Friday, August 29, 2008

Whoa there, Endo!

Well, we met with our doctor yesterday.  I wasn't feeling too hot, I've been menstruating for 17 straight days (sorry for creating a TMI moment).  He did an ultrasound and apparently my ovaries are responding too much to the stimulation phase of the Lupron shot.

If you're wondering Lupron has two distinct phases.  First, a stimulation phase which increases production of estrogen, specifically estradiol.  Second, a suppression phase which dramatically decreases my estrogen levels.  This is similar to what happens during menopause (hello, hot flashes!).

My endometriosis is still very aggressive and loved the stimulation phase a bit too much.  The doctor prescribed a progesterone-type pill to stop the stimulation.  It must be magic, overnight I've almost completely stopped menstruating. 

Now for the IVF update.  We've signed all the consent forms and legal agreements.  I get my next shot of Lupron on September 19th.  Then we move into the medication phase of IVF.  Here's some of the questions we asked Dr. Skywalker yesterday:

When specifically do we start IVF?
He hasn't decided that yet.  He wants to see how my endometriosis is responding to the Lupron on September 19th.  Then he will make a calendar for shots, egg retrieval, transfer, etc.  With no specific date, we are looking at mid to late October to begin the process.

What is our personal success rate?
He cautioned us that success rates were tricky because they are based on a population of couples and realistically every couple has either a 0% or 100% chance of getting pregnant (I thought of my dear Shannon when I heard this; she would love the practical logic).

Basically, he is looking for more than 10 follicles during IVF stimulation phase and at least 8 eggs for retrieval.  If we can achieve this, he feels we have a good chance at implantation and successful pregnancy.

Am I at risk for miscarriage?
Since I've never conceived, we don't know if I'm prone to miscarriages.  He feels we have a good chance at a healthy pregnancy.  He doesn't think my endometriosis will cause a miscarriage; partly because once the embryos implant the body will start producing hormones during the pregnancy that naturally suppress endometriosis.

Any suggestions for health and diet?
Aside from the standard, eat a balanced diet and exercise regularly, there was not much else he recommended we change.  I'm taking a prenatal vitamin, a calcium and an omega-3 fatty acids supplement.  

He's not opposed to acupuncture; he just hasn't come across a place here in Charlotte that he likes enough to recommend.  I will probably go back to Charlotte Acupuncture and Wellness Center.  I went there for 6 months last year.  I found them through a referral while visiting my sister in Boulder (the alternative medicine capital of the world).
We still haven't received our financial estimate for the procedure.  There is a program called Shared Risk Refund Program offered by our clinic.  Basically it's an insurance policy for IVF.  Under the program we pay the cost for 2 IVF cycles (roughly $20K) and get 3 IVF cycles.  If we do not have a successful birth after all 3 tries we get 70% of our money back.  

I don't think we are going to do this program (at least I think we aren't, not sure if Dave and I talked this one out yet).  We did agree to do cryopreservation of any healthy embryos left over from our first egg retrieval.  Cryopreservation (freezing and storing embryos) will cost about $1200 initially and then roughly $600/year to store them.  

Dr. Skywalker recommended saving any healthy embryos.  I'm assuming in the world of infertility, healthy embryos are very precious and the hardest hurdle to jump in the fertility race.  Not to mention if we do additional IVF cycles, we can skip the egg retrieval and harvesting/hatching phase including the associated costs (roughly a 30% savings).

There you have it.  Our IVF update.  

Wednesday, August 27, 2008

Plan B

Because the world can never have enough plans, here's some ideas I've worked up in the unlucky event IVF does not work for us.
  • Clone Lavender and Bailey (with enhanced features like built-in potty training).
  • Buy a Vespa (Dave recommended this one, he said the side car is for Lavender and Bailey).

  • Trade current home for uptown condo and adopt lifestyle of carefree nights and exotic vacations.
  • Save my future teacher's salary to purchase Dave and I a second home at the beach (I did say teacher's salary).

  • Manage my little sister's future American Idol career.

Tuesday, August 26, 2008

What are the chances?

In case you were curious here are the posted pregnancy success rates at REACH (our fertility clinic) for 2006.  Of course, clause 11 of the IVF legal agreement has the following lovely statement:

"Even in normal fertile couples, the chance of pregnancy is approximately 25% in a given menstrual cycle."

