sad, confused, overwhelmed ...

I received an order in the mail (from Dr. Schmidt) for about 15 different blood tests that I needed to have done on cycle day 3 (the third day of my period) if I ended up not being pregnant this time. This blood work needs to be done in preparation for IVF. There are lots of things they need to check for before jumping into the land of IVF. I had my blood drawn on Monday morning (2/21). They had to draw 8 tubes of blood!!

Anyway, I called Dr. Schmidt's office several times this week because I was very anxious (and afraid) to find out my current FSH level. My FSH level back in July 2010 (when we first started infertility treatments) was 12.3. That is elevated, but still manageable. Carol (my favorite nurse) called me this afternoon with my current level. I could tell as soon as I heard her voice that the news wasn't good. My number is 21.4. My heart sank to my toes when I heard the number. Based on everything I've read, most reproductive endocrinologists (fertility doctors) don't even attempt IVF once the number is greater than 20. I didn't know what to say except "wow". Carol said not to panic (too late!), and told me that there is a chance that the lab made an error. Yes, I suppose that is possible, but I'm not holding my breath. She said that Dr. Schmidt also looks at another blood test for anti-mullerian hormone. That was part of the workup from Monday, but the result won't be available until next week. She said that even when the numbers seem terribly dire, there are still options. I can't remember what else she said ... I think I was too stuck on 21.4. If that number is correct, then my ovaries are essentially no longer functioning, and I have no chance of getting pregnant with my eggs. That means our only remaining options are IVF with donor eggs (my amazing sister, Heather, has graciously and sincerely offered her eggs to me), surrogacy (not something I really want to consider, for a number of reasons), or adoption. I am feeling terribly sad. I can't seem to wrap my head around how my FSH could have skyrocketed so much in only 8 months. I have been browsing the internet tonight for answers and more information, but this has just left me feeling more confused and sad.

We will be meeting with Dr. Schmidt next Wednesday (3/2) to go over the blood work results and discuss our options. I guess I will know more and have more to report after that appointment.

really.really.really.really.sad.

I am typing this post with tears running down my face. In the midst of one of the worst nights I've ever had at work (all three of my patients developed major issues that almost got them transferred to the ICU), my period started with a vengeance. I went in the bathroom to cry three different times during the remainder of the night at work. In the past week alone, I had three dreams that I was pregnant. They were so vivid that I even remember the details of watching the pink line appear, crying tears of joy, and calling people to tell them the amazing news.

On this week's episode of "One Born Every Minute" (an 8-episode documentary on Lifetime that was filmed at the Labor & Delivery unit in my hospital), one of the featured couples was 17 years old. They didn't plan to get pregnant, and didn't even seem very excited about having the baby. That was really hard to watch. Life is so unfair sometimes.

I have terrible cramps (so bad that they are making me nauseated), I didn't sleep well today, and I have to go back to work tonight (and rereading this blog post, I realize that I am sounding whiny and feeling sorry for myself. Ugh. I will be back on my feet again soon ... I just need to feel sad right now.). This infertility journey is the pits.

feeling optimistic, but still being realistic ...

One week from today, I will be taking a pregnancy test (assuming my period hasn't started by then). I am still having some pelvic cramping, which is a good thing. While I am feeling hopeful and trying to stay optimistic, I am also thinking ahead. If I am not pregnant now, we have decided to move on to in vitro fertilization (IVF), which is the end of the road for fertility treatments. I have done quite a bit of research on IVF, and the success rate is 50-60%. The quality of my eggs has always been suspected as the cause of my infertility. I have read several research articles about the effect of radioactive iodine (the radiation treatment that I had in 2009 for thyroid cancer) on eggs. There is some speculation that this type of radiation can damage eggs, which is what I have been afraid of all along. With IVF, my mature eggs will be extracted from my ovaries, and that's when Dr. Schmidt will really be able to determine the quality of my eggs. While FSH levels (see this post) can be a good indicator of ovarian reserve, the quality of the eggs can't be determined until they are taken out of me. So, if I am not pregnant this month, it will be good to finally know what's going on with my eggs.

I left a voice mail for Dr. Schmidt's nurses this weekend, asking what I need to do to prepare for IVF, in case I'm not pregnant. Patty (one of the wonderful nurses) called me this morning and confirmed that Dr. Schmidt agrees that it will be time to do IVF if this cycle wasn't successful. She said that Brian and I will need to meet with Dr. Schmidt to discuss everything, and she scheduled that appointment for 3/2 at 4:00. Of course, I will be more than happy to cancel that appointment if I am pregnant, but I'm glad to have it scheduled. Patty told me that I will have to skip a cycle if I'm not pregnant, to get all of the paperwork signed, meet with Dr. Schmidt, and get of all the medications ordered. Plus, I will start taking a daily intramuscular injectible medication called Lupron about a week before my next period (after the one that will start next week if I'm not pregnant) begins, and continue taking it for at least two weeks. This medication completely shuts down my body's production of FSH and LH. That way, my follicle growth and subsequent egg retrieval can be controlled more precisely. Timing was very important with IUI, but it is critically important with IVF.

