Starting Gate

I hope everyone had a wonderful Thanksgiving. My parents came to stay for the week so I was pretty busy visiting. I also ended up with hives! I've never had them or seen them before and I hope I never get them again. I was put on an antibiotic and I think that's what caused the outbreak. Obviously I'm very allergic. I was itchy all day on Thanksgiving and then on Friday, I woke up covered with these huge (quarter size) looking circle-welt things all over my body. They were worse in my warm spots. So my butt was literally covered with tons of these welts that itched like mad. I had them on my thighs, bottom, breasts, face (eyelids and in my ears), even on the palms of my hands...all over pretty much. I called an on-call doctor since my doctors office was closed for the holidays and he confirmed that they were hives and said they usually last up to 6 weeks or even longer. I almost dropped the phone. He put me on Benedryl- 4 pills every 4 hours and I had my Mom and J spray me with that pink calamine lotion constantly. There were times I wanted to scrape my skin off with a knife from the itching... it was miserable. Luckily the doctor was way off on the 6 week time frame and they disappeared almost completely after 3 days. Fun times-

I am still feeling very positive about my new RE...Dr. Z. I had a financial consult and a care coordinator consult early this week. I'll be having a consult with a genetic counselor on Dec 11th. (required) They sent me a very organized binder with everything I need to know. It listed all of the pre-testing that is required from J and I. Since I've already done a lot of testing most of this is blood work. It's a long list of blood tests. Some of the blood has to be shipped to Chicago... those are for the natural killer assay and the antiphospholipid antibody test. The rest can be done locally. They'll be testing for everything from Prolactin, TSH, Cystic Fibrosis, Rubella, Hepatitis, HTLV, VDRL/RPR, ABO/RH, MTHFR, etc... to anti-sperm antibodies, antithroglobullin antibogy, antimicrosomal antibody, and Immunoglobulin IgA (which are all Immunilogical Testing). They also want a day 2 or day 3 FSH and E2 so I'll go and have it all done the same day. I expect my period to arrive early next week so I hope to have all of the blood work mid-to late next week. I really hope my FSH is lower! Say a quick prayer to my pituitary gland so that it can slow down on that FSH production :-) I'll also be driving 4 hours each way to my new clinic for a day 2 or day 3 anteal follicle count w/ Dr. Z. They plan to start me on bcp's at this time in preparation for IVF #1 if all goes accordingly. I'm hoping I can do my b/w on day 2 (isn't FSH lower on day 2 compared to day 3????)or would day 3 be lower?
and then drive up to Dr. Z on day 3. Dr. Z will tell me at that time which protocol he wants me on and I should be assigned some tentative cycle dates.

One negative- Dr. Z uses several infertility meds... he usually had his patients on 80% FSH (such as Gonal-f or Bravelle) and 20% LH (such as Repronex or Pergonal). I really like the Gonal-f pens b/c they're easy and there in no mixing, vials, etc.... well Dr. Z doesn't use the pens...only the vials so I'll have to mix all of my meds, even if I use gonal-f. For some reason he doesn't like the pens and thinks they lead to more errors in dosaging. Oh well- guess I'll have to figure it all out when the time comes- or have J figure it out.

Overall- I'm excited. I'm scared. I'm hopeful. I'm trying to take it one moment at a time.

Hope

**Long post- wanted to get it all down for my records

I held so much anticipation for this consult. I know that this RE (Dr. Z) is highly regarded and many of his patients come to him with two or more previously failed IVF's. All I can say it that I felt real hope for the first time in quite a while. The consult was much better than I had even hoped for. I was so scared that Dr. Z would give me low odds like my past RE (Yeah- PAST RE- that's right...kiss my ass… adios Dr. Hand's off, no more money from me A-hole!)

Not only did he not give me low odds...he actually gave me high odds and he wasn't concerned about my FSH... I was sure that the entire conversation would be about my high FSH and likely crappy eggs. We barely talked about it. Dr Z said that it's more about age than FSH. He said I might have a lower reserve but that he seriously doubted that quality would be an issue. He even said that he thinks we'll be accepted into his shared risk program. He wants to do my FSH test again on my next CD3 and he said if its gone up he'll even let us have an agreement that I'll be allowed into shared risk as long as I produce 8 follicles and reached an estrodiol of 1200 and as you guys know I produced almost that many follies each time I did IUI's and always had an estodiol of more than 1200. His shared risk is different than many I've seen. You pay so much for just one cycle (approx $14,000, and you get 90% back if it doesn't work). Of course this doesn't include ICSI (which we'll need or all of the testing) But- I had completely accepted that we had ZERO chance of doing shared risk with my FSH levels and it looks like we could have a good chance of being accepted. And this shows that Dr. Z has faith in my ability to get pregnant based on the info he has. This is much different than what I was hearing from Dr. A-hole Hands Off.

