Double Trouble

I swear, the International Symbol for Infertility should be:

Well, minus the smokes, of course.


I think I spend as much time waiting for the phone to ring as I do shooting myself up with various poisons. 

Anyway, when last we met, we were hoping for a strong beta today. The definition of a "strong beta" is to double in 48 hours. On Monday (9dp3dt), at 11am, my beta was 42. 

Today (11dp3dt), at 7am, less than 48 hours later, it was 142. 

According to my new best friends at BetaBase.info, my beta has a doubling time of 25 hours.  It more than tripled less than 48 hours. There IS some concern. My progesterone DID drop again. It's now 29. Dr. Z is being very proactive and upping my PIO dosage. Yay - bigger butt shots. Whatever I have to do, i'll do. I'm just glad he's not forcing vag suppositories on me again. Those things suck - and quite honestly, I'm spotting enough already. 

Oh yeah, the spotting. Still going on. Fran says that if I'm still spotting next week, that Dr Z will let me come in for another beta and maybe even an early ultrasound to ease my mind. But she's not worried. 

Because, as a very good friend has told me, I'm good and knocked up. 

Here's my theory - and we'll see how it pans out. Even though I still feel like there's only one in there, and Heather (my acu) feels like there's only one in there, maybe there are 2 after all. I'm wondering if one embryo splitting could cause a rapid beta rise but a slight drop in progesterone. There would only one corpus luteum to produce progesterone, so that would explain that being a little lower, while the beta was slightly higher. 

Another beta and progesterone check on friday. I guess we'll see. 

I can't believe I'm writing this: Monitoring #3.1

When we started talking about this cycle, it was last year and June seemed so far away. How is it possible that it's June 1st and yesterday I spent the morning at my first cattle call monitoring appointment? They make it as glamorous as it sounds. Lining up, at the buttcrack of dawn, first come first served for blood draws and vagcams. Either this is the smallest group i've ever cycled with, or I'm not going to have to fight for the #1 spot this time. Either way, I was first, which is how I like it, because i'm back on the road and on my way home by 7:30am.

The news yesterday was fine. If I didn't hear from them, my hormone levels were where they want them, and I'm still to start meds today. My ultrasound still showed 11 antral follicles with a homogenous lining at 8mm. The only concern was that I still hadn't gotten my post BCP period, but that concern is no longer.

... and away we go.

Which means tonight is the night. Stims start in T-34 minutes. And I'm having a full blown panic attack trying to figure out how i'm going to do this for the next 10 days. Last time it wasn't this hard. I had to give myself a few shots at 7pm. No problem. If I was at work, i just arranged for one or two people that could give me the Menopur. You see, I can give myself the Gonal no problem. Quick. 1-2-3, right in the thigh. The menopur burns like hell and   there's no way I can give it to myself in the thigh. It's a full mL and it just hurts too damn bad. So, we always did those in the backs of my arms. But I can't reach the back of my arm by myself, so I need help with that one.  I work until 6pm this weekend, but I should be home by 7pm, so Chris can still do those. Tuesday is the problem. I have acupuncture at 6:15pm. She's booked and can't reschedule me. So, I asked the obvious question. As a favor to me, is there any way she could give me the shot.

Nope.

Great. 

I have no idea how we're going to do Tuesday. But for now I'm going to focus on tonight. In 31 minutes I'm going to start this crazy all over again. I'm scared, excited, nervous, insecure, overwhelmed... Yep. Still infertile and all of the feelings that go along with it.

.... and away we go.....

UPDATE: my acu texted me back again. She says she reread my text and feels terrible that she misunderstood me. She'll absolutely give me my menopur on tuesday night. Phew. 

The saga continues....

I can't. I just can't.

Okay - so my prescription is still at the 4th pharmacy, and my nurse called to tell me that they called her to change one of the meds. They don't have olive oil, so they want to sub my progesterone in oil for sesame. Um. No.  Sesame makes people itch. Olive oil is safe. It works. I want olive oil. So, not too much of a problem. I was told we had a $50 copay per med, it's under $80 OOP, I'll just pay OOP for the PIO in olive oil from my pharmacy and submit it to the FSA.

