Roadblock

Yesterday we received the first batch of medications needed for the stimulation phase as well as what is needed for the egg retrieval and embryo transfer.  (More is on the way!)  Although I somewhat fear the stimulation injections, I got butterflies when opening the box of mail-ordered fertility drugs.  It really hit me that we are only days away from starting the injections and literally only weeks away from creating a baby.

Today, however, we hit a roadblock.  It saddens me to say that all of which I mentioned has been put to a halt.  I had an appointment with my reproductive endocrinologist (RE) this morning for, what they call, the baseline ultrasound.  Up until this point, I have been doing Estrace priming--part of my IVF protocol.  So, at this ultrasound, my RE would be happy to see a perfect uterus and no follicles on the ovaries.  As the ultrasound started, she described the lining of my uterus as exactly what she was hoping for.  The right ovary looked good.  But, then over to the left ovary....a large cyst.  Normally, if a cyst is found at this stage, they aspirate it, or drain it, in simpler terms.  However, the cyst I have has solidified and is more of a blockage, which means it can't be drained.  This caused some concern, so my RE had blood drawn to check my estrogen level.

A few hours went by, and I got a call from our fertility nurse with the bad news.  My estrogen level is elevated.  Following Estrace priming, at baseline, my estrogen level should be really low.  It's like my ovaries are not properly responding to the medications I have been taking daily for almost 2 months now.

This can negatively impact the IVF cycle, which means that we cannot continue at this point.

So, where do we go from here?  We wait...we wait until I start another period.  We don't know when that will happen, because it should already be here following the Estrace priming and Provera.  But, it's not.  So, we wait until that happens, and then blood will be drawn again to test the estrogen level at that time.  It is possible that the cyst will go away once the period starts.  If this happens fairly quickly and the estrogen level drops, we can proceed, and the next step is stimulation by injections.  If this does not happen quickly and too much time passes, we will have to start the whole Estrace priming phase over again.  We could ultimately be looking at several more months before we get to the point we are profoundly hoping for.

I can't help but wonder if the universe is trying to tell us not to have more babies.  We haven't been able to conceive on our own for 18 months.  We haven't been able to conceive following a laparoscopic procedure in which my tubes were unclogged and adhesions were removed (both due to endometriosis).  So, we turned to IVF, but we struggled with the financial aspect of this process.  And now we've hit a roadblock.  It's heartbreaking, the lengths we (and other couples just like us) have to go through for a process that should come so naturally.  I question a lot right now, especially when, every single day, there is a new story in the media about a child being abused or neglected or killed.  And I question things when I see babies being born as drug addicts or with fetal alcohol syndrome.  Why are those people able to conceive?  And why aren't we?

Roller coaster

The last two weeks have truly been a roller coaster of emotions for us.  If you have ever considered going through IVF, or think you might in the future, don't believe the initial price quotes you are given, especially if you are a self-paying (cash) patient.  If your health insurance covers IVF, you are one of the lucky few.  Our insurance does not cover IVF, so everything that goes into this process is coming out of our pockets.

A week or two ago, we received the final fees from our doctor and pharmacies.  Little things keep popping up with our doctor that are not included in the IVF package, which means more cost.  The injections were more than double what we were initially quoted.  Our hearts sank and we became scared.  Scared that we would either have to stop the IVF cycle or that we would drain everything we have just to continue.  We applied for several programs that offer financial assistance to families going through IVF.  We were either turned down or were presented with an offer that was not going to save us any money.  But, we held on for a few more days, and without going into details, a miracle happened and we are now able to proceed.

Andrew and I met with our doctor yesterday to discuss results from labwork for both of us.  We both passed the infectious disease screening with flying colors...woohoo!    But, my vitamin D level is in the low-normal range.  IVF patients are more successful with normal vitamin D ranges, so I will be adding a supplement to my long list of daily pills.

My doctor also ran a panel for recurrent pregnancy loss, which found some abnormalities.  Although I've had only one miscarriage, she wants to be sure that there is nothing going on that could potentially result in another miscarriage following IVF.  The initial test for lupus came back positive; however, every confirmatory test for the lupus inhibitor came back negative.  There is a good chance that the result for lupus is a false positive.  My doctor said that, for an unknown reason, there is a higher incidence of false positives in Caucasian females. Just to be sure, she will run the test again in 12 weeks.  In the meantime, I will take a baby aspirin every day as an anticoagulant.

Another abnormality that was found is the MTHFR A1298C gene mutation.  It seems that this mutation is of little clinical significance.  However, conditions associated with this mutation include recurrent miscarriage.  This could be because folic acid is not metabilized the way it should be.  For that reason, I will be switching to a prescription prenatal vitamin that contains easily-metabolized folic acid.  (In case you don't know, folic acid is crucial for the developing embryo.)

Andrew and I sat through an injection teaching yesterday, where we learned how to mix the medications and administer the shots (the part I am not looking forward to).  The mixing of powders and diluent is a complicated process!  I think we are both nervous that we won't mix the right amount of medication or that we won't be able to get it all out of the bottle.  And I'm definitely nervous about the long needles.  How can they expect non-clinicians to do this?!  Ugh...

So, that's where we are with things right now.  Next week I will have my baseline ultrasound, where my doctor will look at my ovaries and hope she finds what she is looking for.  My understanding is that they are hoping to see no follicles at the baseline.  A few days following that ultrasound,  I will start the injections, which will hopefully stimulate the ovaries to produce many follicles with good quality eggs.

So much to do

The amount of work that goes into this IVF process is overwhelming at times.  We received an email from our nurse with all of the final steps that we will take over the next month, which will hopefully lead to a healthy pregnancy.

There are several protocols for IVF, depending on why a couple is unable to get pregnant.  We are struggling with fertility because of my endometriosis.  We've learned that our IVF protocol is "growth hormone with Estrace priming."  So, what does that all entail?  Right now, I take DHEA one time a day, Ubiquinol three times a day, and Estrace two times a day.  And let's not forget the prenatal vitamin.  On March 16th I will add Provera to that list, one time a day.  And then, on March 28th, I will start the injections--SIX of them daily, to be exact.  Andrew will be in charge of administering these injections, since I am too much of a wimp to do it myself.  Hopefully he won't get too much pleasure from stabbing me with a needle six times a day for two weeks.  But, before we get to that step, we have to go through the process of mail ordering the injections from an approved fertility pharmacy, and we have to learn how to perform the injections (watch several videos and attend a class).

The hope is that all of this therapy will increase my egg production as well as the quality of those eggs.  This will be monitored by continuous ultrasound and blood work starting on March 26th (just about every other day for 1-2 weeks).  

As of right now, we are hoping that the egg retrieval will take place sometime during the week of April 6th.  Of course, this will all depend on when my eggs are ready.  If they are not ready on April 6th, I will continue with the therapy, and will have ultrasounds every day until it's time for retrieval.

In the meantime, I am continuing with the Fertility Diet and acupuncture.  This is all moving very quickly, much faster than we ever anticipated.  Of course, since starting this process, we've been hoping that we just might get pregnant on our own, but it's just not happening.  On March 18th, we will be signing over a large amount of money for this entire journey.  It's frightening, but also exciting to think about what a successful outcome may be.

written on 3/6/15