Well I had my doctor appointment today. I got straight in to get weighed and measured and bp taken, then sent to sit in the doctor’s office to wait. And wait. And wait. 30 minutes, to be exact. (That’s three for three, if you’re counting – 3 appointments, each waiting over half an hour. I’m just going to have to schedule that in to my day and not expect to get out on time.)

First off, the doctor was a little taken aback with the IVF thing. I forgot that last time I’d talked to her we were planning on an injects cycle, even got a prescription for the meds and everything. I had gotten the IVF info just to read. (It was that visit that revealed the $1500 meds insurance limit, consequently changing our plans to do IVF instead.) That made me feel a little unsettled… I mean, I’m still feeling a little nervous about jumping straight to IVF. If money weren’t an issue we’d be doing an injects IUI first. But Den is CONVINCED it wouldn’t work, and it’s $600 for the meds. But he didn’t remind me that I really do need to check with our insurance to make SURE that they will cover IVF when we haven’t done all the “leading steps”. I don’t want to be caught with my pants down, as it were.

After we talked she asked if I had time for an ultrasound. I’ve been on BCP for about two weeks now, she said it’s the perfect time to take a peek. Boy was that uncomfortable. She asked if it was “tender” when she pushed against my ovary – yes, yes, yes. But she said everything looks great, ovaries are a little shrunken like they should be when they’re “turned off”, lots of antral follicles, and nothing unusual that she could see. So she said that confirmed her decision to put me on 75iu instead of 150. Not sure what my little antral follicles had to do with it, but I take her word for it. :lol:

Okay, on to the details. I’ll do the IVF info first.

Protocol: The protocol I’ll be doing is the Luteal Lupron (as expected), with BCP first, and dosages of 75iu follistim with 75iu menopur. I’ll also be doing lupron (duh), with ovidrel trigger.

Pre-Reqs: Apparently the January IUI we did they ran a S/A on the sample and put it in my charts – which effectively takes care of that requirement. Den is thrilled he doesn’t have to go in for another one. We will need another appointment with the Dr though, to sign IVF consent forms before we start the cycle. She said we can plan that after my surgery. And I believe Den has to be there for that as well, they need both our signatures. She did give me the informed consent forms to look over and discuss with Den though. And of course we need to do the protocol class with the nurses.

Scheduling: She thinks our IVF cycle will start in May. I asked if they schedule everyone to start at the same time, she said they actually spread them out so they have a group starting each week. I’m assuming we’d start in May because the previous weeks are “full”. However she said it’s the nurses who do the detailed scheduling and figuring out exactly when you start so I’ll need to talk to them.

# to Transfer: As for how many embryos/blasts to transfer, her recommendation is one. I explained how freaked out Den is that it’s going to fail – and obviously our concern with money. She said a compromise could be doing 2 embryos at day 3 and only 1 blast at day 5. Which is the conclusion Den and I had already come to. The ASRM recommendations for my age and a “favorable diagnosis” (which is us) is to transfer 1-2 embryos at day 3 and 1 embryo at day 5, so I’m feeling confident with that decision.

Future FET: She said she expects to have frozen embryos after our first cycle, and that the total cost for a FET cycle is $2200. She said we might want to consider paying for that out of pocket if it comes to that, to save our insurance coverage for a fresh cycle if that ever becomes necessary. I’m totally on board with that, but Den isn’t. He says $2200 is $2200 – that we don’t have. Den also isn’t really getting the whole fresh/frozen thing, because when I explained the cost of a FET and how we should save our insurance for a future fresh cycle he said we should just do another fresh cycle thing. I was like o.O uhhh. That makes no sense dear. No one in their right mind does a fresh cycle when they have frozen eggs. So we’ll have to discuss that one in more detail later.

Blast Transfer: The informed conset form goes over risks/benefits of the different transfers. It states “the transfer of 2 blastocysts in patients under 35 years of age will likely result in a 50% chance of twins.” – that was the piece of info that convinced Den to transfer only 1 blast. I think that number was a little higher than he wanted. It also states “There is an increased chance of identical monozygotic twins (2-5%) with blastocyst transfer.” Yeek. That’s all I can say right now.

Baystate pregnancy statistics for 2005 for under 35 years of age:
Average Number Day 3 Embryos Transferred/Cycle in 2005: 2.0
2005 Live Births/Transfer: 50.4%*
% Live Births with Twins: 30.8%
% Live Births with Triplets: 1.5%
*If 1 top grade embryo transferred=47.4% (All singletons), If 2 top grade embryos transferred=66.6% (43.3% twins).

