Monday, May 30, 2016

Pulling the Trigger Tonight!

Today is Memorial Day, day 11 of stims, and I went in for an early u/s and bw appointment and was told I'd be triggering this evening! Last night I decreased my Gonal-f from 125 IU to 100 IU and kept the Menopur the same; Cetrotide was the same this morning, and I will be triggering tonight with 0.8 cc of Lupron (Leuprolide Acetate).

My estrogen (estradiol) levels were 3606 (Saturday, 5/28/16); 4835 (Sunday, 5/29/16); and 5604 (today, 5/30/16). They are seeing approximately 16-18 large follicles. I'm hoping this will be 18-20 by Wednesday, which is Egg Retrieval (ER) day!

My trigger is scheduled for 9:46pm tonight, and the ER will be exactly 36 hours after this, so 9:45am on Wednesday, 6/1/16. Tomorrow night I will take 2 Azithromycin (500 mg) tablets, and then no food or water after midnight. I am excited about the upcoming ER, and not super nervous or scared yet. I'm sure it will start settling in tomorrow night!

Friday, May 27, 2016

Day 8 of Stims

Stims: Day 8 - 4th morning of Cetrotide (25 mg)
7 nights of Gonal-f (175-150 IU) & Menopur (75-150 IU)
Today is my 8th day of injections. The veins in my arms are a little bruised so blood draws are a bit harder for the phlebotomists. During the u/s, the sonographer found 10 follicles in my left ovary and 14 in my right. She said that I could expect to make appointments for every day this weekend. I keep forgetting that the fertility clinic is open 24/7, because the doctors, nurses, sonographers, etc. need to be ready at any point in time to retrieve eggs and implant embryos! Reminds me of when I worked at an emergency vet hospital all during grad. school. Memorial Day is Monday, and they don't get the day off.

I didn't get a call from my nurse this afternoon so I called the after-hours number and the nurse on-call called me back to tell me that the doctor wants me to decrease the Gonal-f dosage from 150 IU to 125 IU, and to keep the Menopur and Cetrotide doses as is. I have another appointment scheduled for tomorrow morning (Saturday).

David comes tomorrow night, so I am excited. It's been lonely and difficult not having him here, and I know he's been bored at home by himself so hopefully this will make things a little easier. David coming means that the egg retrieval is right around the corner! We don't have the date set yet, but it should be some time next week!

Thursday, May 26, 2016

Alcohol and Caffeine

My nurse told me that during stims, "the recommendation for caffeine intake is less than 600 mg" per day and that restricting "all caffeine intake is preferred." She also said that "no alcohol intake is preferred/recommended." I checked and she said that it would be okay to drink caffeine-free Diet Coke and decaf coffee. 

I was a little worried the other night because I read online that "research into alcohol consumption among couples being treated at a fertility clinic found fewer successful pregnancies when the women drank several glasses of wine a week, or the man had a daily beer" (The Guardian, 2009). Another article said that "drinking as little as three small glasses of wine a week could reduce a woman's chances of conceiving by two thirds over a 3-year period," and that "given that egg and sperm maturation takes up to 3 months, it is ideal to stop/reduce alcohol consumption for at least three months before attempting pregnancy" (RSCBA, 2013).

This freaked me out. I had been drinking the occasional glass of wine up until the night before stims, and I know David has had the occasional beer as usual. The doctor and nurse never told us to cut out alcohol prior to treatment. I sent my nurse a panicked email, and she responded the next day with "Not to worry. An occasional glass of wine or beers here and there will not make a significant impact on your IVF cycle or on the sperm." Phew!

I also posted to an IVF message board, and received some encouraging responses that brought me some relief:

