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.  

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).

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:

2001:

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

2005:

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

2006:

Dave and I started trying to conceive around November 2006.

2007:

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.

2008:

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.