Dr. Z spent most of the conversation going over our histories. He said he was happy to see that my Endometriosis hadn't gotten worse in the last year and that it looked like a very mild case. (I sent him pictures) He said that a mild case can still cause immune issues that prevent implantation so we'll have to have me tested for all kinds of immune stuff. He's a big believer in immune issues which is still a controversial topic in the medical community. I'll be tested for almost every immune issue you can think of. And all of them can be treated…but some are extremely expense treatments! He also said that my TSH levels (thyroid) are high (came back at 3.8) and wondered why no one pointed this out to me. He said we'd retest them and most likely treat that as well.

He said he'd give me 50% odds of having a take home baby after one IVF and 40% odds with a FET. His clinic has really high FET success rates... Sure sounds better than the 18% quote I was given from Dr. A-Hole Hands Off!!!!!!

He was also very pleased with all of the supplements I've started taking. I now take baby aspirin, a prenatal, lots of fish oil omega 3's (very good for immune issues), flax seed oil, L'Arginine, CoQ-10, Selenium, Bromelain, Evening Primrose Oil, Spirulina, Chlorella, and lots of Wheat Grass (the last three are pretty gross...I take them in pill and liquid form- but they're supposed to help egg quality so I'd take a bath in them if I had to). I have J on a multi vitamin, CoQ-10 and Fer*tility Blend for men. Dr. Z said that these are all very good for reproductive health. He said that Fertility Blend for men is something he recommends for all men. Women should not take Fertility Blend for women b/c it contains herbs that interfere with the infertility medications. He said some herbs are okay as long as your acupuncturist is knowledgeable and knows that you're ttc through IVF.

Dr. Z also said its fine for me to continue working out. He said it wasn't necessary for me to cut out running this past year. He said that once you become "uncomfortable and bloated " from the stims you should cut back and do lower impact athletics but that he thinks working out is good for you physically and emotionally up until ET. That was when we talked about medications for anxiety/depression and he was very supportive of this. He said constant stress/anxiety can cause immune issues as well and lead to reduced pregnancy rates, so you're better off being on something than trying to suffer through it. He said that Zol*oft, Cel*exa and Lex*apro are the three safest anxiety/depression medications for pregnancy (even nursing) that are out there. Looks like I'll be going on a low dose of Zoloft... (I don't think we always even realize just how uptight and anxious/depressed we are) I know I struggle sometimes but even J has pointed out that he thinks I need this b/c he says I always seem tense and anxious lately...

Let's see- what else. Oh... he prefers that we don't do local monitoring. He'd rather see me himself and not rely on someone else's finding. He does all of the u/s's, monitoring, ER and ET's himself. He works 7 days a week, 361 days a year (sort of scary- wouldn't you burn out big time). He only takes 5 days off a year for medical conferences. I guess he's dedicated his life to this and finds it very rewarding. I'm surprised that he is able to do all of this himself and have such high success rates. He does over 350 fresh transfers a year. The clinic is open 365 days a year and everything is done on site- even blood work.

He says we'll do a Long Lupron cycle unless my FSH comes back higher. Then we'll do a micro-flare protocol. We'll do a 5 day transfer if the circumstances allow for it. We'll do ICSI, but not PGD. I'll have to travel quite a bit. He'll expect to see me 5-6 times before ER. I'll have to drive 4 hours each way to his clinic (not looking forward to this part). I plan to commute most of the time unless I have to be there two days in a row. Then I'll stay overnight in a hotel. I’m not looking forward to the many hours in the car but if this works it’ll be well worth it. I'd like to keep the hotel stays to a minimum since we'll be staying up there for ER and ET... (trying to cut back some of the expense *sigh )Guess I should buy some books on tape - any recommendations?