  • "My nurse told me that I was allowed one glass of wine each night during stims, but I did not partake. I only stopped drinking the day before my first stim shot. I have also been told that 1 drink with caffeine per day is ok...I am still in my two week wait, so I don't know if my cycle worked or not yet, but I wouldn't stress too much about it. Nothing you can do to change it now unless you want to wait 3 more months before you start."
  • "I drank on a regular basis leading up to stims (I'm a one drink per day kinda gal, plus several drinks per day on weekends). I did absolutely abstain during stims though."
  • "We did IVF beginning of January so lots of holiday parties, New Years, both our birthdays in January etc. I got 9 blasts out of 14 eggs and am 19 weeks with a healthy little boy. You know what is worse than the beer and wine you've had... Stress. Don't worry what is done is done and many of us have had a glass or more to get thru this difficult time. You absolutely have not ruined anything!!! I would have him stop drinking by the trigger shot for the fresh sample however. Best of luck! Enjoy that glass now cause you may end up not having one for a long time if you're lucky :)"
  • "I drank up until the day before starting my IVF cycle. I now have a 4 month old. Don't stress about it :)"
  • "This is because it takes eggs and sperm about 3 months to develop. In the 3 months prior to IVF you are both producing the eggs and sperm that will ultimately be used to create your embryos. Technically, anything you do during this time period can have an impact on your eggs and sperm. There are lots of recommendations involving diet, alcohol, supplements and even the avoidance of BPA or other environmental toxins. It's impossible to do everything perfectly and it sounds like you've only had a moderate amount of alcohol anyway! I didn't prepare at all for my first IVF cycle. I had 1 or 2 drinks a day up until 3 weeks before retrieval. It worked for me and many people are successful with IVF without having to prepare at all. I'll be 2 years older (35) for my next IVF cycle and that scares me so I am preparing this time, including drastically reducing alcohol."
I think that it wouldn't hurt to reduce or eliminate alcohol and caffeine in the 3 months prior to IVF (for both you and your husband), but that ultimately, it is not going to drastically compromise your chances. I think that had I known this information prior to starting, I would have cut out alcohol and reduced my caffeine intake starting in March...but since I didn't know this, I'm not going to stress about it. As Plautus said, "Factum est illud; fieri infectum non potest." Done is done; it cannot be made undone.

Day 7 of Stims

Top: Gonal-f
Bottom: Cetrotide in its "Lunchables" pack
I started stims on Friday (5/20/16), had a check up on Monday (5/23/16), and again yesterday (5/25/16). On Monday, during the u/s, the sonographer found 9 follicles in my right ovary and 10 in my left, and was able to measure a number of them that were 10+ mm. That afternoon, my nurse called and told me that they were surprised to see how quickly I was progressing (she assured me this was "a good problem to have") and that the doctor wanted to dial back on my Gonal-f (from 175 IU to 150 IU), to increase my Menopur (from 75 IU to 150 IU) and to add in a morning injection of Cetrotide (0.25 mg). My estrogen (estradiol) level was at 109 pg/ml. Yesterday, the u/s showed that more follicles were enlarging, and when my nurse called she said that my estrogen level was now at 781 pg/ml. My next appointment is tomorrow (Friday, 5/27/16).
Stims: Day 6 - 2nd morning of Cetrotide (25 mg),
5 nights of Gonal-f (175-150 IU) & Menopur (75-150 IU)
Starting Cetrotide
I was a little nervous to inject the Cetrotide, as I've heard it also burns and can cause an itchy rash at the injection site, but I found it to be pretty unremarkable. It is refrigerated, and comes in its own little "Lunchables" style pack, with syringe pre-filled with sterile water, powder vial, and alcohol swabs--I like how convenient this is. My only problem with it is getting all of the powdered medicine to dissolve completely. The injection itself didn't burn for me and only itched a tiny bit the first day, but nothing like a mosquito bite or anything. I did bruise at the first injection site. This morning when I did the injection, I accidentally stabbed my middle finger as the needle bent and went through the cap. I'm not sure if it was the throbbing pain in my finger or the medicine, but I got super nauseated and dizzy, and it was all I could do to rifle through my parents' bathroom drawers to find some Neosporin before I passed out. Luckily, I just barely made it to my bed before falling over. It was a rough morning.

The trigger
I got some good news from my nurse. I have been a little anxious about my upcoming trigger injection, as most of what I've read has stated that they need to be injected intramuscularly (i.e., in the butt muscle). We were prepared to hire a nurse who would be on call for 3 consecutive evenings (cost ~$125-$175) to come give me the injection, which could very well be in the middle of the night. My nurse told me that all my medications including the trigger injection will be given subcutaneously in my abdomen. She explained that there are 2 types of trigger injections: Lupron and HCG. "The reason why some physicians use one over the other is the mechanism of the trigger. For those patients who have a lot of follicles or are at risk for developing ovarian hyperstimulation syndrome (OHSS), you would use the Lupron, as this medication is in your system for a short amount of time. The HCG trigger is for the patient who will have an average response to the stimulation medication as the HCG medication is in the system longer." So I don't need to hire a nurse, and I can do the trigger injection myself!

