Holy Follicles!

I think you could knock me over with a feather right now. 

I have 14 follicles. 

FOURTEEN follicles

Holy Shit!

I am totally and completely in shock. Where did they come from??? I only had 7 antral follies at my baseline, where the hell did the other 7 come from?!?! For someone who was told they'd never have more than 3 eggs to harvest I just can't wrap my mind around 14. Um, have I mentioned holy shit??

As you can see, they range from about 11-19, with one teeny one measuring -3 which is actually 7mm . I think 14/15mm is the smallest size that can contain a mature egg, so they still have some growing left to do before I can trigger. Originally I thought I might get away with only 9 days of stims but it looks like I'm on the hook for at least 12 days.  My poor belly isn't thrilled but I'll do whatever it takes to get these eggs to mature. My lining is also looking excellent, 11.6 today which is wonderful. I'm super hopeful that once we finally make it to transfer, our embryos will have a nice cushy home waiting for them.

Beautiful follies!!

Since I'm out of some of my supplies and meds, my nurse went through the cabinets to try and find some samples. She scrounged up one injection of Ganirelix, which is another brand's version of Cetrotide for me to take tonight. That saves me about $105 so I was really pleased :) The only problem is the packaging. I'm sure I've written before about how I'm allergic to Latex - I'm not deathly allergic, but it does give me a fairly unpleasant rash and I can't take the flu shot or other meds that contain Latex. This package of Ganirelix says right on the box that the "packaging" contains natural rubber latex. I asked both the nurse and the doctor about it and they all said I should be fine to take it but I'm still a little worried. Does that mean the rubber plunger on the syringe is latex? Will I react to the liquid since it's been in contact with the plunger, or will it be no biggie since the plunger itself wont touch my skin?  I'm skeptical but will give it a go since they both said it should be okay. 

My next appointment is tomorrow morning to check in and see how quickly those smaller follies are catching up. If everything looks good, I might be able to trigger on Sunday for a Tuesday retrieval. If they need another day, I'd trigger on Monday for a Wednesday retrieval. 

Come on follies, grow, grow, grow!

Maybe Mature?

Tomorrow morning I'm going in for what is hopefully my last ultrasound and blood draw to check on the follies before I'm cleared to trigger. I was doing a little more research and it looks like Cetrotide can slow down follicle growth, which sort of makes sense since it's designed to prevent premature ovulation. It's probably why these follies didn't exhibit super growth from day 7 to 9, which is also a good thing since slow and steady wins the race in quality follicle development.

As of today I'm officially out of Cetrotide and the Omnitrope syringes as well, so I'm going to need to make a trip to the pharmacy to pick up one more Cetrotide injection and syringe for tomorrow night. If the follies need a couple more days of growth I will suck it up and deal but my poor belly is so, so ready for a break! Four injections is really a lot to do every day and my belly is starting to show the effects. 

I knew yesterdays injection was a bad one as I did it, and as expected it left a nasty bruise. I snapped a gross photo of it for your viewing pleasure in case you were wondering what injection site bruising looks like. In the upper left corner you can see two "good" injection sites where only the needle mark is visible. Then, obviously, there's the big nasty bruise from the shitty Cetrotide injection. Ugh.

Nasty Cetrotide bruise is nasty.

For tonight's Cetrotide injection, I ditched the included syringe and used one of my extras. It was still a pain to mix since it doesn't dissolve well,  but at least I was able to prime it correctly. I'm also not at all a fan of the below the belly button injection site, there has to be some sort of acupuncture point or meridian there since the needle zings and hurts every time it goes in. The lower right/left and upper right/left are much less painful to inject into so I'm definitely changing the site for tomorrow. My belly needs a break!

I've got everything crossed that the appointment tomorrow goes well. Come on follies, I need you to mature! And contain healthy, mature, fragile-x free eggs, that fertilize perfectly and grow into healthy embryos. Positive thoughts!

It's Time for Cetrotide

E and I got so much accomplished this morning! We had a really tight schedule and just managed to fit everything in before he had to go off to work but we got to check a bunch of things off our list. As usual, my first task was this mornings injection - 4 Menopur to the right of my belly button and 1 swallowed dexa. Couple that with a shower, feeding the poor starving cats and dogs (2 had been fed only 2 hours previously while the others hadn't eaten since dinner, you know, a lifetime ago) and we just barely made it out the door in time to get to our vial pick up.

