We had our consultation with Dr. D this past Wednesday to decide what to do next. Up until this point we were being told that we had Unexplained Infertility. They thought maybe it was low progesterone/short luteal phase. Maybe it was due to the poor sperm morphology... maybe poor egg quality, maybe maybe maybe. Boy! Were we ever sick of being told "maybe" and "i'm not sure."
At this last appointment Dr. D looked at us and said, "you no longer are classified under the "unexplained infertility" it is Male Factor Infertility." While this certainly isn't good news, its kind of a relief to know the "why" behind all of this. There's no anger or blame, we refuse to point fingers. Its not his diagnosis, it's our diagnosis.
For whatever reason, his initial counts were "normal" with poor morphology. Ever since, counts, morphology, and motility have all been low. There's not a concern about varicose veins/vericocele because volume is normal. (Sorry, this entire post may be TMI).
So, what does this mean for treatment? Well, according to Dr. D, after 3 IUI's, our chances of success with this method of treatment have diminished significantly. With normal counts, eggs, etc, there's only about 20% success rate with IUI and after three it goes down to about 12-15%... but since we don't have "normal" numbers, our chances are even less. To put it bluntly, our only real chance of conceiving a child are through IVF (InVitro Fertilization). A lot of you probably know what this is, or have at least heard of it... but I'm going to really dumb it down for this post and try to explain it as best I can.
We'll be doing a 2 month IUI with ICSI. For the first month I'll be on medication to surpress my ovaries. I'll still have a normal period, I just won't ovulate that cycle. The second month I'll be on medication to hyperstimulate my ovaries. The hope here is to get around 20 follicles at the time of ovulation. I'll go in for frequent bloodwork and ultrasounds during this month to make sure my hormone levels are ok and that my eggs are growing in number and size without causing my body any harm. I'll have a mid-cycle ultrasound, typically day 13-14, at which point, assuming follicles are mature, I'll be given another trigger injection (I'm planning on giving this one to myself... the RN's at this office aren't very good at giving injections).
36 hours after the trigger injection, I'll go back to the office for egg retrieval. Dr. D said he'll knock me out for this proceedure since I've had.... issues in the past with this type of thing. (Thank goodness!) They'll then go in to my ovaries and aspirate each and every follicle. Bob will also give a sample on this day for the ICSI.
Rather than put our eggs in individual petri dishes with a couple million sperm each, like they normally do for IVF, we'll be doing ICSI (intracytoplasmic sperm injection). This means they'll inject a single, healthy sperm directly into each mature egg. The embryos are then monitors by an embyrologist for (usually) 5 days. They watch for cell division and make sure that they're growing and developing correctly before the transfer.
Because we're so young, Dr. D said we can pick whether we want to transfer one or two embies at a time... I think we'll do 2. So, 5 days after retrieval, I'll go back in and they'll tranfer two embryos into my uterus. Then it's another waiting game, hoping for implantation. Dr. D said our chances for success are 50-60% with the first IVF, then it only drops 5-10% with subsequent transfers.
I've heard of multiple people having 10 healthy embies that are able to be transfered. Assuming we get similar numbers, we'll transfer 2 and freeze the rest for future transfers.
So, that's the procedure. But there's definietly other things for us to consider.
This entire process is going to cost us $10,000! The transfer itself is $6000 and the ultrasound, bloodwork and medications are another $4000. That's a lot of money. We have another consultation with the IVF nurse at the end of the month, at which point they'll go over payment plan options... but the thought of trying to come up with that amount of money is paralyzing. I could never put a price on having a child... but all I can think is... what if we don't have a child. We're gladly accepting donations! :)
Timing is another obstacle for us. Doing the 2 month IVF is going to be kind of a challenge. We have a lot of vacations and trips planned starting in September and don't have two months to commit to this until next January. The ONLY way it would work for us to do IVF this year would be if the timing fell into place perfectly to start the process mid-September and do the transfer mid-Oct. Sadly, timing is yet another thing that is completely out of our control... it all depends on when I start my next period. (Stupid body).
Side effects, side effects, side effects! In case you haven't gathered this from my previous posts, I do not tolerate medication very well at all. No matter what the medication, no matter what's it's use, I WILL have every side effect possible. Femara is supposed to be practically side effect free.... for me... every possible side effect. That being said, being on the medication to stimulate my ovaries will likely cause headaches, bloating, MORE weight gain, acne, insomnia, nausea, constipation, and mood swings, just to name a few.
