Making Announcements - Getting Personal

The time is getting close where we will start making our announcements to friends and family that aren't already in the know. I think...

http://mashable.com/2012/04/18/social-media-and-the-news/

We keep putting it off. At first we wanted to wait until after the first trimester when the risk of miscarriage was still quite high. Week 13 rounded the corner and we decided to wait until we saw the specialist. Once that occurred we were introduced to all the bad things that could happen and decided to wait until after the initial tests. Then we wanted to wait for more tests (ie, the amnio). We still haven't gotten the results from that yet, but we expect them and another ultrasound this week. If all goes well, we will start widening our circle of who we tell.

But when do we make the announcement to our big group of friends??? Is that something you do on facebook? That would seem weird, but it would be equally weird to deal with people who want to know WHY we didn't let them know, when they start (hopefully) seeing baby pictures. Perhaps even more so. My worrying mind can just imagine people thinking "didn't we just see her at so-and-so's drinking wine, flat belly and all?" (Ok "flat belly" may be an exaggeration, because after 3 IVF treatments in 1 year my belly is no longer flat, but I am working on it.)

Ahhhhhh and all the questions we will get from so many people. I don't mind them from our-close friends and family - heck most of them already know my SIL is our surrogate or at least know that we have been trying with surrogacy - but what about the regular friends? We have A LOT. The idea of people publicly posting awkward questions or privately emailing me in droves, and then imagining people gossiping behind my back, is quite horrifying. Even if they don't. Which they will, because it's human nature.

Plus - I really don't like people knowing my business unless it's on my terms. The idea explaining I had cryoablation surgery many years ago (and many other things) makes me cringe. Not explaining it means people will ask if we adopted, or worse, will think my husband cheated. (Not that there is something wrong with adoption,but it is a particularly hard discussion for me because of my own history with it. For the record, I think adoption can be wonderful.) From what I can tell, very few people know the ins-and-outs of IVF and even less know about surrogacy. I'm sure some people would even privately wonder "did she just not want to get pregnant?" as I see written over and over in comment sections of India surrogacy articles.

On the other hand, I think it's important to share my story; if not just to help others. Recently I had a male friend get married and I realized that they would want to have kids. The wife just turned 40 and I could tell that they didn't have the faintest idea what AMA was. Even a friend whose wife went through IUI a few years ago (took on the first try, but they had several miscarriages prior to that) seemed blissfully unaware of the difference between a woman getting pregnant at 38 and one getting pregnant at 41. They were talking about putting off the second child for another year or two. Of course both of these friends I gave the 5 minute run-down, but forcing your experience down someone else's throat is quite different than someone else reading your story because they want to. In fact, I distinctly remember being MAJORLY offended when various women told us that we better get it in gear if we wanted kids. (Ahhhhh - how naive we were back then!)

Oddly enough, I happily shared my story with the lady at the bank the other day who was genuinely interested. It started out simple enough when I was getting our house re-fi papers notarized and the bank lady asked if we were planning on having any children.  Not having told many others I was ready to burst with the news to SOMEONE that we have twins on the way. Still, I didn't want to startle the woman so I eased into it with the ole ego-boosting  "well I have I 21-year old" that always gives me the shock face I adore (wasn't always the case).

From there, the conversation naturally slipped into "we have twins on the way" which led to surrogacy, then our India adventure, and then explaining the entire IVF process. She was a young lady (26) and apologized for being nosy, but she was so sweet and thoughtful in her questions. She explained her aunt was in her late 30's and seemed sad that she may never have kids. She also explained that some women in her family were pressuring her to have more kids now, while she could, even though she wasn't ready. In the end, she told me I should be on Lifetime to help other women. (Her manager had been on Lifetime for something else - lol.) That conversation was so easy and the young lady made me feel great, but I know that isn't always the case in these situations.

The easy answer to addressing friends' questions would be to point them to this blog, but I really don't feel comfortable with that. At all. I've been brutally honest here and I don't need casual acquaintances knowing things of my past or people scouring through to see if they are mentioned. That's a can of worms that I really don't need on any level. I have very close friends that I have never mentioned here and at least one that I have spoken unfavorably about. This is a blog of my experience, the good and the bad, and rather than worry about what I write in the future or sanitizing things I have written in the past, I'd prefer to keep it that way.

