Happy Halloween

I wish I could start this post with better news but it looks like we've actually lost two of the follies we had on Wednesdays ultrasound. The 8 that was hanging out on the right side has basically shrunk to nothing and disappeared and one of the 12s on the left side appears to be arresting - it was only a 10 today. This leaves us with 5 follicles that could potentially have eggs but they're still not big/mature enough to trigger.

I'm telling myself to be positive: quality over quantity, those five follicles could have perfect, mature eggs that grow into five strong embryos. Still, I'd sure feel a lot better if we had 10 fabulous, mature eggs to pick from instead of just 5. I've been feeling really junky lately, a lot of uncomfortable pressure in my temples, one shoulder randomly going numb, sore lady bits and I need this cycle to be worth it. Come on eggs, I need you to grow, we need more embryos to test.  

With the extra Menopur I bought from Kaiser, I have enough to stim for 13.5 days - enough to get me through the weekend. Depending on what my blood work comes back at, my next appointment will probably be way too early on Sunday morning. If the follies are ready then and I have to trigger Sunday night, the pharmacy won't be open so I stopped in at Roxanne after my appointment. 

I don't know what the chances are of me actually triggering soon. I was looking over my old post-its from last cycle and they didn't trigger me till several follies were over 20mm. With these guys growing so slowly, the biggest is barely 18 :(,  I wouldn't be surprised if I had to get more Menopur and wait until Monday to take my Novarel.

 

In better news, I finally found a use for all these obedience classes I've been doing with Milou: Posing her for photos. After Halloween last year I picked up a couple pirate costumes for her on the clearance rack - she's usually a large or extra large in brands that make tiny dog costumes or a medium in brands that make costumes for larger dogs. I think these two came from Petco for a couple bucks a piece and are both larges, definitely a good score. 

 

I think the red and white costume is my favorite, it has a tiny pirate sword sewn to a black belt and is closed with two velcro straps which makes for a nice snug fit. She so sweetly let me pose her sitting or standing and even let me pose a too big pirate hat on her fuzzy head. That bit didn't fit all that well since it's technically my hat, but she put up with me like a champ. I love this girl so much.

Since costumes with straps probably aren't the most comfortable things to wear, Milou wore her second pirate costume to her agility and obedience classes. This one is a soft puppy t-shirt that slips over her head and two front legs and is super comfy. It also glows in the dark which is insanely adorable when we're walking at night - Trick "Arrr" Treat with a puppy skull and crossbones.

I hope everyone has a happy, safe Halloween filled with lots of delicious treats and merriment. If you have a few seconds to send some positive thoughts/vibes/prayers/good juju my way, I would much appreciate it. Happy Halloween!

Disappointing Ovaries

Today we had another ultrasound and I'm trying really hard not to be super bummed. My right side, which is usually packed full of beautiful follicles, has basically pooped out in the most disappointing fashion. My left side is definitely more dominant this time and is picking up a bit of the slack, but not quite enough.

I was so bummed and distracted that I didn't take a legible photo of our sticky note to post. So, I decided to rewrite a more festive version to bring in some positive vibes. Last cycle we had 10 follies at this point and as you can see, we only have 6 this time and they're on the small and peaky side. My estrogen came in supporting their scrawniness at only 486 so we've still got a long way to go. 

Since the follies are coming along so slowly, I'm going to need to stim for longer than I'd planned. I bought enough Menopur for 11.5 days, through Saturday morning, and the nurse suggested that I'd need enough to get through the weekend. That means three more 5 vial boxes of Menopur from the Kaiser pharmacy for a total of just shy of $900. I was short on Omnitrope as well, I only bought enough for 8 days instead of 12 with the increased dosage, so I picked up a third cartridge of that which Kaiser was wonderful enough to cover for the second time. Small victories, I'll take them where I can get them.