Then it gets better. I hear back from the "Case manager" who apparently knows more about my body, cycle and IF needs than both me AND my doctor. (Apparently, my ins co has instituted a managed care infertility program, so I get a case manager to help me through my benefits, who is a certified reproductive endocrinology nurse.) Great. So I call this chickadee to find out who I need to talk to to find out where my benefits are.  She says she knows exactly where to find the answers and will call me back.

And she calls me back to tell me that I don't have benefits through medical and I need to talk to my husband's HR people (he carries the benefits).

Well - if I don't have benefits through pharmacy and I don't have benefits through medical, where does that leave me?

Me. Creek. Paddle. Ugh.

This is just ridiculous already. I live in NJ. It's a mandated state. I HAVE coverage for medications But no one is willing to pay for them.  I have never had trouble like this before.

So, I hauled ass to my husband's office, simultaneously having a stroke and a heart attack. We got on the phone with their rep who proceeded to tell us that we would have to pay out of pocket for the meds (which will cost $8k) and then submit them for reimbursement.

When I stopped laughing and crying from sheer frustration, i realized that if we did that, one of two things would happen. We would submit the claim and either they will be denied for using an out of network pharmacy (when there is none in network) or they will be reimbursed at a minuscule fraction of the cost.

I've been given meds from friends who didn't need them for their cycles. Generous generous friends. But I shouldn't have to use them. I should be able to pay a few hundred dollars copay, use my benefits and pay it forward to other friends in need. But now it's looking like I might actually need to use these meds, and I hate that.

Why does there always have to be something? Is it not bad enough that we're infertile, that we have to do IVF in the first place, that we have difficult deliveries, that our children have medical problems? Does even THIS stupid part have to be a giant pain in the ass, too?

Ugh.

Quick - I need a fix for broken mirrors, spilled salt and walking under a ladder...

Seriously. All I wanted was for everything to go the same as it did in our last cycle. The last cycle worked. So let's repeat it. Step by step, med by med, socks by socks (what, you don't have lucky socks?). 

I should have known... it just will never be that easy. 

First I found out that my acupuncturist is no longer working with Dr Z AND she moved her office AND she can't give me a deal on her pricing anymore. So, now I'm driving further and spending more money (the Amex is getting a workout right now)... but she can't come treat me for retrieval and transfer. I can't drive to her office after because I did that during the first cycle - and that one didn't work. So, can't do that. There is someone new working with Dr Z now, and my acu doesn't want him treating me because she says no one in the acu-fertility world knows him and she thinks he's lying about his experience with infertility. 

acupuncture works

Fortunately, it turns out Dr Z has a new nurse named Rachel and she is a tried and true infertility Acupuncturist and she will treat me for retrieval and transfer. Thank goodness. Acu-crisis averted. 

Then the pharmacy drama started. 

It took three days for the pharmacy that Dr Z always uses to realize that they couldn't fill the prescription because our benefits changed and it doesn't go through our pharmacy benefits anymore. So, she said she was going to fax the prescription to Freedom pharmacy, who can put it through medical.

Then Freedom lost the script. 

Then they couldn't find our benefits. 

And that was last week. I've been so stressed about this. I've been fortunate that some of the more expensive meds were given to me by friends, but I didn't want to have to use them. I was hoping to use my benefits and pay it forward with the meds to some IF friends who are completely out of pocket, as long as our meds were affordable. But now they couldn't even find the benefits. Everyone was denying the claim. It's been a huge headache. 

Then today, Freedom realized that they can't even fill it. They have to send it to Caremark. 

And that scares the crap out of me... because I think CVS is incompetent and now I'm worried i may not even get my meds at all in time to start my cycle. I talked to Dr Z about that today. 

Which brings me to my real panic attack for the week. 

When I got my calendar, it mentioned coming to transfer with a full bladder. Cue freak out. That means he's doing ultrasound guided transfers now. 3 years ago, I asked him why he WASN'T doing u/s guided transfers and his response was straightforward and point blank, "I noticed my success rate was going down once I started doing them, so I went back to the way I was trained, and the numbers went back up". AKA "I wasn't good at them, so i don't do them". I respected the honesty and was grateful for it. 