Just like last time, CA Cryobank was perfectly prepared. Our vials were waiting for us in their filled transport tank and I was in and out of there in under 5 minutes. We confirmed our donor number, the number of vials we were picking up (3), and signed the paperwork promising to return the tank, a errand I need to remember in the next couple days.

With our pick up complete, we headed straight to SCRC. They were really, really busy this morning but their lab tech D was ready and waiting for me. He took the tank to hold on to so I didn't have to lug it around to different rooms and I went in for my ultrasound first.

Today is day 7 and I had to look back through my notes to compare apples to apples but it looks like we're in almost the exact same place this cycle as we were last cycle. We saw NINE lovely follicles, eight maturing together between 10-13mm and one that was just a bit under 10. I am thrilled to tears with these numbers, even if it's likely the 9th one may not mature in time for collection. It's still way better than I was expecting and I am so hopeful that these eggs turn into healthy, viable embryos. Grow follies, grow!

After the ultrasound I went to get my blood drawn and chat with lab tech D. D is awesome, he had all my paperwork ready for me to read over and sign for SCRC and Reprogenetics, the vials for my estradiol and PGD probe sample ready to be filled and he managed to hit the vein in my arm in one go. I was just resolving myself to do all my blood draws from my wrist but now that I know D is such a rock star, I will be sure to ask for him again. He got a direct hit, perfectly into the vein and had those 3 vials filled within seconds. I am so, so appreciative of good techs.

D is going to be sending out one of our donor vials and two purple topped vials of my blood out to Reprogenetics today. I haven't received the saliva kits for my mom and sister yet, so getting those and sending them out is next on my list of to dos.

I also got my marching orders for my medication and it is time to add in my Cetrotide injection. This brings my daily total up to 4 injections, and since I've already done my morning shot, unfortunately means I'll be doing 3 in one sitting. This messes up the careful balancing act of rotating injection sites that keeps me from getting bruised and sore, I was hoping to balance it out to 2 in the morning and 2 in the evening but once you start at a certain time they prefer you keep it at that time. Ugh.

I've been doing:

• 1 Menopur in the morning to right of the belly button with my dexa pill
• 1 Menopur in the evening to the left of the belly button
• 1 Omnitrope in the evening high and to the right of the belly button, though I have done the left once or twice

I've found that even if I do one shot high and one shot low on the same side, I end up having to pinch over a fresh injection site to get the other site which isn't fun. Since it looks like this injection is supposed to go into the belly as well, I'm thinking of maybe trying it lower, below my belly button and somewhere in the middle.

An injection site diagram. I use both Menopur sites every day and change up the HGH sites. I'm thinking the Cetrotide should go down at the bottom.

It's hard to believe that I'm running out of injection sites, especially given how large the injections are making my belly -_- I'll have to give it a shot (ha!) tonight and see if I can pick a good spot that doesn't overlap with any other sites.

Slow and Steady

I just got out of my appointment and the follies are looking excellent. All seven are still plugging along, just at a slightly slower rate since the decrease in Menopur. I think the largest was 15 and the smallest was 13 so they're developing together, nice and even, but they're not quite ready for triggering.  I'm very pleased with their growth but but a little bummed that we'll need more Menopur like we originally thought. I thought we'd get off easy this cycle!

I just picked up two more boxes, another 10 vials, and got my Ovidrel trigger too just in case. If they need me to trigger on Sunday, the pharmacy is closed over the weekend so  I'd have no way of getting it. I will probably be back in for a rare Saturday appointment tomorrow morning depending on what Dr. K decides. If I don't trigger on Sunday (I don't think I will), they're thinking Monday might be the next contender.

My E2 levels came back this time at 926, an absolutely beautiful number, which if you average it out is about 132 per follicle. I'm sure they're not all in the 130s, probably more like 100-150 given the range of growth, but they're all on track and I have no reason to suspect that they won't all be ready to ovulate by the time I trigger. I love seeing those little follies on the screen, they show up as large, round, dark circles which is such a nice change from the empty, blurry grey ovarian tissue we saw last cycle. 

What a tiny order! This is the smallest one I've bought yet, it was only $730. What a bargain!

