Mad Dash to the Finish Line

I don't know who Mr. Pipo is, but this image rocks.
You can get it here: http://commons.wikimedia.org/wiki/File:Mr_pipo_clock.svg

Yea, yea, yea. The ole "I've been a blogger slacker" post. The "I've been too busy" post. The "Too emotional with all that's going on in the world" post. Whatevs. Get to it.

We are on full throttle for surrogacy to start next cycle - which means hopefully the end of this month. (Crap - no drinking on NYE!) I've been a mess trying to get everything done in time, but we really wanted to pay as much as we can this year for tax purposes. Since I didn't work for 8 months this year, much more is applied. 

Plus, let's be real, every month for me counts now. My AMH is like .7 and my FSH is 12.7. Not good. Not horrible, but not good. This will be the last shot with my eggs - period. If this doesn't work I'll crawl into a hole until we are able to consider the donor egg option. 

I have to say that having my first 2 surro cycles in India did not prepare me for the complicated mess I would  have to endure here in the US. In India we just had to show up and they directed us for everything else. Here we are on are own and have to stay on top of things like a frenzied squirrel. Crimmy, I'm even going to have to give myself shots. With my ADD, this is not encouraging. 

Some of the things I've been juggling: 

• Coordinating 4 individual schedules with tight deadlines on when specific things have to be done. Guess who's schedule always gets the shaft (to be expected.)
• Countless phone conversations occurring middle of the day, for a length of time, that has me leaving my trusty cubicle to go hide talk in a conference room. Lest my cube mates get to hear me go on-and-on about the FDA required STD tests I have to take. "Yes, I need you to add Chlamydia  Gonorreia  HIV, Hepatitis  PPD, ... to my blood order. Oh I'm sorry, you want me to repeat that LOUDER for the 3rd time? Ok."
• Working with 3 different pharmacies to find out which can give me the best price, without sacrificing reliability/comfort level of getting all the right things at the right times. All of this again on the phone during business hours. All pharmacies have been given the Rx by doctor and are ready to ship ship ship. "Yes, I'm confirming the order. OH WAIT, you are with whom?"
• Phone interviewing lawyers with experience in surrogacy to see who can meet our tight deadline (are you sensing several themes yet?) 
• Going BACK AND FORTH with my new primary care physician office to try and convince them to add STD blood tests to my blood order for my physical. This way there is a chance insurance will cover it, but I had to go back and forth with them for about 2 weeks. Otherwise it's a couple grand out of pocket.
• Getting a physical so that additional items will be covered under insurance that wouldn't under my RE.
• Multiple doctor visits. Blood drawn yesterday AND today because I had to use 2 different labs. Trying to juggle all these without raising a flag (hopefully) at my new job has been an incredible feat. I'm a contract employee and want to go perm when my contract is up in April. 
• Psych evals - and while I appreciate the "concern" over my emotions, it really was a total waste of time/money for my husband and I. Everything that was discussed in the group session we had already discussed with them privately. I totally "get" why you would want to have one with the surro and the surro spouse, and even a group one, but I don't think every IP couple needs to have this done. Especially if you've been through the process before (even in another country). Thankfully the doctor put the ones for hubby and I as a "family counseling" code - hoping insurance will at least cover that. 
• Trying to get surros insurance documentation to make sure there is no surrogacy exclusion. Not their fault, but company's fault it is taking so long. 

There is more I am sure, but between balancing that and everything else in my life, my brain is kinda fried at the moment. I still have Christmas shopping to complete. Hell, I haven't even gotten all my cards out yet. 

On a Happy Happy note. Insurance covered a HUGE portion of my fertility medications. The pharmacy (Village Fertility) checked on a whim for insurance coverage (even though I told them it wouldn't be covered) and apparently a big chunk was. Had to pay just a little over 1K out of pocket - which is awesome since it was looking to be about 6.5K. She explained that even though we have BCBS for medical (THE SUCK for infertility treatments), the pharmacy is different and is quite good. Covered under Medco, formerly Express Scripts. I guess the lesson is: always check to see if insurance will pay. Even when you are sure they won't. 

