Giggle Moment

2nd cycle tummy shot. Little red dots are from the shots.

Hubby and I burst into giggles the other night while in the middle of mixing my meds I exclaimed, 

"GET IN MY BELLY!"

After the strange outburst, we were a little worried I might spill some of meds from random giggling. 

Hard to be all serious after that. 

Day 11 - Trigger Night

Same disclaimer as Tuesday regarding this post. Half of this was written quickly at work just to get the stats up and the other half was written quickly at home where I have a zillion things I need to do. I don't have time, patience, or the general "sit down and write pretty" warm and fuzzies tonight. (Still want to post the info though.)

Let's us begin...

Ultrasound done by doctor today. I don't remember this doctor's name, but she reminds me of tall Jennifer Garner. It's kinda funny. Funny weird, not funny haha. (I've always loved that phrase.) I've met her before and she is the new doctor at the practice. 

Lining is grade 1 at 7mm. (This doesn't matter in my case except to show that my hormone levels are good.) 

Note: they looked at the right ovary first this time.

right ovary:

14mm

17mm

19mm

14mm

3 that are <10mm

left ovary:

18mm

18mm

16mm

17mm

18mm

Looks some were hiding on the right that have perked up. One of the small ones on the left decided to join in the game as well. 

Depending on my blood levels, we may wait another day before the trigger shot. Will know this afternoon. 

I was out of meds and so my nurse gave me some from the office. Said if I don't have to use them, to bring them back. They didn't charge. 

--Evening update

Triggering tonight. My progesterone is 1.3 and my estrogen is 1779. The nurse explained that when the progesterone starts rising and gets above 1, it indicates that the eggs are getting ready to release (something I did not know previously.) My hCG shot is scheduled for midnight. Haven't watched the videos for that one yet - better get to it! Dose is 10K. 

Tomorrow morning I go back for another appt. They are taking blood and going over the pre-op instructions. Not sure if I get another ultrasound, I was in my car about to leave when they called. 

My GC will start her progesterone shots tomorrow night (ouch.) I still cringe knowing how her shots are big and intramuscular. Super suck. Our transfer is slated for Tuesday. Not sure why we are doing a 3 day instead of 2, but I've put it on my list of questions. 

I've asked 2 other questions that I am awaiting answers on. 1 is regarding assited hatching: do they think it is warranted in our case. The other was about ICSI. I was surprised to find out that they did not have it planned for us. That's a bit startling given I have a low ovarian reserve and we've used it both times before. I've asked for clarification. If there is little downside, and a potential upside, then I don't want a small fee standing in the way. Plus, I've read studies where it can significantly impact small follicle/egg success. 

As good as my numbers look, I was reminded on how good they looked last cycle. In fact I had 12 good sized and 14mm one; only 4 eggs were retrieved. I guess I have to hope that they will have better equipment/process/tweaks of protocol here to release good eggs. Hate to put it that way because quite frankly, my last cycle in India was waaaaayyyyy less stressful than this one here in the states, but a little part of me is hoping that something will be better here. 

My post-op visit (that's new!) is scheduled for the 22nd. Our pregnancy test scheduled for the 27th. That seems kinda early, so I told our GC to expect that she may have to come in for a second one. With her starting a new job only a month ago, it's better for her to know the possibiliy of these things in advance. Heck, I know I would want to know that too. 

Saturday is retrieval day. I've been so busy, I haven't had time to worry [too much] with google or otherwise. Our appointment is at 11am, but we have to go in at 10:15 to speak with the doctor. It's weird to see all these different doctors and nurses. I haven't even seen our doctor since our cycle started, and now she won't even be doing the retrieval. Sigh. I know the other doctor is considered awesome and I've met him once before, but it's still hard. In India I saw my doctor and the same nurse every day. 

That's it. Gotta go hussle and get things done. Haven't even had dinner yet. Wish me luck!