Because I'm so sensitive to medications, I will be getting lower than the lowest dose of the follicle stimulating hormones. My fear is that it will be too low and we'll get terrible counts. But the Dr's fear is that if he gives me any more than that, I'll develop OHSS (a whole different issue). They'll also be monitoring me much closer than most people because of my reaction to meds.
This is a lot of information to process. Its a lot to try to digest. Its a lot to explain to other people. And its a scary thing to decide to do. IVF does not always work... We're struggling with not focusing on that. This is really our only chance of having a baby of our own.
Most of you have probably heard of the 5 stages of grief: Denial, Anger, Bargaining, Depression, and Acceptance. We've gone through these stages 11 times over the past year. Every month we're not pregnant, we experience each and every one of these. Sometimes we process them faster than others, sometimes we experience one stage longer or shorter than the rest. But this time, I'm stuck in the Anger stage... and I have been for over a month. I'm furious. I'm mad that we are going through this. I'm mad that God gave us such a strong longing to be parents, but left us barren. I'm mad that God gives babies to crack whores, but not to us. I'm mad that people keep giving me "advice." If one more person tells me its stress and that I just need to relax, I'm going to scream! You wouldn't tell someone with cancer that its just stress and they need to relax, so why would you tell that to us when we too have a legitimate medical condition? I'm mad that we're being left behind. I'm mad that I've lost friends over this. I'm mad that I distance myself from people with babies, and that people with babies distance themselves from me. I'm just down right angry. I'm angry that I still have hope... I don't want any more false hope. I'm angry that people tell me that if I trusted God more, I'd have a baby. That if I wanted Him as much as I want a child, I'd have a baby (and yes, people have actually said these things to me).
We appreciate your continued thoughts and prayers. We often feel left behind and forgotten, and its comforting to know that there are people out there who care.
We'll keep you posted after out next appointment as to the tentative timing of our IVF.
Friday, July 20, 2012
Saturday, July 14, 2012
Another Disappointment
Well I had my mid-cycle ultrasound this past Tuesday. To recap Dr. D recommended doing at least one more IUI and switched me from clomid (which I was very responsive to but had some side effects) to Femara (which I wasn't supposed to have any side effects on).
The symptoms started the first day of Femara. Terrible hot flashes, mood swings, constipation, weight gain, headaches. You name it, I had it! My only source of comfort was the thought that the side effects meant the medication was working.
Wrong.
I only had 1 follicle at my ultrasound. 1! Are you kidding me! I can get one on my own without all the side effects. It was a good size, at 24 and my lining was 14 which is also very good... but I can get those numbers without the "help" of medication.
The nurse didn't do anything to make me feel any better about the situation either. First and foremost, that woman doesn't know how to give a shot to save her life! I spent 2 1/2 years giving injections to people every day... she had NO clue what she was doing. They wanted me to do another trigger shot, but, get this, "It's very possible we'll miss it this time around because you waited to long to come in. So next month you'll want to come in earlier in your cycle"
I WAITED TOO LONG! Are you kidding me!? Dr. D told me to come in on day 13 or 14 for my ultrasound because I don't typically ovulate without the trigger injection until cycle day 17-19. Now the nurse is pretty much telling me that there's not point in doing the IUI because I waited too long. And it wasn't a if this doesn't work, but when it doesn't work.
We debated just not doing the IUI, but figured we might as well since we'd already done all the prep for it (despite the stupid nurse and her inappropriate comments). So the next day we did the IUI.
To continue with the bad news, the Sperm count was down to only a third of what to was last time... which was hardly more than the first IUI which we were told was practically pointless. This was the most painful proceedure yet, with a lot of cramping and even some nausea, which has never happened.
This week hasn't been very good for me. Bob's been amazing; but there's nothing to say. Nothing to do. Our hope was pretty much destroyed before it even had time to begin. We didn't even want to do this IUI, but Dr. D was so confident that we decided to follow his recommendation.
I know it's not right to give up before we even have results, but I'm sick of getting my hopes up only to be devastated...so I guess I'm choosing to be devastated now instead. I don't want to talk. I don't want to hear anyone say, "Just relax" "Its going to happen" "It's ok, it's not the end of the world."
