More on IVF

March 28, 2008

Hola friendly readers! Sorry for the long delay between posts. Nothing has been happening! (Well, that’s not true. We went to see this Wednesday night–spectacular! Also, my period started on Wednesday, and I went back to a 28-day cycle this time: no idea why, but I like it. And I’ve been doing some cool professional stuff. I gave a talk on my book at a university the next state over, and just found out that I got accepted to present at a major conference in my field that’s taking place out west this October. Which is cool, because my acceptance was a real long shot. But mostly, nothing has been happening)

Anyway, our IVF orientation class was yesterday. It was informative–surprisingly so, since I went in feeling like I already had a pretty good overview of the process–but the nurse who gave the class had a very bizarre teaching style. She. talked. really. really. slowly. and. repeated. everything. twice. So, she. talked. extremely. slowly. and. said. everything. a. second. time. Imagine a class about treatment protocols, medication-mixing and injection mastery with every piece of information–and I mean EVERY piece of information–delivered just like that. The good: it was nearly impossible to miss anything or get confused, because if you somehow didn’t catch her super-slow and carefully enunciated version the first time, you would surely get it the second go-round. Bad: we had to listen to her super-slow, carefully enunciated instructions for three hours with only one ten-minute break.

Afterwards, G and I talked privately to another nurse about the urologist issue (we still have not gotten G an appointment–all the names Dr. No-Nonsense gave us have turned out not to accept his insurance, and are booked well into the summer anyway). She said that there was no problem with us going ahead with an IVF cycle without yet having seen a urologist. According to the nurse, the issue of finding out why G’s numbers are low is more a health issue for him than an obstacle to us going forward. Since G has adequate sperm to do a cycle, the urologist is more about following up than about needing to fix a problem before proceeding. This is good news, but there is some even better news.And that news is: before this morning, I was thinking we might have to pay completely out of pocket for the medications, but no! We don’t! I feel very, very lucky. I’ve already mentioned here, I think, that Aetna does not cover injectible fertility meds. Before the class yesterday I had not allowed this to worry me, in part because my prescription drug coverage does not go through Aetna anyway–any and all prescriptions I need, typically, are paid for by the faculty/staff union’s drug plan. Cool! BUT, after further research, it appeared that this union plan did not cover any fertility meds. Crap! BUT, after even more research, it appeared that the union plan also excluded any and all injectible meds, and instead those are covered by another plan, paid for not by the union, but by an entirely different organ of my employer. Since IVF meds are by and large injectible drugs, this third plan is the place to go for such drugs. Cool! Still, last night the website indicated that while yes, I have some sort of coverage through this plan, “plan details are not available online.” Crap! But I made the call this morning, and good news: we must pay a $100 deductible, plus anywhere from $10 to $45 in co-pays per medication, depending on whether the drug prescribed is a brand name or not, but we do NOT have to pay everything ourselves. COOL!

This is really good news, because at the class yesterday, the nurse said that meds for one cycle can cost upwards of $5,000. Whoa. We certainly don’t have that kind of cash on hand, especially right now, with the tax man knocking.

Apropos of that, I have also been thinking a bit about timing. Yes, I know I have already vowed NOT to try and “time” our journey into IVF, and that is still true, but after learning more about the typical protocol, I have been thinking hard not about the best possible due date, but about when a good time actually to cycle will be. The first two weeks or so of the process, the Lupron phase, don’t require too much monitoring, but once the ovarian stimulation gets underway, there’s daily or every other day monitoring, which means getting from our apartment in Queens to the clinic in Manhattan VERY early in the morning (as in, getting up, showered, dressed, and out of the house by 6:30 or 7:00am). Not to mention, they recommend taking the day of retrieval completely off of work. It all seems like something that should happen after classes are over, or pretty close to the end of the semester.