I have a financial consult and a consult with a nurse coordinator early next week. The nurse coordinator will go over all of the testing I need. I will go up there for my CD3 u/s in the beginning of December and Dr Z expects to put me on bcp's soon after that. He estimates that I'll have my ER and ET during the 2nd week of January.

I just can't begin to tell you how kind he was. I immediately felt comfortable with him. I could tell he’d spent a lot of time reading my medical records and it's a pretty big file. I could actually feel my body relax as the consult went on. (I almost always ended up in tears each time I talked to Dr A-Hole Hands Off) Neither J nor I had any reservations about Dr. Z- not one! We plan to cancel the 2nd consult next week and save the $500 consult fee. (I want to hold on to it for a few days just in case I change my mind but I seriously doubt I will) It was such a relief to finally have an RE that was a take-charge type of guy. Dr Z took a lot of time to explain everything and told us what we need to do. He was positive and supportive and exactly the type of RE I need to help me get through this.

I feel hope... what a nice feeling.

Questions for my IVF consults

***okay ladies. I have my first consult tomorrow and then another a week and a half after that. I hope to decide between the two sometime in early December. I'm actually hoping that I'll be so "WOWed" by my first consult that I can cancel the second one (and save the $500 consult fee). This is the list of questions I have so far. I can't wait to say good bye to my current RE. Am I missing anything? Can you think of something else I might want to ask?


Questions for the RE:

Now that you have seen my records what other testing would you like us to do?

Based on the information you have (medical history, past IUI’s) what are our odds for success with IVF?

What type of protocol would you suggest for me? Long Lupron, with or without birth control pills, micro-flare protocol, antagonist protocol?

How do you anticipate that I will respond to the meds? Poor responder, high responder- how does your protocol account for that?

What do I need to go to retrieval? Egg wise and estrogen wise? Can we convert to IUI if there are less than 6 follicles?

What are your requirements for your shared risk and multiple plan packages? Would we be accepted into those plans? When would will we find out if not?

Do you recommend day 3 or day 5 transfer? Which do you normally do?

We would like to do ICSI, but what about assisted hatching? PGD?

Do you do ultrasound-guided transfer? Give valium for transfer?

Are all procedures done on-site at your clinic?

Is the sperm collection done on-site or do we bring in the sample. Is a room provided for collection?

Do you allow acupuncture before and after transfer in the clinic? Can you recommend someone for me to use? How do you feel about herbs?

What are your thoughts about medication for anxiety/depression?

Is it okay to go on long walks/light jogging and do Pilates up until transfer? How else can I prepare? What books would you recommend for reading?

Who do I see for my monitoring? Do you always do the ER and ET?

Can I do local monitoring in the beginning of the cycle? For u/s’s? for b/w? What local monitoring is allowed?

How long will I have to be in XXXXXXX? How many u/s’s are required for one cycle typically?

Are u/s appt times available throughout the day or only in the morning?

What procedures are performed on the weekends?

Are the clinic and lab open 365 days a year?

Can I leave a message for you or e-mail you with questions? How soon on average can I expect a response?

Is there a phone number for off-hours problems?

We would like an itemized price sheet.

When can we expect to start our cycle? (How long will the testing take?)

What do you do from here?

Loooong Recovery-

I am 75% back to normal at this point. It’s been 12 days since my surgery. I have to say that this time around really put me on my ass. I've had a lot of concerns but Dr. Hands off doesn't seem concerned. I've been bleeding this entire time. And we're talking heavy bleeding. Dr. Hands off says it's from the hysteroscopy, not the laparoscopy. So that is why I didn't have this problem during my first lap. Heavy, continuous bleeding is not fun when you're not allowed to use tampons. I am so NOT a pad type of girl. I was expecting my period 7 or so days after my surgery and it came... but it's hard to know when I started since I've been bleeding from the start. So much for having a day 3 FSH test this month. I debated on doing one on what I thought was CD 3, but I finally decided not to put myself through that. I'd like an accurate test for once... and I want a break. A true break before IVF. If I do the FSH test on my estimated CD 3 and it comes back bad again...then I'll be devastated all over again and what good is that. And if it comes back good then I'll figure I screwed up the dates and went in on CD 1 or something. This surgery has already eaten up a good portion of what is supposed to be my off time from cycling and worrying about IF. So- I just want to have my consults this month and do nothing else regarding testing, appts, etc. After my consults I'll get on the ball again. Now that I think about it, my first consult with Big Guns clinic #1 is this Saturday. Our consult with Big Guns #2 is two weeks after that. This break is looking shorter by the moment.

