Thursday, February 27, 2014

Second Opinion Consult

So I had my second opinion consult with RMA yesterday.  I really liked Dr. M he knew how to balance being nice and being straight forward, not everyone can do this.

So he had me go through all of of treatment so far and he asked questions about each of my IVF cycles and here is his opinion:

First he thinks we have an egg quality issue (duh) and maybe a slight sperm issue as well (my husband's last SA showed 3% morph).  His big concern is the egg issue since a good egg can fix bad sperm, but if you have a bad egg it doesn't matter how much good sperm you have you'll end up with poor quality embryos.  He also disagreed with all of my protocols.  He thinks Lupron and BCP suppressed me too much, he thinks the increase in stims for IVF #3 was a waste (he said studies show that anything over 450 IU of FSH can't be absorbed, so you just make expensive urine),  he thinks that the ratio of FSH:LH was wrong (he say you need 3:1, mine was more like 10:1), he also thinks that I may have been triggered a day too late and that I may have had post mature eggs and that caused some embryo quality issues,  and he thinks Intralipids were a waste and there was no point to testing for worrying about autoimmune when we don't even know if we were transferring normal embryos.

His recommendation for treatment is antagonist protocol with estrogen priming with no BCP.  He also recommended a freeze all cycle since we often have slow growing embryos.  He feels that the uterus and embryo get out of sync, especially with slow growing embryos and that it is better to wait and do a frozen transfer than to transfer fresh with suboptimal conditions.  He also recommended genetic testing for our embryos.  He also sent a list of tests that he recommended we have done, including karyotyping, which my RE shot down the idea every time I brought it up.

It is amazing to me that two different clinics can both have great success rates and radically different approaches to IVF.  Unfortunately we won't be able to afford IVF with RMA, if money was no object I would definitely consider cycling there.  The program seems top notch and I think if anything was going to work after our failed cycles, it would be their approach

We did decide to move forward with donor embryos and I am really excited.  My consult with FI.RM is on Monday and I should be able to get the ball rolling after that.

Saturday, February 22, 2014

It feel like it's been forever...

So it feels like it's been a long time since I posted, but it's only been 5 days.  Maybe it's because I feel like we've taken giant steps forward in the last few days.  I have all of my consults scheduled and they start this week.  Here's my infertility appointments schedule for the next few weeks, I swear I don't have this many appointments when I am in cycle.

Sunday February 23rd: IVF Seminar at my clinic (they raffle off a free cycle)
Wednesday February 26th: Consult with RMA NJ
Thursday February 27th: First therapy appointment with a counselor who specializes in infertility
Monday March 3rd: Consult with FIRM about their donor embryo program
Tuesday March 18th: Consult with CCRM (thinking about canceling this appointment)

We've pretty much decided that we will cycle with RMA if we can afford it (pretty much might come down to us getting in to a clinical trial), otherwise we will move on to donor embryos with FIRM.  DH is excited about moving on to donor embryos, he's been hooked on the idea since we began talking about third party reproduction alternatives back in November.

Honestly I am excited about the option too, but it took me a little longer to get there.  When we first learned that IVF #3 was a BFN, my initial reaction was "I want to cycle again."  I think it came from a mixture of fear and disappointment.  Moving on to other options means trying something new which brings on fear of the unknown.  I know how to do IVF, in fact I am good at it (just not the getting pregnant part).  Donor Embryos involves a FET and travel to a new clinic, both of which I've never done.  My initial reaction was about me wanting to stay in my comfort zone.  I think the other part of my reaction came from the disappointment of our failed cycle.  I was really hopeful this last cycle, much more than the previous cycle.  I really thought it was going to work for us and finding out it didn't was a hard blow.  All I could think about was how close I felt we got and that with one more cycle we might be able to find success.  Once I took some time to calm down and look into all our options and take a hard look at our finances, I knew that we needed to make some hard decisions.  We have the money for one last cycle, but if it failed we will be forced into a financial break.  Or we could look into other more affordable options, like embryo adoption or embryo donation.  I think once I realized this our answer was clear.  I want to be a mom and I want to experience pregnancy and I was willing to go with the option that has the greatest chance of making that happen.  With embryo donation we could afford multiple attempts even with the cost of travel.  Honestly now that I have had time to get used to the idea, I am excited.  I feel like we are on the right path now.

We are also very lucky to have supportive families.  Both of our parents support our decision to pursue donor embryos.  My parents have even offered to give us money to help pay for our airfare.  DH's mom just told him that you have to do what you have to do.  She reminded him that she adopted his brother and she loves him just as much as she loves DH.  They have always offered to help us no matter what path we chose (IVF, egg or sperm donors, embryo adoption or donor embryos, or even traditional adoption).