So what do you think? How do I tell the masses? We are fortunate enough to have quite a large social circle, mostly because of my husband, but that certainly leads to uncomfortable situations about things such as this. What to do what to do? What would you do (or what did you do)? Any advice is surely appreciated. 

Begin at the Beginning...

From: http://aliceinwonderland.wikia.com/wiki/King_of_Hearts

“Begin at the beginning,” the King said very gravely, “and go on till you come to the end: then stop.” 
~Alice in Wonderland

I feel so behind on blogging about what is going on.  Ok. Let's start at the beginning. Or at least the beginning highlights of IVF cycle #3.

Christmas Day I starting on my Viville-dot .1 estrogen patch. The instructions were to change it out every other day until I started my regular cycle meds. Once I began those, I was to leave the last patch on for 3 days. 

Day after Christmas I started my protocol of injecting Ganirelix 250 mcg for 3 days. 

Friday night (12/28) my period started, and that brought me into the ACRM office on Sunday morning to do our baseline ultrasound check: 11 follicles. 

Monday (12/31) I started my Bravelle (6 vials of 75UI) and Menopur (2 vials of 75UI). You can see my discussion about that process here.

Friday I had my ultrasound and was introduced to my new nurse. Our old nurse/third party coordinator was promoted to Director of Nursing (or some similar title) and I was a little apprehensive of having to start with a new nurse. Even though our old has frustrated me a few times. Both nurses were there on Friday and I was actually pleasantly surprised with our new nurse. My fear was that she was going to be a total noob, but I couldn't have been more wrong. Apparently she was the former Director of Nurses took 6 months off, and was coming back as the new third party coordinator. She instantly made me feel at ease with her knowledge and bedside manner. Brava because I was very irritated with my clinic that day. 

The ultra sound showed 6 follicles growing on my left ovary and 3 on my right. All in the 10mm category. She explained BEFORE the ultrasound (which was really smart in my opinion) that it was very early and the number we were going to see that day could change. Not to worry if we only saw a few. At 9, I was pretty happy. 

After the ultrasound, I requested to meet with the financial coordinator. She was supposed to have called me back on Wednesday after speaking with her manager about a mistake they made, but did not. This meeting ended up with manager joining us and I will save that for another post. Suffice to say, I was not pleased about a mess-up and I let them know. 

The rest of the day saw me at work, running around trying to get required IVF forms notarized, and finalizing the attorney items. A busy day indeed. The mountain of forms you have to go through is staggering. 

Saturday my GC had her ultrasound and mock transfer. All went well, but neither one of us was informed before hand that she would be having this mock transfer. I'm guessing it was a bit of a surprise for her. 

Which brings us to today. (Shew.) Another ultrasound and blood work. Lining (where I have it) is striped and at 7mm. There are 4 follicles on the left that are 10mm or greater, and 3 on the right. Several smaller ones that may still be recruited. We will know more at my ultrasound on Tuesday. Blood results came back this afternoon and estradiol is looking good in the 500s. As long as it was in the 300's that was a good sign. 

That pretty much brings everyone up to speed. Well, everyone that reads this anyway. Not technically "the end" but a good place to stop for tonight. :-) 

You have questions...We have answers

Actually I need your answers, so if any of this sounds familiar please post your experience/knowledge in the comment section.

On Tuesday night, I attended a seminar at my old clinic ACRM, here in Atlanta. I described some of it here and also pinky-swear promised to post the questions I posed to the new doctor during the Q&A session. (Ok, I didn't really pinky-swear, but I wrote I would, which is almost like the same thing.)

So here are the questions I asked.

1.) Can endometriosis affect the outcome of an IVF cycle if the woman is using a surrogate?
A.) Yes it is possible. [Sadly I have forgotten the reason behind it. I believe she did mention that there could be an effect on the eggs in a follicle and thus less eggs retrieved, but for the life of me I can't remember if she said certain things or if I am confusing it with stuff I have read.]

