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!

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.