We’ll see. I’m thinking maybe a cycle starting on day 2 of my next period, which should be around April 22nd. To play it completely safe, it might even be better to wait until day 21 of that cycle, which will be around May 11th (the last day of classes for me is May 14th). I will keep you all posted. For now, G and I have to track down our consent forms and have them signed and notarized. Idiotically, we managed to forget to sign them in front of a clinic staff member while we were both there yesterday! I guess the nurse’s endless repetition didn’t work so well after all.

RE update

March 21, 2008

Hi again!

So, the meeting yesterday with Dr. No-Nonsense went very well, as did G’s repeat SA–his numbers, while still low, were better this time. Last time his concentration was 1.5 million per ml, and this time it was 6 million per ml. I’m not sure, yet, what his total volume was (“normal” volume is at least 2 ml, and last time G’s volume was twice that, at 4 ml), but assuming it was at least 2 ml, that makes his total count at least 12 million, more than double last time’s total count. Yay! Dr. No-Nonsense attributes this to the longer abstinence time–five days instead of three–before the second test. She suggested that when we do the actual IVF cycle we should shoot for that, so his count will be as high as possible going in.

Dr. N-N also said ICSI, in which the best and brightest sperm are hand-selected and injected into the eggs, will be a definite for us. She explained the whole IVF process: two weeks of Lupron to suppress the normal cycle, eight to ten days of Gonadotropins to stimulate egg production, and then egg retrieval, fertilization via ICSI, and then transfer back into my uterus after either three days or five days, in hopes that one or two of the fertilized eggs will implant. She said in someone my age they are likely only to transfer two fertilized eggs, which would put twins risk at 25%. I thought, but didn’t say, that I see that number as a “chance,” not a “risk,” as I still sort of would like to have twins. I know I’m probably being naive about that, though.

I did ask about day-3 versus day-5 transfer, and she said they have good results with both; pregnancy rates for day-5 are somewhat higher, but that I shouldn’t stress out if we ended up doing day-3. We also talked, briefly, about cryopreservation of embryos–she said the clinic only freezes embryos if they are of extremely good quality, but that if we ended up with even a couple of extra that met these quality standards, she highly recommended that we grant permission to the clinic to freeze them. FET cycles cost less, are less invasive, and because quality is so important to the clinic, their pregnancy rates on FETs are almost as high as those on new IVF cycles. So that could be good news if we want a second child a couple of years down the road.

As far as downsides, we talked a bit about OHSS, which she said she doubted would be an issue for me because I don’t have PCOS and I do ovulate regularly, so I have average rather than unusually large egg reserves. But she said this was still a slim possibility, and to be aware of it as a reason for cycle cancellation. We also talked about the reverse, under-responding, and why we might have to cancel a cycle as a result of that–she also said she suspected this would not be an issue, because of my young age, but we should be aware sometimes happens. Basically, she first let us know some of the things that could go wrong, before saying that she actually thought our prognosis very good. Why? Well, I’m young, my eggs are young, and G has at least some good sperm to work with. She actually said that she is “optimistic,” which has me pretty excited!

Now G has to make an appointment with a urologist, because she said that while there are a lot of potentially unworkable genetic reasons for low sperm count, there are also short-term fixable things, like hypothyroidism, and it might make sense to hold off on IVF if his issue is something like that. Honestly, I don’t know what that means in terms of our timetable; the urologist that Dr. N-N recommended happens to be on vacation this week, so I’m not sure when we’ll hear from his office on getting an appointment, and I’m not sure what G’s diagnosis, ultimately, will be. Still, the impression I got was that we could start a cycle as soon as we wanted after taking the IVF class next week. My only concern with going ahead before having the urologist weigh in is that if G’s sperm count issue is caused by something treatable, and Aetna got wind of it, there might be some question as to whether IVF should be covered for us or not. I definitely don’t want to start down this expensive road, only to find out that my insurance isn’t covering us after all!

So we’ll see. Either way, though, I’m pretty psyched about our ultimate prognosis being good. There *may* just be a pregnancy and a baby at the end of this for us after all. Woot!

Tomorrow!