Patty told me this morning that my progesterone level from my blood draw on Friday was 12.4. If I remember correctly, that's the highest it's been since I started injectible meds. Patty said that as long as the number is over 3, ovulation definitely happened; as long as the number is over 10, pregnancy can occur. So, I am encouraged by this number. :)

If I am not pregnant this time, I will need to have blood drawn on the 3rd day of my period, to check my FSH level (see the first paragraph of this entry for more info about FSH levels ). My FSH was last tested in July, and it was a reasonable level at that point. It is possible that the number has increased since then. If it has increased too much, this will indicate that my ovaries are no longer functioning well enough to allow me to get pregnant with my own eggs. At that point, we will have four options: IVF using donor eggs and Brian's sperm; surrogacy; adoption; or deciding that we are ok with not having children. It's very hard for me to even think about having to choose one of those options, but it is always in the back of my mind.

For now, I am going to keep on keeping on for the next week, hoping that my period does not start, and wishing, hoping, and crossing every crossable body part that I get a BFP (big fat positive) pregnancy test next Monday. So, here's to wishing and hoping ...

waiting, waiting, waiting ...

This feels like it has been the longest week ever. I can't believe insemination was only a week ago ... it feels like it was a month ago. Time truly seems to slow down during the 2+ weeks between insemination and pregnancy test/period.

I've been having some pelvic pain and bloating in the last couple days. It's not like anything I've felt before during this part of my cycle, so I called my doctor's office to ask about it. I explained that the pain initially felt like it was more on the right side, but it has now become more low and central. Carol (amazing nurse) explained that the pain could be a couple different things. First, the right-sided pain could be the result of some of my follicles not releasing their eggs and instead turning into cysts. These cysts grow rather large and collect fluid. They also cause fluid to collect in the abdomen. They can cause a significant amount of pain and are not uncommon when the ovaries have been stimulated with fertility meds. These cysts are what Dr. Schmidt looks for when he does the baseline ultrasound every cycle on day 3. If there are any cysts present at that time, I have to skip a cycle. :( So far, this has not happened, and I hope it never will. What a double whammy ... to not be pregnant AND to have to skip a cycle. That would be so sad. :(

The more central, low pelvic pain is a good thing, according to Carol. She said that implantation can take place as early as 5 days after ovulation (which would have been Wednesday), and there can be pelvic pain associated with implantation (since this triggers a whole bunch of hormonal changes as well as the placenta starting to grow). She said that if this pain continues, it is a very good sign and may mean that I am pregnant. Of course, I was over the moon when I heard that!! Now, I can't think about anything else. I can't believe there might actually be a little bean (or two, or three ... haha!!!) growing inside me right now. I am SO trying not to get excited, but I just can't help it. So now, I am just wishing and hoping that this pain continues!!

I will be getting my blood drawn later this morning, to check my progesterone level. This level will confirm that I ovulated, and the higher the number, the better. I should get a phone call from one of the nurses on Monday, letting me know the results of the bloodwork.

For now, I just have to be patient ... wish it wasn't so hard!!!

the waiting game ...

Yesterday was our big day. Brian had to be at the lab at 7:30 AM, and then we enjoyed breakfast together at Cosi (yum). We had to be back at Dr. Schmidt's office at 9 AM. Dr. Schmidt's smiling face always makes me feel good. He came in with the vial of liquid baby-making gold and said that this was going to be the month I get pregnant. I sure hope so. He had some trouble getting the catheter through my cervix and angled forward into the top of my uterus, so the insemination process was more painful than usual. I ended up bleeding for most of yesterday and am still feeling crampy (he said that all of this is normal and wouldn't affect my chances of getting pregnant at all).

I will start taking Prometrium (progesterone vaginal suppositories) twice a day starting tonight, to make sure my progesterone levels are high enough to sustain a pregnancy. I will stop taking the Prometrium on 2/16, in case I am not pregnant. That way, I will be able to have a period. If I am pregnant, I will have to start the Prometrium again and take it for the entire first trimester (and possibly longer).