Last night was also day one of Cetrotide and I'd managed to forget in the past 5 weeks how badly this stuff itches. It only lasts about 2 hours but my skin turns red, swells up like crazy and I feel like I need to scratch my skin off. I also hate the pre-filled syringes it comes with, they never prime properly and always leave a nasty bruise. Instead, I prefer to inject the liquid into the powdered vial, switch it out for a regular 3ml syringe, use the included mixing needle, and use one of my own 27 1/2 gauge needles to inject.  My 3ml locking syringes are always reliable, easy to prime, and the 27 1/2 needles almost never bruise like the too small 30 gauge or too long 27 3/4 needles. The smaller needles cut capillaries = bruise and the longer needles are the same thickness but go just deep enough to bruise too. Bleh.

I just finished injecting tonight's meds and I'm wishing, hoping, and praying that more follies pop up and that they all mature. I don't think the cycle is poor enough to cancel but I'm so worried we won't get enough mature ones to get our good embryos. Come on ovaries, you can go it. Grow follies, grow!

Less Than Awesome Ultrasound

So this mornings ultrasound appointment was less than ideal. At this point in our first IVF cycle, we had at least 8 follies 10-13mm and a 9th slightly smaller than 10mm. Today we had only 5 follicles in the 10-14mm range, 3 follicles a bit less than 10mm and 2 less than 5mm. My right side, which is usually my best producer, is basically crapping out at the moment and I'm super disappointed in it.

I was hoping for a bit better :(

Every cycle is different so it's really tough to compare one to another but I can't help over analyzing everything I've done differently. For example, I suppressed for two days longer. I took Tylenol for cramps while on my birth control pills and tums for heart burn.  I was late yesterday for my shot by 30 min. I'm taking the higher, correct dose of Omnitrope. I'm using Italian Menopur instead of UK Menopur.

Realistically, I think the difference is probably from the extra birth control but there's nothing I can do at this point. I just have to hope that a few more follies pop up and the ones we can see grow into beautiful, healthy, mature eggs. I'm going to be adding in my Cetrotide tomorrow since the follies weren't big enough today and my next appointment will be Wednesday. Fingers and toes crossed!

Zonked Out

Today I am completely and totally zonked out. I think I felt okay for the first couple hours of the day but since then I've been exhausted. My head and eyes feel so heavy, I feel like I could sleep the whole day away and still be tired.

Although the medication dosages have been exactly the same, I'm definitely getting side effects earlier with this second cycle of IVF.  With the first, it was probably a good week of stims before I felt any different than a slightly poked version of normal. This time, it only took about 2 days for me to start getting heartburn and bloating and now that we're on day 6, I'm so, so tired.  An exhausted, half asleep lump who looks like they swallowed a fat, firm balloon.

I'm so thrown off that I was actually late for my shot this evening. Since starting the IVF process, I've been vigilant about keeping on top of my injections. My alarm goes off at 9am/pm, I immediately grab supplies and prep my shots, and they're done by 9:30am/pm. This evening, I managed to get everything wrong. I was so tired I could barely stay awake so I took Milou for a nice walk in the finally cool, fall air. I came back at 8:40pm, thinking about my shot with a solid 20 minutes to spare, and then got distracted by a phone call from E.

E was on his way home from work and was hungry. I checked the fridges and cabinets but we didn't have anything that could be easily prepared for dinner. I then had the wonderful idea to give my sister L a ride home from her restaurant and bring home Japanese food. Sounds good right? Delicious food, no prep, easy peasy! Except somewhere in there I'd completely forgotten about my shot.  And then my evening shot event was somehow deleted from my calendar, which means no alarm. Whoops.

I was sitting outside L's restaurant, listening to my Harry Potter audio book for the 5 millionth time, when I looked down at my clock and saw 9:30pm. It took a few minutes to click

...huh, it's 9:32, hope she gets out soon, I'm hungry....9:37...huh...FUCK!

I freaked out a bit, called E who reminded me not to freak out, and then shortly thereafter my sister got off work. I zoomed home as fast as I could, skipped getting the delicious froyo I was planning to buy,  prepped the shot and finally got it done by about 10:05, half an hour late. My beef was stone cold by the time I got to it and I'm still upset with myself and completely exhausted again.

How could I forget for even a second that nothing is normal when you're doing IVF -_- Everything runs on such a strict schedule and here I am acting like I can go do whatever I feel like. Blah. I'm going to go sleep now so I don't accidentally miss my morning shot and next appointment.

Easy Peasy Fix and Oodles of Follies!

