies). So if we only count those women up to age 37, they had about a 30% success rate. I know God is in control, and He could allow me to be in that 30%, but I also believe if He wanted me to get pg He could do so without IVF even though it hasn't happened in the last 5 years.

Well at the very least I decided to find out if there is ANY chance of having the ER the end of August. I left a message with the nurse, and I hope she calls me back tomorrow. I believe my next cycle would start around July 17 or 18 so I asked her if I started the protocol then (first birth control pills and then add in Lupron shots) would the timing be right for a late August ER? It seems to be adding up just right for me, by my calcuations if I started July 17 that would be about August 28 for ER which is good timing as they don't start the next cycle of ER until August 27, and that's also the first week of school for me so I'd have most of it done before school started. If she says that's not possible, then I think I just want to wait. I really can't see doing IVF while teaching MWF mornings from 8-11 as that's when most of the appts are and it would be nigh impossible to schedule all my appts for T/Th/Sat.

If she says it WOULD be possible, then I think I'll keep our appts for Thursday, but I'd still like more time to think about it. I think it would be a little easier to make this decision if we knew for sure that Lifetime and Ukraine are closed doors. Who knows when Lifetime will make their decision, but in terms of Ukraine we'll know by July 2 which isn't far away at all. Plus I am concerned about the potential strike at work and how that might effect us financially (in terms of whether we can afford IVF), and we'll know whether there will be a strike or not by July 1. So even if we follow through with our appts on Thursday (which is dependent on what the nurse tells me), I might still decide to say "time out" and not do ivf this summer. It's a tough decision to make. I'd put my body through just about anything if I knew the result would be giving birth to a baby, but it's hard to psych myself to go through it knowing the more likely scenario (70%) is that won't happen.