2.) Besides cost, what are some of the downsides of using ICSI?
A.) There have been studies done of the offspring conceived by ICSI and it was noted that the male children had a higher rate of sperm problems. Whether this is a cause of the ICSI or due to genetics (ie, the father having sperm issues thus ICSI was used) is unknown. 

[This one I already knew the answer to, but I wanted to make sure there wasn't anything else I didn't know about. Primarily because our clinic in India uses ICSI as a default with no extra charge (unlike here in the States).]


3.) How long after a laparoscopy, do you need to wait to start an IVF cycle?
A.) Generally the recovery time is short and we like to do the next cycle as soon as possible. Especially if the woman is older.
[I know they can't do it the same month as IVF, so I'm guessing that means you just have to wait until the next month.]

I'm getting conflicting statements about #1 and I'm a little concerned about it. Everything I read regarding endometriosis and IVF revolves around the woman carrying the baby, there is very little info for women using a surrogate.

My new OB/GYN did not seem to think that endometriosis would be a problem for me (with regards to lowering my IVF success rates) since we weren't using my uterus. In fact he thought there was a low likelihood that I had it since some of my symptoms were relieved with my cryoablation. He advised for me to find out if the cyst I had aspirated during my first IVF cycle was a chocolate cyst. He did mention at the end of our lengthy consultation that he did not specialize in reproductive endocrinology, so I'm guessing that was his out if he was wrong. The only surrogate cases he probably has is if someone walked into his office who IS a surrogate and already pregnant. Also this WAS before they locked me in the bathroom.

Conversely, Dr. GS on SIRM's forum indicated endometriosis could cause a problem in my case, but it was hard to tell if he understood that I would not be CARRYING the child. Even though I definitely mentioned it. (I am awaiting on a response for that clarification.) He mostly pointed me to articles that either talked about the problems in the woman's lining (and toxins activated in it) or in one case a long article he wrote with one tiny sentence that suggested a gestational surrogate would be a better option. That seemed to contradict his reply to me. Anyhow, I've awaiting clarification.  [UPDATE: Dr. GS did reply and state he missed the part about gestational surrogacy. He said that in the case of immunologic implantation dysfunction, it wouldn't apply to me, but an endometriotic cyst would affect egg quality.]

The REASON I'm even asking is because I don't know if I should be tested for it. We have decided to cycle again, but this may be my last one and I want to optimize my chances. If endometriosis can affect my eggs pre-aspiration, then it seems like a good idea to be tested and get any problems fixed. On the FLIP side, scheduling and doing a laparoscopy  plus recovery time could add a couple of months to the process - thus lowering our chances. PLUS some doctors advise against laparoscopic surgery for poor responders as it can further lower your ovarian reserve and raise FSH levels.

What to do, what to do. Time to go have a real one-on-one with our ACRM doctors again.

As I said at the beginning, feel free to chime in. 

Failed again

The Beta hcg levels went down to 15: chemical pregnancy, ie. failed cycle.

I knew before I even read the email. I knew when my phone went off at 2:55am to let me know that my BFF's baby made its debut. I knew yesterday when I made my limbo post yesterday, I just didn't want to believe it.

This is the part where I feel like a failure.

My husband and I hugged each other for a long time this morning, but then barely spoke after he got out of bed. As hard as this is for me, I think it's harder for him. I have a son - he does not. He has wanted children from the very beginning and I had to disclose the problems we would encounter (my cryoablation) when we had only been dating 3 weeks. His only question then was if I still produced eggs...

He can't console me and I'm not sure how to console him. A selfish part inside wants me to yell out "you can still have a biological kid - it's ME that's the problem". I wonder if his family, or even he, thinks that marrying me was a bad idea. An illogical part of me whispers that he will leave. What do I bring to the table?

I feel broken.

I can't even do the basic function of a woman.

I haven't cried and just walk around pretending everything is fine. My mom says she is devastated and wondered if this is just what clinics do to get more money out of you. I have to be the strong one and explain the plain fact that clinics in India get more money on successes than failures. Not to mention attract more clients.

