The hardest aspect of infertility is the loneliness. It is isolating to be so far on the other edge of fertile. 3 failed IVF cycles this year. I know no-one that has come this far or spent this much with nothing to show (other than those of you in the blogosphere). I know that others have talked about the hierarchy of pain and how we tend to diminish others pain if they have not suffered as much or as long as we have. I want to be a bigger person and not be bitter, but it is difficult to be surrounded in a world of people that know nothing of the pain and struggle we have been through this past year. To listen to my friends talk about the timing of their second or third child, while we are dying to have another is agony. If only we could worry about timing.
I have two friends that have gone through fertility treatments (IUIs and IVF) this year and both got pregnant. One friend got pregnant on her second cycle with twins and delivered her healthy baby girls last week. I found out yesterday that the other got pregnant on her first IVF cycle. I am so weary of never getting to the other side. To see them get pregnant and move on with life. While I am still here, still stuck. Still not pregnant.
I want to rid myself of this pain, but I don't know how. I can't run until exhaustion. I can't cry enough tears. It lives in me, this warped bitter chain of thorns around my heart. Pinching every time I breathe.
Sunday, December 19, 2010
Thursday, December 16, 2010
Cornell Meeting: Hope Glorious Hope
The RE was great: the right balance of concern, empathy, and scientific reasoning. She said that given my husband's numbers, while the morphology was low, there was no reason to believe that we couldn't get pregnant naturally. That being said, she said that she understood how we must find this inconceivable given all that we've been through this past year. She suggested the following:
Protocol change: My AMH and low response did indicate that I had an ovarian reserve issue and she thought that we needed a different protocol that did not include lupron, as it was likely oversupressing me. In addition, she would pretreat the ovaries with a "different agent" to coordinate the growth of the follicle (estrogen priming protocol?). She said that she would also start us at a higher dosage of FSH stimulating (for example, follistim) and limit the FSH/LH stimulating (menopur).
Day 3 versus Day 5 Transfer: She suggested that we do an "aggressive" Day 3 transfer, i.e., transfer 3-4 embryos. She said that there has been a shift in protocol to using Day 3 transfers again and that the body is the best incubator for the embryos, which is why Cornell does co-culture of embryos with endometrial cells from their patient.
No PGD, Immune Issues, Endometrial Implantation Issues: She also said that she didn't believe that we had any genetic issues that impact the quality of the embryos and wouldn't suggest PGD. She said they don't know the long term impacts of PGD and that PGD might identify one cell with an issue, but that other cells may be chromosomally normal. She said embyros have an ability to "heal" themselves and that if the embryos were given a chance to survive on their own, they may overcome any of the issues in one or more cells. She also doesn't believe that we have any indicators of immune or endometrial implantation issues.
So, now what?
We don't have any insurance coverage with Cornell and would have to pay out of pocket. IVF costs $15,000 (co-culture, ICSI, assisted hatching), which I believe doesn't include the cost of the drugs, so tack on another $5-7,000.
We would have insurance coverage for RMA and would likely only have to pay for the PGD ($4,500) if my husband's insurance doesn't cover it.
Do we try one more cycle at RMA since we would basically have to pay nothing and then if that doesn't work go up to Cornell? Or do we just go to Cornell now and suck it up?
Do we do PGD? Is it just a waste of money? If we don't do PGD does it make sense to go to RMA?
Decisions. Decisions.
HELP!
Protocol change: My AMH and low response did indicate that I had an ovarian reserve issue and she thought that we needed a different protocol that did not include lupron, as it was likely oversupressing me. In addition, she would pretreat the ovaries with a "different agent" to coordinate the growth of the follicle (estrogen priming protocol?). She said that she would also start us at a higher dosage of FSH stimulating (for example, follistim) and limit the FSH/LH stimulating (menopur).
Day 3 versus Day 5 Transfer: She suggested that we do an "aggressive" Day 3 transfer, i.e., transfer 3-4 embryos. She said that there has been a shift in protocol to using Day 3 transfers again and that the body is the best incubator for the embryos, which is why Cornell does co-culture of embryos with endometrial cells from their patient.
No PGD, Immune Issues, Endometrial Implantation Issues: She also said that she didn't believe that we had any genetic issues that impact the quality of the embryos and wouldn't suggest PGD. She said they don't know the long term impacts of PGD and that PGD might identify one cell with an issue, but that other cells may be chromosomally normal. She said embyros have an ability to "heal" themselves and that if the embryos were given a chance to survive on their own, they may overcome any of the issues in one or more cells. She also doesn't believe that we have any indicators of immune or endometrial implantation issues.