I was told I could continue my normal cardio and strength training during the early stages of injections (days 1-5), but by day 6, I would want to decrease the intensity and focus on non-impact exercises (yoga, light elliptical, swimming, etc.). Yesterday was day 6, so I took Noah for a 2 mile walk. Today I am going to do the same, but also hit the gym for a light elliptical workout (decreased intensity/time). I did an entire week's worth of cardio/strength from Saturday-Tuesday, so I was at least able to get that in...but it's going to kill me a little to not be able to do strength training as usual. Oh well...I'll live.
Mickey Collector's Series Band-Aids

Little treats
I've decided to reward myself after my nightly injections with a little treat: popsicles. I am loving these little Outshine Fruit Bars. They're only 35-45 calories a pop (ha!). I also got some Mickey Band-Aids, because who doesn't love Mickey? Little things like that, walking the dog, and working out, have helped keep me sane. I've been getting daily headaches which I am able to treat (for the most part) with Extra Strength Tylenol, lots of water, and naps...I've been taking lots and lots of naps!

Saturday, May 21, 2016

1st and 2nd night of Stims

I did it. I gave myself 2 injections last night.

Last night I went to see my friend, Vince, play a show in WV, and then left early to get home before 10:00pm to give myself my first injections. My mom was by my side, but I insisted on doing everything myself.

Currently, I am taking 175 IU of Gonal-f and 75 IU of Menopur. Gonal-f is refrigerated, and can come in the Redi-ject pen, which is a disposable, pre-filled, and ready-to-use. You just dial your dosage, screw on the needle, and inject. Gonal-f (Gonadotropin FSH) is a follicle stimulating hormone that basically makes multiple follicles (cysts containing eggs), and causes multiple eggs to grow to a mature size. The Menopur needs to be reconstituted with sodium chloride solution (sterile water). Then you draw it up in a syringe from the vial and inject it. Menopur has 2 kinds of hormonal activity: FSH (which helps increase egg production, like Gonal-f) and LH activity (which assists with ovulation).

I did the Gonal-f first, because I knew the Menopur was going to sting. I will say that both needles were small and did not really hurt that much going in. The Gonal-f does not sting, but the pen trigger bothers me because I'm not able to watch as the medicine goes in, the way you can with a regular syringe. Mixing the Menopur is an art form, and I had to watch the instructional videos several times. It's really hard to get every drop of medicine out of those vials into the syringe. The Menopur does sting, and it seems to sting more toward the end. It's not unbearable, it's just uncomfortable. 

Left: Look how cute this little Sharps container is!
Right: The Menopur comes with vials of sodium chloride solution you use for reconstitution.
Last night, I felt good after my injections and I was really proud of myself. Today I am feeling a little depressed realizing I'll be doing this everyday (and eventually twice a day) for a couple weeks. I really cannot imagine doing multiple rounds of IVF. There is so much involved!

I think the hardest part, for me, is the isolation. This is a very lonely process, especially with my husband and friends nearly 2,200 miles away. Since we haven't told many people, I can't really post about anything on social media, which is hard. I am one of those people that really thrives on the support and encouragement received from others on social media...and since I can't really talk about my experience, I am relying on the support and encouragement of the few people that know about it...and of course, most everyone is super busy and preoccupied with their own lives, so I don't want to trouble them with my woes.

Right now I really just want to lie on my couch under my favorite blanket, snuggle my Golden Retriever, watch a cheesy Lifetime movie, and cry. Part of me wants to tell everyone, "Hey, this is what I'm doing. Look how brave I am giving myself injections every night. I'm doing this so that maybe we can have a baby. This. Really. Sucks." But I can't. 

So instead, I am trying my best to stay sane...I'm working out as much as I can within the restrictions I've been given. Under doctor's orders, I've eliminated alcohol and caffeine from my diet, and the only painkillers I can take are Extra Strength Tylenol (meaning my normal go-to for headaches, Advil, is out.) 

