Going for the kill?

Overkill... that was Dr. Schoolie's word for whether we should consider CCS for our remaining 10 embryos when we asked him a couple of weeks ago.

We were satisfied with his answer at the time, but I've had some time to think about it and now I'm not so sure.

I believe that knowing how many normals we have left will dramatically change how we proceed.

Scenario 1: No CCS, The original plan. 

• If I miscarried again, we wouldn't know if it was because of an abnormal.  
• It would be more difficult to determine when it would be time to retire my ute. 
• I don't think I have enough stamina left in me to go through any more losses.  Especially if the loss was due to an abnormal embryo, that never would have most likely never had a chance of making it.  
• I could have a baby on the very next shot, and save ourselves the cost of CCS.  Oh, to dream!  (10 embryos is $6,875 + $1,000 because they were previously frozen = freaking gag me.)  
• I would be seriously considering transferring 2 embryos at a time, at Dr. S's recommendation.   Having multiples and the complications and loss that could happen because of this scares the crap out of me. 
• My clock is ticking.  I can't stand the thought of doing this all for many more years.  Six years has been enough.  Miscarriages and FETs take time.  My body seems to get pregnant even when the embryos are abnormal.  Of course, I don't know this for sure.  Especially for our last cycle.  I am quite confident that my first two miscarriages (from our own IVF and the donor embryos) were because of abnormal embryos.   In all reality, to do 5 transfers with our 10 embryos would take over a year.  If more miscarriages or cancelled cycles were thrown into the mix, it would probably be double that. 

Scenario 2: CCS reveals all DE embryos are abnormal:

• This could happen.  This is us after all.  And Dr. S says there is a small chance of this because D has wonky sperm. 
• We would be devastated.  I don't even want to imagine this. We would have flushed a lot of money down the toilet on this DE escapade.   However, knowing this information would prevent us from:
• Throwing good money after bad.  Meds, lost wages, travel costs and FET costs.
• Emotionally, it would be less painful to get one big dose of bad information than have it spread out over many BFNs or miscarriages.
• Knowing this would save us a lot of time.  

Scenario 3:  CCS reveals some normals:  

• Dr. S said 3-4 normal embryos would be a realistic expectation when we started the DE process based on how many embryos we have.  
• We would know what we were working with.  How many transfers to possibly expect. 
• We would only transfer one at a time.  Less risk to me and babies. 
• We wouldn't have to transfer the other 7 abnormal embryos. 
• Less emotional heartache, especially if there was one or more miscarriages. 
• Financially, we could avoid the meds, travel, lost wages and FET costs for (maybe) 3 transfers? 
• Math: If we transferred 2 at a time, assuming all survived the thaw, we would be doing at 3 extra/unnecessary transfers.  FET is $5,005 costs, say $2,500 for meds (Lovenox is expensive), and $1,000 for travel.  These are low estimates that do not include testing that would need to be updated.  The grand total is $25,515 vs. the $7,875 cost of CCS.  
• Physically,  I would not have to take the drugs or have the side effects for those transfers.  Amen. 
• If I knew that I miscarried a normal embryo. 
• It is very important information to know, but not the complete picture.  I now know that 50% of early miscarriages are with normal embryos. 
• Knowing this information would be more difficult for me emotionally because of the implications using my uterus.  
• If I put all of the normals into my body and they don't work, I will have to face the music that I've done all I can do with my body and it's time to move on to something else.
• We could transfer a normal embryo and have a baby straight away.  (I'm ready for this, universe! Pretty please?)
• If we had a child from these embryos, we would know exactly what we had left (if anything) in the freezer.  If we didn't have anything left, but had one child, we might make the decision to end this journey hell trip there. If we had 2 embryos left, and we transferred them, I would of course have my hopes up for another child.   Knowing how many normals we have would give me a big reality check through the rest of this process if we were lucky enough to have one baby.  
• If we try some normals, and have one or more miscarriages, we may be able to transfer our last normal(s) into a gestational carrier (if someone I know will do it - don't think we can spring for the $100k for a GC). 
• Okay, you can have a good laugh here, because I am.  But if we had several extra embryos (ha!), we plan to donate them to another couple.  This is because we were recipients of donor embryos and we would like to pay this generous gift forward.  If I knew that I had say, only one normal embryo left, no matter how many kids I had I would just transfer it.  If we didn't CCS and had say, 4 remaining embryos, after our family was complete (again, I laugh at myself that I'm even writing this), I would probably be thinking of donating them.   Those last 4 could be all abnormals.  I don't want to give another couple abnormal embryos.  And, I don't want to be involved with donating any embryos if I can avoid it.  (PS- Did you know that to have the option of donating the embryos CCRM charges approximately an extra $750 in blood work - that was a nasty little surprise.)