Okay..back to my recovery-
I spent pretty much the first 5 days in bed, the next few on the couch and now I am able to do some chores and my basic daily routine except for the fact that I tire very easily. This is frustrating to me b/c I'm the "can't sit still" type. My parents are coming for 5 days next week and I have a lot to do before they arrive. I tend to over do it when I'm not 100% well, as evidenced by what happened this past weekend.

J and I went to Lowe's to buy a microwave. Ours caught fire internally and the top "inside" was completely melted when we opened it up. I wanted to get out of the house and this seemed like it would be a relatively short trip. When we got to Lowe's we waited forever for someone to help us, and once they did they took forever to find the box of the model we wanted in the back. Once the box was brought out, we opened it up and did some measurements b/c this is a build in Microwave and needs to fit our exact space. It was the perfect size so we should have been on our way, but nope... the saleslady brought out the wrong model. They look the same but are different models. By now I was feeling extremely tired and somewhat dizzy. I was hot and flushed and ready to go home. We waited while they searched for the correct model and I ended up telling J that we needed to leave. We'd been there 2.5 hours. I got up from a chair I was sitting in and had horrible blinding pain in my pelvic region. I doubled over, clutching my stomach and was trying to breath through the pain. At this point I had tears running down my face and couldn't stand so J was supporting me. We were also drawing a crowd to my mortification... in fact a very nice lady with good intentions rushed over and got me a chair. She kept asking me if I was okay and what could she do. J told her I just over did it after having surgery. She then proceeded to say over and over that she had thought I was having a baby. She said she couldn't see me very well since J was holding me up but she saw that I was bent over and it made her think I was about to give birth. She didn't say this once. She said it at least 3 times throughout this ordeal. I would have laughed if I hadn't been in such pain. At one point I told J that I just needed to get out of there. We headed towards the exit and the pain hit me once again. Finally they had J get the car as they wheeled me to the entrance of the store in a wheelchair. I still have no idea what happened or why I had such intense pain. But once we were home I felt much better.

Warning: TMI
Another not so fun aspect has been in the bowel dept. I had my first bowel movement today since my surgery. YES- that's right- 12 days of no action in that area. I was even on stool softeners that my RE told me to take. Does the word toxic come to mind?

So lets just say that I'm glad to be over the worse of this and hope to hell that I don't need a 3rd surgery anytime soon.

Even thought this is my break from ART treatments... I still plan to dig out the OPK's this week... that's right... I will be having sex before I'm officially allowed to b/c I’m going to end up knocked up this month via natural conception just like my good friend Alli for Secondary Infertility. (Congrats Alli!!!) This would make perfect sense too... b/c we'll be committing to a Flexible Spending Acct next week. We're putting in the maximum amount allowed for 2007 so that we can use pre tax dollars for our IVF. Once you commit you're stuck. If you don't use the money for medical needs by the end of the year, then you lose the money. If you're paying out of pocket for you're treatment cycles you should seriously look into this if your company offers it.

Recovering

I had my surgery (laparoscopy, hysteroscopy and HSG) on Friday. Everything went well except for the fact that they had one hell of a time starting an IV on me- I looked like a pin cushion when they finally got one started. It took 3 attempts and I was in tears. *ugh* I've been told that my Endometriosis was mild and my RE was able to remove all of it. They found one small cyst on an ovary and removed that too. Other than that everything looked really good. My uterus looked good- nothing abnormal found in there and my tubes are still clear. So basically my reproductive anatomy is in good shape. Now I can focus all of my worry on my egg quality :-)

I'm having a longer and much rougher recovery this time. For some reason I've been in horrible pain (lots of pain killers needed) and unable to even get up by myself for the last 3 days. I'm thinking I got lucky during my first lap (I was up and about in a day that time and didn't need one pain pill). This time I can feel the gas in my shoulders and under my rib cage. My ribs feel bruised. Every deep breath, hickup, yawn, etc. causes pretty intense discomfort. I've been extremely naucious. I'm finally starting to feel a little better today and can actually sit up for a little while. J's had to take care of everything. I realize just how much I prefer to be the one taking care of him, not vice versa. I'm sure he agrees. LOL

I'll be having another FSH test done on CD3...should be expecting my period in a few days. I was told that my period will be lighter b/c of the surgery so I hope I'm able to figure out which day is cycle day one. Anyone remember if their period was extremely light or just a little lighter? I'm really nervous about this test. I was beyond devastated at the results of the last one. I'm praying the last test results were a little elevated since it was done right after I cycled on meds. So please say a little prayer about my FSH level. I'm just unable to accept that my FSH is abnormal when I'm only 30.