Last week I signed up for a seminar tonight at my clinic here in Atlanta. It's a seminar to discuss infertility options, get a free AMH blood test, and get free one-on-one with one off the doctors. I'm curious about my AMH since the one test in India came back so low, thus I will go. Talking with a doctor will help too. I'll probably avoid sitting next to the peppy people. Shouldn't be hard. I've noticed that everyone avoids people with recent failed cycles. I guess it's like the pregnant girl in high school - they don't want to "catch" it. 

Stupid BCPs

It's official: my back really freaking hurts. Like worst-period-in-the-world hurts. For days now. I've come to the conclusion, based on other "girl problems", that this is the result of taking BCP*. Oh joy. My body wants my period to start and we are artificially postponing it. It's like a freaking war.

Let me back up a bit. Because my period decided to start early 2 months in a row, we had to change when I start my BCPs. Especially since plane and hotel reservations had already been booked for IVF treatment to start in India. What this means is that I had to start BCP a week later AND have to continue with active pills for 28 days instead of 21 days. Yep - I knew my body would LOVE this roller-coaster.

When I was 15 my OB/GYN put me in birth control to help with severe period problems. Unfortunately, most of the time it created more issues. Over the years we tried various kinds, and I think we finally found one that worked, but then I stopped taking BCP and by the time I went back on we couldn't remember which one was the one that caused the least amount of symptoms. Pile on top my ADD** and I would forget to take my pills all the time, causing my period to be everlasting. Wheeeeeeeee! Needless to say, it's been awhile since I have taken BCPs.

So for the last few days I've been dealing with ever-increasing back pain. Having had cryoblation uterine surgery several years ago, this is one of the symptoms that I have not had to deal with much until recently. (I say recently because as my uterine lining has begun to grow back, so has my symptoms have begun to return in increasing degrees.) Nothing like this back pain though; it's been a good 5 years since I've had to deal with this. Holy crap. Any time I take a deep breath it's even worse. Basically I'm walking around not wanting to breath: no fun.

Add on the lovely headache and nausea I now feel every night and I am a barrel full of monkeys good time.
Wine would probably help, but I'm really trying to not drink right now before my IVF treatment. Plus I've only been awake for an hour...Drinking all day probably isn't the best plan for me right now.

I've  tried yoga and back massages (thanks hubby!!!) to no avail. Maybe some Ibubrofen will help. That used to give me some relief. Unfortunately it will do nothing for my tiredness, headache, and nausea that will come later today. Blerg. Given my propensity of having side effects with medicines, I'll bet my IVF treatment is going to be a hootenanny.

*BCP stands for birth control pills
** I still use the older term ADD to differentiate from the hyperactivity symptom most commonly associated with ADHD. 

Notifying siblings

At the beginning of April I sent the below letter to my siblings (and copied my mom, but I had already talked to her about it). Mom immediately responded and made me feel less nervous about the entire situation. Siblings were super supportive and that was a great relief. We had already let hubby's family know as they were checking out stuff for us in India. We are incredibly fortunate to both have such great support from both sides.

Anyhow, here is the letter in case any of you were like me, and were wondering "how the heck do I word this???" I've replaced names with <relationships> as I'm not sure if I want to lose my anonymity. :-)  Also, I wanted to wait to notify other family members until after our trip in June when we have a better picture of where we stand.

--------------------------------

Sigh, I think with most people that this would be more appropriate in a phone call, but for non-trivial things, I'm really awful with the phone. I sometimes have trouble with auditory processing, most notably on the phone, and the more serious the discussion the worse it becomes. I'm very self conscience about it and with the exception of a small handful of people who I regularly speak to on the phone, it's tremendously hard for me. So if you are wondering why this is in an email - that is it in a nutshell. Feel free to call me with any questions, I just don't know how to start the convo about this on the phone and I get panicky when I think about calling people it. (I'm much better with it once the ice is broken.) Hopefully you will forgive me for this lapse in etiquette. 

<Hubby> and I have always known that we wanted to have a child or two after our marriage. We knew from the start that this would be a challenge as many years ago I had a surgery to remove my uterine lining due to medical issues. I still produced eggs, but would not be able to carry a pregnancy. 