Tuesday's Update (A Day Late)

This post is a bit cryptic as it is one of those posts that works as a handy dandy reference for me down the road, and thus the information is more important than the "elegance" of how it is written. If I wait till tonight to write it (instead of quickly at work) then a.) I might not get it done and b.) it loses it's value of reference to me later when it is delayed too much.

What I am left with is my notes I made to email hubby, mom, and surrogate - polished up a tad from their original version. (Otherwise, my mom would have no idea what I meant.)

Here's the deets

Left ovary, follicles and size:
15mm
14mm
12mm
14mm
3 that are small at 10mm

Right ovary, follicles and size:
15mm
14mm
2x at 10mm

Still a couple of days away from trigger shot. Looking for lead follicle to be in the 19-20mm range.
If we have to order more meds (only have enough for Tuesday and Wednesday), then there is a local pharmacy that can fill the order. Shouldn't be a problem with insurance since it would be a one time deal. They also have some in office if there was a problem with the other.


Trigger shot will potentially be on Thursday. Normally I take my stimulation meds at night, but I wouldn't take my other meds on same night I do trigger shot. Depending on what day trigger is, we can expect retrieval on Saturday or Sunday.


I was worried that my doctor (Dr. Carpenter) would not be available on the weekend as we never seem to have any staff we know when we come in on the weekend. My fear was correct and our new nurse (who I really like) told me that Dr. Toner would be the doctor if retrieval occurs on this weekend. We would meet him before going back to the OR. He is director of third party and our nurses direct boss.

Our other nurse emailed me later in the day and said my lab results look great. Estrogen at 969.8 and Progesterone 0.9. They want me to continue with my same dose of medication on Tuesday and Wednesday: 6 vials of Bravelle, 2 vials of Menopur, and 1 ganirelix. Thursday 1/10 I am to return to the office at 8am for another ultrasound and blood work. I was initially concerned about missing Wednesday, but the nurse confirmed that the doctor did not feel I needed to come in on Wednesday.

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. :-) 

Time Out for this Message about Meds

I'll freely admit now that despite what one might think, doing IVF with surrogacy in India was much easier for me. Administering meds is a prime example. I simply went to the clinic every morning, laid on a cramped patient table, and let them stick a bunch of needles in my belly. Some days hurt worse than others, but overall not too bad and the security of having someone who does this every day for years was great

Here in the US, you do it all yourself. The ordering, the mixing, the injecting. The day of my first ultrasound I was supposed to have injection training, but then I found out they wanted to charge an extra $160.00 for the training. Our pharmacy has online videos for our specific meds, so when they told me of the extra charge, I declined. Chances are I wouldn't remember what they said  when I got home anyway and would have to pull up the videos and instruction sheets. I ended up watching a bunch of videos from a bunch of different websites and then picking the best one to show my husband so he could watch me and make sure I was doing it right.

Video from my pharmacy on injecting Menopur.

This gives you a bit of an idea, but I had a lot 

more vials

Basically the process is:

• sterilize counter and tops of vials 
• wash hands thouroughly and carefully
• get syringe and remove the big needle
• attach a q-cap
• add a little over 1mm of air to the syringe
• puncture sodium cloride and push in air. This helps draw out the needed +1mm of liquid back into the syringe
• puncture vial of Bravelle and add liquid from syringe. Make sure everything dissolves, but don't shake too much. Add back to syringe, making sure to get all the liquid
• repeat with adding the newly mixed liquid into the next vial of Bravelle. 
• repeat with all vials of Bravelle and Menopur. Should still only have about 1mm of liquid in the syringe when done, but all 8 vials will now be dissolved into that 1mm of sodium chloride.
• remove q-cap and attach smaller needle for subcutaneous injection
• alcohol wipe your belly, make sure no air is in syringe, pinch a fatty area of your belly, and insert needle at about a 90 degree angle. 
• slowly inject medicine. 
• make ouchy face

No one really warns you that some medications in the vials dissolve better than others (no rhyme or reason) or that liquid can get caught in weird places in the vial. They don't tell you about your heart skipping a beat when you almost drop a syringe full of $500 meds. They don't tell you that it will cross your mind on several occasions "shouldn't someone more qualified be doing this?" They may have gone over this in the $160 training, but somehow I doubt it. 