This is going to be a long couple of weeks...

Tuesday, May 17, 2016

Baseline Appointment & Starting Stims

I finished my birth control pills yesterday, so today was my baseline appointment at the clinic. They drew my blood and then did a (vaginal) ultrasound (u/s) to check the follicles in my ovaries. The doctor said that my uterine lining is thin (as expected) and although it took them awhile to find my left ovary (which was hiding), all my follicles look evenly sized, which is good.

My nurse called this afternoon and said my bloodwork (bw) and u/s results look good, so I should begin my stimulation (stim) injections on Friday. I will start with 2 injections in the evening only (Gonal-f and Menopur) and then they will do more bw and another u/s on Monday, and then again on Wednesday. 

I am super nervous about giving myself the injections. My parents have offered to do them for me, and my mom also has a friend (former nurse) who has offered to help, but I feel like I need to suck it up and learn how to do it myself (at least the subcutaneous injections). Even though I'm only doing them once in the evening now, I may eventually need to do them twice a day, and it's likely I will have to give them to myself at some point. I've read that the Menopur stings, so I'm apprehensive about that. I had to give subcutaneous injections to my dog before, so hopefully I can learn to do it to myself too.

I asked the doctor and nurse if I can continue working out, and they both said that moderate exercise should be okay. Hopefully that will help keep me busy and my mind from worrying!


I saw this IVF baby announcement in the headlines yesterday. I read the article because it is relevant to me, gasped at the number of injections (since I begin stims Friday), and then made the mistake of reading some of the comments.

The majority of the commentary is supportive and positive, but there are a few comments that are extremely ignorant and downright mean. I mean, it's the Internet after all; what do I expect?

I thought I'd post some of those comments here, post some of the meaningful responses to them, and address some of them myself. 

"Maybe you just aren't meant to have kids..."

There seems to be many comments like this one pointing out that this woman "wasn't meant to have kids" because her body was obviously telling her not to. This frustrates me because people often assume that infertility is always a woman's issue--it's not. "Infertility is often believed to be a woman's problem. However, studies indicate that 30% of infertility is related to male factor problems such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders" (RESOLVE, 2016). This hits particularly close to home given our particular situation. I particularly like Galyna's response to Marcus.

"If you have the money to do IVF, why don't you adopt?"

This is another common one. My response is that not everyone is called to adopt. Adoption, just like IVF, isn't for why do people who can afford IVF (and are considering it) have to be the only ones to consider adoption? There are plenty of "privileged" fertile people out there that "should" consider it too. Many argue that adoption is "free" or "cheaper" than IVF through the foster care system, but why doesn't that pressure fall on everyone else too, not just people who choose to try IVF? There are also many that are able to afford IVF because of their insurance, but may no be able to afford adoption.

Not all adoptions are free. According to American Adoptions, the average total cost of adopting through a domestic adoption agency is $39,966 (including agency fees, legal fees, birth mother expenses, and advertising/networking). International adoption averaged $36,338 in China, $45,960 in Ethiopia, and $40,067 in Ukraine from 2012-2013. Going through your state's foster care system is "the least expensive method" but again, "foster care adoption is not for everyone and presents it's share of challenges to adoptive families." There are also home study fees, attorney fees, and travel expenses involved. 

Adoption itself can be a controversial topic with people criticizing those who choose to adopt internationally vs. domestically, or those who prefer to go through a private agency vs. their state's foster care system. Again, I think people can be overly critical and judgmental. I think most couples think long and hard about what they feel led to do, and what they feel is best for their family and given situation. My husband actually has 2 adopted siblings, we have many friends who are adopted, and we know many that have adopted or are in the process of adopting. I think this is great. I also don't think we would never consider adopting, but we have decided we want to try IVF at this point in time. This is our choice and our decision. 

I've also heard many stories where foster care and adoption ended in devastating heartbreak. There may be so much more to why a couple has chosen to try IVF instead of adoption, and vice versa. The thing is, you don't know their particular situation, so don't make hasty judgments! Some friends of ours have been going through the international adoption process for 3 years, and it will probably be another year before they are able to bring their child home. This has been a long and frustrating experience for them.

I love some of these responses:

"This cant be healthy..."