Sunday, February 16, 2014

The hard part of infertility

So everyone thinks the hard part of infertility is giving yourself shots, or dealing with the side effects of hormones, or having to go through invasive/embarrassing procedures.  To me all of that is the easy part.  Stabbing myself in the stomach with a needle multiple times a day (or letting DH stab me in he ass with a needle), easy peasy.  Hot flashes, headaches, mood swings, heart burn, all a piece of cake.  Dates with the vag cam, letting a doctor stick a giant needle up my vagina to suck eggs out of my follicles, letting the doct stick a catheter up my cervix while I try not to piss myself because of my full bladder, and generally spending most of my appointments with my feet in stirrups and lady bits exposed, no big deal.

Right now is the hard part.  Waiting for appointments, not knowing exactly what the future holds.  Not knowing exactly what the next step is.  This is hard for me.  The worst part is knowing that it will possibly be the end of March before we finish our consults and make a finalized plan for our next steps. I am a planner.  I need a plan or I just feel lost, like we are just stuck not moving forward.

I am trying to relax and just focus on the next appointment.  Right now I need to finish up my RMA paperwork and get it all emailed in.  Then next Sunday is my clinic's IVF seminar and I hope to get to  ask the head RE her thoughts on our situation and maybe schedule a consultation with her.  Then the 26th is my phone consult with RMA.  That along with work ought to keep me occupied until the end of the month.  You would think 2.5 years of TTC would have taught me some patience.  Yeah, not so much.

Friday, February 14, 2014

WTF Appointment

Ok, so I have been waiting to write this post because I needed time to let things sink in, time to process it all.  I have always been quick to react emotionally to our WTF appointments, partly I blame the residual hormones and partly I blame my emotional personality.  I didn't want to write this post in my over emotional state, which I think was a good choice I feel like I've had time to settle down and think about what is important to me and it has really helped give me some clarity.

Let me start with our WTF appointment, which didn't go exactly as I thought it would.  I went in fully prepared for my RE to bring up donors again, but he didn't.  His current recommendation is that we get some second opinion consults.  He recommended CCRM.  He thinks that it would be a good idea to have another set of eyes look at our case and maybe they could come up with something he hasn't thought of.  I brought up another clinic that I had looked at previously, when we were considering getting some second opinions, RMA NJ.  I have always liked this clinic and besides having great success rates, they do a lot of clinical research studies, which besides advancing ART techniques, could save us some money if we qualify for a trial.  My RE thought that RMA was also a great clinic and encouraged me to get a consult from them too.  So today I have a consultation set up with Dr. Molinaro at RMA NJ on Feb. 26th and a consultation set up with Dr. Schoolcraft at CCRM on March 18th.

We did talk a little about additional testing and my RE was willing to do sperm DNA fragmentation assay for DH, even though he doesn't think this is an issue.  I know that most cases of high DNA fragmentation present with other MFI factors, but I feel like this is important to rule out if we decide to move on to donor eggs.  I would hate to spend money on a DE cycle only to have a similar outcome because DH has a DNA fragmentation issue.  My RE also seems to not be in favor genetic testing for us, although he is ok with genetic testing of the embryos.  His reasoning is that we can't change our DNA, so we should focus on finding the best normal embryo.  I understand his argument, but also feel like genetic testing could help us decide which treatment option is right for us.  If we found out that due to some genetic issues, we make a higher than normal number of abnormal embryos, and combined with the fact that we don't make a lot of embryos,  would point towards moving on to donors.

In addition to looking into RMA NJ and CCRM, I have also printed some info on the NEDC or National Embryo Donation Center in Knoxville, TN.  They run an Embryo Adoption program that has great successs rates.  They do require a home study, like a regular adoption, so it would involve a little more paperwork, but overall is much more reasonably priced than another fresh IVF.  I also left a message with FIRM about their embryo donation program.  They do anonymous donation, so no home study required.  The price is extremely reasonable, so I am interested in talking to the program director about this program.

DH and I have done a lot of talking and have come up with a tentative plan.  We are going ahead with the consults, but as of right now don't plan on cycling at CCRM.  The cost is just too high  and if the cycle failed, we would be forced into a financial break.  I've also heard some women are turned off by the clinic, it is a big clinic and I think some feel lost in the shuffle.  Cycling at RMA is a possibility, depending on cost.  We will have to wait and see how the consult goes and what kind of plan the RE comes up with.  If we decide not to cycle with RMA, our plan is to look into embryo donation through FIRM.  The program seems to have short waiting times and is reasonably priced.  While I don't want financial concerns to decide our course of treatment, I also want to be able to afford to raise any child we might have.  To do this, I can't spend every last penny I have on treatments.  If FIRM falls through, we will probably look at the NEDC.  Right now this feels like the right plan for us.  Honestly I am excited about our plan.  It feels great to have an idea how you will move forward, even if it not how you originally planned it.