On an unhappy note - I had no idea that the attorney was going to be so much. 2500 for the surro agreement (REQUIRED) and then another 4K if we make it to the second/third trimester. They have to go to court and petition that our names are put on the birth certificate. Otherwise we would have to adopt our own child. GAH! Oh well, I guess we should totally HOPE/PRAY/RAIN DANCE that we are so fortunate as to get to shell out the money in the future. That would be a good thing - right?

That's it for now. And to prove how busy I am at the moment, I'm going to publish this after only "checking" it once for mistakes. That's HUGE for me. Normally I read it and change it 10x. THAT'S HOW BUSY I AM. Or crazy. You choose. 

Another option

http://www.robinurton.com/blog/2008/05/belly-cast-painting/

The other day I received a shocking offer. One that could solve a lot of problems for us. Maybe. If we are lucky - and that's what it usually boils down to in the end. In a Tim Burton kinda twisted way.

Someone close to us has offered to be a surrogate here in the States. 

Interestingly enough, my husband and I had 2 different reactions. He was ecstatic and slowly realized that I... well... wasn't. Don't get me wrong - it will be FABULOUS if it works out, but just a mere offer doesn't turn into a done deal and I guess that's what has me a little nervous.

This person is very close and dear to us. I love her completely and I nearly cried when I read her email. BUT, I'm afraid to get my hopes up.

Today my Atlanta Clinic called and they had my AMH results back: .86. Not good. Not good at all. Not horrible (like in India), but definitely not good. It has dropped over half from January. So I'm fairly certain this will be our last try with my eggs. And that's IF ACRM will even take me now. I'm hoping that the fact I had 3 good embryos last month will help convince them.

The idea of using someone close to us make me nervous for so many reasons. What if we plan everything, go through IVF, and then she decides she can't do it? I would understand why, but that would kill me. What if she isn't approved medically? She smokes, how do I know she will be able to quit? That's a HUGE thing. (I'm guessing she quit 5 years ago when she was pregnant, but I didn't ask.) And how much time to we have to wait for all of these things to align?

Also, how will she feel giving the baby to us and seeing the baby all the time? One commenter on my carrier's perspective story made me feel better about that, but is that the norm? So many questions. We are meeting with her and her husband this weekend to discuss everything.

We also had a super close friend (2 actually) offer to be an egg donor for us. (Yes - we are surrounded by truly phenomenal people.) Not sure if those offers are genuine either, and more importantly, thought out. Am I being too pessimistic? Am I letting MY personality traits (agree to things before really thinking about them) bleed into how I think others would react? I don't know. I just know I can't take much more of the roller coaster. Sadly, it's a roller coaster no matter which way we choose. Isn't it?

Tuesday Catch up

If you are a regular reader of my blog, you know that Tuesday was a bad day for us. It was also a very busy day for me.

After getting our bad news of the failed chemical pregnancy, I had to get up and go to my dentist appt. My dental hygienist is also going through IVF and just had a failed cycle (though she has had success in the past.)  We both gave brief updates of our failures and the all-knowing, strong grieving/supporting smile passed between us. It's weird that after only 2 cycles I feel like some sort of veteran. 

After that appt, I call my vet. She was a few miles up the road from my dentist (but is far from my house) and I had discovered the wonders of tapeworm segments in my friend's puppy that we are babysitting. Fortunately my vet is also my friends vet, so she was able to RX a dewormer without me having to bring the puppy in to see her. As I was leaving, I noticed a Kroger next door and headed over to grab some food/coffee. 

Tuesday Morning was also next door and it occurred to me that I should see if there was something there to pick up for my friend who had a baby that morning. Had told her that I would come the next day to visit her and the baby. I wandered in the store, but somehow couldn't bring myself to buy any baby items. 

Next on the list, was a visit to the DOL. I have entered into my 1st tier EUC unemployment and there are new validation rules I have to follow. Unfortunately there was also a gap when I was informed of these new rules and thus a few weeks had passed without the new information being entered. Not only did I have to turn in a previous weeks validation, but I had to make sure that the other previous weeks validations weren't required. I will spare you that conversation. As with typical government offices, people are trying to process you as fast as possible and rarely listen to what you are actually saying. When the gentleman realized I wasn't going to budge, he slowed down enough to get the right information for me. 

