The nasty little what IFs that keep me awake at night

Have you ever found yourself wondering if things in life happen for a reason?

Like the story about the man who misses his flight because he has a flat tire, only to find out later that the plane crashed, killing everyone aboard. 

Was he spared for a reason?  Is there some greater purpose in life he has yet to fulfill? 

It's a subject I've been thinking about a lot lately.  Not about plane crashes, of course, but reasons.

Purposes.

They're thoughts that almost hurt too much to speak out loud, as though somehow just saying the words could make them true.

What if I am infertile because I was not meant to be a mother?


What if this is life's way of telling me I am meant for some other purpose? 

There--I said it.

I am not a particularly religious person (although I was raised as one).

I could list a million different rebuttals to these questions.

There are a million perfectly logical reasons why this line of thinking makes no sense.

Why then, is it so difficult to silence that little voice that comes and whispers in my ear when I least expect it?
    

So here's the latest...

I realized today that with all my whining about early morning appointments and money and broccoli juice, I really haven't said much about where we are in our cycle, so it probably would be good if I provided an update. 

I think I mentioned the baseline ultrasound I had a week and a half ago on CD16.  Luckily the doctor didn't find any cysts (other than my ever-present endometriomas, of course) and my progesterone levels looked good, so we were cleared to start the Estrogen patch, which I was expecting to do for the next 10 days or so until AF showed up.

Ha, ha--wrong!!  Four days later, AF arrived. 

Yes, that's right folks, if you're doing your math that was a 20 day cycle. For the record, I don't really know what that means but I'm pretty sure it isn't good.

So the doctor had me come in again on Day 3 (last Thursday) for another ultrasound and, to make a long story short, I already have a dominant follicle that's measuring at 12mm.

Now given my history of short cycles, I'm not terribly surprised.  The last few years, I've been ovulating earlier and earlier.  I'm sure the whole problem has something to do with aging, but so far no one has really been able to explain (to my satisfaction, anyway) the exact reason why it happens.

In any case, the result was a fairly abrupt change in plans.  Instead of starting stims as I should've this week, the doctor added Ganirelix to my daily regimen of estrogen patches, and it looks like I'll be taking it from now till retrieval.  The point of the Ganirelix is to degrade the 12mm follicle, so we'll be back to baseline and don't have to worry as much about a dominant one.  I'll go back for another ultrasound this Thursday and hopefully at that point I'll be ready to add the Femara and the Gonal-F.  Tentative target date for retrieval--May 10. 

Of course, Ganirelix would be the one drug my insurance only covers at 50%, so that little change will cost us about $500 but hey, what's another $500 when you've already spent $12,000, right? Ha!

Isn't it odd that insurance would cover IVF meds when it doesn't cover IVF?  I can't quite figure out the logic behind that one but I guess I won't complain since the Gonal-F alone would have cost us $6,000.  With the insurance, we paid only $35.

Anyway, I guess this means we're now doing a modified Agonist/Antagonist Conversion Protocol (A/ACP).  Has anyone else ever tried this approach?  If so, I'd be curious to hear your experiences.  From what I've read, it's a protocol SIRM developed and likes in particular for poor responders (why does this term feel like the medical equivalent of a dunce hat?).   

In other news, I think we've finally decided to go forward with (gulp) a 3-Cycle banking package at our clinic.  As it stands now, we've paid for a single cycle but we have until the day of retrieval to change our minds and write another big check for cycles 2 & 3.  Of course, that won't be the end of the expenses because we'll also have to pay for ICSI x 3 (extra) and CGH (lots extra) but the remaining expenses would be spread out a bit more over time.

The up-side of all this is that I'm feeling a little less stressed about our current cycle.  While it's far from a sure thing, succeeding in three cycles seems much more within the realm of possibility than having to succeed in only one, right? (Can you hear me trying to convince myself?)