Risks to the embryos:

• We are waiting to hear this from Dr. S during our second regroup on Wednesday. 
• Some of our normals might not freeze well a second time, or survive thaw at transfer time.  We could harm an otherwise normal embryo.

We have a lot of hope still tied up into these 10 little embabies.

We'll see what Dr. S has to say about all of this Wednesday.  I wonder if he'll change his tune?

What do you think? What have I missed?

Calendar confusion

Since December 19th, I've been trying to figure out if I've ovulated, or if I'm in my luteal phase.  And yep, it's January 10th.

I know, it seems kind of basic, right?  Something that should be simple.  Something that a top notch fertility clinic could figure out?

At CCRM, a regular donor cycle would normally start out with some birth control pills and in the luteal phase, Lupron would be added to quiet my hormones to prepare for the next month's transfer.

Except, I can't use birth control pills because of my family history with stroke.

So, the nurse suggested to use ovulation predictor kits (she suggested the clear blue easy kind with the happy face).  I told her that I was worried that it wouldn't work for me.  I've never had luck with the OPKs in the past.  Not that I've used them that much anyways, because when I found out I had ovarian issues, I also learned at the same time that they were so severe that an ovulation kit was really not going to help my cause.  With D's low sperm count, trying to use those kits every month seemed futile and emotionally exhausting.  Not to mention a waste of money.  So I never used them more than a few times, back when I didn't know how messed up my body was.

I asked my nurse if it would be worth the risk to just take a low dose birth control pill for the one month instead?  After all, I was on the pill for 10 years before and didn't have any side effects.  The nurse agreed that this sounded reasonable and checked in the doctor.  He said that he didn't feel comfortable with me taking the pill.

So we trekked onwards with our OPK plan.  As a back up, the nurse said she would send be for blood work if we got past a certain part of my cycle and I had not picked up a surge yet.

I monitored all of the way through the Christmas holidays, consistently and properly, but I did not get a surge.  So, on the 30th of December, I cut my Christmas plans short and traveled back home to get my blood work done and have an ultrasound to check my lining.  My lining was homogeneous and there was a 21mm follicle.

Later that day, my nurse called to say that my local clinic didn't draw LH and they got an FSH result instead.  She said not to worry though because my other levels (estrogen and progesterone) were still low, so they didn't think anything had happened.   She told me she thought that I was about to ovulate on my own because of the 21mm follicle.   Because of the error, I had them re-run my results form the 30th for LH.  The LH came back low (in the 8's).

Due to the New Years Eve holidays at my local clinic, I went back on Monday January 2nd to repeat blood work and ultrasound.  Cue horrible snow storm.  School buses were canceled due to the snow and very low temperatures.  People weren't able to dig out their cars out to go to work.

The roads were ok for the first 30 minutes of my drive but then turned wretched.  There were so many cars in the ditch.  I battled the roads, and drove white knuckled to my clinic.  The one hour drive took me close to an hour an a half.  When I got there,  all of the lights were off because they had closed the office due to the storm!

Luckily, there was one nurse there who was able to draw my blood.  Phew!