After finally getting through that eye-poker of an errand, I drove across town to pick-up my BFF's dresses she had on consignment at a wedding/formal dress boutique. They are expensive gowns and my one job if she went into labor was to make sure they were picked up. The store is awesome and we had visited when I was wedding dress shopping a few years earlier. I browsed while they found her dresses. Even wandered over to the wedding dress side and was promptly reminded that I must wear gloves to handle the dresses. They are all designer and some of them are quite exquisite. I was happy to see that I still did not see a dress that I liked more than the one I chose. 

Another Tuesday Morning store was next door and I told myself that I needed to try again. In the store I found the most beautiful fake fur bear baby hat. It had bear ears and everything. I bought it not even knowing if I would give it to her or keep it. The only other things I have bought for our [possible] baby is the book The Very Hungry Caterpillar by Eric Carle (English AND Hindi edition). Now that I think about it, I bought that book when I was shopping for her baby shower. 

After that, the time was about 4:30pm and I know I need to get home to let the dogs out. They needed some reprieve from their crates - especially the puppy. I rushed home and let them romp about for about an hour. Meanwhile, I got ready to go to the seminar at our local infertility clinic that I had signed up for the week before. "Free AMH test" the newsletter announced. I really wasn't in the mood to be around a bunch of hopeful infertile couples, but so be it. Yes, I know how awful that sounds. I don't care - it's how I really felt and I just wanted the to take the test. When I left for the clinic I texted my husband where I was going and why. 

The seminar was pretty good. I already knew most of the things they went over, but it was still cool to see the science parts. Most of it was a slide show that we watched in the dark. Non-interacting - yay. There was a super-peppy "success story" lady that spoke and for a moment I secretly imagined punching her. The moment passed. This was followed by a Q&A session with the clinic's newest doctor. (I'll post the questions I asked in a separate blog post, because I'd really like to get your opinions on the answers.) 

The Q&A was followed by the blood test. My recent trips to India gave me some secret tricks to getting ahead in line and getting out of that office as soon as possible. The lady that took my blood was cheery and asked how my day was going. It was going crappy and I kinda told her as much. Pretty sure she wasn't ready for that and she gave me some pre-canned pep talk answer that didn't even apply to me. I just nodded. I didn't really want people to feel sorry for me, but I was DAMNED if I was going to sport a fake smile and act like my day was great. 

Drove home in the dark. Still had not cried. Walked up the flight of stairs to the living room level of our house. My husband greeted me with kisses and a long hug. Then he held me and burst into tears. For a really long time. 

Days are flying by: Day 6 - Part deux

Good and bad.

The bad was the AMH results, but for reasons I will not go into right now, I don't have absolute confidence in the results from the blood peeps. That could be a preserving mechanism, could be erroneous results, maybe my cyst threw it off, or maybe the results were simply wrong. Whatever. I'm not going to focus on that either way. PLUS, from what I understand, AMH is a direct reflection of follicle/egg count and if that's the case then it doesn't make sense that....


MY FOLLICLES ARE WAY UP! I have 11 that are growing. 7 of them are good sized. The 4 smaller ones can always potentially catch up, but I'm very happy about the 7 follicles. That's much better than last time.

(pic my send friend sent me during my 1st cycle)

I realize that 11 follicles isn't earth shattering news for some, but it's great news for me. Let's just hope that they have good eggs inside and that will grow into great embryos. 

Days are flying by: Day 6

I've met the most interesting people this time from all over the world. Couples from Africa (including Casablanca!), Europe, Japan, China, USA, and of course many from other parts of India. My husband and I  are not even the only mixed couple this time. There is a Chinese lady married to a Norwegian, a lady from South Africa married to an Indian (they just had twin boys!), and a Irish guy married to an India lady (who graciously invited me to dine with them at lunch yesterday.)  Everyone is super friendly and I feel much more relaxed.

