Saturday, June 30, 2012

Good news bears

Appointments: scheduled.  Hotel room: reserved.  Drugs: ordered.  Pool time!

After hearing from Nashville that our schedule had been set and the drugs had been ordered, we spent the weekend in fear of the cost.  The estimates that the fertility clinic offered ran between $3K and $6K; Heather is taking a high dose of Lupron, and you pay for the convenience of FSH in pen form, so we were twiddling our thumbs waiting for the bad news.  We had a $6,000 credit card available and weren’t sure if it would be adequate.  (Yeah, I know, debt is sucky, but we’d exhausted most of our cash supply and will be able to pay off the card soon, so please don’t judge.)  Could we use multiple cards?  Could it wait till payday?

We did a little back-and-forth with the pharmacy on Tuesday, exchanging information (including, optimistically and vainly, that of our insurance company), and waited for a call Wednesday to settle the last of it.  To my great delight, they called Heather’s phone to get the payment, so I had no part in it.  A signature is required for delivery, which I find both frustrating and extremely reasonable since it’s approximately 600 degrees outside and the box is worth thousands of dollars.  On top of that, the Lupron expires in 30 days, so there was some juggling to do in scheduling the package’s arrival.

$3,000.   We don’t know how it happened.  What were the discounts?  What was the pre-discount cost?  When Heather told me, I just laughed.  Seriously?

So now we wait for the box.  It should arrive Tuesday, then we go to Nashville for an appointment Thursday, and Friday Heather’s scheduled to start injections.  We’re supposed to practice beforehand, and I’m hoping the Nashville people will help.  ("The only way to learn is to do it," Heather said philosophically.  I'm not convinced she'll feel that way in a week.)

Because of Independence Day and the Nashville trip, we’re taking off most of next week, planning to float in the pool and watch unending episodes of “The Good Wife.” 

It's June 30th.  The first pregnancy test is scheduled for August 1st.    That gives us a month to make a mockery of nature by manipulating Heather's body with pharmaceutical substances, tiny catheters, and aspirated cells before finding out if we're getting a baby or tickets to St. Croix.

Sunday, June 24, 2012

Another perspective on hormone issues

Heather asked me yesterday if I thought we were going to have a baby.

“I don’t know anymore,” I said.  “I felt confident before, but the AMH test has me doubting it.”

“Yeah,” she said.  “I feel kind of the same way.”

Months ago, after another unsuccessful effort at ICI, I remember sitting forward on the couch with my head in my hands, crying.  Heather started to cry, too, and told me to stop—that I was supposed to be her rock and she needed my support.  “I feel like it’s my fault because it’s my body, and you’re making me feel shitty.”

This time, she seemed to be at peace, though.  Not pissed, not grieved, not bitter. 

“At least it’s a reason.  What was pissing me off was that there was no explanation for why I wasn’t getting pregnant.  If it turns out I just don’t have enough eggs, or they’re not in good shape, then at least we know.  If it doesn’t work out, at least I can say I did everything I possibly could to get pregnant.  I’ve always wanted a baby, but maybe it’s not meant to be one that I carried.  Maybe it’ll be one that you carry.  Listen: if it’s meant to be, it’ll happen.”

Wednesday, June 20, 2012

Bad news bears

A nurse from the Nashville clinic called to say that the AMH test results had come through-- mildly gentling my general hostility towards Dr. King's lab and clinic.  Oh, and they're bad.

IVF drugs, types, brands, methods, syringes, pens, etc., etc., etc.

Heather has been way mellow this week.  Pleasant, warm, affectionate, and laid-back.  Does anyone know if birth control has such a side effect?  Or any way I can keep her on it?

There is absolutely zero else going on.  We were both delighted to finish up with the antibiotics and attendant queasiness yesterday, and this afternoon we heard that the AMH results were in.  ("They look good," said the nurse.  "Um, yeah, did you fax them?"  Of course they look good; every test looks freaking magical and Heather's no more pregnant than she was during the first hundred tests.  Fax the goddamn thing.)

The theory, I suppose, is that someone in Nashville will call us this week to set a drug schedule for Heather.  Now that it's getting close, I keep going back to my notes from the IVF class last month to see what's coming.  AND I found out, in doing so, that I was totally wrong about what all this stuff is.  So I'm going to review.  (Teaching is the best way to learn, right?)