Den and I went back and forth on those numbers for a while. It’s the difference between 1 and 2 embryos transferred that he’s focussing on; it’s the 43.3% twins that catches my eye! But… I think a part of me is kind of hoping for b/g twins. What scares me is getting two of the same!

Okay, now on to the info about the surgery… it’s not much. Part of this is from the doctor, part of it is from the phone call I got from someone who works at the hospital who went over the proceedure and asked me all sorts of health questions. (She concluded that I am pretty damn healthy. And yep, I am – other than the depression and OCD my body has done me pretty well. This will be my first surgical proceedure, first time in a hospital as a patient other than the IUIs. Weight change of more than 10lbs in the past few months? Nope. Viruses or illnesses? Nope. Allergies? Nope. Heart problems, liver problems, any kind of problems?? Nope. Just the depression.)

• 15% of women with normal x-rays and ultrasounds have some endo/other abnormalities found in a lap
• There are risks to the surgery, including damage to the bladder or the bowel. (Well, this was when they go over all the risks and such. A little unnerving.)
• There is a chance if endo is found in hard-to-reach places that they may need to make a larger incision to get to it, which would result in a longer stay at the hospital.
• I am not to take any advil or midol for 7-10 days before the surgery (so – stopping now).
• I am not to have anything to eat or drink after midnight before the surgery. (Nothing, not even gum or hard candy.)
• And to make life even more fun, there giving me some nasty tasting stuff to “clear out my bowels” the night before. Oh I’m so looking forward to THAT.
• No nail polish or makeup the day of the surgery. I read someone else mentioning that it’s because they want to be able to tell if you’re losing color/turning blue. Fabulous!
• I should dress comfortably, something that won’t irritated the incisions afterwards, and no jewelry or things that could get lost. I should have asked if that meant my wedding ring – it aint coming off too easily, I’m not exactly worried about losing it. (It’s a plain band I plan on replacing, heh.)
• I’m to arrive at 11:30, and I’ll get undressed, the anesthesiologist (I so had to google the spelling and I got it right! will go over what he’s going to do to me and I’ll sign consent forms and stuff. Pre-op stuff.
• After the procedure I’ll be hooked up to all sorts of monitors, may have an oxygen thing in my nose or over my mouth, blood pressure cuff on, stickies on me, IV still in. She said not to worry about it, but to concentrate on how I’m feeling.
• The surgery itself should take about an hour and a half, and afterwards I should be able to go home about 2 hours later. Den will be there waiting and they’ll tell him how it went, how I’m doing, what they found, etc. Then he gets to take care of me, bwahaha.

I think that pretty much wraps it up. That’s a lot of info for one doctor visit, two sheets of paper, and a phone call with a hospital staff member huh?? A lot to take in, as usual.

I love this memory book for a little girl. :D This one is quite nice as well.

I also like this one for a pregnancy journal. Edit: I just noticed this one is $75. Holy crap. I really really like it…. but there’s no way we can afford $75 for it!

Okay I lied – I’m not feeling comfortable about any decision right now. I’m just worrying about everything. And feeling frustrating that I have to make all these huge decisions that will probably affect the rest of my life. Yes, it’s a good way to look at things if you want to freak yourself out. But think about it… the decisions we make regarding this IVF cycle (and our fertility treatment in general) will affect the outcome of having no pregnancy, pregnancy, or twins. That’s so huge.

I have to say now I’m channelling my husband or something because I’m worried about transferring just one blast. Yeah, I was so sure, so stubborn… and now I’m feeling a little disappointed by it…. disappointed, just a little tiny bit, that if we get to blast stage we wouldn’t really have a chance at twins (well there’d be a slight chance of identicals, which is not what I’d be hoping for!). Is it kind of… silly… that I think I might prefer a day-3 transfer. It’s more rolling the dice… more unknown. Twins, singleton… let mother nature sort it out. Take me out of the decision.

I guess I’ve been thinking so much about the possibility of having twins these last few months I’ve sort of warmed to the idea a little… enough that the thought of transferring only one blast and having no possibility of it makes me a little sad. Which makes NO sense considering how freaked out I was/am. I still am freaked out, don’t get me wrong! The thought of having two babies to take care of is so huge. I’m still freaked out by the idea of having one baby to take care of, nevermind two. But… but. Having two little babies… to play with each other and be each other’s best friend… to have two perfect little beings and not have to worry about possibly never having a sibling for him/her… it’s a warm feeling deep inside.