The downside is I'm feeling a lot more stressed about money--particularly the amount we'll be losing if we fail.  Not to mention, we most certainly won't be taking any vacations this year (ouch).  Or working on the house (big ouch).  Or buying any new clothes (really, really big ouch).  :(

But with the CGH at least we'll know before shelling out for an FET whether we have anything viable. 

And if it so happens that we're out all that money with nothing to transfer, at least I won't have wasted my time sweating through 3 months of medically-induced menopause.

That's something, right?
    

Sabotage

You know those inspirational stories about formerly barren women who miraculously conceive after changing their eating habits? 

Like the woman who drank broccoli juice for breakfast every morning and got pregnant with an FSH of 50?  Or the one who became a vegetarian after 10 years of infertility and spontaneously conceived at age 44?  Or how about the woman who cured her endometriosis by cutting out wheat and dairy?

I am not going to be one of those stories.

Why, you might ask?

Because my diet sucks.

I mean, I probably don't have the worst diet ever consumed by anyone.  I generally avoid fried food.  I don't drink regular soda, and I eat very little red meat.

Now for the bad news.

My dinner tonight was a half bag of baked Tostitos and a tub of guacamole from Whole Foods.  Oh, and a decaf  Diet Coke with a rice milk ice cream bar for dessert. 

And last night?

Some rotisserie chicken and 5 walnut brownies.  And a decaf Diet Coke.

Pardon my French, but WHAT THE EFF AM I DOING?!??????

I suppose it doesn't help matters that I don't cook.  Other than Duncan Heinz brownie mix, that is.

In fact, it's probably a very good thing that I wasn't born in a prior generation or I'm sure I would have died old and alone.  I mean, who would've wanted to marry a woman who doesn't cook, doesn't clean (well, rarely) and can't have babies?   

Luckily for me I have a husband who somehow seems to love me anyway.

Besides, he doesn't cook or clean either, so I guess he can't be too judgmental, right?  And together we really do a lot to keep the house-cleaning and frozen dinner industries in business.

But I digress. 

WHAT THE EFF AM I DOING?!??????

Yes, I really did read the book by the broccoli juice woman and I even found it...dare I say mildly inspirational?

In all honesty, I'm quite sure that diet can and does have an important influence on egg quality.

In fact, I'm so sure of this, I actually spent a four-month period back in early 2008 cutting all wheat, dairy and simple carbohydrates from my diet.  I even gave up Diet Coke (which may not sound like a big deal, but trust me--it is).

Of course, I still didn't get pregnant but it's clear now that that particular failure had nothing to do with my diet. 

So why is it that now, when the stakes are higher than ever ($12,000 higher, to be exact) I can't bring myself to eat in an even moderately healthful way?

I keep telling myself that I will.  I have a refrigerator full of expensive salads, fruit and fresh veggies and yet, somehow the junkiest, unhealthiest crap in the entire house seems to keep finding its way onto my plate. 

Once again, I'm sure there must be something mildly pathological about all this (the more blog posts I write, the more I'm starting to think I belong on a psychiatrist's couch somewhere rather than in an RE's waiting room).

Why am I sabotaging my chances for success?

Maybe it's because my expectations of success are so ridiculously low?  Why make myself miserable eating celery when I'm so sure we'll fail anyway?

Or maybe it's some sort of deep-seated psychological defense mechanism designed to help me avoid a total meltdown if and when this cycle ends badly?  "I'm not completely inadequate as a woman--I only failed because I didn't give it my all!"

Then again, maybe I just have no willpower.

Le sigh. 

So, to make a long story short, I've decided that my story will be a different kind of miracle.

In fact, I've already come up with a title for my book.

"You Too Can Conceive Twins on the Brownie & Guacamole Diet!"

Think I'll make the bestseller list?
   

A week of freak-outs

I'm afraid I've been a bad blogger these last few days.

It's not that there isn't anything going on to write about--it's more that there's been too much going on and not enough hours in the day.  Or maybe my time management skills are just poor?  God knows how I'll ever manage if and when I actually have a baby to take care of.   

In any event, this turned out to be a week of freak-outs for me--some minor, some major. 