Although the appointment went well, the blood test this morning was a little hairy. I didn't have my usual phlebotomist and this new one didn't take my warning of difficult veins seriously. She tried first on the left, which is nearly impossible to find, before giving it up as a bad job and moving to the right. The right was already a little bruised from the draws on Monday and Wednesday and she only made it worse by repeatedly poking me and wiggling the needle around in my arm. It wasn't super painful, but was enough to raise my blood pressure up about 20 points as we saw when I went up to the nurse after. I usually have low pressure, especially in the morning, with a systolic reading around or below 100. My pressure today was 126/67 whereas Wednesdays reading was 103/60, already 4 points higher from a good blood draw than my usual haven't-been-stuck-with-needles pressure.

A nurse should be calling in the next couple hours to give me instructions on the Menopur and let me know if I'm going in Saturday. I'm predicting now that they're going to keep me on 6 vials, have me come in Saturday, but not trigger until Monday. I received a wonderful offer to hang out with my friend M, Roxie and Deano's mama, but my acupuncture appointment is smack in the middle of the day and doesn't allow for any other plans. Although I'd much rather hang out with M, it looks like I'll be spending the rest of the day driving to and from the acupuncturist in horrible Friday traffic. All this acupuncture had better be worth it in the end!

Blah

Today was much more of a blah day then yesterday.

I woke up to what definitely looked like a light period, complete with miserable cramps and since E and I are dog/house sitting, I had no pads and there is apparently not one single Advil or Tylenol in the house. Today makes day 11 of this month's "period," which sucks no matter how you look at it. It started as soon as I stopped the progesterone like it should have, but then I started the birth control on CD 2. I bled through CD 4, spotted through CD 7, and then thought it was done until I stopped the birth control. I was being too optimistic since it started right back up and I've been spotting CD 14 - today, CD 17. I feel like I should be looking this up or asking other people following an IVF-ish protocol if they've experienced the same thing, but biologically it makes sense. Stupid period, why don't you go disappear for 9 months -_-

After determining that I would need to go buy some supplies, I felt rushed through this mornings shot. I was running late to meet up with our old vet to pick up our animal's charts and had tried to stick myself three times before realizing that the needle must be a dud. It acted just fine when I primed the injection, but must have been dull or slightly bent since it absolutely refused to go in. Ouch. I'm now one needle short, since I had an exact amount, and am going to have to buy more next time I'm at Kaiser.

Won't you throw my ball for me? See how cute I am in this tiny bed?

Revisiting the topic of side effects, I can't tell if I didn't get enough sleep or if the Menopur is making me crazy tired. I feel drowsy, like I can't fully wake up, and I can't seem to shake it off. I tried napping, was unsuccessful, and have felt "ugh" and "blah" all day. I would try to put it more eloquently, but I can't summon the energy required to do so. Blah it is. Poor Milou seems to be feeding off my energy,  she's been laying around looking at me all mopey and sad, even though she had her favorite class, Agility, today.  Now I just feel guilty that I'm bumming out my puppy, completing the circle of "blah".

Blah puppy. Sorry Milou

Update: I just administered my evening injection and was greeted with the unwelcome sight of little round bruises :( I was really lucky with my first cycle and managed to not get a single bruise on my belly. This time I have one on each side to go with the little red pin marks from the blunt needle and my previous injections. I really hope they don't linger, the designated injection area is so small that I'm going to have to inject on top of bruises if they don't fade quickly.   

$2,000 down and 4th Injection Done

Since it's become apparent that the insurance company has no intention of honoring their original medication coverage, I bit the bullet today and paid for my meds out of pocket. It was painful.

My first stop was Kaiser. I got the Menopur there for $57.52 per vial which is an excellent price as far as I can tell. I should have also purchased my Endometrin there, but there was a minor miscommunication with the other pharmacy I was purchasing from. They quoted me a cheaper price than Kaiser, but neglected to mention that my RE had ordered two boxes of Endometrin, not one.

When I checked out, the pharmacist said he'd never rung up a bill so high in the 6 years he'd been working there. He'd never seen anyone pay 100% OOP for fertility drugs, the most he'd encountered was 50% and he was astounded that we had literally no coverage for the meds. He actually wasn't sure the system could ring up a bill that high and it did decline my card the first time I swiped it. The second time it worked, with extra authorization, and I left with my $1725.80 worth of Menopur.