So, now what?
We don't have any insurance coverage with Cornell and would have to pay out of pocket. IVF costs $15,000 (co-culture, ICSI, assisted hatching), which I believe doesn't include the cost of the drugs, so tack on another $5-7,000.
We would have insurance coverage for RMA and would likely only have to pay for the PGD ($4,500) if my husband's insurance doesn't cover it.
Do we try one more cycle at RMA since we would basically have to pay nothing and then if that doesn't work go up to Cornell? Or do we just go to Cornell now and suck it up?
Do we do PGD? Is it just a waste of money? If we don't do PGD does it make sense to go to RMA?
Decisions. Decisions.
HELP!
Monday, December 13, 2010
Updates from the past week
No updates in a while because I have been recovering from a full family plague of the stomach flu....
The only thing worse than having the stomach flu is having a husband and small child suffering at the same time!! Let's just say there was a lot of television watching going on...I think we watched every Christmas show out there. And, I've had a very healthy diet consisting of cookies, pizza, and bread for the past few days. I have to get back on the leafy, green vegetables and fruit train again soon. And, maybe a little exercising again once I stop feeling dizzy when I climb one flight of stairs.
Sher Institute Consult:
Last Monday, I spoke with an RE from the Sher Institute. He spend over an hour discussing my prior IVF cycles and explaining immune testing. He indicated that he thought we should definitely have immune testing done as we had repeat IVF failures. When I asked how we could have immune issues after successfully conceiving my son, he said that the body is not a static and, just as women become hypothyroid after their first child, so can our body change in terms of immunity. I would like to get the testing done...which would be approximately $1 K, but I can't seem to convince my husband to sign on. He doesn't think we should persue this avenue as we don't have repeated losses or any family history of immunologic diseases. Plus, this is just getting expensive. Between therapy, accupuncture, and adoption stuff, we've dropped nearly $2K this month...and we still have all these upcoming fertility cycles to pay for...My motto is generally "better safe than sorry," so we're at a bit of an impasse.
RMA Consult:
Our meeting with RMA last week was...unsuprising. Of course, he agreed with our prior RE that there was no reason to suspect implantation issues, immune issues, or other hormone issues. He believes that we may have a genetic issue and wants us to do the antagonist protocol. Due to my low antral follicle count (9 as of last Thurs), he doesn't think I'll ever be a big responder to meds and shouldn't expect more than 9-10 eggs retrieved, which of course lowers my chances of finding a viable embryo. He attributes embryo quality issues to the egg and said that--aside from age--the biggest differential in producing good eggs is improving the protocol. He said that his clinic has an 80% implantation rate for eggs that are genetically viable. He wants us to have one natural cycle and then would put me on BCP for 1-3 weeks and then start the stimming. He doesn't believe in immune issues, thought my HSG looked good, and said that genetic issues such as chromosomal translocation and the such are typically characterized by repeat pregnancy loss, which I don't have. I did like the way that the clinic was run and can do most of my monitoring down here at my local clinic. Also, he said that I shouldn't have my heart rate go over 130bpm during exercise while cycling...which basically means slow walking. My old RE said that I could continue running below 20 MPW as well as other exercise. He said the biggest problem with exercise is that it increases your body core temperature. He said that I could swim, which would increase my heart rate, but wouldn't matter because my body core temperature would remain low. Also, they are strong supporters of laser accupuncture and have an on-site clinic that will do accupuncture prior to retrieval and transfer. It's $200...so I'm definitely signing up.
The RE poo-poo'd many of the studies I cited from Sher...saying that they weren't based on statistically sound studies. He doesn't believe in immune issues or that too much testosterone (androgens) from long lupron, antagonist, or micro-dose lupron flare protocols negatively affect the growth of eggs in women with diminished ovarian reserve.
Duking it out with Cornell:
I don't know who to believe. I'm not sure whether "group think" is occuring and newer theories are automatically being thrown out without given full consideration. There is no One Truth in anything: in faith, life, or science. As much as doctors think they know, there is twice as much that they don't know. And, I could see them being wary of testing new theories if it would call to question everything they have previously posited. I would hate to be the victim of Type One errors. So as to seek out a 3rd, neutral party, I have a con call scheduled with Cornell on Thursday. I'm paying out of pocket (and not telling my hubby), but I feel that I need closure on whether we are pursuing the right path.