Freak-Out #1 - Cycle Postponement:  At the last minute (about a week and a half ago) our nurse had given us a long list of additional tests she wanted us to complete, including a pap smear for me, since I hadn't had one in a while.  Her instructions were clear--I wouldn't be able to start meds as scheduled on the 16th unless all the results were back.

Setting aside my own desire to move forward as quickly as possible, a postponement would wreak havoc with my work schedule.  I'd originally been set to travel in early May, and  rearranging things was a huge pain in the butt.  I'm also pretty sure I pissed some people off by rescheduling a trip that had been on the books for more than 6 months.  Putting off our cycle for another month would have made this all for naught and possibly necessitated the cancellation of yet another trip in June. 

As a result, I spent pretty much all last week trying to make sure we met the nurse's deadline and, in general, stressing out about whether or not that was even possible.

Along the way, I learned a number of things I'm pretty sure I never cared about before last Monday.

For instance, there's no such thing as a "stat" pap smear.  Yes, that's right folks--there are no pap smear emergencies.

Not only are there no pap smear emergencies, it takes a minimum of 3 weeks for pap results to come back from the pathology lab.

Or so my PCP's office tells me.  Call me jaded, but I personally think it was more a matter of no one wanting to go to the extra trouble.

Do you see where this is going?

So, to make a long story short, the pap results didn't come back in time.

Cue major freak-out on my part.

And as it turns out, it didn't matter.  On Thursday the nurse called and said to go ahead and start meds.

So apparently, it wasn't that important to have all the test results back after all.  Go figure.

Freak-Out #2 - First Big Payment Due:  Wrote a check for $12,000.  'Nuff said. 

Freak-Out #3 - Baseline Ultrasound:  The local doctor who diagnosed my immune issues has been nice enough to agree to do my remote monitoring, since staying in Manhattan (at a mere $300/night) for the entire cycle clearly isn't feasible.

But in truth, I've been dreading the whole idea of morning monitoring almost as much as I've been dreading the shots (more on that part in another post).

The major issue is that I'm really, really, not a morning person--as in, I chronically run late for work or almost anywhere else I go in the mornings.  I'm fortunate in that my boss generally turns a blind eye to it (probably because I also stay late) but I really shouldn't be pushing my luck any more than I already do.

With that in mind, my plan was to arrive at my doctor's office no later than 7:30, so I could be out by 8:00, and at my desk by 9:15 or 9:30am (my normal arrival time).  If all went well, I wouldn't even have to tell my boss that I had a doctor's appointment.

Sounds good, right?

Now let's see how this scenario actually played out. 

After sleeping through my alarm, I leave the house at 7:40 (this isn't good--I'm already 40 minutes behind schedule) and promptly hit a major traffic back-up.  Mapquest directions are wrong, resulting in another 10 minutes lost.  I arrive at the doctor's office at 8:20.  The nurse seems surprised to see me--not a good sign (I'm starting to feel a freak-out coming on).  After 30 minutes twiddling my thumbs in the waiting area, I'm finally ushered back and am out the door at 9:20.  By 9:45 I'm at the train station but I'm so late, the parking lot is already full.  Now I have no choice but to race home and try to catch the bus.  Bus arrives at 10:05 and takes me back to the train station, where I wait another 10 minutes for a train.  Arrival time at work?  11:05am.

That worked out well.

Freak-Out #4 - New Parental Arrival Time:  At 11:15am my phone rings.  It's my mother calling to let me know that she and dad are on the road and will be arriving for the weekend around 6:30.   Um, wait--weren't they coming on Friday?  It's only Thursday.  No, my mom is quite sure she told me Thursday.  I'm quite sure she said Friday.  The house is not clean.  Gonal-F still in the fridge.  I won't be home from work until at least 7:00.  A frantic phone call to grumpy DH ensues.  He's off at 3:00 so now he'll be the one to have to clean.  Not good.

Is this cycle over yet?
  