Wednesday, February 12, 2014

Mini Breakdown

So last night I had a mini breakdown.  I had a really good morning, but by the afternoon I could feel the emotion welling up.  I kept fighting it off, determined to make it through work.  Then what I had been dreading happened, my coworker asked if I had any news.  This was the exact reason I didn't tell her about IVF #1 and 2, she's the type of person that asks for updates.  As soon as I got back to work after my ET, she asked how things went.  When I told her it went well, she talked non stop about how happy she was for me and how she new what she would get me as a present.  I kept reminding her that it hadn't worked yet and that IVF isn't a sure thing, but she is naive.

Anyway, I am getting ready to leave and she asks how everything was going.  I try to avoid the topic and tell her I'm fine.  She then pushes the topic and asks if I have any good news.  I just say no, that it didn't work.  It was like she couldn't believe it.  I have to explain that even under perfect situation, the success rate is only about 50%.  She had thought since I had taken time off for my blood work that it must have been good news.  I had to explain that they do blood work on everyone.  I started to lose it right there at work, but was able to get to my car before the real tears started.

It was like I had been successfully burying all of my feelings about this cycle and having to say out loud that it didn't work was a trigger for all of these emotions to start flooding in.  I sobbed when I got home.  I told DH that I just don't want to go to our WTF appointment if the doctor is going to give me bad news.  I know it sounds stupid, but I just don't want to hear any more bad news.  I am at my limit of bad news.  I hate knowing what my RE is going to say, he was ready for us to look into donors last cycle.  I am just having a hard time accepting this.  Every IVF cycle we have done has gotten better, I feel like we are so close to success that I shouldn't give up yet.  My big fear though is wasting more money cycling again with my own eggs only to have another failed cycle.  I just don't know how many more failed cycles I can get through.  I'm not ready to give up, but it need to make sure we have a good chance at success.  I don't have the money or energy to waste on cycles doomed to fail.

Monday, February 10, 2014

Beta #2 is a BFN

No surprise here, beta #2 is negative.  My normal nurse wasn't the one to call me and this nurse asked if I had been given instructions.  I told her I hadn't, but it wasn't my first failed cycle.  Time to stop progesterone, wean off the steroids, and make a follow up with my doc.

Good news is that I was able to get an appointment this week with my RE.  My WTf appointment is scheduled for Thursday.  I am glad that my doc is quick to see you after a failed cycle.  I know some women need time to grieve a BFN, before moving on, but I am not one of them.  I am a planner.  I won't feel better until I have my plan for our next steps, whatever those may be.

Now it's time to come up with what I want to talk to my RE about.

Friday, February 7, 2014

It's the little things...

So today overall is a much better day than yesterday.  Only a few tears on the way home from work, which means I made it about 20 hours tear free.  Major accomplishment.  Seriously though, I will be happy to be off the progesterone, I feel like an emotional crazy woman at times.

So back to the title of my post.  Sometimes the little things make me happy.  I've been a crazy woman when it comes to tracking our medical expenses and organizing our receipts for our taxes.  When I say crazy, I mean full out certifiable nut job.  We are talking keeping multiple spreadsheets tracking expenses (FSA and claimable expenses, it also breaks out between IF and non-IF expenses for my own curiosity), organizing receipts (with insurance EOB for expenses covered by insurance) into a binder (complete with plastic page covers).  The receipts are sectioned off by service provider, since my RE and clinic both provided me with financial ledgers, which are included in the binder.  I'm usually not this organized, but when things stress me out I go overboard with organization, it gives me a sense of control.  Anyway when I was organizing everything, I realized I was missing my statements from the clinic for my October cycle.  There was one statement for my cycle balance and one for my anesthesia bill.  Of course this was the one statement that I didn't make a copy of (I copied August's bill).  I had the non detailed receipts, copies of the checks, and my financial ledger (doesn't include anesthesia though it's a third party service), so I wasn't too worried about it, but it was driving me insane that it was missing.  I am so happy that I found it today tucked in a purse that I was carrying in October.  Woohoo! Knowing that all of our documents are officially in order makes me so happy.  Now I just need to call an accountant and make an appointment to have our taxes done!

Thursday, February 6, 2014

8dp5dt beta day

I took one last FRER this morning another stark white negative.