March 19, 2008

Drive-by post to say that G and I are meeting with the RE tomorrow! G is also repeating his SA, the process of which he has described, in terms that are somewhat politically incorrect, as “like an Indian burn” on his, um, you-know. I guess because of the lack of lubrication? Ye-ouch. Sorry, dude.

For some reason (in spite of G’s upcoming discomfort) I am super-excited to sit down and talk to Dr. No-Nonsense about our next steps. She’s a great RE, or has been so far. I really like her practical and calm bedside manner. I actually talked to her today, because she called to tell me the results of my follow-up blood test. Definitely negative for sickle-cell, and no other related hereditary issues, but she said I am anemic–my red blood cell count is around 32.8%, and they like to see it at least at 35% (according to Wikipedia, 38% is even better). So she recommended that I check in with my primary care physician about it. Sigh.

Anemia has been a problem for me over the years, and now that I’ve been off the Pill for a while and my periods are back to being super heavy, I’m not surprised that the situation has worsened again. I suspect that I’m going to get put back on some kind of awful iron supplement, as my daily multivitamin is clearly not doing its job. Hmmm. Maybe I’ll try to look at this as preparation for taking all of those big prenatal vitamins. 🙂

More on all of the things we learn at tomorrow’s appointment in my next post, which hopefully will be on Friday…

Sorry it’s been so long since I updated! There’s really nothing new to report, which is why I haven’t been posting. Well, that, and the fact that I’ve been crazy busy at work. I had an article revision due by March 15, two overlapping batches of papers to grade (poor planning on my part with that one!), and a couple of long novels to reread for my classes. It’s been a little overwhelming, but still better than last month.

Now, thankfully, I just submitted the revised article to my editors today (whew), so that’s a huge load off. Plus, next week will be light on teaching duties, because it’s midterm time for my undergraduates. And the book I need to read for my graduate students? It’s the same book that my recently-submitted article was about! So I feel fairly caught up on that, even though I do plan to reread it quickly this weekend.

Anyway, blah blah blah. There IS one other thing that has changed; I found out that I will be going on sabbatical this fall. Yay! This is good for many reasons–the main one being that no matter what, I will now have uninterrupted time to work on my second book before bringing a new baby into our family. No teaching for basically eight months, all time that I hope to devote to the new manuscript. Which is good, because I have a lot to get done on that project–mostly reading and researching, at this point. Although I hope to get at least one chapter/article written while I am on leave, I probably won’t be ready to produce anything truly substantial, like an introduction, until early 2009. Luckily, the fall of 2009 is when I’m supposed to take the second half of my sabbatical. Ideally, that will be the time to finish up the writing.

Of course, by then we just may have a baby in the house (at least I hope so!). I’m going to try and stay flexible and not freak myself out too much about what that ultimately will mean, career- and bookwise. I know it will all work out. One thing I do NOT want to do is rush this new book, just because I have other things going on in my life, including our IVF plans. This book has the potential to be a major step for me, professionally, if I give it the time it needs to develop, and give myself the time I need really to think through the ideas I’m trying to parse. So I don’t want to rush myself too much–I know I’m not going to be anywhere near finished with the book by December 2008, even if I have a much better sense of where it is going. And that is okay, because I want to give myself the time I need to produce a second book that I can be proud of.

Similarly, I don’t want to constrain or otherwise try to “time” or control our IVF efforts, with any professional obligations in mind. I have realized, since my last post (and thank you all, as always, for your wonderful, reassuring comments) that this process is not in my control. And, further, even if I try to control it, there are many things I simply cannot foresee. I could get pregnant right away and have an easy, uneventful pregnancy that allows me to work happily through my ninth month. I hope that happens. But I know that I also could have bad morning sickness, or just be too exhausted to get much work done, or end up on bed rest, or any number of things that would still mean a healthy baby at the end, but might make the actual pregnancy not so easy and work-friendly. There’s no way to know. Worrying about it now is only going to stress me out and make an emotional process even more difficult.

So instead, I am trying to have faith. Faith in the idea that G and I ARE going to be parents, sometime soon, and that when we do cross that bridge, we ARE going to figure out a healthy and manageable way to handle the details–financial, professional, and personal. I know that the universe wants that for us, and the universe is going to help us make it happen.