Something Positive:
Taking a note from Ms. Brightside, here's my positive for the week: at my ultrasound on Thursday, I had a big beautiful follicle growing! The doctor estimated that I would ovulate in 4-5 days. I'm on Day 5 now, but still haven't gotten a + from my ovulation predictor...but I think something is happening and it should be coming soon. Perhaps delayed due to my stomach flu? So, thankfully, I'm not going to have another 60+ day cycle before I get my period!
Also, I took a photography course this past Saturday. Which made me want a more expensive camera...but was also a nice way to disconnect from all this infertility stuff.
The only thing worse than having the stomach flu is having a husband and small child suffering at the same time!! Let's just say there was a lot of television watching going on...I think we watched every Christmas show out there. And, I've had a very healthy diet consisting of cookies, pizza, and bread for the past few days. I have to get back on the leafy, green vegetables and fruit train again soon. And, maybe a little exercising again once I stop feeling dizzy when I climb one flight of stairs.
Sher Institute Consult:
Last Monday, I spoke with an RE from the Sher Institute. He spend over an hour discussing my prior IVF cycles and explaining immune testing. He indicated that he thought we should definitely have immune testing done as we had repeat IVF failures. When I asked how we could have immune issues after successfully conceiving my son, he said that the body is not a static and, just as women become hypothyroid after their first child, so can our body change in terms of immunity. I would like to get the testing done...which would be approximately $1 K, but I can't seem to convince my husband to sign on. He doesn't think we should persue this avenue as we don't have repeated losses or any family history of immunologic diseases. Plus, this is just getting expensive. Between therapy, accupuncture, and adoption stuff, we've dropped nearly $2K this month...and we still have all these upcoming fertility cycles to pay for...My motto is generally "better safe than sorry," so we're at a bit of an impasse.
RMA Consult:
Our meeting with RMA last week was...unsuprising. Of course, he agreed with our prior RE that there was no reason to suspect implantation issues, immune issues, or other hormone issues. He believes that we may have a genetic issue and wants us to do the antagonist protocol. Due to my low antral follicle count (9 as of last Thurs), he doesn't think I'll ever be a big responder to meds and shouldn't expect more than 9-10 eggs retrieved, which of course lowers my chances of finding a viable embryo. He attributes embryo quality issues to the egg and said that--aside from age--the biggest differential in producing good eggs is improving the protocol. He said that his clinic has an 80% implantation rate for eggs that are genetically viable. He wants us to have one natural cycle and then would put me on BCP for 1-3 weeks and then start the stimming. He doesn't believe in immune issues, thought my HSG looked good, and said that genetic issues such as chromosomal translocation and the such are typically characterized by repeat pregnancy loss, which I don't have. I did like the way that the clinic was run and can do most of my monitoring down here at my local clinic. Also, he said that I shouldn't have my heart rate go over 130bpm during exercise while cycling...which basically means slow walking. My old RE said that I could continue running below 20 MPW as well as other exercise. He said the biggest problem with exercise is that it increases your body core temperature. He said that I could swim, which would increase my heart rate, but wouldn't matter because my body core temperature would remain low. Also, they are strong supporters of laser accupuncture and have an on-site clinic that will do accupuncture prior to retrieval and transfer. It's $200...so I'm definitely signing up.
The RE poo-poo'd many of the studies I cited from Sher...saying that they weren't based on statistically sound studies. He doesn't believe in immune issues or that too much testosterone (androgens) from long lupron, antagonist, or micro-dose lupron flare protocols negatively affect the growth of eggs in women with diminished ovarian reserve.
Duking it out with Cornell:
I don't know who to believe. I'm not sure whether "group think" is occuring and newer theories are automatically being thrown out without given full consideration. There is no One Truth in anything: in faith, life, or science. As much as doctors think they know, there is twice as much that they don't know. And, I could see them being wary of testing new theories if it would call to question everything they have previously posited. I would hate to be the victim of Type One errors. So as to seek out a 3rd, neutral party, I have a con call scheduled with Cornell on Thursday. I'm paying out of pocket (and not telling my hubby), but I feel that I need closure on whether we are pursuing the right path.