Last year we started our journey and looking into our options, when my doctor informed me that my uterine lining had begun to grow back (which explained why I was starting to have issues again.) This offered us new options and hope, only to be told that the lining was only back in some places, and with other damage the doctors still did not feel I could carry a pregnancy. When we questioned about new available procedures to possibly fix the problem, we were met with a new reality - the meaning of a woman's "biological clock." This doctors informed me that to try and temporary fix the problem would have a low success rate and the time that elapsed would mean that my "ovarian reserve" would have diminished. Essentially, we may miss our very narrow window of conceiving with my eggs. 

I won't go into the long explanation of "ovarian reserve", but suffice to say a woman's chances of having a baby starts a steep decline at age 35. By 43, most clinics will not even consider using your own eggs.  We have now gone through sufficient tests to know that my eggs aren't awful, but they aren't super awesome either. Still, the doctors think we have a decent chance, though we still have the issue of me not being able to carry a baby. 

Enter surrogacy. Again, we knew this would be the main option for us when we first started dating. What we did not know was how expensive it was going to be. Using IVF with my own eggs - surrogacy easy enters into the 6 figures. More if we have to use donor eggs. There is no guarantee of a baby and many couples have to go through several IVF cycles at 15-20K a pop. Add on all the other costs, and it is crazy overwhelming. 

Enter India. When researching surrogacy, which is horrifically expensive in the US, the idea of India came to me. I had looked at international options for medical tourism many years ago, and wondered if IVF and surrogacy was an option. Turns out it is a big option in India; the price is 1/3-1/2 (even with airfare, travel, time off from work).

The main thing that concerned me with this option was the possibility of exploitation. After endless hours of research, I am happy to report that I have a 100% confidence in my findings. In the US, a surrogate mother is paid 15-30K (more for twins). In India, while it is much less (6-12K), the money is LIFE CHANGING to the surrogate mother. It's is often more money that the woman (or her husband)  makes in 10 years time. With the money many women buy a house (around 2500), educate their children, or help their family start a business. I do not feel we could make such an incredible difference in another woman's life here in the US. 

That said, we wanted to be careful that the money would actually help the woman. Again, after many, many weeks of research, I have found several places that have international reputations. As one surrogate put it "carrying another woman's child and making 10 years salary is not exploiting, working 15 hour days, 6 days a week, crushing glass is." With <hubby> having family in India (often close to the places we were considering), we had the extra benefit of them being able to check everything out from over there. We are pleased that we have decided on a location that is known for tremendously helping the women. They not only insure that this is the decision of the surrogate, but also provide housing, health care, nutrition, 24 hour care, help towards the surrogate's children, education, and a trust fund to continue education to the surrogate even after giving birth. At present the clinic, besides being internationally known medically for IVF, has a waiting list of woman wanting to be surrogates for them. 

We have recently completed all of our tests here that need to be done to determine the best course. The doctors think we have a reasonable shot with my eggs, so we are going to try that. Hopefully we will have success. If we have to use donor eggs, that becomes much more complicated as to get USA citizenship (for the India option), the eggs have to be mine OR we have to wait for <hubby> to become a citizen. Thus we are trying with my eggs first. In June, we will be traveling to India for 3 weeks to try for our first IVF cycle. That cycle will really give us the best picture if my eggs are truly viable, or if we have to start at other options.

Obviously very few people know about this right now. I wanted to let immediate family know before trying to figure out how to tell others. I guess I'll work on figuring that out next. 

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THE END.

Someone needs to write a paper

An idea appeared in my head that will probably be only interesting to a tiny, tiny subset of people in the entire world. Even in the tiny subset of women that do IVF, it will only be of interest to less than about 1% of those females. And some fertility doctors. And maybe some researchers. BUT THAT'S IT. And only if it isn't a medically ridiculous theory to begin with. (I only play a doctor in my brain.)

Screw it. Here it goes anyway. You can say you saw it here first. I'll be anonymously famous!

I'm wondering if cryoablation, or any uterine lining issue, would cause the pituitary gland to mistakenly produce slightly elevated levels of FSH. 

Feel free to chime in if you have any medical knowledge on the subject!

Trying to get research data on that would be a doozie. You'd need solid baseline before and then calculate proceeding ones with the norm for the age range. Oh yea, and you'd need to find enough women who were having it done.

I'd ask my doc, but I think that would officially put me in the "she asks weird questions" category.