Lupron is central to the ovarian-suppression phase and is designed to drain your reproductive hormones.  According to my notes, the Lupron will come in a little bottle and will look dangerously empty.  It won't look like there's enough for the whole cycle, but allegedly there is.  So says Nurse Jennifer.  You inject 10 units every morning with an orange-capped insulin needle.  It can be injected anywhere you can pinch the skin, but the stomach is often least painful (so long as-- and I was vague about this before-- you don't insert it along the longitudinal line of the navel).  You poke it in at a 90-degree angle; my notes say that 45 is too shallow.  Not sure why. 
Side effects are due to low estrogen levels.  The most common are headaches and, just before you begin FSH, nighttime hot flashes.

FSH (Follical Stimulating Hormone)

FSH is the beginning of the ovarian-stimulation phase.  Right around Day 27 of the cycle, you have a "suppression check"-- something that the Nashville people take very seriously.  It's a super-long appointment, we're told.  They check estrogen  (technically estradiol or E2) levels, do a pelvic ultrasound, and do a test run of embryo transfer where they use the catheter to "map the cervix" and figure out which things twist which way.  I guess so they don't poke your innards too hard during the real thing.  Once they see how all that plays out (the E2 level should be below 50), they kick off the FSH.  What's ridiculous is that the Lupron has been suppressing your FSH all this time, so after the suppression check they wean you off the Lupron while jacking you back up with the FSH.
FSH is definitely supposed to be injected into the belly.  The average dose is 300IU.  There are a few different ways of administering it.  We picked Follistim because Nurse Jennifer said that was what PGD manager Amy would want-- and we were grateful because the four options they gave us were confusing as fuck.
1) Bravelle: This one scared me most.  It's a powder that you mix with sodium chloride, and there's a whole long thing about the "q-cap," which goes on top of the syringe...  All of which is to say that my eyes began to glaze over at, say, step three out of what the Bravelle website describes in eighteen.  (You can take a look at their website for the FIVE videos it takes to explain this, along with the PDF instruction sheet.)  Per my notes, Bravelle is a pain in the ass, but cheaper than the pens at about $50 for 74IU.  
2) Menopur: Also a powder; uses the exact same process as above.  It's not clear to me what's different about the two, as they're made by the same company.  According to the Menopur folks, it is "the most widely used and extensively studied reproductive hormone, proven to be both safe and effective."  Not claimed about Bravelle.  Both Menopur and Bravelle contain a combination of FSH and LH (luteinizing hormone), but in different concentrations-- Menopur has a higher level of LH.  Our doctors didn't give us any sign that one is better than the other, and from a casual Googling it looks like a lot of doctors put women on a combination of the two, or switch depending on what's effective.
Also, both are made with hormones extracted from urine of postmenopausal women.  Neat!
3) Gonal: This is a pen application, like Follistim.   It comes with little needles in cartridges that look like the Keurig K-Cups.  The pen portion has a little dial at the end opposite the needle, and you twist it to select dosage.  When you pull back on the plunger, it locks the dose in.  The pen will also warn you when there's not enough in it.  This one, you hold in your fist like a murder weapon, then push the needle all the way in at a 90-degree angle.  
4) Follistim: Also a pen.  The drug comes in little cartridges that you place inside the pen-- like you would replace ink-- on top of a springy plunger.  You twist the two halves (see below) together to close it.  One nice bonus is that you can cap it for portability.  The best thing we learned about it was that, if, when you spin the dial, you go too far, turning the dial in reverse will cause the whole thing to squirt.  I got it in the face during our training session and there was much merriment.  So, anyway, just keep turning it in the same direction till you get back to the appropriate dose.

During FSH treatment, you have to be all cautious-like because it has caused your ovaries to swell grotesquely (okay, maybe not that much, but still enough that there are creepy warnings).  If the FSH gets you too excited, you can get into OHSS (Ovarian Hyper-Stimulation Syndrome), which means that the standard side effects of stimulation are severe enough to cause illness.  Bloating, headaches, and worse.  Even without reaching the level of OHSS, during your time on FSH you're not supposed to have any alcohol, lift anything over 10lbs., make any kind of twisting motion-- vacuuming, for example-- or exercise beyond light walking.  Heather's kind of upset about the vacuuming part, actually.
FSH also seems to mean a lot of doctor's visits.  From my notes, it looks like you have to get testing done on days five, seven, and ten of the FSH process.  On the third visit, the doctor will most likely assign you to employ another drug, hCG (Ovidrel), to trigger final cell division.  I'm very excited for this one because Ovidrel comes in pre-filled syringes.  One in each side of the belly, then you're done with that, FSH, and Lupron.  In the next day or two, you go through egg retrieval.