Something Positive:
Taking a note from Ms. Brightside, here's my positive for the week: at my ultrasound on Thursday, I had a big beautiful follicle growing! The doctor estimated that I would ovulate in 4-5 days. I'm on Day 5 now, but still haven't gotten a + from my ovulation predictor...but I think something is happening and it should be coming soon. Perhaps delayed due to my stomach flu? So, thankfully, I'm not going to have another 60+ day cycle before I get my period!
Also, I took a photography course this past Saturday. Which made me want a more expensive camera...but was also a nice way to disconnect from all this infertility stuff.
Wednesday, December 8, 2010
Crossroads
I think I'm about to lose my mind. I feel a bit diametrically opposed, two parts in one, and not sure of the direction I am going.
Over the course of one week, I will have:
--had my first homestudy interview
--gone to an adoption agency interview
--gone to an accupuncturist for fertility treatment
--bought Dr. Beer's book "Is Your Body Baby Friendly"
--had a con call with Dr. Corley from SIRM
--driven to NJ for an initial blood work-up at RMA for any genetic issues and SIRM for immune issues
--set up a meeting with Cornell for next week
--set up a meeting with an adoption attorney for the following week
After our first homestudy and the adoption agency meeting, I felt calm, at peace. Going to the adoption agency and learning about all the support they provide in terms of support groups, training, etc., I felt welcomed into a new sub-group. A place where I could belong. A place where others would understand my pain and struggle. A place of healing. We could have a child. While it wouldn't be our biological child, and in some ways we would always be "broken," we would be making a choice to hope for the best, to embrace that our truest heart's desire is to love a child and have a family.
But, at the same time, I reeled at the thought of never carrying another baby. Of being the odd person out at baby showers. The broken one. And, I know that this is my perspective. I won't say that I loved every minute of being pregnant. Labor and afterbirth was hell. But, It had it's amazing moments. To create life. To feel my little man moving in my body. Those were some of the most precious moments in my life. For me to admit and accept that they might never happen again seems too much to bear.
My straight-A student, try harder indignance comes out and I want to fight for my biological child. Do all the research. Try all the tests. Make sure that I exhaust myself completely in this journey for another biological child.
Then I grow weary. Tired of the struggle. Tired of trying to figure out whether the doctors have an agenda, can be trusted, and are doing everything in their power to get me pregnant. I just want a break from it all. From life. From my mother calling every day to remind me "how lucky we are to have Nuggett" and that I shouldn't "mope around" and I "need to get in the spirit of Christmas." (From the woman that got pregnant on her first try with all four children.)
Over the course of one week, I will have:
--had my first homestudy interview
--gone to an adoption agency interview
--gone to an accupuncturist for fertility treatment
--bought Dr. Beer's book "Is Your Body Baby Friendly"
--had a con call with Dr. Corley from SIRM
--driven to NJ for an initial blood work-up at RMA for any genetic issues and SIRM for immune issues
--set up a meeting with Cornell for next week
--set up a meeting with an adoption attorney for the following week
After our first homestudy and the adoption agency meeting, I felt calm, at peace. Going to the adoption agency and learning about all the support they provide in terms of support groups, training, etc., I felt welcomed into a new sub-group. A place where I could belong. A place where others would understand my pain and struggle. A place of healing. We could have a child. While it wouldn't be our biological child, and in some ways we would always be "broken," we would be making a choice to hope for the best, to embrace that our truest heart's desire is to love a child and have a family.
But, at the same time, I reeled at the thought of never carrying another baby. Of being the odd person out at baby showers. The broken one. And, I know that this is my perspective. I won't say that I loved every minute of being pregnant. Labor and afterbirth was hell. But, It had it's amazing moments. To create life. To feel my little man moving in my body. Those were some of the most precious moments in my life. For me to admit and accept that they might never happen again seems too much to bear.
My straight-A student, try harder indignance comes out and I want to fight for my biological child. Do all the research. Try all the tests. Make sure that I exhaust myself completely in this journey for another biological child.
Then I grow weary. Tired of the struggle. Tired of trying to figure out whether the doctors have an agenda, can be trusted, and are doing everything in their power to get me pregnant. I just want a break from it all. From life. From my mother calling every day to remind me "how lucky we are to have Nuggett" and that I shouldn't "mope around" and I "need to get in the spirit of Christmas." (From the woman that got pregnant on her first try with all four children.)
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