Sunday, June 24, 2012

Journey through the Land of IVF: Part 1

This particular entry relates my roller coaster ride through the land of infertility.  I feel like women do not talk about it openly.  As I was going through it I personally didn't want to talk about it with everyone but I did confide in a few people.  I think part of the reason I do not have an issue talking about it now is because I am a success story.  I did not think that this was how my life was going to end up when we started talking about starting a family. 

I got married to my husband when I was 28 years old and he was 31.  I did not feel the need to start a family right away.  We wanted to travel, I had just started my career as a lawyer.  A little before my 30th birthday we decided to start trying.  The first few months went by without success but I figured no big deal.  Then another few months went by without success.  We even went on a relaxing Alaskan cruise for my 30th birthday and nothing.  I finally went to my ob/gyn and everything had looked normal.  He had me go for a test called a hysteropingogram.  Basically they inject dye into your lady parts to see if your ovaries and tubes are clear.  Mine were.  So after all these months, nothing appeared to be wrong with me. 

Enter the specialist.  After almost a year of trying on our own, my husband and I finally went to see a fertility doctor. We had an initial consultation with the doctor where we went over our history and then came the tests.  I felt like I gave them two pints of blood and I had my first of many vaginal ultrasounds.  Once the tests results were in we had another meeting.  I remember being incredibly tense that he was going to inform us children were not possbile. 

I breathed a big sigh of relief when the doctor said we could have children but the road ahead of us was not going to be smooth.  There was no official diagnosis, I was in the category of "unexplained infertility," but my ovaries were small for someone my age and my FSH levels were a little high.  What this means apparently is that I will most likely go through menopause at a young age.  This did not completely suprise me, knowing that my own mother had been through menopause  by the time she passed away at the age of 50.  Knowing that there was still a chance I could get pregnant, I was excited to get started.  The doctor was upfront and told us that IVF was most likely going to be our best hope based on my small ovaries.  However, before going for the most invasive procedure, we were going to try three cycles of IUI (Interuterine insemination).  This meant that they would stimulate my ovaries to produce several follicles which would hopefully contain eggs and then inseminate me with my husband's sperm after triggering ovulation.  Unfortunately,I found a large part of infertility is trial and error and this meant every cycle was going to be an experiment to see how my body would react to the drugs.  But I am getting ahead of myself. 

Step One: The Drugs
The first step in our long process was to learn how to administer the drugs.  My husband and I attended a class at our fertility doctor's office.  We arrived with our orange in hand to practice the injections.  We learned how to use a variety of needles for various drugs because the particular fertility issues you had and, of course, the insurance company you had, would dictate which drugs I had to give myself.  I was preapred to give myself injections at least three times a day of 1-2 drugs at a time.  I would inject myself in my upper thigh, alternating legs to keep the bruising to a minimum.  The final step in the preparation process was ordering the drugs.  This was not a simple call to CVS to fill a prescription.  Thankfully we have medical insurance and they covered the fertility drugs needed for each cycle (at the time I was hoping we would only need to do this once, but  I was completely wrong).  The prescriptions were called into a mail order pharmacy that specializes in fertility drugs.  They sent me everything; the needles, the box to dispose the needles, the alcohol swabs, and, of course, the vials of drugs.  Some drugs came in a pen, some had to be mixed, some had to be refrigerated.  It was a whole job in itself to keep track of it all.  Now that I had all the tools, it was time to try our first cycle. 

Step Two: IUI
In order to get started I had to go in for blood work to test my base levels bright and early in the morning before work.  Then I would get a call in the afternoon from the nurse giving me my medication instructions.  I was anxious and excited to finally get started.  After I started taking my medication I would go in for daily blood work and vaginal ultrasounds.  The doctor needed to monitor not only how many follicles there were but also the size so that we could trigger ovulation at the right time.  Based on the blood results and the ulstrasounds I would recieve instructions each day to either keep doing what I was doing or modify the meds accordingly. It was always fun to find time during my work day to inject my upper thigh with drugs.  So far my follicles were only partially cooperating.  While the medication casued me to produce follicles (and hopefully eggs) in both ovaries, they were not growing together.  This meant that I may ovulate or lose the eggs before it was time.  After about two weeks of daily injections and blood tests and ultrasounds, it was time to trigger ovulation and do the IUI. 

In order to trigger ovulation, my husband had to inject HCG into my upper butt using a really big needle.  I was probably more worried that my husband would inject me in the wrong place than of the big needle.  Although, I am not going to lie, the big needle really hurt.  I bruise pretty easily and between the multiple blood tests and the daily injections I was not looking pretty.  IUI is relatively simple (compared to IVF).  I went in to the doctor's office at a specified time based on when the HCG shot was given and my husband's sperm was inserted directly into my uterus.  I had to lay in the doctor's office for about a half hour and then I was sent home and instructed to have lots of sex with my husband to increase the chances of pregnancy.  I have to admit it was a little weird to be instructed to have sex. 