This morning was my stim day 4 appointment and we got surprisingly good news all around! Since Friday and Monday seem to be the clinic's busy days, there was a decent line for ultrasounds and blood work and I decided to go up to the financial office first. I hadn't received a call back from my contact yet but when I went up to her office she had already listened to my message and was ready to help.

As I already knew, everything on the estimate was incorrect. She took the aCGH testing off first since we are paying Reprogenetics direct and then corrected the third cycle ICSI to the second cycle price. I thought she might go back on her earlier statement about only paying the biopsy fee once but she didn't! She looked up the payment records, saw that we'd already paid it once, and took it right off the bill. I have to admit, I was impressed. I was expecting a lot more push back for what turned out to be a 5 minute conversation. Basically, I was working myself up, worrying about nothing. Whoops.

I would have just paid for the ICSI today since I had the estimate in hand, but our credit card company has helpfully decided to replace my card due to "potential fraud". As one might guess, the potential fraud they're referring to is my charge to IVFmeds.com, a charge that I had already spoken to a supervisor about and approved. This still wasn't good enough for them so I'm now waiting on a new card to come in the mail, and my old one will only work if they're swiping it directly, which neither SCRC nor Reprogenetics would do. Given the hassle, I figure it's better to wait and give them a card they can actually run.

With that all sorted out for the time being, E and I went down to my ultrasound and even more good news. Both my left and right ovary each had 6 tiny follicles, for a total of 12 follies after only 4 (really 3.5) days of stims! The largest on the left was 8mm with the largest right following just behind at 7mm. This means the follicles are well synced and will hopefully continue to grow at the same rate so they can all mature together. If you recall, I wrote about last cycles stim day 4 ultrasound here and I only had 8 follies visible at that appointment. I did an extra two days of suppression for this cycle so I'm not surprised these follies were a bit smaller but I certainly wasn't expecting to have an extra four right from the get go!

What I'm wondering now, is whether or not I'll have to stim longer than last cycle to give these follies more time to mature their payload. Are two extra days of suppression enough to require an additional day or two of stims? I already have to order a third cartridge of Omnitrope, with the adjusted dosage the two cartridges I bought will only last about 8 days and I'm anticipating needing enough for at least 11-12 days. I don't know if I'll get lucky enough to have Kaiser cover this last vial like the did the other two, but it would be seriously wonderful if they could.

Please order more things. I don't have enough boxes!

My next round of ultrasound/labs will be on Monday so in the meantime, I'll try to send lots of positive, growing thoughts to my follies. We want to keep them all growing nice and evenly so they're perfectly mature and ready to be fertilized after retrieval.

The Financial Fuckery Begins

One of the main complaints I've heard about the IVF process is a distinct lack of communication between the actual IVF staff and the financial department. The financial departments of IVF clinics all over the country get slammed for poor billing practices involving incorrect numbers, screwed up payments and noticeably poor communication. Knowing this going in, I spoke extensively with the financial department for each lab/clinic we're working with and quadruple checked my numbers to try and head off any potential problems. I made a valiant effort but apparently it wasn't enough.

When I got home from work this evening around 8:15pm, I found this letter waiting for me from ART, the surgical center in my clinic.

Um, No.

As you can see, there are several mistakes. For starters, it lists my ICSI fee as being for a third cycle - this is only my second. I actually owe them $150 more than the bill says here.

Secondly, they want $3950 for aCGH testing. This is so far off that it's crazy. We did in fact decide to add aCGH testing on, but we're paying Reprogenetics directly and the fee is only $2,250. That's no where near 4 grand and there's no way I'm paying that to ART. All of our dealings with Reprogenetics have been direct, there's no reason SCRC/ART should have any part in fee collecting for them.

Their third and final strike is the $1650 for embryo biopsy. Here the number is correct, but we've already paid it. Before signing up with SCRC, I confirmed over and over again that the fee for embryo biopsy was once due once when purchasing their two cycle plan. As I've already paid them their $1650 when we did our first cycle, we will not be paying it again.