Secrets and Lies

OK, so I realize this is a bit of a cliche in the IF world, but I have to say that coordinating an IVF cycle is a lot of work.

A lot of work as in, I'm having trouble getting my real job done (the one that actually pays me) because I'm having to spend half my time (more than half?) trying to coordinate the last minute details of this cycle.  Sheesh.

Everytime I turn around it seems like there's something else that needs to be done.  This past week has been a whirlwind of covert phone calls with the nurse in my office courtyard, emails back and forth with my clinic's financial coordinator, faxing documents, digging out old test results, and last minute trips to the lab, my local doctor, the pharmacy and the notary.

And we haven't even started with the early morning monitoring visits yet.

Not to mention, my parents are coming to town this weekend, which means the entire house needs to be scoured from top to bottom (lest my poor mother realize what a horrible housekeeper she truly raised) and everything that has anything to do with IVF/infertility, banished to the basement or some other appropriate hiding place.

Yes, it's true, I haven't told my parents about our foray into the land of infertility.  This frustrates my husband to no end, who just can't understand why I would possibly care if anyone knows, be it my parents, his parents or the nice pregnant lady from down the street who asks if we have kids.

He probably would understand it a lot better if I could actually explain it myself.

Why am I more comfortable seeking support from anonymous posters in the blogosphere than from my own mother who knows and loves me and even spent time of her own stuck in the (secondary) infertile lane more than 35 years ago?

I'm sure there's something mildly pathological in the answer but I can't quite put my finger on it.

Is it a fear of displaying any less than perfect aspect of myself to those who know me (yes, even to relatives)?  OK, that's certainly possible.

I'm somewhat ashamed to admit I'm a very competitive person.  Maybe I don't want the nice pregnant lady down the street to know she's beaten me at the happy family game (even if it's only temporarily).

Fear of being pitied?  Maybe.  I doubt that applies to mom though.

Fear of being judged?  OK, maybe that too, although I'm sure my family would be nothing but supportive (at least on the surface).

Oops, why did that parenthetical just jump in there? 

OK, so I don't think my parents would approve of how much money we're spending (throwing away?).  They wouldn't say so outright, but deep down I don't think they would approve.

Although that still doesn't explain my reluctance to discuss the issue with them pre-IVF.

So, in spite of all my navel-gazing, it's pretty clear that I still have no answer.

I guess I'll go hide my syringes.
 

Bad habits and protocols

I've developed a very bad habit of second-guessing my doctors.

They recommend Course A, and I am suddenly struck with a deep-seated compulsion to research Courses B, C and D.  Passers by shoot me strange looks as I sit in the parking lot of my doctor's office, surfing Google on my iPhone.

Why is A the best? 

Does he really know what he's talking about?

Why did he rule out B, C and D?

And what about E or F??

I've come to wonder what crazed, type-A infertiles like myself did in the world before Google.

This is often followed by a ritual known as, "getting a second opinion."  Or a third.  Or a fourth.

I'm embarrassed to report that in 2 1/2 years, a total of 4 REs (and an Ob-Gyn!) have had the dubious honor of probing my nether regions with the ultrasound wand. 

Of course, we all know where this bad habit has gotten me.  Doctors #1 and 2 advised me repeatedly not to have surgery for my endo.

"Your follicle count is too low already," they warned, punctuating their opinions with appropriately solemn head-shaking. 

But did I listen?  Nooooooooooooooooooo.

Instead I ran home and surfed story after compelling story of women who miraculously conceived (only one month later!)(twins!!) following their laparoscopic surgeries.

And I had a lap.

And was miraculously successful in raising my FSH from 5.6 to 17.2 in only two months!  Who says miracles don't happen?!

So I learned my lesson, right?  No more second guessing.  A Master's in Public Administration does not a medical expert make (duh!).    

Except... 

Doctors #1 and 2 also told me I didn't have immune issues.  No such thing.  No siree, Bob.  Only an unscrupulous quack would even think to recommend such a waste of money as expensive immune testing.

And they were wrong.

