Nurse's Consult and Acupuncture Session

Babe and I had our nurse's consult this morning.  It was pretty brief and simple, since this will be our 2nd IVF with this clinic.  We went through our IVF schedule and the list of the meds that I will be on.  We are on a different protocol this time around, using the antagonist protocol.  Last time I was on the long Lu.pron protocol.  This time no "loopy Lu.pron"(yay!), so the cycle will be much shorter.  I will be starting my stims (Meno.pur and Follis.tim) on July 2nd.  Ganire.lix (antagonist) shots will start when the follicles are 14 mm or larger.  If all goes well, egg retrieval will be on the week of July 11th.

I only have one week left of BCPs.  Yay!  For some reason, I have a hard time remembering to take my BCPs.  I find myself running out of bed at night to take my them, remembering only right before I fall asleep!  It's so annoying.  I'm glad I'm almost done with them.  I was able to get a bunch of free samples of meds last time - Follis.tim, Endome.trin, etc.  I asked about them again, but I wasn't so lucky this time.  We got nothing.  I guess they were out of everything.  This time though, I asked to make sure we get enough meds on the prescription sheet the first time around.  There is a copay for each drug on we get from the pharmacy.  The last time, I needed additional Follis.tim and Menopur because I needed to stim a couple days longer.  So we had to pay copay again for the refills.  Hopefully, this time we will have enough without having to do a copay again.  We also made our payment for this cycle.... ouch!  It's a huge investment.  Let's hope this investment pays us back greatly!

I also had my appointment with AcuGirl this morning.  I am enjoying my acupuncture sessions and look forward to it every week.  Every week, AcuGirl asks how I'm feeling, what my stress level is, how I am feeling emotionally, etc.  She always checks my pulse - today my pulse was fine - fine as in thin, not fine as in OK.  Not really sure what that means.  Also my tongue looks good today.  I had been told to avoid dairy as it can cause "congestion" in the body.  Last week she could tell that I had been been a bad patient and have been having dairy by looking at my tongue.  Today, she was quite happy with the way my tongue looks.  She also advised me to eat a handful of goji berries everyday.  I like AcuGirl.  She and I get along well and chit chat quite a bit.  We always talk about food and discuss new places to eat.  We even talked about how Babe and I are starting to have less in common with our friends because everyone has kids but us, and she's having the similar but opposite experience.  All her friends have decided to not have kids, so now her and her husband (they have a young son) have less in common with their friends.

***While I was writing this post, the pharmacy called to verify my prescription order (the nurse faxed it in this morning) and to tell me that I had almost reached the $5,000 max of my coverage for infertility drugs.  After my last IVF cycle, I now only have less than $1,500 left.  I would have to pay the rest in cash.  That means I have to pay around another $4K in cash!!  This sucks!  I knew IVF meds are expensive, but I guess I didn't really know how expensive they are!  I told the pharmacy to hold off on filling out my script until I've had a chance to talk to (warn) Babe tonight.  Plus I am really going to have to bug the heck out of the clinic for some samples!

TWO Phone Consults

Yesterday, I mentioned that I was supposed to have a nurse's consult on Tuesday for our next round of IVF but I cancelled.  I wanted to talk to Dr. Hopeful first about trying to access the eggs in my right ovary.

So yesterday, I was finally able to talk to Dr. Hopeful over the phone.  I again told her about my concern that we can only access my left ovary.  Was there any other way to access the right ovary that was located high and behind the uterus?  It feels like such a waste to not be able to access the eggs on my right ovary, cutting down the number of eggs to 50% for my next cycle.  This is what I found out:

• She will not try to retrieve eggs from my right ovary by going through the uterus unless it looks like the position of the ovary has changed.  This is unlikely, but it is possible.  She does not want to risk going through my uterus with a needle, jeopardizing the condition of uterus which may impact implantation of the embryos.
• Many people have successful IVFs even though they only have one ovary.  This of course, is no comfort to me, knowing the crappy quality of my eggs.  Also it's not the same thing having only one ovary, versus having 2 good ovaries and knowing that your eggs from the right ovary is just being wasted!
• She will not be able to do a laparoscopic surgery to remove the eggs during the IVF retrieval process.  In the past, egg retrieval was done via laparoscopic surgery, but that procedure is no longer used for IVF.  They have found that it is inefficient and have low pregnancy rates.  
• Dr. Hopeful's clinic is not set up to do laparoscopic surgery.  It totally makes sense.  She is not trained for laparoscopy, and I wouldn't want her perform it on me!
• Most IVF clinics do not do laparoscopic egg retrieval for IVF anymore.  According to her, there are no clinics in MN that do that anymore.  I would have to go out of state to have it done.  Today I called another IVF clinic here in the Twin Cities asking about laparoscopic egg retrieval.  They don't offer that in their clinic either.  I will try to call another clinic next week to see if they do it.  Just out of curiosity.
• If I wanted, I can consider doing a laparoscopy surgery to try to move my ovary to better position, making it more accessible for egg retrieval.  But there are no guarantees.  It would mean postponing my IVF cycle for a few months.
• For our next cycle, we will be doing 100% ICSI.  From my first IVF cycle overseas, I didn't seem to have any issues with fertilization, and therefore, ICSI was not considered.  But we will do it this next time around.