Progesterone in Oil

This starts right after embryo transfer to keep hormones pumping while the placenta develops.  I am not kidding when I say that my notes state that it "maintains uterine integrity."  Much to Heather's chagrin, the drug is drawn up into the syringe with a giant pink needle; when you're ready to inject, you take that one off and replace it with a skinny gray one.  You do this around dinnertime, injecting the drug in the ass, in the northern hemisphere of either cheek.
Even without the big pink needle, the progesterone shot seems like a painful one.  There are really detailed suggestions for avoiding pain, like warming the vial beforehand in your bra (I am so prepared for this) so that the oil will disperse more easily.  Using a heating pad on that area afterwards helps, too.  Some people recommend icing beforehand, but the nurse pointed out that a cold muscle and cold oil were just going to result in a chilly oily bubble on your back, so you should go for warmth instead.  Baths are good, too.  
Another suggestion was to press your finger hard into the skin for several seconds.  Use the divots as insertion sites.  The nerves, they say, will be "distracted."  The deeper you insert the needle, the better.
Ickily, they allow vaginal inserts of progesterone after a few weeks, but they're messy and most people stick with the needles.  Haha.  Also it makes me think of Suzanne Somers and her hormone creams.

Saturday, June 16, 2012

Third doughnut, third call

Glazed, sprinkled, and chocolate.  Yes, it was worth it.

I paused my sugar rush to get some Mountain Dew from the car (my co-worker pointed out the irony of doughnuts and diet soda, but that’s how I roll) and took the opportunity to leave a semi-hostile message on the nurses’ voicemail at Dr. King’s office.  It was a follow-up to a call I had from the lady in the records department there, asking if I was referring to labs from May.  No.  No no.  Tuesday, I said.  Three days ago.  Per usual, she was flustered, telling me that all she did was scan paperwork and that she would leave messages for the lab and Dr. King’s nurse.  Because I understand being in a support position with no control of anything that might be important to a customer/patient, I thanked her kindly.  Then I called the main office back to leave a direct message on the nurses’ voicemail.  I might have been pleasant to the records lady, but it doesn’t mean I trust her to deliver messages.

Heather asked me afterwards what the story with the AMH results was.  She was no more surprised than I was about the records lady’s confusion, and I told her that I had left a grumpy message for the nurses.  She frowned.  “No, really.  I was almost grumpy enough to satisfy you.  Not up to your standard, but pretty bitchy.”  I’m not sure that she believed me, but she still seemed reassured.

My grumpiness was exposed as the fraud it was when the nurse called back.  Goddamn it.  She was apologetic and said that she wasn’t sure who would have suggested the results would be available so soon—in fact, she said, it usually takes something like a week.  I felt bad.  I don’t know how Heather does it.

When Marsha at NFC returned my anxious call, she was a lot more mellow than I was.  That’s cool, she said.  We don’t need to do anything just yet.

Dude.  No more calls till the test gets in.  Nobody else needs money.  Heather is having caffeine withdrawal, but we’re handling the antibiotics just fine, and we’ll occupy ourselves with surreptitious baby shopping online.  Sheepies and toyland, trains and giraffes…  I like giraffes.

Thursday, June 14, 2012

Antibiotics, nausea, and Oreos

Tuesday was Day 3 of Heather’s cycle, and we celebrated.  She returned from her early-morning blood test with McDonalds, and we snacked and speculated about how many calls it would take to get the results to Nashville.  We welcomed the first of seven days of antibiotics with a hash-brown welcoming committee in our bellies.

Wednesday morning, I started putting on eyeliner and dry heaving at the same time.  Surely not.  So I did some deep breathing, looked back at the magnifying mirror, and vomited.  I recognized it was taking meds on an empty stomach, so I zipped to the kitchen and grabbed the first food I could get my hands on: a vanilla Oreo with red & blue icing.  I went back to the bathroom and subsequently vomited into the sink.  Okay.  Twenty minutes later, I was texting my boss that I’d been in the car but vomited out the window (and, no, not all the way outside the car) and was now in the parking lot of a gas station, waiting for my stomach to calm before hitting the interstate.  I vomited again and got to work half an hour late.  Heather was an hour late, curled up in bed with a combo of cramps and nausea.  We gathered they weren’t kidding about the “with a full meal” warning.

Monday, June 11, 2012

Oh, man, oh, man: the one-day wait

I am so freaking excited.

Heather started her period two days ago.*  Her antibiotics and birth control are in their pharmacy wrapping, sitting ready on the bathroom counter, and there are approximately three things in the way of getting the ball rolling.  Then the wee icy center of the snowball will form and hopefully next May it’ll melt down to a chubby baby.

Saturday, June 9, 2012

In IVF escrow

I don’t know for sure what escrow means.  I think it has something to do with having money and putting it somewhere to sit until you need it.  That’s where we are.