Well, except for today. Today I get my AMH results back and a sonogram to see how I am progressing. I'm  very scared. I've had flash thoughts of having to tell my husband "don't bother coming". Fortunately I'm not obsessing over those thoughts, but this morning they are definitely there.

Have had several mini-adventures that involve me trying not to get lost while still exploring new places. Managed to find the Anand version of Target on foot, something that I am extremely proud of given my propensity to get lost. Doubly exciting as my flip-flops broke on my walk to the clinic that morning. The road was a slushy mix of mud, trash and probably poo (lots of cows here!), thus barefooting it was not really an appealing idea. Was able to pull a temporary McIver move with a safety pin as you can see below. It held till I was able to find Target - yay!

Also managed to find the baby Mart (called 7-eleven), but that was a little more hectic as I ran into a couple of hustlers along the way (more on that later.) This almost never happens with my husband around and it's interesting to notice the difference. Often I tease my husband for walking around with such a stern look on his face, but now I see why.

Well that's it for now. Have to get ready to go to the clinic.

Day 1 and 2 with the doc

Some of my meds

Yesterday was my first visit with the doctor. We thought we were going to have to aspirate my cyst, but Dr. P thought we should check my hormone levels first. We would only aspirate if the hormones were off.

 Last cycle I had a 3cm cyst and my estradiol was way off. I only had 3 follicles and we had to aspirate in order to proceed and get my hormones back in line. Once it was aspirated (general anesthesia - ACK!), we saw 14 follicles. Not exactly sure how that works (were they hiding???, why were we able to see more later on the unaffected ovary?), but that made the initial panic of 3 follicles easier to deal with.

This time I knew I had a 5cm cyst walking in. Turns out it had reduced to 2cm, but I only have 5 follicles currently showing. 4 and 1. My hormone levels came back normal, so we opted not to aspirate. Dr. P ordered an AMH test, and I get the results back tomorrow. Truthfully, I am a bit horrified to get the results back from that one. The follicle thing I can not worry about and simply hope more "appear", but a bad AMH right off that bat will crush me.

We are starting off with a stronger course of meds this time, though the Gonal F is at the same range we started last time (we increased it halfway through last time). 4 shots to the belly right now. Here is the breakdown:

gonal f - 375 IU

luveris/lutropin - 75 x .2

lupride/ leuprolide - 1. mil IU

human chorionic gonadotropin (hCG): HOCOG - 1250 IU

I started researching some stuff yesterday and then I just stopped. It was too depressing and I don't think it is doing me any favors right now. Hopefully my AMH has not tanked (it was 1.7 in February) and then I can be cautiously hopeful. Not even sure if cysts can affect AMH, but I'm too afraid to keep looking. 

Today I'm ok. Got shots in the belly and then socialized a bit with some other patients. For some reason, buying dog food to leave for homeless dogs (I especially worry about the lame ones) made me feel better. I don't know why, it just did. Maybe because it gives me a little bit of control or maybe it's because I feel like I can do a little tiny something to help. Right now I need a super simple way to make myself happy and that did it. I'm sure there are plenty of more laudable things I could be doing right now, but that comes with such complications at times and often tons more stress. 

I'll confess that in the last few weeks, I have, on occasion, semi-prayed. Given my atheist/agnostic ideology, this is quite complex to me internally. Not posting this because I want I bunch of comments regarding religion (quite the opposite), I just thought since it is part of my journey that I better fess up. If you are religious and are reading this, feel free to send your prayers, good vibes, or whatever else my way. I need all the help I can get. :-)

That's it for now. 

Special Lady Cocktails

When I first was swept up by the internet infertility tornado, I remember reading forum posts from other hopeful women. Falling on a theme (as I often do), I obsessed over the ridiculousness of women taking all kinds of crazy pills - usually without having a doctor recommend them. OMG! DO YOU JUST TAKE ANYTHING YOU FIND ON THE INTERNET??? Some posts swore by the helpfulness while others confessed that they worried it may have hurt. Once discovered, some doctors gave full-on lectures how it was not appropriate for the poster's situation, only to find out that someone else (usually another doctor) in their clinic had told them to take it. Truthfully, I was personally affronted that such naivety and desperateness could drive women to arbitrarily take anything in an attempt to conceive.