I will have my blood drawn to check my progesterone level on Friday (2/11), and I will give myself an HCG booster shot that day, too. My official pregnancy test day is February 21. That day seems so far away. I really struggle with being patient when it comes to this whole infertility journey. It's so strange knowing that for the next 2+ weeks, my body will know whether or not I am pregnant, but I will not. I'm starting to feel pessimistic already. :( I'm just so afraid to get my hopes up.

3 big fat follicles!!! :)

I had my ultrasound and estradiol blood draw today. To my surprise and amazement, my follicles are ready!! I have 3 big follicles in my left ovary. A follicle is considered mature once it reaches 15 mm in size. Mine are 14 mm, 20 mm, and 21 mm. :) Dr. Schmidt shared my excitement today. He told me that it appears we have finally found the right cocktail of meds for me. To give a comparison, my follicular phase (the amount of time between the first day of my period and the day of ovulation) was 19 days last month (and even longer in previous cycles) and will be 14 days this cycle. That may not seem significant, but it is a really big deal. In a "perfect" cycle, the follicular phase is 14 days. I have never had a perfect follicular phase in my life. So, this is huge. I was on cloud nine driving home from the doctor's office. Unfortunately, it took me awhile to come off cloud nine enough to fall asleep today. Last night was my first of three 12's in a row at work, and I only ended up getting about 5 hours of choppy sleep today. :( But it's ok. Maybe the sleep deprivation is a sign of things to come in about 9 months? ;)

So, Carol (my wonderful nurse!) called this afternoon with my instructions for the next few days. She told me that my estradiol level is 164. In some past cycles, it never even got that high. In the cycles when it did get that high, it took a lot longer. So, I am going to do one more night of injectible meds (1 of Bravelle and 1 of Menopur, instead of 2 Bravelle and 1 Menopur) tonight, and then I will do my HCG trigger injection tomorrow night at 9 PM. Then, Friday will be the big day. We have to be at the lab at 7:30 AM for Brian to do his thing, and then we have to go next door to the office at 9 AM for insemination. I am trying my hardest to not get my hopes up, but of course those attempts are futile. Everything seems to be going right this time, and I can't help but believe that this is a good sign.

So, here we go again ... :)

insurance nightmare (with a happy ending)

We have our health insurance through UnitedHealthcare, but our prescription coverage is through CVS/Caremark. CVS/Caremark has a specialty pharmacy (mail order) that supplies fertility, chemotherapy, multiple sclerosis, etc. medications. I have been so impressed with them (and the coverage for fertility meds is amazing ... Dr. Schmidt's nurses have told me that we have some of the best prescription drug coverage they've ever seen!) since I started the injectable meds. I just call them to order the refill, and they overnight (for FREE!) the meds to me so I get them the next day. I've never had any issues with them ... until this week.

After I had the ultrasound with Dr. Schmidt on Monday, I met with Carol (one of his nurses) to go over the new injectable meds (she showed me how to mix them, inject them, etc.). She told me that she was going to fax the prescriptions to CVS/Caremark that day, and I should call the next day to arrange delivery. So, I called CVS/Caremark on Tuesday afternoon. The person I spoke with told me that the medications required prior authorization. When I asked for more information about that, I was told that my doctor had to provide this prior authorization before the prescriptions could be filled. I called Carol and left her a voice mail explaining this (I was in panic mode at this point, since we were running out of time to get the meds to me so I could start them today). It was late afternoon at that point, so she called me back on Wednesday morning. She said that she had just waited on hold with CVS/Caremark for over a half hour before finally getting a live person. That person then transferred her to someone who assured her that the authorization would be faxed to her that morning so she could complete it and fax it back. I was really starting to panic, but trusted that the fax would be sent that day. Carol called me back at 3:00 and said that she had she spent over 2 hours that day on the phone, being given the runaround about this fax that she never received. She asked me to call CVS/Caremark at that point, and try to get something done from my end. I was so upset (not with Carol ... she went above and beyond). She gave me the phone number of the person she had been working with, and I tried to call this person. Of course, it went to her voice mail. I then called the number that I call to get my refills mailed to me, and the person I spoke with was not helpful at all. She said that my only option at that point was to pay out of pocket and hope to be reimbursed by them (NO guarantees) after the fact. She told me that the meds would be almost $3,000 out of pocket. I lost it. I was a crying mess at that point. There's no way I could come up with that kind of money on the spot, especially without a guarantee that I would be reimbursed. I cried all afternoon that day. I was so afraid that this wasn't going to be resolved by today, meaning that this cycle would be ruined. 

Side note: I worked three 13+ hour nights in a row this week (M-T-W), and was barely able to sleep on Tuesday or Wednesday during the day (because I was so worried about this). So, the sleep deprivation was not helping matters at all. 