I really do think that everything happens for a reason, and that our path to parenthood is ultimately going to work out, as is my path to a second book and, eventually, full professor (not to mention G’s path to a better, less stressful administrative position and/or a better, more lucrative clinical practice). Maybe this odd line I feel myself to be walking, between growing my career via the “birth” of this book and growing our household via IVF and a very much hoped-for future pregnancy, is an early introduction to the tricky process of balancing work and family, something I haven’t really had to deal with much before now. (G is definitely “family” to me, but so far it has not been too much of a challenge prioritizing our marriage and still getting the work done that I needed to get done, since we are both professionals. Adding a baby will definitely take things up a notch).

Right now, I really do believe that even though I can’t see around this particular corner, things are lining up just as they should, and what I must do is be patient, continue in the process of both working on the book and pursuing i/f treatment, and just see how things unfold.

But first, more updates: it turns out the class that we were scheduled to attend on March 4 was an IUI class–obviously not quite so useful for us now. The IVF classes are on Thursdays, not Tuesdays. So I cancelled for the 4th and scheduled us for the next available IVF class, which is Thursday, March 27th. Seems like an age from now, but again, I know time will fly by. G’s repeat SA is also scheduled, for Thursday, March 20th. On that day, we’re also going to sit down together with Dr. No-Nonsense to talk about our options.

That’s pretty much why the “thoughts and feelings about IVF” in this post are only part I. I’m quite sure that after we talk to Dr. N-N, I’ll have more to say. But, I figure, I might as well start musing now.

So. Thoughts and feelings (so far)? Well, I am a little freaked out by the idea of entering infertility treatment at the top level, so to speak. No easing into it with Clomid for us! Instead, it looks like we’re going straight for the big guns. Which does mean that we’re going straight for the method most likely to work for us, but also means that if IVF somehow doesn’t work, well, there’s nowhere else to go medically. And since we only get three covered-by-insurance attempts, I am feeling a lot of fear about how much seems to be riding on each cycle. I’m trying to feel the fear and let it go rather than obsess about it, but it is hard not to get stuck in negative thought loops of this sort: What if the first cycle doesn’t work? Or what if it works, but then (God forbid) I miscarry? Talk about “wasting a turn.” (I apologize if this sounds flippant, as I don’t mean it that way) Or, if it takes us all three covered tries to get pregnant, will my head explode during gestation from anxiety about everything we have riding on this last chance for a successful pregnancy? Or, if it takes us all three covered tries to get pregnant, what will we do when it comes to child number two, if it comes to that?

And, the one that I can hardly even bear to write out, but lurks behind all of these: What if all three cycles don’t work?

Logically, I know that the odds are probably reasonably in our favor. I’m young, and (thankfully) in overall good health. Surely that means we have as good a chance as anyone does for IVF success, right? In 2006, my clinic had a 67.2% pregnancy rate for women under 35 years old, though I don’t know the live birth rate. But the point is, the “under 35” group is the group with the best chances, that’s clear from the numbers. So I know there’s really no reason to be all doom and gloom about it ahead of time. I also know that focusing on failure before we even get to the beginning of the process is a good way to create that reality for myself, so I want to start shifting my thinking in a more positive direction. But it’s hard to do, I admit. Maybe because I’m afraid to get my hopes up? Or because after sixteen or so months of trying, unsuccessfully, to get pregnant, I’m finding it impossible to believe that pregnancy really is in the cards for us?

I don’t know. All I know is that the idea of IVF is scarier, on an emotional level, than I thought it would be.

…And yet I’m also impatient to get started! Part of me wants to throw caution to the wind and do our first cycle in April rather than May. I will see what G thinks, and what Dr. No-Nonsense says when we talk to her. I can cross the due date bridge when I come to it, deal with the maternity leave issues and the timing issues and all the logistics later. Right now I’m feeling like, well, let’s just go ahead and give this scary shit a try. Why not?