When the news came a couple of weeks later that I was not pregnant, I was devastated.  We tried again and again another failed cycle.  Finally we did IUI a third time and for us it was not a charm.  It was now time to regroup and meet with the doctor again.  I remember asking him point blank if he thought it was even possible that I could get pregnant based on what he had seen through the three failed cycles.  He assured me that all it takes is one egg and one sperm.  It was not about the quantity but rather the quality.

Step three IVF
I was always trying to be optimistic and I tried to look at each failed cycle as a way my doctor could get one step closer to finding the right formula to get me pregnant. Because the doctor discovered I am such a poor responder to the medication during IUI and I was not busting at the seems with high quality eggs; one approach he wanted to take was something called ICSI. This meant that the doctor would take my husband's semen; pick out the best sperm and inject one sperm into each egg we retrieved. This procedure is normally used in situations where men have a low sperm count but the doctor had also used it successfully in situations like mine where egg quality was an issue. 

Another hurdle my husband and I were facing- IVF was not covered by our insurance. While the medication and the doctor's visits were covered (with co-pay); the actual IVF was not. Unlike IUI, IVF is a more intensive procedure that requires anesthesia, an operating room, an embryologist and a ginormous needle. For the egg retrieval and implantation it would cost us about $11,000. We had already spent a few thousand dollars in co-pays and we did not have this type of money lying around. As a result, my husband and I were able to procure a personal loan to pay for the IVF. Stretching our financial resources to its limits just added more pressure to the already stressful prospect of becoming pregnant.  I didn't want to think about the possibility that this round of IVF would not work.

I took my medications and went for my blood work and ultrasounds. This time, because insemniation is controlled, the goal is to get as many eggs as possible, and as a result it meant a more aggressive apporach with the medications.  You see alot on an ultrasound but you can't see everything.  The doctor can get a sense of how many eggs we may end up with, but there are no guarantees.  Based on the size of the follicles you hope there are viable eggs in there to retrieve and later fertilize.  My blood work was looking okay and we had about a total of 8 follicles.  When I obsess over something, such as getting pregnant, I read and read and read about that topic.  I found myself googling everything and anything IVF and discovered women retrieving 10-20 eggs at a time and freezing embryos...I had the possibility of 8. 

Finally it was the morning of the retrieval. I got taken into the operating room and I remember asking how quickly the anasthesia would take effect. Up until this point in my life I had never spent a night in the hospital, needed stitches or even broken a bone, let alone needed to be knocked out. They told me I would be out cold in a few seconds. I remember nothing until they woke me up, which is a good thing because I had  seen pictures of the huge needle they put in you to retrieve the eggs when they went over the procedure with me earlier. I woke up to find out they were able to retrieve only seven eggs. People may think that is more than enough, however you don't know how many of those eggs will fertilize and make it to the next step.

I received a call from the embryologist the next day that of the seven eggs only three had fertilized. As a result, the doctor was going to put the embryos in me after only three days. The ideal situation would be to put the embryo(s) in after five days, not three. Nothing was going according to plan.  This was devastating news to me but I was holding out hope. Upon arrival at the doctor's office for the implantation we were told that only two of the embryos had survived. I thought, okay twins, I can handle that.   I was awake when the doctor was putting the embryos into my uterus and my husband was allowed to be in the operating room which I though was fitting since this could possibly be the pseudo conception of our child/children. The doctor does not put the embryos in blindly; rather he was aided by ultrasound so he could find the perfect place to put my potential children. Evidently based on the ultrasound my uterus was tipped in a weird position and not only was I going to be on bedrest for the next few days but I had to be on my stomach as much as possible.  I was given a picture of my two embryos to take home with me and I left with positive thoughts. 

My stress level was extremely high at this point. My father had recently passed away after being in and out of the hospital for months. Now after all this time, money and medication this IVF cycle was not looking like it would be successful.  It would take two weeks to confirm pregnancy.  Of course all I could think about with every little twinge, flutter, ache that I felt in my body was could I be pregnant, it has to work, can we afford to try again, would I ever have children....for two straight weeks. 

Finally the morning of my blood test came.  They drew my  blood around 8am and then I played the waiting game again.  I carried my cell phone with me everywhere I went with me that day, including the bathroom.  It was so hard to focus on work.  Finally around 3pm the doctor called and told me he did not have good news.  I was not pregnant.  I scheduled an appointment to come in so we could regroup and figure out our next steps.  I stayed in my office with the door closed for the rest of the afternoon trying to get work done.  The good news was that I could have a nice big glass of wine when I got home.  All I could think was what was wrong with me, how could this not work, we did everything right.

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