These are numbers for IVF cycles using fresh embryos from non-donor eggs (that would be Dave and I) in women younger than 35 (REACH posts results for other ages, etc. on their website).  

Number of cycles in 2006:  285
  • 54.4%  cycles resulting in pregnancies
  • 46.1%  cycles resulting in live births
  • 51.3%  retrievals resulting in live births
  • 56.6%  transfers resulting in live births
  • 35.1%  transfers resulting in singleton live births
  • 36.8%  pregnancies with twins
  • 3.2%  pregnancies with triplets or more
  • 38.0%  live births with multiple infants
  • 2.1  average # of embryos transferred
What does all this mean?  Dave and I have a roughly 56.6% chance at a live birth using IVF.  Early on our doctor told us we had a 60% chance of success, so that's pretty close to the average.  

Looks like we have a 38% chance at giving birth to twins.  Not just fraternal, but possibly identical (Dave is totally pushing for twins).  Here's a cool BBC News article explaining why IVF increases the chances of identical twin births.  

Monday, August 25, 2008

Graduate School Checklist

Just a brief 'To Do' list I created for my first day back at school:
  1. Be late to your first class (check)
  2. Get lost at least 3 times (check)
  3. Spend an egregious amount of money on textbooks (check)
  4. Get easily winded while walking across campus (check)
  5. Forget your umbrella on a rainy day (check)
  6. Haggle over $4 parking fee with minimum wage garage attendant (check)
Apparently every student at UNCC had an 11am class.  I knew parking would be bad, but I wasn't expecting it taking 30 minutes to find a spot (sorry Dr. Professor for being late).  I'm reviewing my public transportation options.  I can take the light rail and one bus to get to campus.  It's only an hour commute (which can be used reading a book and listening to my iPod while trying not to get mugged).

This morning I had Modern Latin America with a professor who reminds me somewhat of my dear friend Kammer (just not nearly as smart or funny as Kammer; but Dave and I both agree no one is).  I'm already doomed in this class; 5% of our grade comes from a geography quiz next Wednesday.  The professor warned us our spelling will be graded (there is a mutual disagreement between spelling and me).

My next class was Secondary School Experience.  The professor has some nervous tick where he snorts repeatedly.  It's a quiet snort but done in a rapid series of 3 - 4 at a time.  I mentally chastised myself for fixating on this (then promptly forgave self when he picked on a teacher who used to pause and say 'uh' repeatedly)

In fertility news, we meet with our doctor on Thursday.  We'll ask him any remaining questions we have about our specific IVF treatment plan and sign all the consent forms.  Still don't know how much it will cost us.  Haven't received the mailed quote yet.

Saturday, August 23, 2008

Back to School Junkie

Monday I start my first semester of grad school (okay, second semester).  I took a class this summer (but in my mind that doesn't officially count, since it wasn't technically on campus).  I'm taking 12 hours this semester; and yes, I've geeked out.  I went 'Back to School' shopping this weekend and bought myself some new jeans (I'm already planning my outfit for Monday)!

On a more serious note, I'm not sure how IVF treatment will interfere with school (there are a few days during the process I will be out of commission).  One thing I do know (wait, I know two things).  First, I'd rather be a full-time student than a full-time employee while going
 through IVF, being it's an intense 4 - 6 weeks.  Second, I'm more than lucky to have a husband who understands and supports my decision to go back to school full-time to become a teacher (thanks Dave!).

Here's a list of the classes I'm taking this semester:

SECD 5140  Secondary School Experience
READ 5255  Reading & Writing in Content Area (sounds dubious)
HIST 2207  Modern Latin America
ECON 1101 Economics for Non-Majors (most certainly will be oldest student in class)

Also, here's a list of some of my favorite school accessories I've been acquiring since I made the decision to go back to school (more proof I've totally geeked out).  I've assured Dave all these items are essential to my educational pursuits:

Little Debbie fudge rounds

Quo Vadis academic planner

GAP Essential jeans

Rocket Dog shoes

Pigma Micron pens

Moleskine notebooks


KEEN laptop bag
Built NY laptop sleeve

SIGG water bottle
Shiraleah bag

Thursday, August 21, 2008

If the Jolie-Pitts can do it, so can we!