I was driving to work at 6:30 on Wednesday evening when my phone rang. It was the person at CVS/Caremark. She was very apologetic and explained that since it's the beginning of the year, almost everyone's insurance company requires prior authorization for specialty (including fertility) meds, so the authorization department was very backed up. Fighting back the tears (unsuccessfully), I explained to her that I HAD to have those meds by today, or this cycle would be ruined. She said that she had gotten permission from the authorization department to call Carol the next morning (Thursday) and take verbal authorization instead of a fax. She assured me that once this verbal authorization was obtained, I would be able to order the meds to be overnighted to me for today. My tears of sadness turned to tears of joy (all of these hormones make me an emotional mess, and I am not normally a crier!!), and I thanked her profusely. I called Carol and left her a message explaining everything. She called me the next morning and said that she did the verbal authorization, and everything was good to go. I thanked her, thanked her again, and then thanked her one more time before we hung up. She has been amazing. I had left her a tearful voice mail at some point this week, and when she called me back, she said that she got tearful listening to my message. They all care about their patients so much ... such a refreshing change from some doctors out there. 

I called CVS/Caremark and arranged for delivery. I asked for the total due, and the person I was speaking with told me $200!!! What amazing coverage ... remember, I was going to have to pay $3,000 out of pocket!!! The person on the phone assured me that the meds would be overnighted that afternoon and I would receive them by 3:00 today. Things were starting to look up again.

This morning, I got an email from CVS/Caremark saying that my prescriptions could not be processed because they were not authorized. WHAT?!?! The tears flowed again as I called them to find out what was going on. I waited on hold for almost a half hour before getting a live person. The person I spoke with said that the meds had indeed been mailed out yesterday, and the email was a mistake. As she was waiting for the shipping information to come up on the computer, she said there was a chance that the meds were delayed in transit by bad weather, and I wouldn't get them until Monday. *Cue tears again* I sat there with tears running down my face, waiting for her to confirm a delay or no delay. She put me on hold for about 5 minutes, and finally came back and said that my package was in Columbus, and it would be delivered to me by 3 PM today. I should have been ecstatic upon hearing this news, but I knew that I wouldn't relax until that package was in my hands. 

I had a bunch of errands to run today, but when I pulled into my driveway at 4 PM, that beautiful package was sitting on my front porch. I felt the stress and tension disappear from my head, neck, and back muscles. What a stressful week. 

I gave myself the first injection this evening. OUCH! Up until now, none of the other injections really hurt at all (other than the initial pain of the needle going into my skin). This one burned and stung like crazy as I injected it into my abdomen. Yikes! It's going to be a long 10 or so days of injections. Oh well ... if this gets me pregnant, then it will be worth every ounce of pain.

I've been having significant ovarian pain (both sides, although the right side is worse) since yesterday afternoon. I spoke with Cathy (one of Dr. Schmidt's nurses) today regarding the pain. She said that it was most likely caused by my ovaries producing several follicles. I haven't had that pain at all until now, so I am feeling optimistic that the meds may be working better this time.

I recently realized that I have become "that person" ... the one I swore I would never become. I have known people who went through fertility treatments, and I have spent plenty of time reading posts in online infertility support groups. I used to think some of these women were a little nutty ... becoming so focused on getting pregnant that they lose sight of other things in their lives ... figuring out several weeks ahead of time when ovulation will be occurring and making sure that their schedules are open during that week since you don't know until the last minute when insemination will be ... dreaming about being pregnant ... etc. Indeed, I have become that person. It's kind of comical, I guess. I know that I am not alone. So many people struggle with infertility, and they feel the same things I'm feeling. I just wish I could figure out a way to accept the fact that I may not get to experience pregnancy. I'm not at that acceptance stage yet. Dealing with infertility seems a lot like grieving. There are five stages of grieving ... denial, anger, bargaining, depression, and acceptance. I have experienced each of those so far, but I haven't gotten to the acceptance part. I get so angry and sad sometimes, thinking about how many babies are born to parents who don't want them. Then there's us (and all the other couples who struggle with infertility), who would give anything to have a baby. It all just seems so unfair. I guess life isn't fair, though ... right?

I think about my parents and how much I want to give them a grandbaby. They would be the most amazing grandparents. I think about Brian and what an amazing dad he would be. He is a kid magnet. He attracts kids everywhere we go. Kids think that he is just a big kid. :) I think about my sister. She would be the most fabulous aunt. I just feel so out of control in this journey. I have no control over this situation. We can do everything that an infertility textbook says to do, and we still may never get pregnant ... and if that happens, we may never even know why we couldn't get pregnant. It's all just so surreal.

Enough rambling. I'm trying to stay optimistic. There's no other way to be.