I've been fully immersing myself in work and putting on a happy facee, but I've given up.... at least for now.
The symptoms started the first day of Femara. Terrible hot flashes, mood swings, constipation, weight gain, headaches. You name it, I had it! My only source of comfort was the thought that the side effects meant the medication was working.
Wrong.
I only had 1 follicle at my ultrasound. 1! Are you kidding me! I can get one on my own without all the side effects. It was a good size, at 24 and my lining was 14 which is also very good... but I can get those numbers without the "help" of medication.
The nurse didn't do anything to make me feel any better about the situation either. First and foremost, that woman doesn't know how to give a shot to save her life! I spent 2 1/2 years giving injections to people every day... she had NO clue what she was doing. They wanted me to do another trigger shot, but, get this, "It's very possible we'll miss it this time around because you waited to long to come in. So next month you'll want to come in earlier in your cycle"
I WAITED TOO LONG! Are you kidding me!? Dr. D told me to come in on day 13 or 14 for my ultrasound because I don't typically ovulate without the trigger injection until cycle day 17-19. Now the nurse is pretty much telling me that there's not point in doing the IUI because I waited too long. And it wasn't a if this doesn't work, but when it doesn't work.
We debated just not doing the IUI, but figured we might as well since we'd already done all the prep for it (despite the stupid nurse and her inappropriate comments). So the next day we did the IUI.
To continue with the bad news, the Sperm count was down to only a third of what to was last time... which was hardly more than the first IUI which we were told was practically pointless. This was the most painful proceedure yet, with a lot of cramping and even some nausea, which has never happened.
This week hasn't been very good for me. Bob's been amazing; but there's nothing to say. Nothing to do. Our hope was pretty much destroyed before it even had time to begin. We didn't even want to do this IUI, but Dr. D was so confident that we decided to follow his recommendation.
I know it's not right to give up before we even have results, but I'm sick of getting my hopes up only to be devastated...so I guess I'm choosing to be devastated now instead. I don't want to talk. I don't want to hear anyone say, "Just relax" "Its going to happen" "It's ok, it's not the end of the world."
I've been fully immersing myself in work and putting on a happy facee, but I've given up.... at least for now.
Tuesday, July 3, 2012
What the Doctor Said
We decided to have a consult with our Doctor before moving forward with any further treatment. Initially, Dr. D wanted us to do 4 IUI's (one "normal" and 3 on clomid). But after two failed IUI's we didn't feel like this was a very effective treatment and wanted to talk with the doctor.
Before meeting with Dr. D, I had to have an ultrasound to check for any residual cysts... and that was all normal. Here's a summary of what he said.
"To be blunt, the first IUI had very little chance for success because the sperm count was much lower than we anticipated. That doesn't mean it couldn't have worked, just that the chances weren't very high. That being said, you've really only had one good IUI. You responded VERY well to the clomid, we almost never see that many follicles on such a low dose. If you were my daughter, I would say you should do one more IUI, maybe two... but if you feel emotionally drained from all of this, we can take a break and start up again in a couple months."
We don't want to stop completely, not yet anyways... but just don't want to continue with something that's ineffective.
"Because you respond so strongly to clomid, you aren't a candidate for Follistim (which is a much more potent medication to produce follicles). You would likely produce more than 8 eggs, and IF successful, would almost certainly end up with at least triplets if not more. But because of the complications and heartaches in pregnancies with high volume multiples, I don't believe this would be a good/safe idea for you. Also, there are more side effects and you run the risk of getting OHSS. I think we should do one more Clomid IUI cycle. If that isn't successful, we have three options.
1. Take a break.
2. Laproscopy to check for endometriosis
3. IVF
"I recommend moving right to the IVF. Even though you have some family history of endometriosis, you don't have any signs or symptoms. The biggest indicators for endometriosis are if your periods are getting progressively more painful or heavy (which mine haven't... they've actually gotten better over the last 5 years.) Also, laproscopy is more invasive, and it costs as much as IVF. In looking at it from a cost basis, you have 0% chance of coming out of laproscopy pregnant, but you have 55% chance coming out of IVF pregnant. If an IVF is unsuccessful, we could then decide if we want to try a second one, or do laproscopy."