My medical records have been sent off... I'm excited and nervous about my upcoming consults.

I'm planning to have a flu shot this Friday. Can anyone think of a reason why this would be good or bad? I figure it's a good idea since I plan to do IVF during the flu season but I don't want to do anything that could be harmful in any way. And I can't ask the new RE's until I'm an official patient. They are reluctant to answer any medical questions until my consult.

***headed back to bed. Day time TV sucks!

meds anyone?

I've been having a tough time. I'm much better than I was but still have periodic bouts of anxiety. I can usually shake it off with a jog, a bubble bath, meditation, breathing exercise, etc... But there are times that I feel literally ill from the heart racing, shallow breathing, mind racing, and fear that hit me out of the blue. The worst part is that for the past two weeks I wake up in this state. I seriously open my eyes for the first time after waking (still half asleep) and feel tightness in my chest and a pounding/racing heartbeat. It’s frightening and horrible. J has to comfort me b/c I feel like someone died or is about to die. This entire infertility journey is stressful and causes anxiety but this seems to be so much more that a "normal" level. It's almost like my subconscious in now fearful and stressed to the max. SO... my question is meds or no meds? First of all I am reluctant on many levels to take anything. I feel like I should be able to manage it with stress reducing techniques... and I don't want to take anything that could be harmful in any way to my body, for conceiving or to a fetus (I can hope can't I).

But, I realize that this might be bigger than something I can fix on my own. It’s been going on for over 2 weeks now. It's terrifying at times...especially when I wake up with it and I know this can't be good for my body. My whole goal is to take these two months and try to get into a good place mentally, physically, etc before we start IVF #1. If I'm in such a high state of anxiety than that will wear down my body and isn't good at all for conceiving. So- no meds...could hurt my chances of pregnancy if I really need them.

The next question is which med? I was told that they want you to stop any meds before IVF. This only gives me 2 months or so... a lot of drugs take 3 months to reach their full effect, and it's not good to stop them cold turkey. Those types would be pointless. I also worry that I'd take something to stop the anxiety and end up with other side effects, such as weight gain, loss of interest in sex, irritability, etc. Then we have the option meds such as Xan*ax,, Klon*opin, Vall*ium, etc... that you take as needed. I could take one occasionally, when needed, up until the IVF cycle starts.

So... I ask you, are you on any medications for anxiety/depression? What does your RE say about it? Has it helped????? and do you have side effects?


IN OTHER NEWS: I'm having my surgery on Friday (I'll be thinking of you Hopeful Mother). I'm having another laparoscopy. This time they'll actually remove the endometriosis that they found during the last one. I'll also be having a hysteroscopy (where they dilate your cervix, and look inside your uterus with a fiber-optic camera) at the same time... They also plan to do another HSG (dye in the tubes) since they'll already be in there. They'll remove anything they find that shouldn't be there. Whether it's the Endometriosis. lesions, fibroids, cysts, or polyps. Hopefully we'll know exactly where we stand as far as my reproductive anatomy goes. I was surprised at how "serious" they have made this surgery sound compared to my 1st diagnostic lap. I have to shower with medicated antibacterial soap the morning of the shower. I'm not allowed to have any products on my hair, no make-up, no lotion, no nail polish, no jewelry, etc. I can't eat or drink after midnight the night before. NO water? I'm being admitted a few hours before my surgery but my actual surgery isn't until early afternoon. That's a long time for no water at all. Then I was told no sex, no tampons and no baths (I'm a total bath girl) for 25 days. WHAT!?!? yes, that's right. 25 days. Is this for real? Or can I take more like 10 days and then proceed if I feel okay. They are trying to take away my chance for an oops month, :-) of getting pregnant on our own next month before our IVF cycling starts.