Waiting, Wondering, Worrying

Well here we are, the day before Thanksgiving, the day before we're supposed to get our results. I thought I'd been dealing with the waiting and what ifs pretty well, I've been staying super busy and for the most part haven't allowed myself to think or dwell on it. I've been intently picking out super cute leggings from various Aussie websites (It's turning into an addiction and I don't even have my first pair yet), hunting for boots to go with said leggings, working on my aquarium which is always soothing and getting everything ready for Thanksgiving. I haven't been counting the hours but it would pop into my head every few days that we were that much closer to results. Somehow they always seemed far off, something that would be happening in the future.

Now, it's the night before and I'm thinking I'm not so okay. After a conversation about socializing with friends turned into a conversation about parents and babies, I suddenly felt quite irrationally emotional, like a cup in the process of overflowing. It's clear that even though I haven't been consciously dwelling on it, my subconscious has been drowning. I tend to internalize things so I can carry on calmly and I now feel like an idiot for genuinely not knowing why my hair seemed to be falling out the other day. It's one of the telltale giveaways that I'm under stress but at the time I couldn't think what it could be. Way to block out the big stuff brain, I'm sure that's super healthy.

On what will likely be the eve of our PGD results reveal unless the clinic closes for Thanksgiving, which is still a possibility, it appears my brain has run out of distractions. It's hit me like a freight train that this is it and I don't know what to do.  I can't stop going over horrible things even though I'm trying to put only positive energy and thoughts out there.

We still haven't paid for our PGS. H never called me back to get our credit card. Does this mean all our embryos were effected so they never did the PGS screening?

What if all our embryos are sick? What if we went through this for nothing?

What if they don't call with our results? How will I get through Thanksgiving with all those people? How will I get through it anyway if it's bad news?

E just got sick and has probably now exposed me. Will that effect our FET if when we get there?

I'm so, so scared our results won't be good. We've been through so much, I've been through so much I need these frozen babies to be healthy.  Now all I can think about is the worst case scenario and I feel like I'm going to choke on the lump it brings to my throat. Please be healthy embryos. Please be healthy.

Christmas Delays?!?!

Originally, I was planning on putting an embryo back straight away after this IVF cycle. I psyched myself all up for a November transfer and told myself I'd have good news for the holidays. I was ready to go, let's get this embryo toasty warm in my uterus!

Then, Dr. D put the kibosh on that. He said I've been injecting waaay too much medication into my body, two months in a row, and that wouldn't make for the most ideal environment for our embryo. Damn. He suggested that we take a wash cycle, wait for the drugs to really leave my system and start fresh with a nice, fresh cycle. Okay, I don't love the idea of waiting yet another month, but I would never do anything to jeopardize the success of my frosties so I got on board. One wash cycle to get everything out and THEN we'd thaw out a frostie and put it back.

With a regular cycle, it's pretty easy to plan when things should be happening. With this period showing up right on time I was pretty much positive that we'd be doing our transfer shortly after Christmas, probably sometime around the 28th if Dr. D really planned on transferring on CD 17. I've heard some people transfer later, closer to CD 20 or 22 but Dr. D said CD 17 so that's what I went with. I psyched myself up again for a Christmas transfer told myself I'd have wonderful news around January 9th. A September baby would be wonderful, right before the holidays really started to pick up.

I was reading through my IVF support group, reminding myself to practice patience when I read about some clinics closing for the holidays and delaying treatments. This should have been obvious, of course they'd want to go on holiday, but my clinic couldn't be closing because I'm transferring right after Christmas, right?  Right??

Nooooooo!!!

I got on the phone to Dr. D's nurse and asked them about their Christmas schedule. Bam, my worst fears were confirmed. They usually close for two weeks spanning the end of December to the beginning of January. Fuck. Right over when I was supposed to be doing my transfer. Double Fuck.

I explained to the nurse that I was supposed to be transferring over that time period and wasn't expecting my period to start until December 12th. She elaborated that the ART center closes completely for those two weeks but there's still a crew on the clinic side. The last day for most things is December 18th and there are only certain days after that where they can perform specific procedures. This is probably for those people who need to stim longer than expected and need their retrieval done over those two weeks, not for people who are looking to transfer a frozen embryo that's perfectly happy waiting on ice.

She told me to call with the first day of my period and we would see how things look then but it looks like we'll be delayed yet another month. I was just getting used to the idea of taking one month off and now we have to take two. I told my acupuncturist S how disappointed I was and she said that success rates are lower around Christmas because people are stressed out so I wouldn't want to transfer then anyway, but I'm pretty sure she was just trying to make me feel better. I don't see out of town family members or deal with a lot of family drama over Christmas so I'm fairly certain that my chances wouldn't be any lower just because it's the holidays.  My frostie certainly doesn't know it's Christmas.

All I want for Christmas is a batch of healthy embryos! One in my belly and the rest on ice.

If we have to wait two months, we won't get to transfer until the end of January, probably around the 25th. This means that I would potentially be getting good (because I refuse to believe otherwise) news on my birthday. It would be a wonderful birthday gift but I'm so anxious to get an embryo back where it belongs. This process takes so long and every month more feels like forever.