I was concerned because my requisition was only to have LH drawn this day.  I was cycle day 27 for crying out loud.   I called the emergency line for the CCRM nurses and discussed my concerns.  Wouldn't they want estrogen and progesterone too?  Or how about an ultrasound? My CCRM nurse wasn't in, but after some debate amongst the on call nurses, they told me that the estrogen and progesterone results wouldn't  have changed that much, and I didn't need them.

I felt better hearing that.

Until the afternoon when the CCRM nurse called.  She wasn't my regular nurse, because mine was off for the holidays.  She said to me, "I don't really know how to interpret your results.  They only sent in your LH, which hasn't risen much from your last draw.  I don't know what to tell you.  I think we should wait until your nurse is back tomorrow".

In my head, I said every swear word I could think of.  "What do you mean?" I said. "I called for the emergency line this morning asking if I should have these exact tests!"  I was fuming mad. I drove all of that way through the ice and snow and didn't even get what I needed to have done.  I could have melted all of the ice in town with the heat steaming out of my ears.

The nurse asked me to have them re-run my results.  But I'm not able to do so because there was no one working at the clinic due to the storm.

She says, "Don't worry.  I'll have your regular nurse call you first thing in the morning".

When I don't hear from my nurse in the morning, I called her.  She phones me back at 6pm my time and says "Sorry I was waiting to get the blood results back from your local clinic, but they never showed up".

I explain to her politely what has happened.  We decide that I will call my local clinic when they reopen in the morning and have the results re-run.

I anxiously await her call on the next day with an interpretation of what is going on.

However, when she calls, she doesn't have much to tell me.  Except they aren't sure if they missed my ovulation (uummmm, ya!) and she inquires about whether I've been doing the did the OPK correctly and if I bought the brand she suggested.  I'm so infuriated! This is why I didn't want to use an OPK to begin with.  She told me she had reviewed my case with other nurses and a supervisor.  I asked "did you check with the doctor?". She said no, that he's only returning from vacation today.   I didn't bother to ask why she didn't consult another doctor there, but should have.

I asked her to please review this with the doctor and call me back.  She said she would.  I told her that we have a lot invested in this, emotionally and financially.  I wanted to know what is going on? Should we consider scrapping this cycle and opt for a different one?  I don't want to start this with huge doubts about if my medications were even started at the right times.

Late the next afternoon, I phoned the nurse in the later afternoon to see what the doctor had said.  3 hours later, I got a call back.  She said the doctor had not looked at it yet.  She told me that she once again reviewed this case with her supervisor and she said there are two likely options.

1.  We don't use Lupron this cycle.  My progesterone has been consistently low.  They will control my progesterone exposure to get me a period (I've never had a problem getting my period in the past, it's been late many times but has always shown up).

2.  They use the Lupron and coordinate it with Prometirum for 10 days.  In approximately 3-4 days after that I will get a period.  They will time the Lupron in the last 5 days of my Prometirum.

I'll admit that I don't totally understand the ramifications of these two options yet.  This is all new to me.

She wanted me to go in for more blood work and an ultrasound again today.  This will tell them what happened to my lining and that follicle.

To make things just a tad bit more annoying, CCRM didn't give me a requisition for today's blood and ultrasound, and I forgot my phone at home.  My nurse didn't want to do the ultrasound or have blood drawn without the requisitions saying it was "bad medical practice" for her to do so.  I think my sweet little local nurse had a point, but she also had a little tone in her voice letting me know that she was throwing a dig CCRM's way.  Not necessary Ms. Nurse.  Just ask me to get the freaking requisition.

By the time everything got straightened out, I'd spent an hour in the waiting room.  There were kids everywhere.  Seriously.  When I left the clinic two women walked in with FOUR children.  What the hell? There were kids at every row of seating. I chose to sit near a couple and her 3 year old son.  Both parents were barely paying attention to the kid.  I cringed inside.