I'm hoping these were innocent mistakes but I admit it really cheeses me off. I went over this with all the different financial departments - SCRC, ART and Reprogenetics and I was so hoping we wouldn't get slammed with the usual financial fuckery. When our first cycle got billed correctly I thought we'd avoided any pitfalls but it looks like I got ahead of myself.  I left a voicemail for my financial contact at ART since it was way after business hours and I sent an email to my financial contact at Reprogenetics.

Your clinic and labs hold all the cards when you're doing IVF - they literally have your embryos, your potential children, the lab has my probe, and SCRC has over $20,000 of our dollars so it's not exactly like we can stamp our feet and refuse to pay if they won't fix the problem. With any luck, I'll get two satisfactory answers tomorrow correcting this estimate because there's no way I can give them another $6,600.

Our Probe Is READY!

Yesterday morning, I went ahead with my plan to phone Reprogenetics to get an update on our probe. I can never manage to catch someone at their desk so I left a message and waited for a call back. They're usually pretty good about returning calls and it only took a couple of hours for their New Jersey caller ID to pop up on my phone.

My rep for our probe process wasted no time in telling me that our probe is DONE! It's ready! We were originally quoted 6-8 weeks but it ended up being less than 4 weeks from the date they got our samples to the date of completion. I was so surprised, this is wonderful news :) I was anticipating a deadline closer to the 8 weeks and was worrying that we wouldn't get results in time to go right into a FET.

Once we conclude this cycle and the lab has received all our biopsy samples, it takes 15 calendar days to get PGD and aCGH results on our frosties.  Those will be two loooong weeks and I'll probably be going crazy but I know we'll get some good results.

(Source)

This is an example of Fluorescent In-Situ Hybridization, or FISH, a quick result type of PGD that we can't use for Fragile X but that is super cool to look at. This one is for muscular dystrophy. Embryo C is a normal male embryo, I believe the light pink is Y, the dark pink is X and since there's only one X in a boy, a single green dot for a normal chromosome. D and F are both normal female embryos, two green dots each, one for each X, the two dark pink dots. A shows a female carrier embryo, one of her chromosomes is affected but the other is okay, two dark pink dots and a single green dot, and B and E show affected male embryos, no green dots.

Hopefully we will have lots and lots of healthy embryos from both cycles but first we need a nice, big haul from this one. I just started up shots again today, this time 4 Menopur and Omnitrope in the morning and 4 Menopur in the evening. Every time I start up another cycle, I forget how much the Menopur burns!

Round Two is a Go!

This morning I had my official baseline ultrasound and lab work to make sure the birth control has done it's job. The tech who was so good last cycle couldn't find the vein in my right arm and gave up after repositioning the needle six times. She prepped my left arm, which is my less cooperative side, but gave up without trying when that vein didn't pop up either. The only option left was my hand which always stings in the weirdest way, but is at least easy to find. 

According to the ultrasound, my ovaries are nice and quiet, successfully suppressed! My lab work confirmed the suppression so we are officially cleared to start IVF number 2!

Fist pumping kitty approves!

Although it's only been about 4 weeks, I think I'll call Reprogenetics for a progress report on Monday. I know the probe won't be finished yet, but it will make me feel better to hear that there's progress happening. 

In terms of protocol, my last birth control pill was yesterday so I'll start stims on Tuesday morning. I've got everything ready to go except my Novarel which I don't need for a couple of weeks. Everything is falling into place and I'm predicting a November 3rd retrieval date.

Deep breath, cross my fingers, and here we go again!

Lucky Break on Meds!

Unlike my last package of IVF meds, todays package came bright and early at about 10:30am! It had the remaining 43 vials of Menopur I'll need for this cycle, all well packed in bubble wrap. I even got an out for delivery notice from IVFMeds.com letting me know the package would be coming soon.

MeRopur!

I emailed their customer service Tuesday night asking about Meropur vs Menopur and their rep called me Wednesday morning. Instead of emailing, he wanted to explain to me personally that they were in fact the same drug by the same company, Ferring. IVFMeds sources their Menopur from several different countries in Europe and as I thought, this batch happened to come from Italy. Thus far, I'm once again impressed with their quality and customer service.