This is a legitimate concern. There are many drugs and hormones involved with the IVF procedure, as well as many of the other non-IVF fertility procedures. Calling IVF "Frankensteinish" is a little brash, but I can understand why. People wonder how IVF affects the mother as well as the baby. I think that most couples going through IVF do a lot of thinking and research, and seriously weigh the risks and benefits before jumping in. The truth is that 1978 (the first IVF pregnancy) is not that long ago, and more research remains to be done. I will say that I know several people who have healthy, intelligent children as a result of IVF. In fact, one of my students this year was an IVF baby, and she was at the top of the class. I also know that there may be future health risks involved. However, again, I weighed the risks and benefits just like I do when I take any new medication or vaccine, and I decided that the benefits outweighed the risks in our case.


The majority of the comments were positive and encouraging. It's nice to see people be happy for and kind towards others. 

I will admit I was a little hurt when I read some of the negative comments posted on the Yahoo! version of this story, and I made the mistake of reading some of the corresponding FB and comments, but my mom made me feel better about the situation. She reminded me of the many Internet trolls that have nothing better to do than to post controversial comments to get others riled up. She also reminded me that my decision to try IVF was between me, my husband, and God, and that it was no one else's business but ours.

We still haven't told anyone beyond our parents and a few close friends about our choice to try IVF. I honestly don't know what people will say, how they will react, or if they will support our decision. I admit I'm a bit nervous about it...but right now I am focusing on the task ahead--mainly, starting my stims injections in a few days--and we will cross that bridge when the time comes. 

My point in writing this post is to encourage you to not to let others get you down. Remember that some people are naive, some people are ignorant, and some people are just downright mean...but the majority of people are kind, encouraging, and supportive. Focus on the comments and well wishes of those people, and don't let the trolls and ugly hearts get you down!

Wednesday, May 11, 2016

Mother's Day

Sunday was Mother's Day. This is a joyous day for some, but difficult for others. All over social media, people start posting Mother's Day memes, photos of themselves with their mothers, their grandmothers, their kids...but what about those who have lost a mother, lost a child, or grieve the child they cannot have? It's easy to become bitter, calloused, and upset.

The most important thing is to know that it's okay to feel that way. It is understandable that given your situation, you might not want to celebrate Mother's Day. It is understandable that all the memes and posts and photos and words of others remind you of your loss, which may remind you of your pain.

What can you do? Well for starters, if you are reading this, and you never thought about how Mother's Day may be hard for some, then I invite you to just be conscious of this. That doesn't mean you shouldn't celebrate Mother's Day, but it may be that you are just more sensitive around those who may not enjoy Mother's Day. Perhaps you can adjust the privacy settings of your social media posts so as not to include those who may be hurt by your posts. 

If you're sad on Mother's Day and you know it's going to upset you when you scroll through your social media feed, make it a point to avoid social media on this day. Spend time with someone who may understand your pain or grief. Do something special for yourself. Most importantly, don't hold it against others. Know that those who unknowingly wish you a Happy Mother's Day, or those who are celebrating their mothers or motherhood, are not doing it maliciously, and are not doing it to hurt you. Unless they have gone through the pain of infertility or the pain of losing a mother or child, they are likely unaware of the sadness that a day like this can cause.

Love it or hate it, don't let Mother's Day define you. You are you, and you are worthy and valuable and loved.

Tuesday, May 3, 2016

Everyone is Pregnant but Me

I both love and hate social media at the same time. It's a great way to stay in touch with friends and family and to feel connected to them even when you're miles apart...but it's also a breeding ground for jealousy. Women often struggle with comparing themselves to others, and it's very difficult not to do so when we're constantly seeing the highlight reels in each others' lives.

It's especially hard when you're struggling with infertility and it seems like everyone on social media is posting pregnancy announcements, baby bump shots, and newborn photos. As Kristen Dalton Wolfe said, "social media doesn't make staying pure-hearted easy." 

I watched several of my friends suffer from infertility before I even thought about having kids myself. I could feel their sadness when they saw everyone around them getting pregnant. I know that social media contributed to this. In February of this year, no less than 6 of my friends announced their pregnancies, including one of my best friends (her first) and my sister-in-law (her 4th). I realized at this time how easy it would be for me to feel jealous and horrible about myself...but I think that the years of watching my friends in pain have prepared my heart in some ways.