Who would willingly pump their bodies full of crazy hormones in hopes of having children?  Well Dave and I for one, and apparently Brad and Angelina (now you know my guilty pleasure is celebrity gossip).  

Of course we have absolutely NOTHING in common with the Jolie-Pitts (except for maybe in vitro).  In the off chance you aren't interested in our IVF treatment procedure, just remember that Brad and Angelina might have done something similar (are you hooked?)

Most of this information came from our fertility clinic's information booklet.
  • The entire process takes 4 - 6 weeks (from the start of menses to pregnancy test time).
  • We are not allowed to schedule any trips or vacations during the 4 - 6 week process (sounds like we'll be spending Thanksgiving and maybe Christmas in Charlotte).
Pre-Screening Phase
  • Dave and I need to get tested for infectious diseases (like HIV, Hepatitis, etc.) prior to starting IVF (failing this one would be awkward).
  • We'll have to attend an injection teaching class since I'll have to take between 3 - 4 shots a day during portions of IVF (after a unanimous vote, Dave will be administering most of  these).
  • In the next few weeks I will do a trial embryo transfer with my doctor (a full dress rehearsal, if you will, so he can make notes on how easy/difficult the transfer will be).
Ovarian Follicle Development & Monitoring Phase
  • Once we determine an IVF start date, I'll take gonadotropin injections for 8 - 13 days to stimulate multiple follicles in each ovary (follicles house the eggs).
  • During the 8 - 13 day time period I will visit the clinic frequently to monitor follicle development (this will be done via ultrasound and blood work).
Egg Retrieval Phase
  • Once Doc says I have enough mature eggs, I'll take Ovidrel to time egg retrieval.
  • 36 hours after taking Ovidrel, Dave and I report to the clinic for egg retrieval and sperm depositing.
  • Egg retrieval takes approximately 1 hour.  Apparently it's a painful procedure so I'll get a 'light anesthesia' (not sure if this is full sleep, light sleep, grogginess, etc.  either way I've been assured I'll be out of it).
  • The embryologist then cleans the eggs and inseminates them to create embryos.  The embryos strengthen in the lab for about 3 - 6 days (the longer the better, just depends on the quality of development).
Embryo Transfer Phase
  • I'll take an antibiotic and steroid after egg retrieval lasting until the transfer.
  • Additionally, I'll start taking a daily progesterone shot until the pregnancy test.
  • I've been told the embryo transfer process is relatively painless (but they will give me a valium for relaxation during transfer).
  • The embryologist will select the best 2 embryos for transfer (unless we request more); the remaining embryos will either be frozen for our later use or disposed.
  • I'm required to 'remain on strict bed rest for 30 mins.' post embryo transfer at the clinic, lay in the backseat of the car on the ride home and stay in bed for 48 hours once home (Dave started laughing when I told him this part.  I think his exact words were 'I'm confident you won't have any trouble with the 2 days of bed rest')
  • After transfer we wait for 12 days before taking a pregnancy test.  No exercising (except for walking) and no lifting (basically nothing to strain the abdominal area).
Pregnancy Test Phase
  • If we are pregnant and everything looks normal, we return to our obgyn for normal prenatal care.
  • If we are NOT pregnant we schedule a post IVF consult 2 - 4 weeks after the negative test results to discuss what happened.
There you have it!  The basic outline for our IVF procedure.  If all goes well we will have a very Merry Christmas.  If not, I'm thinking a vacation somewhere tropical is in order (Dave is not aware of this idea yet)

Wednesday, August 20, 2008

Cellular Wars

For those of you wondering why endometriosis causes infertility (we're right there with you), here's my best attempt at re-explaining what our doctor told us.

***NOTE:  Endometriosis does different things to different people.  This is my personal experience with it.***

In a pelvic region far, far away. . . the dark forces of endometriosis began an invasion (Endometriosis is tissue from the uterine lining growing outside the uterus.  The uterine lining being the stuff that grows each month during your cycle to prepare the womb for implantation).  

(In my case, I had a good bit of endometriosis growing inside my ovaries causing cysts in both ovaries; as well as some growing on the outside of my ovaries slowly adhering them to the back of my abdominal wall).  

But, there was a small band of rebels trying to fight the dark forces (My body registers the endometriosis as foreign cells which triggers my immune system to fight ALL foreign cells in my pelvic region.  Unfortunately, my immune system doesn't know the difference between Dave's swimmers and the endometriosis cells).