With my Menopur safely in hand, it was time to move on to my Kaiser order! I called them on Tuesday as well to confirm that my prescription was ready for pick up and got the all clear. So I climb in the car, battle through traffic, find a lucky street parking spot, and stand in line. I get up to the counter to pick up my "ready to go" prescription and surprise! it's not ready. The tech tries to tell me that he doesn't have it at all, I insist he does, and he agrees to get everything together if I don't mind waiting.

So I wait. And wait. And wait some more.

He finally calls me up to the counter only to tell me sorry, he doesn't have my Omnitrope. Le sigh. Again, I insist that he does have it, remind him that I got confirmation that it came in, and he's still insisting that he doesn't have it when another tech walks by and says hey, isn't that in the fridge? Oy. So he finds the Omnitrope, huzzah!, tells me he needs to write it up and I need to wait some more. Okay, I'm good with more waiting. And waiting. For another 20 minutes.

This time I get called up to the counter by a different tech, they go through my prescriptions and surprise! they don't have my big mixing needles. She can't seem to figure them out, apparently 22 gauge needles in the same quantity as the other needles is a complicated request, and she eventually decides to just make a new script for them. So again, I wait.

About an hour after I get there, the pharmacy eventually gets everything correct and ready to go! A third tech started scanning all my items, rang me up, and asked for my card to swipe at the station over so I didn’t immediately see the price. When she handed me the bill to sign I just about died - it was only $30!!! Whaaaaat???

My $15 Omnitrope!!

My last Omnitrope order ran me over $300. Whatever they did differently this time, my medication rang up as covered!  I kind of froze because it seemed too good to be true, I didn't want to draw attention to the price in case it was a mistake and I didn't want to pay more so ahhhhh I just signed the bill, took my bag and hightailed it out of there! I don't know how it happened but it was so worth the wait and I am so grateful to whatever they did to get my meds covered. This process is running us a small fortune and every little bit helps!

Cilly and Fuckie confirming via bodily inspection that I have removed all items from the bag

IVF Meds Package!

Look what finally arrived! My first batch of meds for this cycle :) I would have had them yesterday but it was Columbus Day and I completely forgot that there was no mail. Since I have to sign for the package or they won't leave it, I worked my schedule so I could be home today. Then I waited. 

And waited.

Annnnnd waited. 

All Day!

My other two packages from IVFMeds came at 10am and 2pm. This package didn't come until FIVE! I could have done a million other things not the least of which would have been to pick up my Kaiser order which is still sitting and waiting for me at the pharmacy.

This batch of Menopur came in blue boxes labeled "MeRopur". The last batch came in pink boxes labeled "MeNopur", the left overs are in the bottom right corner of the photo. A quick google search told me that it's the exact same medicine, by the exact same company, but its from the lot distributed to Italy where they call it Meropur instead of Menopur. Apparently the word or pronunciation of "Menopur" in Italian translates to something like "Not Yet" which Ferring thought would have a negative connotation. I opened each box to inspect them and make sure none broke in transit and the actual vials themselves appear to be the same vials, with the same med pellet but with different labels. 

The 5 Cetrotide were the exact same as last time, little kits with a vial of powder and a pre-filled syringe. The remaining 43 Menopur vials are on their way from London to New York right now and I'm curious to see whether they'll be Menopur or Meropur. I might call and ask but I don't think it makes a difference either way.

Magical Chinese Cure All?

I wrote here about the rash that cropped up practically the second I started this cycles birth control regimen. It was itching like crazy and I still have no idea what caused it - hormones? All the medications? Detergent in my sheets? something I touched? A yeast skin rash from the birth control? A combination of the above?

I asked my acupuncturist about it and she said that from a Chinese Medicine stand point, rashes like that are the result of damp heat or "wind" in the skin. She used several points to help clear out heat and dampness in my acupuncture session and gave me this herbal wash that she usually gives to her post postpartum patients to help with healing tears, hemorrhoids, yeast infections and a whole host of other things.