The picture above is from MY house. That's right, Ms. Holier-than-thou is ...well, the same as everyone else.

At first it started small. My first pill was THE PILL, and I was told I would have to take it by my Indian doctor to make sure I was synced properly for my IVF treatment. Fair enough. I called my OB/GYN and promptly got a prescription. Let me mention here that I do not like taking birth control pills (bcp) as not only does it make me gain weight and experience occasional nauseousness, but sometimes I experience additional glum side effects (depending on the brand). Fine - whatever - I set my alarm on my phone to give me a daily reminder; particularly because my history of remembering to take medicine on a daily basis is pretty dismal. Especially BCP. Our local IVF doctor also advised to add a pre-natal vitamin (another item bound to make me nauseous) and I immediately relented as I ran to our local Publix.

Baby aspirin and acupuncture were added to the regime - the latter being something I normally would have scoffed at a year earlier. Doctor semi-recommend it and so I shelled out the cash. My husband gave me the big-eye, but I'm guessing he recognized my fervent look and said nothing. 100 bucks a pop for 6 weeks = not cheap. What can I say except I wanted no regrets.

IVF treatment #1 was dismal. 2 eggs retrieved, only 1 fertilized. Even that 1 took a damn long time to fertilize.

Now I am prepping for treatment #2. In typical fashion, I have been obsessively researching similar cases. Not just blog posts, but academic papers and any type of current research I can lay my grubby little eyes on. A clinic in India recommended 25mg of DHEA for 3 months. I rush to pull up the scientific documentation and realized all of the research is really based on a tiny Tel Aviv study. The study showed a significant difference in live birth rates with women who were poor responders and took 75mg of DHEA for 40 days vs women who did not. A follow-up study had additional encouraging results. Screw the 25mgs -I only had about 40 days till cycle, I was going to go full boat - 75mgs it is! [I would like to make a note here that I was not able to take the full 75mg initially because of side effects. I had to build up and even now I have minor side effects.]

Next I read how melatonin could also help woman with poor ovarian reserve and immediately I was hunting down more articles and recommended amounts. 3mgs seemed to be the magical number, but that amount knocked me on my butt. Still 1-2mg was doable and thus it was added. Combining it with the DHEA means I sleep really well, but I'm groggy as all get-out when I wake up. Heaven help me if I don't get a full 8-9 hours. Oddly enough, my friend says she takes 10mg all the time and it barely helps her sleep. What can I say? I'm a lightweight.

Did I stop there? Heck no! I was on a search that day and after reading some articles (which I can not find at the moment) regarding myo-inositol, my amazon shopping cart increased. Among other things, myo-inositol was suppose to help women with cyst issues and a giant cyst almost caused a no-go last cycle. My OB/GYN found a cyst last year and I began to wonder if some of the pain issues I had felt over the last year were cyst related. GIVE ME MYO-INOSITOL NOW!!!

There were a few other things on the list, but these 3 new items had good scientific data to back them up and they applied to women with similar (if not exact) conditions. The other pills I noticed my fellow women-at-arms were taking were either less scientifically regarded or didn't apply to me. Besides, as I mentioned before, I'm a light weight and I wanted to see how I was going to handle this new concoction.

Which brings me to last week. I'm not quite sure HOW I ended up at the Rainbow (read: hippie) Grocery store - but all of a sudden I found myself at the cashier's stand with CoQ10, some fancy fish oil supplements, and yes even some Royal Jelly that was well hidden in a jar of honey. And some awesome low-sugar dried mango. And a yummy nut mix. And Activated Charcoal that I told myself would be good to have on hand if my dogs ever get into something they shouldn't. Somehow I think my subconscious was trying for an easy excuse to get some for me. You know. Just in case.

"Just a spoon full of sugar..." (or honey) 

Test results - Phase 1

When I first started investigating infertility, I noticed ALLLLL these tests that people were either posting about or asking about. In the interest of other OCD peeps that likes to compare everything under the sun, I've listed mine below.