I watched a nurse come out with a cute chubby cheeked baby and bring her to the receptionists to oogle over.   I was assuming she was the result of one of the clinic's treatments.  I continued to watch the 3 year old beside me try to get his parents attention.   The nurse came out to talk to the mother of the 3 year old.  She let her know that her appointment will be another 30 minutes yet.  She says "He's going to do her ultrasound today because of what's going on".  The patient says she just needs to know, "Can you do my ultrasound right now she says?"  From their muted conversations, I gather that she must be pregnant and bleeding.  I start to feel really bad for assuming things about her, and her parenting.  I realize why she and her husband aren't being responsive to their 3 year old.  It's because they are waiting to find out if she's miscarrying.

I finally got called into the ultrasound room.  I stop to talk with the nurse at the desk and I see the woman's ultrasound pictures on the desk.  They are requesting more blood work for her.  I see two small  but empty looking sacs on the pictures.   It reminds me so vividly of where we were two years ago getting that exact news.  My heart breaks for them.  And it breaks for me and D all over again.   I realize why my sweet nurse had a little bit of attitude this morning.  She's feeling emotional for them too.

My lining appears homogenius again, and that the follicle appears to have collapsed.  There are 3 smaller 3mm follicles forming.

I'm hoping this will all make more sense when my blood work comes in.  And that my nurse can give me a good explanation of everything and that I will be able to assertively ask the proper questions of her.  

This is getting a little too real... money for eggs and babies

Things have been moving along with our egg donor and adoption plans. I can tell by our bank account. 

Our homestudy is well on it's way to be completed.  The social worker is taking off for a month, but says she'll have our report completed in early January, which is fine with me.  On the egg donor front we've got the paperwork almost completed, and the donor is scheduled to do her one day work up soon. 

I'm hoping for the donor to start taking stims within 2 months.  We'll have 1 month for the CCS testing to come back (If we decide to do that again), and then the next month (maybe February) we'll be all set to go with a transfer. 

I'm gagging at the amount of money this is going to cost.

In case any of you were wondering:  

To the donor agency:

Set 1: Administrative Fees:

$5750.00 – Administrative Fees for coordination of cycle

$ 400.00 – Donor legal consultation

$ 300.00 – Supplemental Donor insurance

..................... Total: $6,450

Set 2: Donor Fees:

$6000.00 – donor fee

$  400.00 – estimated donor expenses (local mileage, prenatal vitamins, birth control etc.  These fees are due in check form and any portion not used would be refunded to you at the end of the cycle.) 


.................. Total: $6,400

To CCRM:
$23,955.00 + $3690 (ICSI, IMSI, PICSI) + $6,800 CCS testing

.............. Total: $34,445

Meds:  $5-7000
................ Total: Let's say $6,000

Grand total: A gagging $53,295 or $46,495 without the CCS.  We might need to forgo the CCS. 

F*ck.  And that doesn't include our travel to CCRM or lost work time for my self employed hubby. 

Or, what we've already flushed on 5 years worth of embryo adoption and our other fertility treatments.  

On the adoption front, they tell us that we can expect the pleasure of paying around $20,000 after homestudy expenses.  The agency also informs us that the birth mother can back out and leave us stuck paying the majority of that fee.  Whaaaaat?  that better not happen because I don't think I could handle it.  I can't even think about being in that boat, especially after paying for all of this egg donor stuff (not to mention the emotional problems associated).  

Don't get me wrong,  I'm very thankful that hubby has a job that has even allowed us to consider egg donation as an option.  I realize the fortune that we have being able to try to do this, no matter how hard it's going to be.  But, I still can't bring myself to feel happy about draining what's left of our savings.  I also can't help but dwell on wishing baby making for us was just a roll in the hay. 

...And I wonder why I'm feeling depressed all of the time. 

Words from my 2012 income tax

I got a print out from my clinics outlining the expenses we've paid for 2012.  The statements are very detailed and very helpful.  It's a lot easier for me to keep track of my expenses with one detailed report from each clinic.  I'm thankful for this.