I got to the lab as soon as they opened to have my blood drawn.  I have one decent vein in my right arm (deep, but a good vein) and the girl couldn't hit it.  She ended up drawing from my hand.  Fortunately the lab was quick to process my blood work and I got a call from my nurse about 2 hours later letting me know that it was negative, beta was < 2.  It's recommended that I stay on my meds until after my second beta on Monday.  I plan on doing so unless I run out of PIO in my vial.  I am not opening a brand new vial for  a BFN.

After Monday's beta, I will be given new instructions.  I know exactly what they will be though, discontinue progesterone, wean off the dexamethasone, and make an appointment with my RE.  Honestly, I love my RE, but I am dreading this appointment.  He was ready for us to move on to other options after IVF #2, it was a second opinion from another RE that gave us our plan for IVF #3.

I am a mix of emotions right now.  Part of me really wants to cycle again, even though I originally said that this was our last cycle with my eggs.  This cycle was so much better than the last two (except for the outcome, obviously) and I feel like we  could have a real chance at this working for us, but it's a lot of money to possibly throw away on something that so far hasn't worked.  Another part of me feels like maybe I've become obsessed with fertility treatments, almost addicted if you will.  I've been doing treatments pretty much non-stop since last April and what if my desire to do another cycle is less about me thinking it will actually work, and more about me just being able to do something?  My sister has offered repeatedly to donate eggs, but the idea makes me upset.  Not because my children won't be biologically mine, but because I want to do the injections, go to the monitoring appointments, have the egg retrieval.  I want to be able to do it, not watch someone else go through what I couldn't do.

The option that is becoming more appealing to me right now (other than cycling again with my eggs) is embryo adoption.  My clinic gave us info on the NEDC and I really like them and their success rates are fantastic.  From what I can tell it would cost less than half of what another cycle with my eggs would cost.  I've also looked into embryo donation through FIRM, but their success rates according to SART worry me.  They are extremely affordable though, their costs are about half of the NEDC and they don't require a home study.  I have also looked at frozen donor eggs through RBA.  A cycle costs $16,000 which is cheap for donor eggs, but you only get 6 eggs.  They do have a guaranteed take home baby plan though (for $30,000), where you get 5 cycles (plus any FETs) and if you don't have a live birth you get your money back (only about half I think, you end up paying $3,000 per cycle).

It's a lot to think about right now.

Wednesday, February 5, 2014


FRER is still stark white.  I know people will say it's early and that I need to wait for tomorrow's beta before I can call this cycle a bust, but I know in my heart that this cycle is over.  DH won't give up hope until we get the beta results, so I have to pretend that I also have hope.  I can't continue to hope for something that is clearly not going to happen.  It will be bad enough getting the negative beta call knowing that it is coming.

Tuesday, February 4, 2014


FRER is still negative.  DH is still so hopeful, but I am starting to accept that it looks like this cycle might be a bust.  Beta is in two days.

Monday, February 3, 2014


Well because I have no willpower and my husband is a pee pusher I tested with a FRER even after my wondfo was stark white.  What do you know, a BFN.  I know that 5dp5dt would be super early for a BFP, but I was hoping maybe we would be lucky and get a squinter.  Nope stark white, even with my fantastic line eye, I can't imagine a second line for this test.  I guess on the bright side I know my trigger is out.  I just don't have a great feeling for this cycle.  I was so positive going into it and so positive after transfer, but the last few days I've felt less positive.  At least I will know for certain the outcome of the cycle in 3 more days.  Good or bad the waiting will be over.

Sunday, February 2, 2014


After driving myself crazy with squinter lines while testing out my trigger for IVF #2, I told myself I wasn't going to go through that again with IVF #3.  Yet here I am.  I have no willpower.

So I decided like any normal woman going through IVF that I needed to test out my trigger, just so I could be 100% certain that when I test for real that any line I see is a real positive.  So the day of transfer I start testing each morning with wondfos to make sure my trigger is out.  Yesterday at 3dp5dt I had what looks like a negative wondfo, but decided to test again this morning to verify that my trigger was indeed out.  My test this morning has what might be a super faint barely there line.  This line could be a few things, an evap (it was super hard to see until the test dried), what's left of my trigger, completely imaginary (I have been known to have line eye, the ability to see lines where there really aren't any), or the start of a BFP.  There is not much to do but to wait and keep testing.  I will probably test again tomorrow with another wondfo.  Tomorrow is 5dp5dt and 12 days past my trigger, I am pretty confident that if I get a line tomorrow that it is a real BFP and not my trigger.  I promised myself that I would wait until 6dp5dt (Tuesday) to take a FRER and I am going to try to stick to this plan.

I haven't had much in the way of symptoms.  Maybe a little cramping and I've been completely exhausted, but all can be blamed on the progesterone.  Beta is Thursday I am just praying for a nice strong beta this time.