The next stop was Northridge Plaza pharmacy, which had my Orvidel for around $77, which was great, but my Endometrin was over $200 for two boxes. I ended up checking out at around $295 and here my card was declined again. I ended up having to call my credit card and assure them it wasn't fraud before they would allow me to make the purchase. They promised it wouldn't happen again and I let them know I'd be making another $800 purchase in the next few days.

While I was waiting on the phone, a woman came up to purchase her trigger shot. She's doing her IUI on Saturday and was thanking the pharmacist for running her Menopur through her insurance. Apparently her Menopur was only $30 and she was so happy she almost cried. I wished her luck, looked down at my $1725.80 worth of Menopur (I was afraid to leave it in the car) and hoped/wished/crossed everything I had that this cycle yields a healthy baby.

On the way home from Northridge, the wood inset on my driver's door handle literally fell off on my foot. It felt like the universe was just rubbing salt in my wounds. I know my car is over 10 years old but I can't pay for insanely expensive fertility medication and a new car at the same time, so she's just going to need to hold herself together. I super-glued the panel back on with some Gorilla glue and I hope nothing else decides to fall off my car in the meantime.

Finally, today was CD4 and injection number 4. It burned like last night but I didn't have any problems with bubbles so the entire process went a lot faster. My routine takes about 15 minutes, I turn on my music, sterilize everything, mix up the injection, put it away, go pee, sterilize everything again and give myself the injection super, super slowly. I could probably shorten the process but it seems to be working for me and there are a lot of vials to sterilize :/

Tomorrow is my next ultrasound, please let there be lots of little follies growing in there!

Injections Day 3 and OOP Expenses

After crossing everything I have and holding my breath and arguing and hoping that my insurance would come through and pay for my meds, they have predictably decided not to cover them.

E and I were not expecting to be shelling out this much for a week's worth of medications, but since we have no other options, I called a every promising pharmacy I could find and comparison shopped. I think I've got the best prices I'm going to find between two different pharmacies so I'm heading over tomorrow to pick everything up. I still need to get 30 vials of Menopur, one Ovidril injection and 30 Endometrin capsules.

Today was also day three of my Menopur injections and this one was probably the most physically uncomfortable. There was a bubble that was a huge pain in the ass to get out and then the liquid burned like hell going in. It's still uncomfortable now and I'm starting to think my left side might be more sensitive than my right. Bleh.

Positive thoughts. I'm thinking positive thoughts.

Insurance Run Around and the Second Injection

Today I woke up a little sore. I was expecting most of the uncomfortable feeling from last night's injection to fade but it has stayed with me pretty much all day. It's not awful, just noticeable when I move around or bend over,  like some kind of tender heaviness in my stomach.

I spent pretty much all morning on the phone with insurance companies (aka on hold). My first call was to Kaiser, who reiterated that I should have coverage but oh wait, apparently I don't. The service operator at the Kaiser payment assistant center is also undergoing fertility treatments so she was sympathetic when I asked about discounts for cash customers, but she couldn't help. Her supervisor suggested I call Medi-Cal, which was just laughable.

Next I called our health plan provider, who said we have a separate prescription plan independent from Kaiser. This is news to me, considering that we've been getting all our prescriptions at Kaiser without issue until now, but okay. I rang them, they said hmm I don't think it's covered but it's on the list for injections so they transferred me to a different company that handles injections.  They said sorry, we don't cover infertility meds and transferred me to Freedom Fertility. We still have no idea if we have any kind of insurance for our prescriptions but my RE faxed over my scripts and we should have an answer tomorrow. Either way, I'm running out of donated meds so we'll have to get some in hand soon. Please keep your fingers crossed.

(Batiuk)

After my gym class today, I took my second Menopur injection. It was much less eventful than the first since I think I got out most of my internal despair yesterday. I didn't burst into tears at the sight of the syringe and I was able to psych myself up for it fairly quickly with some good music and a few deep breaths. This shot also burned a bit less so I'm hoping the injection site is less sore tomorrow morning when I have my next gym class. It still hurt to bend over and squish my tummy, but again it's really not that bad. 

My goals for the rest of the week are to sort out the prescription debacle and stay positive. We still have a 50% chance for a healthy baby if this works and stress will not do me any favors.