Part of it might have been brought about by my cats. Now this may sound really silly to most, but I’m a major pet person so bear with me. See, my pets have always been special to me, but there’s always been a definite heirarchy to them. My dog has always been the special one. The cats were a step below her. And at my parents there was “my” cat and then the family cat. What I’m getting at is that it was always very clear to me that I loved one “more” than the other. Now we have two dogs, but again, one is mine, one is not. Very clearly defined. I had my cat, who I love dearly, but obviously a cat is still not on the same level as my dog.

And then we got a second cat. I wanted one, obviously – it was my idea. But still I worried that the new cat would replace the old one in my heart, that I’d love one more than the other. And I didn’t want that to happen. Then the new cat came, and the two kitties became best friends in about an hour (literally) and… well, honestly I love them both so much. It sometimes even feels to me like I love them more now that there’s two of them. They’re both black and white, they make a very striking pair. They have very different personalities in some ways, and yet are annoyingly similar in others. New cat is a major cuddler and I adore cuddles from him… but I swear the best days are when I have both of them curled up with me.

It all has reassured me that I can love two beings equally… and that sometimes two is better than one. I can’t imagine having just one cat now – the two of them are a set.

The doctor really didn’t seem to think transferring two blasts was a good idea for me – or at least that the possibility of twins was pretty huge. But a part of me thinks… shit… would that be so bad?

Can I just mention yet again how much I love my husband? He’s just awesome.

He works in the military, in the medical unit. He’s not really a medical personnel – he does workplace safety and air testing and such – but his office is in the “clinic”. One weekend a month they have drill, where they all have to work and it’s not just the regular military staff, it’s all the reserves who come in. Anyhow, they do a lot of vaccines and stuff there on those guard weekends. So today you know what Den did? He got people to show him how to do injections. He knows we have a class with our nurses but he wanted to practice, to make sure he’d do it right for me. :love: That’s just the sweetest thing.

I told him about that pregnancy journal I found that I adore, and how much it costs. I’m like, “$75!!” and he nodded and replied, “Babe, it’s for life.” Okay, totally NOT the response I expected! (I also thought about how much it would cost if I did my own scrapbook… it came out to a lot more than $75. I spent FAR too much money in scrapbook stores, and I’ve done very little with it!)

Den and I also talked a wee bit more about the number of blasts. Yeah, there’s a tiny part of both of us that wants to throw in two and just let mother nature sort out how many. Plus of course the thought of twins isn’t worse than the thought of no pregnancy at all. I think we’re going to have to discuss it with our doctor. We’re both feeling really emotional over all of it. I’m usually so fact-oriented, right? ;) (Kidding!) But the stats sheet they gave us stated a 66% chance of pregnancy with a blast transfer, with a 50% chance of twins. Which to me says 33% chance pregnant with twins, 33% chance pregnant with singleton, 33% chance of no pregnancy. That aint bad.

My husband has remarked several times lately – and I too have noticed – that my face has completely cleared up. Granted I still have all kinds of scars from previous break-outs, but it’s been extremely good lately. I just started wondering if that’s due to the pill or not. And maybe that explains why the past year has been so horrible. My body does not like those extra hormones, apparently. I can wash twice a day with special stuff (Proactiv) and keep it mildly under control… or go on the pill and poof, all gone.

Now I don’t know if this is a side-effect or not – probably not – but the last few days I have randomly felt like bursting out into tears. A few times I have. Now granted there have been outside factors that cause me to get upset, but tonight there really isn’t. I’m just feeling bummed. Den went to bed (and I’m the one who has to work tomorrow!), it’s so quiet in here, it’s dark, and I just feel kind of grumpy. The annoying part is that I recognize that I’m irrationally grumpy so I can’t even be grumpy with a clear concience.

I’m getting nervous about the lap surgery. I know it’s not really a big deal, but I really want to get it over with. I think the week leading up to it is going to be worse on me than the actual surgery. It’s all a big unknown to me, I think that’s the worst part. Being in a hospital bed, having monitors hooked up to you, going under anethesia, having a doctor make cuts on me… all of it is this huge unknown. And is it totally stupid that I wonder if the hospital bed will be even halfway comfortable? (I think about that for labor too. I’m used to a very soft, squishy, large bed. I can only sleep in one position.) Oh, and I forgot to mention that the doctor gave me a script for percocet. That’ll be fun.

Then I have quite a wait ahead of me. I hope to get the protocol class and doctor appointment scheduled so I have mini milestones along the way, or March and April are going to be extremely slow.

