25 - First Night of Shots - July 27th, 2008

This morning I went to the hospital lab (because it is a Sunday and the office labs weren't open) and got my P4 drawn (progesterone). This was to make sure that I ovulated. SIDE NOTE: I begged the lab person to use a butterfly needle because I have bad veins...she refused because she was "so good". Guess what? She had to poke me in both arms before she got any blood...and did eventually use a butterfly needle. CCRM used butterfly needles as a standard practice..thank goodness. Anyway, the results were sent to CCRM within a couple of hours. I called the on-call nurse. She reviewed the lab results and gave me the go ahead to start the Lupron and Dexamethasone.

So tonight at 8PM I gave myself my first shot of Lupron...not painful at all, although the area around the shot got a little tender. CCRM has a link to videos (on the homepage of their website) that show you how to give the shots - very helpful. Also, I read somewhere that you should reward yourself after the shots so that they don't become a source of dread. I think this is a great idea and plan on coming up with a reward routine in the next couple of days. I just took my dexamethasone and now plan to head to bed. It feels good to finally get this process started and I am in great spirits.

Nothing other than the Lupron and Dexamethasone until my period starts (probably August 4th or 5th). Then I go in for an ultrasound and blood work here in Michigan. If these tests show that the Lupron has successfully shut down my ovaries, then the real fun begins...the stimulation drugs.

24 - Food for IVF and beyond - Month of July

Based on the book "The Fertility Diet" (which I purchased several months ago, but didn't implement until about three weeks ago) and recommendations from my CCRM nurse, I have made major diet changes...I feel WONDERFUL and very healthy. Here are some of the guidelines I've been following:

ABSOLUTELY NO:
caffeine (including chocolate)
alcohol
white flour
processed sugar
processed foods
drinks other than water

EVERYDAY I EAT/DRINK:
-Prenatal vitamin
-Water (about 2 liters)
-1 cup red raspberry leaf or nettle tea
-Three bright/deep colored fruits (raspberries, strawberries, blueberries, kiwi, cherries)
-Protein smoothie with 1/2 cup organic whole milk yogurt (and above fruits)
-Three brightly colored vegetables (Broccoli, carrots, bell peppers, sweet potatoes)
-One bean/lentil protein (usually for lunch)
-One meat/fish protein (salmon, tilapia, chicken - usually for dinner)
-One extra protein (such as hummus or a hard boiled egg)
-One serving of whole grain/multigrain (such as toast, whole grain pasta, quinoa)
-One serving of nuts (either whole nuts or almond/peanut butter)
-One whole dairy serving (another 1/2 cup yogurt or cottage cheese)

Maintaining this diet has been somewhat time consuming (but completely worth it). Because I am mainly buying fresh food (and organic, when available and affordable), I need to shop more frequently...and because I've been making everything from scratch...this takes a lot of time. Perhaps the most time consuming part of this diet is the mental energy it takes to maintain it...I am use to grabbing a donut and diet pepsi for breakfast...seriously. So, I feel like I am rewiring my brain. Hopefully, it won't feel as consuming once the rewiring is complete. My relationship with food is definitely changing - before, nurturing myself was splurging on french fries...now nurturing means a protein smoothie or some red peppers and hummus. I feel like I have such a good start to pregnancy if this ivf cycle is successful.

23 - Meds received - July 15th, 2008

Somehow we did not hear the fed ex person when he arrived in the morning with the meds (we were both home - we think it was a doorbell malfunction). I just happened to noticed the "sorry we missed you" type tag hanging on the door at about 9AM...I flipped out. Freedom Fertility Drugs emphasized that someone MUST be home to pick up the drugs because one of them (the gonal-f) was temperature sensitive. We called fed ex and attempted to get the truck turned around (without much success). So I then called the pharmacy to get the true scoop...would my meds actually be okay if I didn't pick them up until 4PM from the fed ex pick-up place? Yes, the gonal-f was actually packed with ice packs and only had to remain room temperature.

So I arrived at fed ex at exactly 4PM and picked up my crate of meds. Okay, maybe not a crate, but to me, the box looked huge...I think that is because I know that all those drugs will be going into my body over a relatively short period of time. Here is a list of the contents:

-LUPRON - this is the drug that will shut down my pituitary gland, and, hence, shut down my ovaries...making them a "clean slate" so to speak. I will take the Lupron via shot once a day starting around Day 22 of my cycle.