The report also tells a story that makes me cringe.  It kind of sounds like a really creepy poem to me.   Not including all of the blood work and ultrasounds and some other things, it says:

Abortion, threatened
Abortion, missed
Missed abortion, surgical, first trimester
Payment
No insurance

Ovarian failure
Ovrian dysfunction
Follicle puncture
Payment
No insurance

ICSI
Culture
Hormone imbalance
Abortion, threatened
Payment
No insurance

Abortion, missed
Pregnancy, unconfirmed
Ovarian dysfunction
HCG
Pregnancy unconfirmed
Payment
No insurance

Failed or canceled cycle
Payment
No insurance



PS) The grand total last year that we spent on medical expenses was about $43,000.  It feels like we spent a million.

Ordered My Meds

I just placed my meds order.  It cost a gagging $5,365.19.  I will get some coupons for a rebate which will bring the cost down around $5,000.

I was a little nervous about how much to order because the last time I stimmed for a long time.  And it will be more difficult for me to arrange to get more meds because I will be away from home.  The nurse helped me figure out how much to order.  And she said that I can ship to my hotel room, if I need more.

Some of the relatively minor, but trickier things: A) I will need to have a fridge in my hotel room and B) I don't like cutting it close with my meds, given that they might take a few days to come in. C) The drugs are too expensive to order a lot of extra.  D) We many not need any of our extra meds again.  If we don't get any normal embryos this will be it.

I told the nurse I stimmed for a long time the last time.  I asked her if this is likely going to be indicative of this time, given that it's a much different protocol?  She said that people usually stim for 12-13 days in her experience.

Here's my cocktail.

Gonal-F
Cetrotide - new
Clomid - new
Dexo-something-or-other - new
Menopur
Novarelle (HCG)

Another step closer, to "an answer or a baby" as Dr. Schoolie said.  We're banking on it.

A Hot Mess

That's what I've been the past day or so.  Yesterday I could feel something coming on, a mood that wouldn't lift.  It's been threatening to come for a few weeks now, but I kept trying to send it packing.

A few small things happened and, bam.  I'm crying at the dinner table again.  Preceded and followed by a hefty dose of the why-me's. 

I'm trying to process what this funk is all about, and I think I have a few reasons.  Some are new.  Some aren't. 

I'm sick of rehashing old crap.  Over and over again without any different resolution. It's exhausting. And unproductive.   Obviously it isn't resolved for me though or else I wouldn't have anything to rehash?

My new reasons ...

-  I spent an evening and morning watching my friend's kids last week while she and her husband went to an out of town funeral.  Her children are lovely and sweet.  They had problems sleeping and by morning they were both cuddled up with me in bed.  My friend warned me in advance that this is what they do with them.  The little boy spent the early morning curled up next to me.  I've watched them many times before, but this experience was a new one for me.  It made me realize so much more of what we are missing.  I could write a whole post on this, but I don't want to relive it any more right now.  

- My brother's girlfriend is due to have her baby any second.   This makes me excited to be an aunt for the first time.  However also tremendously sad.  Watching my family's excitement is like a thousand little papercuts. I know they mostly hide their excitement from us to protect us, and that hurts too.  F*ck,  I wish it was us. I wish it was our turn.

- The reality that we will likely not be able to transfer any embryos (if we make any normals) until June is a real piss off.   This wasn't supposed to take this long.   This means I bought the stupid bridesmaid dress way too big.  If this doesn't work, we will have invested way more time than I ever thought we would in this.   Days are dragging on for years and whooshing by all at the same time.

- There have been a rash of Facebook baby announcements.  Why do I look at that thing?

- I have no projects and limited activities on the go.  In the past, I was working on a degree, on home reno projects, on various things.  I've graduated and the home reno budget is drying up.

- I'm really missing my friends and feeling lonely these days.  Oh, wait.  That's not new.

- I'm feeling very disconnected spiritually.  As in, I like the church, and still want to go but something is missing.

My old reasons...

- I'm tired of complaining to D.   I hate bringing him down.  He just wants me to be happy and I just can't.

- I'm sick just thinking of the money we are about to spend on these upcoming procedures.  If this doesn't work and it all is flushed down the toilet...