The fighting was fierce, and Darth Endo managed to isolate the rebel's princess (When an egg is released each month into this 'war zone' my immune system creates a protective barrier around the egg.  Making it virtually impossible for any surviving swimmers to fertilize my egg.  Here's where surgery, laparoscopy, becomes necessary).  

Just when all was thought lost, the good side of the force partners with the rebels (In June, my doctor removed all the cysts in my ovaries and any endometriosis he saw in my abdomen.  The goal in removing the endometriosis was to neutralize the area and encourage my immune system to relax, i.e. quit attacking Dave's swimmers and over-protecting my eggs).

(One way of monitoring the success of the surgery is through a blood test to measure CA125 levels; this is typically used to monitor ovarian cancer but has been shown to help with endometriosis as well.  
  • A normal CA125 range is between 0 - 35.  
  • In May, before the surgery my CA125 level was 127.69.  
  • In June, after the surgery, my levels were at 71.66.)  

The rebels have temporarily won against the dark side; though there is still unrest in the galaxy (Somewhere in November-ish we use IVF to let my eggs and Dave's swimmers rendezvous in a romantic, peaceful setting, aka the petri dish, in hopes of becoming embryos.  Then we put them back inside me and hope my body allows them to implant and grow into a healthy--and of course beautiful, baby or babies).

Tuesday, August 19, 2008

When your dog's day is more eventful than your own. . .

Dave and I met with the IVF counselor today.  While slightly informative, it was more a baked potato rather than steak meeting.    I got my first shot of Lupron.  I will get my second shot the middle of September.  Along with Lupron, I'm taking the birth control pill, Yaz (as seen on TV!), until Saturday.  All of this is needed to suppress any leftover endometriosis from my surgery in June.  After my second shot of Lupron in September I will be ready to start our IVF treatment plan.

What is our IVF treatment plan?  (Good question, Emily)  Today we discussed the basics surrounding the treatment, but Dave and I still need to meet with our doctor to understand the details of our personal treatment plan.

So, how much will this cost you guys?  (Wow!  Another good question!)  The estimate is in the mail.  Apparently we will get a letter in 3 - 5 days which outlines how much our treatment plan will cost based on our insurance coverage.

The real winner today was Lavender!  She managed to catch a squirrel.  Here's a picture of our fearless wonder, looking out the window for more squirrels (post reprimand and banishment from the backyard).

Monday, August 18, 2008

Goodbye romance. Hello IVF!

Dave and I are struggling through 5 very dry, technical and legally redundant documents provided by our fertility clinic on IVF.  Dave is napping right now . . . document #2 made him sleepy (this is Dave 'posing' for the camera).

So 4 of the 5 documents are legal agreements with such sizzling titles as:

Consent Form for In Vitro Fertilization/Assisted Reproduction
Consent Form for Intracytoplasmic Sperm Injection
Consent Form for Assisted Hatching and Fragment Removal
Agreement for determining Disposition of Embryos not transferred, etc.

Basically, these forms make sure we understand the scientific and political/ethical issues surrounding IVF.  For example, we've got to decide what to do with any embryos we don't implant. . . do we freeze them for later use, donate them to science or dispose of them (frankly, I'm not sure I really want to think about that right now).

One thing is becoming clearer, IVF puts a damper on the romantic pregnancy daydreams for a young couple.  I'm sure the '101 Ways to Romance Your Wife' does not include a chapter on how to give hormonal injections.

Then there are the inevitable questions from Junior (or Juniorette) about how they were conceived.  'Well dear, you started out in a petri dish in a climate controlled environment.  Then you were placed in Mommy's stomach using a needle.  Unfortunately, your brothers and sisters didn't make it; we couldn't afford the cyropreservation storage fees . . .'

Anyway, we meet with the IVF coordinator tomorrow at noon.  I'm sure there will be loads to talk about after that meeting.  Keep you posted.

Friday, August 15, 2008

Vegas in a test tube?

Dave and I scheduled an appointment with the IVF coordinator for Tuesday.  This is a picture of the clinic we are using.  Basically our doctor will outline all the needles, pills, pokes and prodding I will undergo during IVF.  Most importantly though, we will meet with the financial counselor who will tell us exactly how much IVF will cost.  We expect it to be around $10K for one try.