News To Be Thankful For?

I still haven't heard back from H, the financial person at Reprogenetics, so I shot an email off to my Reprogenetics genetic counselor D to see if she could give me an update. H is usually really good about getting back to me, she must be on vacation or out of the office because she's never had me wait more than a couple days. I know they won't release my results until they're paid so she's going to have to get back to me eventually to get my credit card.

Lucky for me, D is in the office and she got back to me pretty much right away. I asked her to confirm that she'd received the samples since I had only heard from Dr. D about that, and asking whether testing had begun because we can't wait for some good news.

The message I got back basically said:

I know the waiting is hard. We've started testing,  it will take the full 15 days. You'll know on 11/27.

I know Garfield. I know.

For those who didn't catch that bit at the end, 11/27 is Thanksgiving. When we will have all sorts of people in the house. We will be getting either really good news or really bad news with a house full of people. The waiting is so tough,  I can't wait to find out, but this is not how I wanted to do it.

Plus, I'm sure Dr. D won't be working on Thanksgiving. If he's not in the office, we don't get our results. Reprogenetics is sending them directly to Dr. D not to us, since the sensitive information should be explained by a doctor yadda yadda. I'd honestly rather they just email them so I don't have to talk to anyone if the results are bad but that isn't an option.

E and I wanted time to ourselves to process and deal with the results. We didn't want to share them with the few family members who know, especially if they're not good, until we'd digested them and figured out our next move. Honestly we really wish they didn't know the testing was going on since their questions/expectations/hopes/certainty really make us feel worse and not better. I don't think they realize how difficult the process is, how often people end up with no healthy embryos to transfer. Even with 6 to test, we could very easily have no healthies and their certainty that all our embryos will be healthy and everything will be roses and sunshine feels shallow.

Maybe we'll get lucky and we'll get wonderful news early. I'm still hopeful that our embryos will be healthy, that we'll have 6 frosty babies to be thankful for this Thanksgiving. But it would be really nice if we could get our results without an audience.

AF With A Vengeance

Unsurprisingly, my period showed up exactly on time, 11 days after my trigger. There has to be something said for predictability, at least I know when the witch should be rearing her ugly head. The first couple days I had to top up my Advil every 4 hours instead of every 8+ like I usually would, those cramps break through surprisingly quickly. A couple days in they're not awful, uncomfortable yes, but I'm good with just a couple Advil each day.

I think the toughest part has been waiting with nothing to do. I've taken the supplements, done the injections, done the retrievals, and now all I can do is wait and wait for my test results to come back. There's absolutely nothing I can do to help or speed up the process which is a very unusual position for me to find myself in. I'm not even sure if they've started the testing yet since I haven't heard back from the financial person yet, I'll probably give both her and the lab a call tomorrow to ask for an update.

(And wait....and wait...and wait...)

Once I stop bleeding like a dying person and feel halfway normal again, my plan is to hit the gym hard and try to take off some of this IVF weight. I feel like I've been packing on inches by the handful and I'd really like to get some of it off before I get pregnant. I already know I won't be allowed to gain a ton of weight, not that I really expect to gain a ton anyway, but it would be nice to start at a more normal point for me instead of this far ahead. Of course, starting a diet/exercise plan right before Thanksgiving is probably not the smartest thing I've ever done, but I don't have a lot of time and I need to get rid of this IVF fluid belly so I have room for a baby in there!

Biopsy Samples Off!

This was supposed to post yesterday, I'm not sure why it didn't :/ Weird! 

I wasn't expecting a call this morning since our embryos have already been biopsied, vitrified and tucked safely away, so I was surprised and a little worried when I saw SCRC come up on my caller ID. It turns out Dr. D was just calling to give me an update and let me know that my biopsy samples had been shipped and should be arriving at Reprogenetics today! I wasn't expecting them to ship out so quickly, especially since today is a holiday, but we're officially ready to start testing.

Dr. D said he spoke with Reprogenetics today and they're going to run our tests consecutively - the PGD for Fragile X first, and then the aCGH PGS on any unaffected and premutation carriers. This means that only Fragile X negative embryos will be screened for chromosome issues, which makes sense. What I'd like to know, is if we pay for "up to" 8 embryos and only test 6, can we test 2 more in the future without additional charges? Probably not, but its definitely on my list of things to ask them since I've heard of other people doing this with their labs. I still need to give them my credit card information for the aCGH but I haven't been able to get in touch with their financial person H yet. I left a message with their messaging service on Monday so I'll probably call again tomorrow.

Cilly sneaks into the linen closet for a relaxing nap

Dr. D also hinted that he thought we might get our test results early. He said the 15 day estimate was quite conservative, if the lab was busy, etc. Once the PGD is complete, and this is the portion that takes a bit longer, the aCGH will be performed the next day and then we'll have our results. Everyone at the clinic has their fingers crossed for us and we're all thinking positive and willing these embryos to be healthy.