Yin Care

I've been using this stuff for two days and I have to say it's friggin' magical. It's like there's nothing this stuff can't treat.  The ingredient list is full of herbs and extracts, some I recognize and others I'm totally unfamiliar with: 

Extracts & Essential Oils of:

• Di Fu Zi - Kochia
• Yin Chen Hao - Artemisia
• Du Huo - Angelica
• She Chuang Zi - Cnidium
• Shi Chang Pu - Acorus
• Ai Ye - Artemisia
• Bo He - Mentha
• Jin Yin Hua - Lonicera
• Zhi Zi - Gardenia
• Huang Bai - Phellodendron
• Huang Qin - Scutellaria
• Ku Shen - Sophora
• Cang Zhu - Atractylodes
• Tu Jing Pi - Pseudolarix

The list of things this stuff successfully treats is unbelievable. You can use it as a compress, rub, rinse, douche, soak, spray, mix it with a compounding cream and even soak tampons in it. Depending on the ailment you're treating, you dilute it with different amounts of water but you can also use it at full strength.

Topically, Yin care treats:

• Acne, Eczema, Psoriasis, Rashes, Rosacea, Hemorrhoids
• Shingles, Cold Sores, Sty, Athletes Foot, Poison Oak, Poison Ivy 
• Fungal Infections in the nail, toe or skin, Insect Bites and Staph Infections 

 For Gynecological issues, Yin care treats:

• Yeast, Bacterial, Fungal, and Trichomonia Infections 
• Vulvitis, STD
• Cervical Dysplasia, Cervicitis

A herbal solution that treats everything from acne and hemorrhoids to poison ivy and yeast infections? How does this even exist? I can even use it on Milou's flea bite/lick granulomas. This stuff is insane, it's already helping to clear up some acne and a small rash E had.

OMG. Just this very moment I think I figured out what caused the rash on my groin. I'm fairly sure that the day I started birth control I also shaved my bikini line. With E's man scented shave cream. That I am obviously allergic to. Whoops.

I still don't know what caused the one on my stomach but that one is basically gone, so major points to Yin-care.  

Those little dots are the last remnants of the belly rash. Bye bye!

IVF Meds Take Two!

Now that the stim start date is inching closer and closer, I went ahead and placed my order for the next round of IVF! Since we had such good success with IVFMeds.com last time and the meds are SO MUCH CHEAPER, we went with them again. Even with the good amount left over from the extra we had to buy for last cycle I still had to order a tooooon of Menopur.

Thanks IVFMeds.com for saving me a ton!

Last cycle I had some extra Menopur left over from my second IUI and even with that extra, I still used a few of the last minute Menopur order. If this cycle is anything like last time, they expect me to use 90+ vials and stim for at least 11 days so I'm ordering over 80 vials of Menopur. Since I was one short last time, I also ordered 5 Cetrotide injections and hopefully that will be enough.

After the second batch of meds took a bit longer than was ideal to get here last time, IVFMeds.com offered to credit me the difference in cost for the extra vials I didn't use. I was skeptical because come on,  that's really excellent custom service, much more than I would expect from an online company based in another country. Instead of placing my order online, I rang up customer service and got the same wonderful rep that helped me last cycle. He remember me and my order snafu and in just a few minutes was placing my new order with a credit for the difference in the extra vials.  I'm still kind of shocked! It was all quick and easy, I rang them up, rang the bank to authorize the transaction since it got flagged again, and my nurse emailed me the new scripts to upload only minutes later. After all the calling and price checking and back and forthing of last cycle, I never knew the process could be so smooth.  

Impossible to beat these prices!

They're moving like ninjas this time and have already shipped out the first batch of my order, 40 Menopur and 5 Cetrotide. Like last time, I ordered so much Menopur that their pharmacy can't fill it all at once from in store stock so they're shipping it in two separate batches. This order went out on Friday so I'm not quite sure when to expect it. Priority Mail Express International does a lot of things regular Priority doesn't do, it's even delivered by a separate branch of USPS. If the package moves on Sunday, it should arrive in New York tomorrow and will probably be delivered by Monday. If it doesn't travel on Sunday, it'll hit the big apple on Monday and I'll get it Tuesday.  I also have to call Kaiser to authorize them ordering my Omnitrope and needles/syringes. The order was called in on Friday but from past experience I know they won't actually order it until I ask for it.

It doesn't make a difference protocol wise if the Menopur arrives on Monday or Tuesday since I don't need it just yet, but since I have to be here to sign for it in person, I have to plan my schedule around the delivery. Kind of a pain but well worth the savings!