-DEXAMETHOSONE - this is a steriod that will help prevent my body from rejecting the embryo (i.e. treating it like an invasion). I will take this via pill and start it the same day I start the Lurpon - around Day 22 of my cycle.

-GONAL-F - this is a stimulation drug of pure FSH which will stimulate multiple eggs to mature. I will take this via shot in the evening starting a few days after my period arrives (about 10 days after I start the Lupron).

-MENOPUR - this is another stimulation drug, only this one is a combination of FSH and LH. I will also take this via shot in the morning starting the same day I start the Gonal-f). So at the height of this process, I will be giving myself 3 shots - one in the stomach and one in each of my thighs.

-NOVAREL - this is HSG and will be given via shot (this is the not fun, inter muscular shot which I will probably have a nurse to give it to me) the night before the retrieval to induce ovulation.

-MEDROL - this is another steriod that I will take via pill the night of the retrival (once a day for 4 days). Its purpose is similar to the dexamethosone - to prevent the body from rejecting the embryo (s).

-TETRACYCLINE- this is an antibiotic that is taken via pill four times a day for four days starting the night of retrival.

-ENDOMETRIN - this is the progestarone suppositories which I will begin a day or two after the retrival and continue for a few weeks...keeping my uterus a viable environment for the embryos.

-VIVELLE - this is estrogen which will be given in the form of a patch. I will begin this about 9 days after the retrival.

So now I sit and wait for this med cocktail to begin. I will go for a P4 test (progesterone test) somewhere around July 27th/28th. This will confirm that I have ovulated. If I have, then I will start the Lupon that night.

22 - Meds Available in Canada? (July 2008)

Because we live so close to the Canadian border, I felt it would be worthwhile to investigate obtaining the fertility drugs from Canada. After studying the US Customs and Border Protection website, I've come to the conclusion (which may or may not be accurate) that purchasing/bringing in meds into the US if prescribed by a US doctor is illegal, however, bringing in meds prescribed by a Canadian doctor is not. I googled "pharmacies and Windsor, Ontario" and started making phone calls. The first three pharmacies I tried didn't carry fertility drugs. The forth pharmacy I called carried all the drugs that I would need, but they would only fill a prescription if that prescription was co-signed by a Canadian doctor (which makes sense considering the US customs policy I had read about). Conveniently, they had a phone number for a doctor that, for a small fee, would co-sign the prescription. I called the doctor, and, sure enough, this was the protocol. I could not make an appointment - it was a walk-in clinic.

So, at this point, I decided that the next step would be to price the meds to see if making a trip to Canada would be financially worth it. I was very surprised - based on the pharmacies that I called (and had the meds), the meds were about 15% more expensive in Canada (of course, factoring in the exchange rate). I then priced several places within the US and was very pleased to discover that the pharmacy the CCRM recommended (Freedom Fertility Drugs) was the cheapest I could find. The process of ordering the meds with this pharmacy is very smooth. CCRM called in my order yesterday and today I will call in my credit card number. We will arrange a time for them to arrive - I will have to be home when they arrive because these drugs are temperature sensitive.

21 - Follow-up phone consultation (July 1st, 2008)

On July 1st, the doctor gave us the results of our ivf work-up over the phone. According to the doctor, the sperm morphology tested the same at CCRM as it did at the University of Michigan (i.e., there is still a morphology problem). This was slightly frustrating and a bit of a surprise - the day after the testing, a CCRM nurse called us and told us that although his sperm morphology was 3% (they like to see 4%), because the rest of the sperm analysis numbers were very good, his sperm was considered "not an issue" (exact words). So prior to this July 1st phone consultation, we were really under the impression that although we would probably continue with IVF, there was a strong possibility that we would not have to do the ICSI procedure (where they inject a single sperm into the egg). The ICSI procedure is about $2500 additional and the sperm aren't given the luxury of fertilizing the egg on their own (which there is some conflicting research about whether or not this ICSI process increases the chances of genetic issues). So the fact that the sperm morphology was still below normal was little bit of a blow, but not a complete surprise....based on the University of Michigan numbers, Dr. Surrey said from our very first phone consultation that we would probably be good candidates for ICSI.