(Oh and PS – if anyone who has had a lap in the past could tell me how soon I’ll be able to go back to work? I don’t really have anyone to fill in for me, so whatever time I miss kind of needs to be made up before and after the surgery. I’m hoping/planning to be able to go in the weekend after the tuesday surgery to do some stuff, even if I can’t do any heavy lifting. I’m hoping I feel up to that.)

I made two calls so far today – one to the hospital to “register” for my surgery. I am still very confused as to why that’s necessary, as the appointment is already made, and someone already called me to get my medical history etc and let me know what I need to do to prepare… but then I have to call and “register”? Huh?? Anyways, that’s done and I’m all set.

Then I called the IVF “people” and scheduled our protocol class! She said the next available was March 22, which works out great for me. :D A week and a half after my surgery. I do want to have the class as soon as possible so we can work out a timeline as to when we’ll be starting our IVF cycle (want to make sure I get on the calendar as soon as possible.) Though it is looking like we won’t be starting until May, as after the protocl class we still have to have another appointment with the doctor to sign consent forms – I should call and book an appointment soon too, because I usually can’t get an appointment with her for a month or so.

Surgery next week. I’m starting to get a little nervous. I’m at work currently (lunch break ;) and all this week is prepping to make sure everything is taken care of for next week. I just can’t believe the surgery is next week already!

For once I think our insurance coverage’s vagueness works to our advantage. I just called to check to make sure we aren’t going to get dinged for going to IVF so soon. She said the paragraph was indeed typed wrong in the book (well duh I figured that, it’s pretty obvious) and that what it SHOULD say is as follows:

(What it actually was printed was “these cycles are not covered when…” which basically means IVF is only covered if IUI works, which is non-sensical.)

So I asked if there were any specific numerical requirements on those “lesser treatments” before IVF is covered – like, do I need to do all three IUIs before going to IVF. She said no, it doesn’t say so. (Which of course I am aware of, because I can read.) I really think they need to clarify that whole thing and not leave it so open to interpretation, but in any case there is apparently no unstated rule that you MUST do X before Y.

So hopefully we’re all set for a smooth ride in IVF.

I fear sounding redundant, but I feel the need to write.

I’ve been poking around information both online and in the stack of data my clinic gave me and everything I’ve read has said that blast transfers have the same rate of success as a day 3 transfer, without the risk of high order multiples. The data that my clinic gave us doesn’t specify a percentage success rate for single blast day 5 transfers, but it seems to suggest that it is the same as transferring two high-quality day 3 embryos. Which would mean whether we transfer two embryos on day 3 or one blast on day 5 we have the same chance of success. The ONLY thing we gain by going to blast transfer (with the anticipated #s, at least) is reducing our chance of twins down to 2-5% (the chance of identical twinning with blast transfer, as stated by the same data). 2 day 3’s would give us a 50% chance of twins, with 1-2% of that being a chance of identical twinning (so yes, a very slight chance of triplets in that scenario).

Interesting, no? As backwards as it sounds, I’m considering electing to do a day 3 transfer regardless of how many embryos we have. (It would also mean more to freeze.) Only given my above numbers/assumptions are correct, of course. You could throw out the idea of doing two blasts, but with the increased risk of identical twinning I’m not so certain that would be a good idea – plus I’m not so certain my doctor would even agree to do that. (Max of 1 blast is recommended for my age/diagnosis.)

I am so tempted to just do a day 3 and let it sort itself out. I’m really not a spiritual person – I’m an athiest, in fact – but there is that part of me that believes (or at least wants to believe) that things happen for a reason.

I’m trying not to obsess, I really am. :) I do agree with my commentors that I’ll probably change my mind a hundred times. However they want us to sign consent forms – including a “how many embryos to transfer in each situation” form. So we really do need to know what our hopes and plans are by that doctor’s appointment, before we even start the cycle. Plus mulling it all over in my head helps me figure out what I need to ask the doctor at that appointment before making that final decision. Den’s pretty amenable to anything right now, long as we don’t intentionally reduce our chances.

