Wednesday, August 24, 2011
Ode to Michelle and Kaye: BFF's
As I am getting ready to start a new school year I often think about these two women. They taught first grade with me for the last 7 years and we became the closest of friends. This year they have both moved on to new chapters in their lives. Kaye had a beautiful baby girl...Madison and will be staying home to provide for her the way that she deserves. She is such an amazing mommy and that little girl couldn't have been more fortunate to be born into the Hough family! Michelle accepted a job in beautiful Bear Lake where she will get to be close to her hilarious and loving family. She will be teaching third grade and those families have no idea what they have coming their way! She will touch their lives forever as she did mine. These women have been my support, my entertainment, and my muse! I love them both dearly and they will be truly missed. Thanks Kaye for coming in to volunteer in my classroom and help me get this school year started off great!
Ultrasounds
We started going in for ultrasounds to check the growth of the follicles on Monday August 8th. The original plan was to have the egg retrieval on Thursday or Friday and these ultrasounds would determine which day based on the size of the eggs. Because they can't actually see the eggs, only the follicles, the way they determine whether they are mature is how big the follicles are. The follicles can grow anywhere from 1-3mm per day. Usually they are mature when they are anywhere from 18-22mm. On Monday they expect ed them to be around 16 mm. Our ultrasound on Monday showed that they were on the small side, there were two at 12 mm, 2 at 11mm, and 10 under 10 mm. They knew at this point that we would most likely not be ready for egg retrieval on Thursday or Friday but possibly on Sunday. They told us at that point if we went past Sunday the percentages of a live birth go down. Dr. Johnstone decided to do another ultrasound on Wednesday to make sure they were still growing. With each ultrasound we became more confident that we would have the retrieval on Sunday. John would also have his biopsy on Sunday about an hour before my procedure. That way we would have the freshest eggs and sperm possible. The goal was to have at lease 10 eggs matured, but the ultrasounds on Wednesday and Thursday seem as though we would probably only get about 6 mature eggs, but they could never tell for sure until they got the eggs out. When they do the egg retrieval they take out as many eggs as they can, but they can only fertilize the eggs if they are mature. Our final ultrasound on Friday told us that although we didn't have the goal of 10 mature eggs, the ones that we did have looked as though they would be ready on Sunday. The last test before we did the HcG shot Friday night was the estrogen test. The estrogen test is the second test to ensure that the eggs are mature. They expect the estrogen level to be at least 200 for each mature egg. If the estrogen level is not that high it could mean that there is not an egg in every follicle or that the eggs are not healthy. They wanted my estrogen level to be 1500-4000. It came back at 917 This was the devastating point! Dr. Johnstone told us that we had a few choices. We could still go ahead and see what we get, we may only have a few eggs to work with. The problem with this is you usually lose a few eggs with each step. Not all of the eggs fertilize and some just don't make it. The second choice was to go an extra day and see if the estrogen levels increased. Or the last choice was to cancel our cycle and try again at a later time. If we decided to go ahead and it didn't work we would lose the whole $10,000 plus the cost of medication at about $2300. If we canceled they cycle we would just lose the cost of the medication plus the cost of the ultrasounds that we had done so far which is about $1000. They can either refund the rest of it or put it toward our next cycle. The doctor's recommendation was that we cancel and said that we could start our cycle again the next month. We decided to follow her advice. She put me on progesterone for two weeks to shrink my ovaries back down to normal size. My period should start within the next week after I stop taking it. I will start birth control on the first day of my period. I will take that for two weeks and then start the Lupron shots again.
Thursday, August 4, 2011
In the Beginning
As I am writing all of this I realize that some things may be my understanding of what happened and might not be totally accurate. Keep in mind that I am hopped up on all kinds of drugs:)
The weird thing about IVF is that you start it by taking birth control for a minimum of 2 weeks. I started my birth control pills on June 24th. My understanding of the reason you take birth control pills is so they can manipulate your cycle. I took them for longer than two weeks so that all of the appointments that I have to go to wouldn't conflict with my vacation schedule.
On July 17th I started injections of 10 units of Lupron and continued taking the birth control pill. From what I understand Lupron reduces estrogen levels and basically shuts down the ovaries. It makes it so you don't ovulate. After being on Lupron for 7 days I stopped taking birth control and continued the Lupron. Sometimes cysts are formed on the ovaries because of this drug so I had an ultra sound on July 27th to check and there were no cysts found....Yea:)
On August 1st I decreased the Lupron to 5 units and began Follicle Stimulating Hormones. For the first 3 days I did 200 of Follistim and 1 of Repronex.
Today is Day 4 of FSH and I am decreasing Follistim to 125 and continuing 1 of Repronex and 5 units of Lupron. So far I feel a bit bloated. When I started the FSH I had to stop alcohol, caffeine and exercise. If I am standing for long periods of time my stomach starts to hurt a bit.
The weird thing about IVF is that you start it by taking birth control for a minimum of 2 weeks. I started my birth control pills on June 24th. My understanding of the reason you take birth control pills is so they can manipulate your cycle. I took them for longer than two weeks so that all of the appointments that I have to go to wouldn't conflict with my vacation schedule.
On July 17th I started injections of 10 units of Lupron and continued taking the birth control pill. From what I understand Lupron reduces estrogen levels and basically shuts down the ovaries. It makes it so you don't ovulate. After being on Lupron for 7 days I stopped taking birth control and continued the Lupron. Sometimes cysts are formed on the ovaries because of this drug so I had an ultra sound on July 27th to check and there were no cysts found....Yea:)
On August 1st I decreased the Lupron to 5 units and began Follicle Stimulating Hormones. For the first 3 days I did 200 of Follistim and 1 of Repronex.