It is so easy to look at someone else's happiness in life and summon up feelings of envy, rivalry, and malice...but I have found that if you look at this person's life and evoke genuine feelings of joy and gladness, that you in turn recognize the blessings and grace within your own life. This is what brings forth true feelings of contentedness, fulfillment, and ultimately, satisfaction.

This doesn't mean that you shouldn't ever feel sad, upset, or envious. We are human after all, and infertility is not a pleasant thing! However, there are things we can do and precautions we can take to protect our hearts and souls. If Facebook or Instagram are making you sad, do something about it. Take a hiatus from social media, or temporarily unfollow the friends whose lives are evoking these negative feelings. Find comfort and solace in a safe place--maybe your husband, mom, best friend, or a network of other women who are going through the same thing. Do something that makes you feel good--get a pedicure, take your dogs for a walk, work out, read your Bible--this is a chance to do something good (and healthy!) for yourself while also giving your mind a break. Last but not least, it's okay to cry. It's okay to stay in bed sometimes, to cry and scream into your pillow, to have a glass of wine...we can't be put-together, strong, and perfect all the time. And hey, your pregnant friends can't have that glass of wine! ;)

Every time I'm on social media and I start feeling myself get that tinge of jealousy or start summoning up feelings of resentment, I try to do something to better myself. I go to the gym and have a really good workout, or I think about something positive in my life that makes me feel good about myself. Soon those negative feelings start to dissipate, and eventually I even find them turning into true feelings of happiness and gladness for others.

Sunday, May 1, 2016

The Phone Call

David and I had only been trying to conceive for a month when we got our diagnosis. When I told my OB/GYN that we were trying, she suggested that David have a SA done, due to his medical history. The urologist ordered the SA as well as some other tests. One afternoon after coming home from work, I got that phone call from my husband. His doctor had just given him some devastating news after reviewing the lab results. I hung up on him.

I spent the next 3-4 hours making phone call after phone call, calling doctor after doctor. It had been so long since I had felt this way: hopeless, disconsolate, heartbroken. I didn't know what to do, nor where to turn.

I can name at least 6 friends who are currently suffering from infertility, some of it unexplained. Many have been trying for years. My heart goes out to them. Here we were, trying for a mere few weeks, and we already knew it wasn't going to happen. In some ways, that phone call became a blessing. Instead of trying for years to no avail, we know what we are up against and we know what we have to do. This is not at all the path we had planned, and it is going to be a long and scary journey. Almost every day, I feel guilty that we even have this opportunity...but my mom said something so comforting to me: she told me that we were given this opportunity and we should take it...that we shouldn't feel guilty because we were blessed with the chance to give this a try. 

If you haven't seen a doctor yet...
For those of you who have been trying to conceive and are losing hope, I highly recommend that you speak to your OB/GYN or urologist and have some testing done. It may seem expensive up front, but it can save you months of frustration. I would suggest first having a SA done (by a clinic or lab). The reason I suggest a lab (vs. an at-home test) is because the lab is able to look for things like sperm count, motility, velocity, morphology, volume, and liquefaction. While at-home tests measure sperm count, this is only one factor in a man's fertility. A normal sperm count may not necessarily indicate if you are fertile or not. Home tests only determine concentration, and do not measure other import factors, many common causes which are missed with these at-home tests. Having the male partner tested with an SA is going to be less invasive and less expensive than having the woman tested first. 

If the SA results are normal, I suggest moving on to the next step: having the female partner tested. Again, if infertility is not covered by your insurance, this may seem expensive, but in the end, it may save you much frustration. Your doctor may recommend an HSG, which can diagnose fallopian tube blockages and uterus defects. Another test is a transvaginal ultrasound, where the doctor can view images of the ovaries and uterus and determine if there are any follicles in the ovaries. These 2-3 tests may just give you the answers you are looking for, and help determine what further routes (if any) you want to pursue next. And if you don't want to pursue anything further, that's okay too.

I am so glad I spoke to my OB/GYN and she suggested we have the SA done. I am also thankful my husband's urologist ordered further tests. Doing this so early in the game has saved us months (if not years) of frustration, and though we received some heartbreaking news, we are blessed to have the opportunity to move forward.