Estradiol: 30.3

FSH: 12.4

LH: 4.7

Progesterone: 3.84

Prolactin: 1st test - 12.0; 2nd test - 14.8

X-Prolactine?: 6.9

TSH: 1st test - 3.77; 2nd test - 2.38

X-TSH:2.1

AMH: 1.7

The first prolactin and tsh actually has an E before it, but the X ones were on the same day. Not sure what that is about...

From what I understand, my FSH is troublesome. :-( We have to use surrogacy because I had surgery a few years ago that removed most of my uterine lining. It has grown back in many areas (causing me problems), but still tons of damage and the doctors do not believe I can carry a pregnancy. 

I really hope we can use my eggs, but only time will tell. Don't get me wrong, I would love any child equally, but I would really love to see a child that is a mesh between my husband's genetics and my own. My father died when I was young (accident), but both he and my mother come from an intelligent, attractive bloodline. 

Course some of us are a bit loopy, so if we can't use my eggs then I can focus on the fact that the child won't get that. 

Ahhhhhh - the ups and downs. 

Stats! need stats, stat!

Where we are right now: we knew from the beginning that we would have to go the IVF/surrogacy route (more on that later), but late last year we were given some hope that I may be able to carry a baby. Several tests and renewed hope/worries, we were told a few weeks ago "that ain't gonna happen". Ok fine. Back to square one. What we were not prepared for was the cost... After much research I had to inform my husband that the possibility this could easily go over 6 figures, was very real. Not to mention costs if something medically went wrong with the gestational carrier (new code word for surrogate) and she doesn't have insurance. I'm guessing most won't.  (All of this lead to my idea of surrogacy in India, but I will save that post for a later day.)

Here is a tiny shred of info about us: 
My stats - 40 years old, Caucasian, good BMI of around 22, generally a healthy eater, exercise semi-regular, semi-weird health issues over the years with nothing serious.
DH - 40 years old, Indian, mid-range BMI for male, generally a healthy eater, exercise semi-regular, no known health issues.

Current state of basic tests:
His tests showed good count, with a little slowness.
My tests showed an AMH of 1.7 (normal range), FSH of 12.4 (GAH!), and 16 follicles (yay). (Stay tuned for my rant on confusing AMH numbers...)

I honestly expected a much lower FSH and the news hit me hard. The news of 16 follicles earlier that day was probably the one thing that didn't make me crumble in a pile of tears. Just kinda stone-faced for a few hours. I'm hoping that the HUGE amount of stress I have been dealing with lately (tremendous stress at job, followed by loss of job, car accident, worrying about money, worrying about this whole IVF/Surrogacy thing, blah blah blah) may have had some affect and that with proper stress reducers, followed by a few lifestyle changes (no alcohol, cut way back on caffeine, muti-vitamins, baby aspirin, avoid toxins, etc) that this will help.

The logical side of me worries because I saw a blurb on the interwebs that some doctors believe your highest FSH is where you are at no matter if it fluctuates later, but the hopeful side of me reminds me that all of this is not known yet and thus doctors can not have an absolute certainty of what may or may not help. Besides, the article very vaguely stated "some doctors believe..." with no facts or numbers to back it up. Plus, I tend to be the girl that doctors say how unique my situation is. With everything. Want proof?  My normal AMH combined with my FSH puts me at less than 5% of cases of a study that was about AMH and FSH numbers combined. When looking at SART reasons for infertility, my medical issue of why I can't carry a baby has me at less 2% of the population that goes to infertility clinics. Essentially, it means I really don't have a lot of stats I can lean on at the moment to gauge what our success will be.

Our US doctor will be calling me later to either "discuss the results from last week" or "schedule an appointment to discuss the results from last week". Not sure which since the lady on the phone (when I was driving no less), gave me the info and I honestly did not hear much after "FSH 12.4" and "doctor team will discuss internally at their meeting on Monday". We are in the process of talking with several clinics in India as well and will see how that goes. On SART, our clinic had an over 30% success rate with women my age last reporting period (2010). This statistically significant enough that it will make them stand-out, but it also makes me wonder if they skew what they advise. As in "you really need to use donor eggs" instead of what might be a perfectly normal range of odds for my age.

Sigh. I told you I over-think things.