Today is Day 4 of FSH and I am decreasing Follistim to 125 and continuing 1 of Repronex and 5 units of Lupron. So far I feel a bit bloated. When I started the FSH I had to stop alcohol, caffeine and exercise. If I am standing for long periods of time my stomach starts to hurt a bit.
Phone Call
There are many things that you have to do in preparation for IVF. I had lots of blood tests, one showed I wasn't immune to Rubella so I also had a rubella immunization. John submitted the semen sample, then we got the phone call. We got the shocking news that there was no sperm in the semen sample. They didn't know why, they expected to at least see some dead ones especially since there were some after the reversal. They suspected that there could be scar tissue that formed but couldn't be sure and they wanted us to go see their urologist.
They didn't want us to start the IVF process if there was no sperm. So we made an appointment with the urologist. They did an exam and they thought that because John already has two kids and there was sperm after the reversal there is probably scar tissue that has formed. This new made IUI out of the question and put us on the IVF track. They can do a testicular biopsy to extract sperm. This is where more decisions came. We could do the biopsy before we started IVF to make sure there was sperm and freeze them if there were until we were ready for them, but fresh sperm have a better track record. Our other option was to start IVF and have the biopsy done the day of my egg retrieval. This is what we decided to do.
There are two options in IVF. One is where they extract the eggs and put them in a petri dish and surround them with sperm. The other is when they do ICSI (Intracytoplasmic sperm injection). This is where they take one sperm and inject it into one egg. Because we will have a limited number of sperm through the biopsy. We will be doing ICSI. They told me they would like to do this with about 10 eggs. Then they will let the eggs grow for three days and evaluate which ones look the best. Depending on how they look they will implant them into me on either day 3 or day 5.
They didn't want us to start the IVF process if there was no sperm. So we made an appointment with the urologist. They did an exam and they thought that because John already has two kids and there was sperm after the reversal there is probably scar tissue that has formed. This new made IUI out of the question and put us on the IVF track. They can do a testicular biopsy to extract sperm. This is where more decisions came. We could do the biopsy before we started IVF to make sure there was sperm and freeze them if there were until we were ready for them, but fresh sperm have a better track record. Our other option was to start IVF and have the biopsy done the day of my egg retrieval. This is what we decided to do.
There are two options in IVF. One is where they extract the eggs and put them in a petri dish and surround them with sperm. The other is when they do ICSI (Intracytoplasmic sperm injection). This is where they take one sperm and inject it into one egg. Because we will have a limited number of sperm through the biopsy. We will be doing ICSI. They told me they would like to do this with about 10 eggs. Then they will let the eggs grow for three days and evaluate which ones look the best. Depending on how they look they will implant them into me on either day 3 or day 5.
The IVF Consultation Appointment
The consultation appointment for in vitro fertilization is about $400 and it is not covered by insurance so we wanted to be serious about it before we went. When we got to the University of Utah Center for Reproductive Medicine or the UCRM everyone was very friendly and we felt totally comfortable there. We met with Dr. Mark Gibson and at first I felt like he was grilling me a little. He said that usually they require that couples try at least a year to get pregnant and because of the reversal healing time we probably had only been trying about 6 months. He wanted me to explain to him why I was so sure that we needed to take this route. I explained to him that the doctor who had done John's reversal told us that if we weren't pregnant by Christmas we might want to explore other routes. I also told him that because of John's age (He is 49 right now) and my school schedule it would be beneficial if we could do it sooner rather than later and we felt we needed to find out about our options so we could plan ahead. We have a few friends who have had vasectomy reversals. One of them ended up doing in vitro because after the reversal the sperm was not strong enough to penetrate the egg. The other couple are still not pregnant and are saving up to do IVF. Dr. Gibson said that he would like us to try a few round of IUI (Artificial Insemination, about $350 per cycle) before we went the much more expensive route of IVF(about $15,000 with medications).
During that appointment we had a vaginal ultrasound to check my ovaries and make sure they looked healthy. I had 8 maturing eggs in one ovary and 10 in the other. We also had a test where they put saline in the fallopian tubes to make sure they were open. Everything looked great.
We learned so much during this appointment. One thing we learned was that a woman has all of the eggs she will ever have when she is born. Each month the eggs compete to be the most mature one. The eggs are microscopic but each egg has its own follicle. The follicle is the part that matures. The follicle fills with fluid and the egg that has the biggest follicle is the one that "wins" and that is the egg that you ovulate that month. The average ovulation day is about Day 12 in your cycle.
The next step we needed to do was get another semen sample. It had been about 6 months since the previous one so we needed to see what we were working with to see if it was worth it to try IUI.
During that appointment we had a vaginal ultrasound to check my ovaries and make sure they looked healthy. I had 8 maturing eggs in one ovary and 10 in the other. We also had a test where they put saline in the fallopian tubes to make sure they were open. Everything looked great.
We learned so much during this appointment. One thing we learned was that a woman has all of the eggs she will ever have when she is born. Each month the eggs compete to be the most mature one. The eggs are microscopic but each egg has its own follicle. The follicle is the part that matures. The follicle fills with fluid and the egg that has the biggest follicle is the one that "wins" and that is the egg that you ovulate that month. The average ovulation day is about Day 12 in your cycle.
The next step we needed to do was get another semen sample. It had been about 6 months since the previous one so we needed to see what we were working with to see if it was worth it to try IUI.
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