We’ve allotted part of my stock money for the $4,250 PGD (preimplantation genetic something or other that involves stealing cells from embryos to find out if they’re going to make fucked-up babies and, incidentally, if they’re going to make girl or boy babies), which presumably I will pay up on Tuesday when we have our phone consultation with the head of the PGD department in Nashville.  This clinic is so hardcore that they have a lady who talks about this full-time, so much so that we had to make an appointment weeks in advance to talk on the phone with her.  I don’t know how long it takes to say, “We would prefer a healthy child,” but I’m pretty sure it’ll be followed by, “Okay, well, you guys seem to know what you want, so let me transfer you to the financial office.”  Still, charges and appointments are unending—as Heather points out, a favorable outcome for these appointments will be followed by prenatal appointments, then pediatrician appointments, then college visits…

If things play out as planned, by Tuesday Heather will have already coughed up the first $8,800 for the NFC flat fee, and will shortly after pay the $5,000-ish for medications.  Next week is a big one for money, but I am way, super, crazy excited that things are really going to be in play.  Once Heather’s period starts, this is for real.  Much as appointment follows appointment, one drug follows the next.  After about seventeen days, Heather will begin piercing her belly with Lupron-- FYI, the nurse told us in class that you shouldn't inject yourself along the line of your navel because it hurts more; who knew?-- and some time after that there's FSH.  After egg retrieval, she'll be taking three medications, some of them multiple times a day.

For now, though, there are prenatal vitamins in the morning and folic acid at night, and I can't begin to say how thrilled I am that we're only a few days away from the pharmaceutical marvels that lead to a baby.  This time next year, we should have one.

Wednesday, June 6, 2012

The Wannabe Lesbian Mom and AdSense

You may have noticed that there are crazy-ass ads popping up in the midst/sides/bottom/top of the blog now.  I don't feel great about them-- this is a very personal blog and I think it's icky to exploit the people who bother to read it-- but I am a) curious and b) greedy.

I'm going to try this out for a little while, maybe a month or two, see if I'm rich, and either keep going or discontinue it.  Part of me wants to find it's a waste of time so I can take it all down, and the other part says that, if there's cash involved, fuck it: I can betray my principles.

So, anyhow, don't hate me for being a capitalist, but Mama needs to pay her phone bill.

Tuesday, June 5, 2012

What to Expect When You're Expecting: Really Expensive Prenatal Vitamins

I don't know what's in Prenaissance Plus Oral.  The basics seem to be calcium, iron, DHA, folic acid, and DHS.  Somehow, the magic formula of those over-the-counter supplements seems to run about $50 for a 30-day supply.  What the eff?

WebMD says Prenaissance Plus is comparable to CitraNatal 90 DHA*, described on its website as "a comprehensive prenatal vitamin with increased amounts of iron. It has now been reformulated with a patented dual iron combination of ferrous gluconate and carbonyl iron.  The formulation contains calcium citrate and ascorbic acid, which enhance iron absorption."  Moreover, the site says, "CitraNatal® 90 DHA also provides docusate sodium, a gentle and effective stool softener that protects against the discomfort of constipation."

"No, you didn't do anything wrong, but you get on my nerves, and I don't like that."

Today I have ordered what I hope is our last vial of sperm ever.

Today I have also been embarrassed talking to Marsha in Nashville because she totally knows, as does Therapist Michele, that it's me (again, if you want to say something about "it's I," you are probably ridiculous) and not Heather who's calling.  We have two phone numbers, and I have lied to both of them by saying that we trade phones around to be sure there's always someone to get these calls.  What really happens is that I babysit the phones and the calls, and Heather makes the physical appearances when blood or a uterus is needed.  "Oh, no, you're totally talking to Heather."

Monday, June 4, 2012

Helpful facts

Okay, I'm sick and phlegmy, so this is going to be disjointed at best.

One, I looked up assisted hatching and found via Google some guy's explanation:

Assisted hatching is the oldest and most commonly added procedure aimed at improving an embryo’s ability to implant. Embryos must break out or hatch from their shell that has enclosed them since fertilization prior to implanting into the uterine lining. This can be performed mechanically, chemically and most recently by utilizing a laser microscopically aimed at the zona pellucidum, the shell surrounding the embryo. Assisted hatching appears to benefit patients who are older than 38 years of age and those with thick zonae.

Sunday, June 3, 2012

Of Tums and deviance

This morning, Heather asked me when her period was due.  Her stomach hurt, she said.  “Nope.  Nope.  Not till next weekend.”  There is no wiggle room for her to deviate from schedule; she needs to take some Tums and suck it up.