And I was right.

How do I know?  Because those expensive and unscrupulous tests (can a test be unscrupulous?) told Doctor #3 my NK levels were some of the highest she'd ever seen.  And all the symptoms that doctors #1 and 2 attributed to endo, or a bad period, or a hysterical-infertile-who-doesn't-know-what-the-heck-she's-talking-about, suddenly disappeared after I began immune treatment. 

And here I sit, surfing Google yet again.

So here's the "protocols" part of tonight's post.

With all the hours upon hours that I've spent researching implantation issues over the last 2 years, I've spent very little time paying attention to anything IVF related.  I'm an IVF newbie in the truest sense of the word and all the endless permutations of different protocols literally make my head spin.

Like the the Micro-Antagonistic LV2A Conversion or the Long Flare GnRH Agonist + Menopur, or the...

OK, so I made those up.

But you know what I mean, right?

So here's my question.  Has anyone else here ever tried a Femara protocol with IVF?  My current doctor (who I really do like and respect) has me on a modified Estrogen priming protocol that starts with the patch on Day 16 of my current cycle (next Thursday) and adds Femara on Day 2 of the next.  Shortly thereafter come a mix of Gonal-F and Menopur every day, and it looks like I eventually add some Ganirelix too, although I'm not sure when?

The problem is I've read several places that Menopur can negatively impact egg quality due to increased LH/androgen production, and Dr. Sher recently responded to a question on his message board saying he doesn't ever recommend Femara with IVF for the same reason.  Not to mention, my LH already seems a bit high (6.1).

So are there any IVF vets out there who'd like to weigh in with their opinions on this?

Should I be concerned or should I (for once!) trust my doctor's expertise?

Edited to say:  Thank you all so much, by the way, for your comments on my last post.  I really wasn't expecting to have much in the way of followers so it's been a lovely surprise.
   

Negativity

Fair warning for anyone who might actually be reading--this isn't a shiny, happy Easter post.

For whatever reason, I've been feeling really negative lately.  Negative, as in, I'm pretty much 100% convinced that this IVF attempt isn't going to work and I just want to get it over with so we can move on to the next step.

It occurred to me this morning how ridiculous that is.  Let's hurry up and throw away our $17,000 so we can move on to spending another $30,000 on donor eggs.  I don't know when I became so flip about throwing around that kind of money, particularly considering that we're far from rich and have plenty of other things we could be spending our money on.  Like a new kitchen.  Or a deck.  Or, you know...food.

Can you imagine if other aspects of life were like IVF?  

"Well, Mrs. Infertile Lane, we can definitely do the work.  Just write us a check for $17,000 and there's a 15% chance you'll end up with a beautiful, new kitchen...and a mere 85% chance that you'll end up with the same crappy kitchen you've always had."

"Sounds great!  Where do I sign?"

Ha!

So you've probably guessed by now that we decided to move forward and do at least one cycle with my own eggs.

I'm still not sure why given my negativity as stated above but, oh well. 

We found out this week that the 2-cycle package I mentioned earlier isn't available to us after all.  Apparently you only qualify for that package if you're young (i.e. <39) and have more than a snowball's chance in hell of  succeeding (i.e. FSH <15).  Hence our failure to qualify.

So we're back to spending $12,000 + meds for a single cycle, plus another $5,000 on top of that if we do CGH (which I think we will).

Here's my thought process.  If we do a single cycle without CGH I have to go through multiple intralipid/IVIg infusions, 2 months of medically-induced menopause and a trip for 2 to Mexico (to re-do the LIT) before we can even think about transferring whatever we might get.  That means 2-3 months of hellacious night sweats, hot flashes, mood swings, hassle, and possibly pointless expenditures before we can find out that my eggs are shit and get our official BFN (or better yet, a miscarriage!).

If we do CGH, we only have to wait 4 weeks (and pay $5,000, of course) to find out that my eggs are shit.

So the CGH probably still costs a bit more but look at all the hassle and heartache it saves.

Happy Easter!!