Here's the mental dilemma. . . $10K is A LOT of money (if by chance you disagree. . . let's talk about you donating to our 'make a baby' foundation).  It's a lot to spend on one procedure that has only a 60% chance of success.  It feels like high-stakes gambling (did I mention I'm not good at gambling?).

I know if we have a successful pregnancy the point is moot.  But the morbidly negative side of my brain wonders how I will feel if we come up empty.  Obviously not something to dwell too much on right now. . . trying and failing is much better than doing nothing at all.

Thanks to all for such positive feedback!  More later.

Applying for Residency in the State of Denial.

Well, today was a pivotal day for Clan Donovan (this may be news for Dave-- I can never tell).  We've 'officially' decided to start In Vitro (aka IVF) treatment to address our infertility issues.

Just what are our infertility issues?  Here's a brief history of our quest to start a family:

I discovered I had endometriosis.  I tried suppression therapy for a few years.

We did laparoscopy and the diagnosis was mild/minor endometriosis (the doc said my tubes, ovaries and everything else looked healthy.  Yea, Em!).  

Dave and I started trying to conceive around November 2006.

In August, my gyno recommended we try Clomid.  Clomid is a fertility drug, taken orally; it promotes ovulation of both ovaries.  We tried this for 6 months (the recommended trial period).  Apparently, if you haven't gotten pregnant within 6 month on Clomid, continued use of it will not increase effectiveness.

In April, we were referred to the REACH fertility clinic.  To my surprise, I was told I had Stage IV endometriosis.  During an ultrasound the doctor found 2 cysts in my left ovary, 1 cysts in my right ovary and a polyp in my uterus (for those of you wondering, Stage IV is the most severe form of endometriosis--boo, Em!).

In June, I did laparoscopy to remove the cysts and polyp (Dave was a champ for taking care of me).  Post surgery, my doctor wanted me to do 2 months of Lupron (a common suppression therapy drug) then move into IVF.  He said we had a 60% success rate doing IVF.

Not feeling completely comfortable with this decision (let's just be honest, I was trying to avoid IVF), I opted to try a 'clomid-type' drug for a few months in hopes of bypassing IVF.  The doctor said we had a less than 20% chance of success (then again, my sister told me 'it happens to someone, why not you?').

So here we are-- 2 months of fertility drugs later and no conception; a looming severe case of endometriosis that will only get worse with time and a possible 60% success rate if we bite the bullet and do IVF.

I made the call to my doctor today.  We are going to do IVF!  I'll outline what this means soon.

Thursday, August 14, 2008

Who cares what I think?

Hello All!

I've been very reluctant to start a blog for many reasons (we'll get to those in a bit), but my mind has now changed (and for some strange reason Dave thinks this is a good idea).  The tipping point came late last night while I was reading two blogs sent by a very admired and trusted friend, Amanda H.

Basically, I've been keeping a mental 'Pros' and 'Cons' list on starting a blog.  Here's my running list.

  1. To entertain my dear girl 'Teppie' while she works.
  2. This past February, I quit a lucrative career in Marketing (therefore I suffer from communications withdrawal).
  3. Dave and I are dealing with serious fertility issues (writing about it will most likely be therapeutic).
  4. I just finished reading a GREAT blog from Amanda's friend who is documenting her In Vitro journey (giving me some much needed confidence for my own).
  5. I have family and friends, literally all over the world, to keep in touch with (blogging eliminates time zone challenges).  
  6. For some crazy reason I'm going to grad school to become a Teacher (there's got to be a story there just waiting to happen).
Now, for why I've been so reluctant. . . 

  1. Who cares what I have to say?
  2. The Internet is a scary place full of pervs, right?
  3. Who cares what I have to say?
  4. I'm the world's worst speller.  Who wants to read a blog full of my typos?
  5. Who cares what I have to say?
  6. Surely I will say something inappropriate and inevitably regret it.
  7. And finally, who cares what I have to say?
So the 'Pros' finally outweighed the 'Cons'.  There you have it, 'Emily Logic' for why I've finally decided to jump on the blog-wagon.  

Here's my promise to everyone:  

I will promise to regularly write on this blog, as long as you promise to regularly read and occasionally comment.