Image of an Ultrasound Guided Embryo transfer

So, today I mentioned that I noticed the "full bladder" thing on the calendar and asked about what he had said previously. I was really happy with his answer. He said that the technology has changed and you can now SEE the catheters on ultrasound, whereas before you couldn't. So now you can see exactly where the embryos are being deposited. Before, you had to go by feel while looking at the monitor and there were too many opportunities to miss something. 

I also talked to him about my pharmacy situation. He said, worst case scenario, he can get me emergency meds and we can just "replenish" the supply when my order comes in. So, no worries there either. 

The only thing I'm still up in the air about today is whether or not to take baby aspirin. Fran (my nurse) says I don't have to... but I did last time, so I really think i need to again. And Fran, knowing me, laughed when she told me I didn't have to, because she knew what I would say. However, I can't find ONE that doesn't have either food coloring or lactose. Ugh. Back to the drawing board. I wonder if I can get it compounded. 

And now for the interesting information:

My lining is typical. 9mm and homogeneous, meaning it is one layer. Closer to retrieval it will be a triple stripe which is optimal for implantation (i've already started my pomegranate juice spritzers in preparation for that). I have 11 antral follicles (6 on the left and 5 on the right).  And we're trucking along... 3 days ago, I didn't even feel like this was real... and now I'm right back in the zone. Feeling a little fluttery and nervous again.  Last BCP will be May 28th. First monitoring appointment will be May 31st and first stims are June 1st. 

Wishing.... hoping...

Cross everything for us. 

Panic, Fear, Worry... Yep. Must be cycling.

The best thing about not getting my mail until 5pm, is that if there's a problem that shows up in the mail, I can't deal with it until the next day. Normally that's not a problem. A bill here, an EOB there... but yesterday it was something else.

My calendar.

Sample IVF calendar

You would think that for someone who has already done this twice, my calendar wouldn't strike fear in me, but it raised questions of procedure changes since my last cycle and now I'm terrified. I needed so desperately for everything this cycle to be EXACTLY the same as the one that worked, and already so many things are different. I have to use a different pharmacy. It's a different embryologist (a better one, so this works in my favor ;) ), a different in house acupuncturist, so I have to travel now... and now a different technique. It's scary for me. I'm scared the slightest change will make the outcome different.

I have an appointment for my baseline ultrasound today. Poor Dr Z doesn't know about the barrage of questions that is coming his way.

Stay tuned....

Back on this crazy train.

I can't believe it's been almost 3 years since we were on this path. The tears, the grief, the fear, the apprehension, the doctors visits, the shots, the ultrasounds, the retrievals, the transfers and then, finally.... 

... her.


It felt like it took forever to finally get pregnant and carry her. She came into this world in the manner we had grown accustomed to. Stressfully. But an emergency c-section later, she was here. All 5lbs and 8oz, perfect little fingers, crooked little toes, blue eyed, fuzzy headed, peacefully perfect. Her.


And now, 17 months later, we're ready for Smudge to be a big sister.

Daddy dressed me

I can't even explain how this feels. It's like we're right back where we were - with the exception of already having her. But now we KNOW it can work, as much as we know it doesn't. And I can't express my emotions as openly as I did last time either. I can't let her see me in that much pain if it doesn't work again. I have to be stronger. If there's one thing I'm learning, clear as day, it's that having a baby does not make you any less infertile, physically or emotionally. I'm as infertile as I was 3 years ago. I'm infertile and I'm scared to death.

But we're ready - and we're moving forward. I had my HSG yesterday (all clear!!) and my bloodwork is back. As it was in the past, my FSH and other hormonal bloodwork are all normal, but miraculously, my AMH is tripled!! Granted, tripling crap is still crap. But i'll take it. In Dr Z's world, under 2.0 is a low AMH. For our first two cycles, my AMH was 0.5. Now it's 1.49!! He thinks I'll stim better this time. One can only hope.

Anyway - this is us. I blogged our entire journey while we were trying for Smudge and it was therapeutic for me to have someplace to say how I felt. I'm hoping for the same this time. I need to be able to talk about how this feels. I'm hoping you'll be my audience again.

BCPs started sunday. HSG yesterday. First u/s in 2 weeks.

Here we go....