Dr. D was incredible kind through this conversation... the way I've written it probably comes across as him being stiff and insensitive.. but he was the complete opposite! He kept saying, "it's up to you, but I really believe this would be your best option.... this is what I would tell my daughter to do."
I asked about the possibility of doing ZIFT, but he said the success rates are much higher for IVF than for ZIFT. The only reason he does ZIFT anymore is if he can't implant into the uterus for some reason. After a little more discussion with Dr. D, we decided to do one more IUI and once that's finished, we'll make the next decision. He did switch me from Clomid to Femara. I was having hot flashes, constipation, and bloating on the clomid.... I gained 7 pounds from the clomid alone, add that to the 4-5 I gained from the progesterone the cycle before... and my clothes definitely don't fit!
Dr. D said that I wouldn't have any side effects from the Femara, and probably wouldn't produce quite as many follicles as on the Clomid, but it would still be effective.
Femara is terrible! I only have to be on it for 5 days, today is day 4 and I've had terrible hot flashes, headaches, mood swings, and I haven't been able to sleep at all. Thank goodness I only have to take it tonight and tomorrow night and then I'll be done!
We don't have a date set for our IUI, it all depends on what my ultrasound shows next week.
Thank you all for your encouragement and prayers... they're needed and much appreciated.
Before meeting with Dr. D, I had to have an ultrasound to check for any residual cysts... and that was all normal. Here's a summary of what he said.
"To be blunt, the first IUI had very little chance for success because the sperm count was much lower than we anticipated. That doesn't mean it couldn't have worked, just that the chances weren't very high. That being said, you've really only had one good IUI. You responded VERY well to the clomid, we almost never see that many follicles on such a low dose. If you were my daughter, I would say you should do one more IUI, maybe two... but if you feel emotionally drained from all of this, we can take a break and start up again in a couple months."
We don't want to stop completely, not yet anyways... but just don't want to continue with something that's ineffective.
"Because you respond so strongly to clomid, you aren't a candidate for Follistim (which is a much more potent medication to produce follicles). You would likely produce more than 8 eggs, and IF successful, would almost certainly end up with at least triplets if not more. But because of the complications and heartaches in pregnancies with high volume multiples, I don't believe this would be a good/safe idea for you. Also, there are more side effects and you run the risk of getting OHSS. I think we should do one more Clomid IUI cycle. If that isn't successful, we have three options.
1. Take a break.
2. Laproscopy to check for endometriosis
3. IVF
"I recommend moving right to the IVF. Even though you have some family history of endometriosis, you don't have any signs or symptoms. The biggest indicators for endometriosis are if your periods are getting progressively more painful or heavy (which mine haven't... they've actually gotten better over the last 5 years.) Also, laproscopy is more invasive, and it costs as much as IVF. In looking at it from a cost basis, you have 0% chance of coming out of laproscopy pregnant, but you have 55% chance coming out of IVF pregnant. If an IVF is unsuccessful, we could then decide if we want to try a second one, or do laproscopy."
Dr. D was incredible kind through this conversation... the way I've written it probably comes across as him being stiff and insensitive.. but he was the complete opposite! He kept saying, "it's up to you, but I really believe this would be your best option.... this is what I would tell my daughter to do."
I asked about the possibility of doing ZIFT, but he said the success rates are much higher for IVF than for ZIFT. The only reason he does ZIFT anymore is if he can't implant into the uterus for some reason. After a little more discussion with Dr. D, we decided to do one more IUI and once that's finished, we'll make the next decision. He did switch me from Clomid to Femara. I was having hot flashes, constipation, and bloating on the clomid.... I gained 7 pounds from the clomid alone, add that to the 4-5 I gained from the progesterone the cycle before... and my clothes definitely don't fit!
Dr. D said that I wouldn't have any side effects from the Femara, and probably wouldn't produce quite as many follicles as on the Clomid, but it would still be effective.
Femara is terrible! I only have to be on it for 5 days, today is day 4 and I've had terrible hot flashes, headaches, mood swings, and I haven't been able to sleep at all. Thank goodness I only have to take it tonight and tomorrow night and then I'll be done!
We don't have a date set for our IUI, it all depends on what my ultrasound shows next week.
Thank you all for your encouragement and prayers... they're needed and much appreciated.
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