As for me, all my numbers came back fine (which we pretty much knew before we left the work-up) except for my AMH - anti mullerian hormone. This is a new hormone that some clinics are testing (within the last year or so). I have found it very difficult to get a lot of information about this (I asked CCRM and even they couldn't provide me with much additional information). Basically, they think it is an indicator of ovarian reserve and how the patient with respond to the stimulating drugs (low AMH meaning that there is also a low ovarian reserve and less of a response to the drugs). I had an AMH level of .5 and CCRM would like to see an AMH level of 1.0. This is a little confusing to me (and I think actually confusing to the doctor) because all the other hormone testing was fine and I had 18 resting follicles. Needless to say I was (and continue to be) concerned about this AMH number. However, Dr. Surrey assured me that based on the overall picture, we were still good candidates for ivf. The .5 AMH just means that he will put me on a very high protocal of drugs to compensate for any possible difficulties in the stimulation process.

At first, I took the news of this low AMH pretty hard, but the more I thought about it, the more I was grateful that CCRM tests this hormone. If we were going someplace that didn't test this hormone (a lot of places still don't), they probably would have put us on a very low stimulation drug protocal (based on all my other tests), which may not have worked.

So we just got our schedule via email. We start the antibiotic today (doxycycline) and will take it for 10 days. Then it looks like I start the Lupron. I will call the nurse today to see about the next step, which is ordering the meds.

20 - What we learned at the IVF work-up

What we learned at the IVF work-up:

-CCRM deserves to hold the title of #1 fertility clinic in the US. While not all the testing was exactly pleasurable, the day felt more like a day at the spa than a day of infertility testing. The staff was very professional and compassionate - we felt very cared for.

-Check to see if your insurance company will cover any of the testing. Since our insurance is not that great in most cases, we just assumed that they wouldn't cover a dime of the process. We were wrong - they covered 80%. This saved us about $2,000.

-Do not waste your time getting checked for communicable diseases with your regular doctor/obgyn. CCRM requires that these tests are completed on site.

-Don't stress about the shots...I am a big baby when it comes to shots and medical procedures in general, and I found the first set of shots to be painless (and I gave one to myself in the office). The shots that everyone talks about is the second set of shots that are required just prior to implantation (and then continuing for a couple of weeks minimum). These are the inter muscular shots. However, there is another option to these shots - vaginal suppositories...messy, but not a inter muscular shot.

-If they don't offer you a break during the days testing and ask you if you are okay to "push through", tell them that you would like a break. This break (for us) kept the day stress-free.

Now it's just the wait game until our July 1st phone appointment.

19 - Hysteroscopy (June 18th, 2008)

Well, they saved the best for last (not really). The last test of the day was the hysteroscopy. This was different from the hysterosalpingogram (HSG) and the sonohysterogram because those two tests were primarily used to see if my tubes were open by filling the cavity with fluid (either saline or iodine). This test actually use a small scope to look very closely inside the uterus. Prior to this, they also did a "trial transfer". My understanding of this test is that they do it to make sure there aren't going to be any anatomy issues that may hinder a smooth embryo transfer - and if there are, this is their opportunity to figure out those issues.

This test was done by Dr. Surrey, and my husband was not allowed to go into the room. A speculum is used. VENTING MOMENT: I HATE that thing...I seriously believe it is a manifestation of the Devil. After they did the trial transfer, they needed to thread the scope through the cervix. My cervix was too small for them to do this without dilating it - so they numbed, then dilated it. The whole process took about 10 minutes. I must be honest and say that it hurt more than the other two (the HSG and the sonohysterogram), but wasn't unbearable because it was only 10 minutes long. The doctor did not give me the results from this test immediately - he will give them to me when we have our phone consultation. They then gave me a prescription for an antibiotic to take for the following 4 days (along with a coupon to get it for free - it is included in the cost of the days testing) - doxycylcine. Also, no intercourse for 5-7 days if they have to dilate your cervix. Couple that with the 5 days of abstinence prior to the semen analysis....it can be a challenging week following this ivf work-up appointment :-).

With the completion of this test, we had made it though our work-up appointments! I'll tell you - it felt like quite an accomplishment. We were in good spirits in that the first real step for us having a child was complete and successful (as far as we knew at this point). We set up another phone consultation with the doctor for July 1st and went on our way. On July 1st, Dr. Surrey will lay out his recommendation and time frame for the next step in the process.

**Near the end of our appointments, we got a nice surprise. The receptionist discovered that our insurance company, United Health Care, would actually cover 80% of the day's testing (testing only - anything after the work-up would be out of pocket). CCRM had just signed an agreement with United Health Care in May.