- Side note: D says I have a guilt-problem.  He says that I feel guilty for too much stuff and I should just let it go.  We've been dealt a bad hand with this IF and we shouldn't feel bad about spending the money or not being as productive as we would like.   I asked him, "aren't we supposed to rise up when faced with adversity?" he said, "that's something that mostly just happens in books".  Hmm.  Not so sure about that.  Something in the middle sounds good.

- I don't think I want to live where I do anymore.  I feel disconnected to the town we live in.  I want to live closer to my family.  I don't want to leave my best friend, and I feel guilty (there it is again) about separating D from his parents.  Some days I would leave in a second.  I day dream about moving away, living in a community that I feel connected to, in a home that we built.  With kids in our house... Before we were married I told him that I didn't know if I could live here forever.  That was nine years ago.  He said he would move and still does.  However his employment situation and future plans may not lend itself to that very well.  During really confusing days (like today) I wonder if the grass isn't really any greener over there anyways.

- I need to find some purpose with my life.  This could mean going back to work but I have no idea what I would do.  

2nd Consult and a guilty conscience

Over the Christmas break we had a consult with Dr. Schoolie.  I was very nervous about it, because it was initiated by the doctor.  I found this to be unsettling considering we had been happily corresponding through the nurses, and I thought everything we had discussed was resolved.

The key issue we were debating was whether or not to a) pursue the laproscopy and tubal ligation b) if it could be done in the country in which I live (because we have socialized medicine) and c) if the opinions of the doctors would be similar enough and therefore yield the same result.

I was worried that there was a new issue that the doctor had found.  Something so bad that the nurse didn't feel comfortable telling me herself.   Thankfully, this wasn't the case.  He just wanted to regroup.  I guess we had asked so many questions that he wanted to speak to us directly.  D thinks he was just tired of the back and forth.

I'm slightly peeved about this because it's not cheap to talk to the doctor each time.  And we felt we had all of our questions answered.  Not to mention the emotional stress of thinking that he had something life altering to tell us.

We didn't waste the opportunity to speak with him though.  We were able to add clarity to the surgical choice we had made to have the procedure.   We also decided where we would have the procedure.  

The doctor we chose at home did not seem overly familiar with requesting the surgery based on the testing we had in our ODWU.   It's kind of ironic now that he was asking us at the time if we trusted him.  Because now I don't really, and that is what this decision has come down to.  We're deep in expenses on this cycle however,  D doesn't think this is the place to try to save money.  There's too much at stake. The tubal ligation will basically depend on a judgement call from the doctor.  I really don't want it if I don't need it.  And the laproscopy could yield important information, that I would rather be viewed by my treating physician.   And a the big one he pointed out, that if things didn't work out and we didn't go with Dr. Schoolie, that we might wonder what-if, effectively ruining our regret management strategy.

It's $4,000 just for the surgery, not including travel.  Boy, I could spend that money in much more fun places.  A trip somewhere warm, a bathroom renovation.  Or, what would be more likely, keep it in the bank for more fertility stuff down the road.

Thinking about the costs of IF treatments have always been uncomfortable.  But now it is really stressing me out. We've slowly flushed the cost of a few vehicles down the drain, and we're about to flush one more.  Instead of flushing used cars we've moved on to flushing the cost of a new SUV.  It's gagging.  Especially as my current vehicle is starting to show it's age with new rattles and noises.

I feel bummed and guilty even complaining about this.  On Resolve.org I've heartbreakingly read about people who can't afford any medical treatment, or much less have the IF testing.  I'm grateful that we are able pursue treatment but it still doesn't take the sting away from paying the bills.  And the absolutely disgusting feeling of knowing the money we are about to flush would provide food to a small orphanage for months.

There's so much guilt tied up in this whole process for me...  Guilt for punishing my body with all of the meds.  Guilt for dragging our families through this.  Guilt for dragging D through this when he was ready to move to adoption a year ago.  Guilt for spending so much money on this.  Guilt for still pursuing a genetic link.  Guilt for wasting so many otherwise good moments on IF.