In another track of my mind… I’m going to have to go back to my primary care doctor soon for a refill on my celexa. It says I have 2 refills left before 2/2/2007, which, obviously, has already past. (Really wonder what happened there… more than likely I’ve missed a lot of days in the past year. Doh.) I don’t have any intention of changing my dosage, I’m doing really well on the 20mg and it appears to be the lowest dose I can go without going downhill. However I am considering asking for a referral to a psychologist. I think I could really do well to have a professional help me deal with everything – and more than in a “So how are you feeling?” kind of way. I need someone more hands-on, intelligent, willing to explain things to me and push me to actually do something rather than just tell them once a month how the meds are working. I’m not sure how complicated it will be with insurance, though – I guess I’ll ask my doctor. The psych would be another $30 copay each time though, so it’s something we’ll have to think about. Not huge, definitely not – but we’re going to have a ton of co-pays coming up with the IVF. And our bank account? Is not doing well right now.

In addition to that I was considering asking the doc for a FULL thyroid blood panel – not just TSH. Someone on a forum suggested I do that, since thyroid problems can certainly affect fertility. I’ve always wondered why most docs only test TSH, since I know it doesn’t always tell the full story about the thyroid.

Finally found some data regarding the different success rates, here from the CDC (section C). What I have not found however is anything showing the differences between day 3 and day 5 transfers while comparing the same number of embryos transferred. These are just overall numbers, so you don’t know if the different success rates are because people are transferrring more or less embryos or not.

The page linked to contains data regarding

1. How many embryos are transferred
2. How many transfers are day 3 and how many are day 5
3. The success rate of day 3 transfers vs day 5
4. How many embryos are transferred on day 3 vs day 5
5. http://www.cdc.gov/ART/ART2004/section2c.htm#f35

All of the data is from 2004 though. I know success rates have changed significantly since then. It is just so hard to find relevent data, since so many factors affect the success rate: the age of the mother; the cause of infertility; the quality of the embryos; the number of embryos transferred; the day of the transfer. So while I’m able to find data that considers one or two of those factors, I have yet to find any data that takes into consideration all of them. (I know that would be a huge undertaking for any type of researcher, though.)

Oh I should have been an accountain or statistician or something. I can’t help it, numbers make me giddy. (I’m a computer programmer instead, LOL)

First off I want to thank all of you for all your wonderful comments! It’s really neat to see people post here and find new blogs to read. I really appreciate all your support and advice.

We went to the Resolve support group tonight. Den went grudgingly, but I promised him he’d only have to go to the first one – I get a little nervous in new situations, especially new social situations. But he was a good boy, despite some fidgetting all the way through. ;) He even contributed to the discussions! I’m not certain how helpful the Resolve group will be to me… apparently I am not typical in being an information-fiend. But it was kind of interesting to talk to others who go to the same clinic as we do. (There is only one clinic in western MA, so it makes sense!) I’m wondering if it will be more helpful when I’m in the midst of my cycle. But I did kind of get the feeling that I actually get more out of the forums I’m on and this blog… both allow me to vent my frustrations, work things through in my head, and get back valuable support from other people going through the same situations. It really made me appreciate how wonderful these internet communities are.

Den said to night about our decision on what to transfer: it all comes down to the question of do we want twins? Or do we not want twins? And honestly, he’s right, it does come down to that. Of course there are no guarantees in the slightest, anything can happen. But if we do A we stand a good chance of getting twins. If we do B we have a very good chance of getting a singleton with a minute chance of twins. Which to put our bets on? I guess we have some soul-searching to do about what we really want.

Den says all he really wants is a baby. One, two… doesn’t matter. Me, I’ve only recently started thinking twins, and it grew on me. But I have three main worries regarding twins:

First, the physical demands not only on my body, but the risks to the babies. I know twins pregnancies are usually very healthy nowadays – but it does increase the babies risks of early birth and other issues, and any risk is scary.

Second, the financial aspect: two babies will need (in most cases) twice as much things. Of course that’s worrisome. I’m going to be a stay-at-home-mom, so we’re going to have to be relying entirely on Den’s income.

And thirdly, and possibly the biggest thing that is worrying me, is the emotional risks. I have OCPD with subsequent depression. It is managed with medication. However one of the issues I deal with is that I get easily overwhelmed… lots of anxiety, sometimes leading to very black depressive moods. I’m placing faith in my own abilities and my inner strength that I WILL be a good mother. But I worry that twins could be pushing it. The last thing we need is for me to fall into PPD when we have infants. And I know the first few months (or first year) of twins is the hardest. That’s the time that I’m worried about. Having one baby will be hard, and I don’t know how well I’d handle two of them and the increased stresses and lack of sleep.

As Den said tonight, “We’re just going to have to make a last-minute decision.” Boy how I hate that. But he’s right. I guess I’ll just have to go with my gut. Do you hear me, gut?? Speak up!!