As for recovery, I'm still really bloated and starting to get occasional cramps in anticipation of my period which should be due at the end of the week. I can wear my regular jeans but the belly is definitely there and it's deflating unevenly. When I woke up this morning my belly button looked off center which is so weird, the right side seems to have gone down a bit faster than the left. I can't wait for my belly to be huge and lopsided because there's a tiny person in there, not just a ton of fluid.

Day 6: SIX EMBRYOS Going For Testing!

Both embryos made it! Holy shit! We now have two more hatching blasts to add to our batch, making 6! I can't believe it, after such a crappy cycle and only retrieving two eggs, I never would have dreamed they'd both be strong enough to make it. Taking them to day 6 was definitely the right decision, the embryologist says they look perfect.  We're going to send these 6 samples out for PGD/PGS and hope/pray/wish/cross everything that they're healthy!!

I was planning on putting one embryo right back once we get our results, an early December transfer, but the doctor says I should take a "wash" cycle. Not everyone needs to take a break but most people only take $1800-$4000 in meds for their cycles and do just one. I've been injecting $9200 in hormones two months in a row and he thinks I should have two periods to wash them all out. The first would be the upcoming one, due at the end of this week if I follow last cycle. Then I'd wait a month, have my next period and start the medication for transfer. He's right and it makes sense, I would never rush anything that could compromise an embie's successful implantation, but it's so hard to be patient!

Right now our biopsy samples are probably being packed in liquid nitrogen and readied for their journey to the east coast. I believe they'll be over nighted to Reprogenetics and then as long as all the samples are good, they'll begin testing. We decided to go ahead and add on the aCGH testing for $2250, it seems crazy to go through all this to test for Fragile X, a developmental disability, and then not check for Down Syndrome or other Trisomy problems. I need to confirm whether they run the tests concurrently or consecutively, hopefully we'll have all healthy embryos and it won't matter, but if somehow they're all affected with Fragile X, they should hold off on the aCGH testing. We won't need to go there though, our embryos are going to be strong and healthy and we'll have a healthy baby before we know it.

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.

Day 4: Acupuncture and Patience

Today, I'm finding it difficult to be patient. We don't get an update on our embryos and I know they're in the most difficult phase of growth where many embryos are often lost. Last we heard, four were doing very well with 7-8 nice, even blastomeres (cells) and two were growing nicely but a little slower with only 6 nice, even blastomeres.

On day 4, we need those embryos to be in the Morula stage, the last phase before they grow into blastocysts, form the blastocoel (fluid filled cavity) and start differentiating cells. Today, and possibly tomorrow if they're slow growers, they should have between 10 and 30 cells.  They might even have begun compacting like the embryo below, which is where the cells start squishing together like the embryo below.

Nice quality Morula

Hopefully they'll make it through the morula stage and grow into nice blastocysts tomorrow. If they're not quite there yet it's still okay as long as they're progressing. They'll be allowed to grow to day 6 when plenty of embryos are frozen and I probably won't sleep until we get the call. As blastocysts, they should be dividing into the inner cell mass (ICM), the Trophectoderm (TE) and the blastocoel (fluid cavity), which gets bigger as the embryo expands.

Nice Blastocyst

We need good cell differentiation to get a clean biopsy of the embryos for PGD. They need to sneak some cells out of the TE on the side there, the cells that will become the placenta, so we can test the fetal DNA for abnormalities.

Since there's nothing I can do to help my embryos grow, my distraction for today was a much needed acupuncture appointment. I haven't been since my retrieval and it's supposed to really help with recovery and the symptoms of OHSS. I laid down on the table, S took one look at my belly and said "Oh boy, you're definitely hyper stimulated". Clearly other people think I look 6 months pregnant too.

I already knew that I probably had OHSS but it's still a bummer to have it confirmed by a nurse. I also woke up sore this morning, my hamstrings and back felt like I'd worked out, and S said it's because of all the fluid I'm retaining. The fluid is responsible for my bloat, my repeated peeing, the heart burn and now the muscle soreness. Oh the joys of IVF.

Dr. D's nurse also called today to ask us about aCGH testing for our embryos and to see how I'm doing. I told her we'd probably base our decision for chromosome testing on the number of embryos we get, our lab doesn't really need an answer until they have all of our biopsy samples but as long as we get a good amount from each cycle I think we'll probably go ahead and add it on. If we only end up with a couple of embryos from each cycle, I'm not sure if it's worth doing, but if we get six lovely frosties each time I'd say it's worth the extra $2500.

As for next cycle and the crazy bloating, she said Dr. D usually takes a "flush" cycle in between IVF cycles to allow all the hormones to flush out of your system. It would also give me a good amount of time to order my meds from IVFMeds.com so I wouldn't be doing things so last minute. She made a note for Dr. D to chat with me about it tomorrow when he calls with our embryo update, so I'll probably be holding my breath until the phone rings tomorrow morning. I so, so hope our six embryos are doing well, I worked so hard for them and I won't be able to relax until they're safely biopsied and frozen.