Third Party Coordination Goes Awry - Meds Edition

A few weeks ago I had to figure out where to order my and my surrogate's meds from. ACRM recommended 3 pharmacies and called the Rx in to all 3, allowing me to compare prices and such. One of these pharmacies, Village Fertility Pharmacy, actually had the forethought to test my insurance coverage even though I told them it wouldn't be covered. Thankfully I was wrong, so we went with them (a huge bulk of mine were covered!) I ordered both mine and my surrogates meds, shipping to our respective homes. Mine took 1-2 days. 

Since we paying ACRM extra money (~$3100) to do "third party coordination", I naturally thought that if I ordered the meds, that they would do more of the "coordination" and stuff. Honestly, they have not done a good job with this. Repeatedly I feel like I'm running around like a crazy person doing the bulk of the coordinating. With my ADD and new job, this is terrifically difficult for me. 

When my GC came in for her appointment on Monday, they gave her a written Rx for her meds and told her to fill it. No one thought "hey, we've already placed an order with the IP a few weeks ago, maybe we should check on that." The reason I found out? The nurse copied me on an email to the GC that said "You don't need to pick up the Lupron in your original order." All of a sudden I was like "Is this a double order???" The nurse emailed me at first and said that maybe the fertility pharmacy sent the Rx to Kroger. I asked my GC, and she said no - no one told her  about the previous med order and ACRM just gave her the Rx when she went for her baseline ultrasound. She was suppose to start meds that day and not one red flag was thrown up. A few back and forth emails, and it was apparent that no one on their end was really keeping tabs on this. 

Truthfully I should have checked that her med order went through smoothly weeks ago when I got mine. I had informed my nurse that I had received mine, but then got violently ill and forgot to double check if our GC got hers. I had no reason to believe she didn't and I guess with all the balls I am juggling, that was another one I dropped. I'm terrible at organizing these types of things, which is why I didn't mind paying the extra money to the clinic to do so. And I really don't consider $3100 a small fee to do this. As I am sure you have already guessed, our GC did not receive her meds from Village Fertility and it upsets me that I feel like I'm having to do the bulk of "third party coordinating" while paying them a chunk of extra cash. (Yes, I know some of this goes towards the medical aspect, but we were also told it goes towards things like this.)

All of this resulted in frantic phone calls, in the middle of a workday, with my very public cube, to multiple people. This is sucktastic for me to have to do at a new job. Village Fertility Pharmacy said they did not ship the GC order because they had left 2 messages to set-up a profile for the GC and she did not call back. My GC said she never received the messages and I 100% believe her. I asked Village why they didn't call me when they couldn't reach her, and they admitted they should have. (As a side note: I am very forgiving when people admit mistakes and then do whatever they need to do to correct it - Village did this.) Village apologize and after I altered the order (minus the no longer needed Lupron and minus the already procured Estrace), they were able to ship out overnight. 

In the long run, I think the mess-ups of everyone (me, the clinic, and the pharmacy) saved me money, but that still doesn't give me a warm and fuzzy. Especially mid-cycle. I'll write more later on my HUGE upset about a screw-up in charges. It's a freaking shame because we adore our doctor over there. 

How to be Good Friends with an Infertile

Excellent read for those of you that are not infertile, but really want to know how to be awesome to those of us who are. Hell, who am I kidding? Excellent article for us infertiles to pass on to our fertile friends. At least the ones that haven't already violated every "do not" on the list already...

http://tertia.typepad.com/so_close/2004/05/how_to_be_good_.html