During my conversation with Dr. Hopeful, I mentioned that I had not been able to get a hold of the andrology lab director.  She had suggested I go over my lab results with him.  However, I had left multiple messages for his admin, but she never got back to me.  So I gave up on trying to reach him.  Well she said she would email him (he is based in Utah) asking him to call me.  

Less than an hour after I hung up the phone with Dr. Hopeful, he called!  So I had my second phone consult of the day, with Dr. Lab Director.  I was very surprised that he called me back so quickly.  He's what he told me:

• Based on my first IVF cycle overseas, he didn't expect the outcome of my last cycle at the clinic.
• My last cycle here, 8 eggs were retrieved, and 6 were mature.  3 of the 6 were mature but had vacuoles (similar to bubbles) in them, indicating that there were some issues with the egg.  According to him, this is very unusual.
• According to Dr. Lab Director, in IVF cycles that have bad outcomes (like mine), in the next cycles, if nothing is done differently, 40% - 50% of the time they get a different outcome.  Possibly just a fluke.  The other 50% of the time, they get the same result.  So I guess, it sounds like we have a 50-50 chance of it working the next cycle?
• So the question is, is the issue the egg or the sperm?  According to Dr. Lab Director, Babe's sperm seems to be fine, based on previous IUIs and IVFs.  Generally sperm tends to be more consistent.  It seems like the issue is with my eggs (no surprise here!).  Unfortunately, there is no good test for eggs.
• His guess is, my body may have responded differently to the drugs or protocol of my last cycle versus the one overseas.  It's a possibility, but we will never know.
• Doing ICSI is a good idea for the next cycle since we had such a low fertilization rate (only 2 out of 6). This will increase the odds of our eggs fertilizing. 

Based on the 2 phone consults I had, I have decided to continue with our original plan of doing our next IVF cycle in July.  We now have a nurse's consult next Wednesday, June 23rd.  I am praying that acupuncture and herbs will help improve the quality of my eggs.  I can sure use all the help I can get.

Estimated IVF Timeline and the OPK Guessing Game

I managed to talk a nurse from Dr. Hopeful's clinic today.  If AF is on schedule (which is doubtful based on the last couple of months), she should be here January 31st or February 1st.  I would start birth control pills starting on day 2 or 3 of my next cycle, followed by shots for 2 to 3 weeks.

Currently, my Egg Retrieval is estimated to be sometime the week of March 15th.  Embryo Transfer will be 5 days later.  I am scheduled for a Saline Infused Sonogram and trial transfer on Feb 9th, and our nurses consultation will be Feb 16th.  Finally, things are starting to fall into place and I have a plan!  I'm such a planner.  I've already updated our calendars in our home office and on my Palm.  I've also started an "IVF Log".  It's just something that I am using to keep track of dates of visits, conversations with nurses, notes, future appointments, next steps, etc.  Help keep me organized and something to refer to when I need to remember what was said and done, by who, and when.  It can be overwhelming.

On another note, tonight I peed on a OPK, being that it is CD12 and this will be my absolute last chance of having a baby the normal way!

What the heck!  There was no line at all!  At least last night there was a faint line.  So I fished out yesterday's stick from the trash can to make sure I am not losing my mind.

Here's a picture of the two sticks.  The top is from yesterday, it has a very faint line but it was darker last night (you are supposed to read it 3 minutes after you pee on it).  The bottom one is from tonight and it has no line at all.  Why is that?  I'm only on CD12 so I don't think I ovulated yet.  The same thing happened to me a couple of cycles ago too.  I thought it was because I bought the cheaper generic Targ.et brand.  This month I used the good stuff, Clearb.lue.  I wonder if drinking a lot of water might affect it.  I did pee on the OPK after I got back from working out at a Zumb.a class the the Y.  So maybe drinking too much water can dilute your urine and no line appears?

I guess I will just have to pee on an OPK again tomorrow and see if the line magically appears again.