A New Doctor

After our last failed cycle of in vitro we were left feeling pretty desperate. Our doctor at the University of Utah didn't seem too interested in communicating what the next step should be and we felt like maybe we just weren't in the right situation. I wanted to wait for at least 3 months before trying another cycle to see if taking all of the extra supplements/vitamins/and witch doctoring would help. While going through this wait we decided to explore another Reproductive Endocrinologist that I had heard about.(I have taught 2 students that have come from this doctor) We had a consultation with a Dr. Hatasaka at Reproductive Care Center in Sandy. He studied our case and gave us lots of options. He said that after looking at our previous cycles and the embryos we got he wouldn't recommend doing IVF with our own eggs again but that if we wanted to try one more cycle he totally understood and he would support us in that. He gave us lots of different options for using our own eggs: we could go with even higher doses of meds, we could do a low stimulation cycle, we could take human growth hormones, the list went on and on. After canceling our first cycle we did a high dose cycle and it really didn't seem to make a difference so we decided to do the low stimulation cycle. When doing this kind of cycle they expect to only get a few eggs but what they are finding is that usually they are the best eggs available during that cycle. Since we have diminished ovarian reserve and we don't get a lot of eggs anyway we decided that this would be the way to go. It's also a little cheaper. The base price is $7,000 vs $11,000 but it only includes 2 ultrasounds and you have to pay $450 for every extra ultrasound and if you get more than 4 eggs there is an extra fee. Well I definitely didn't think that would be a problem since we could never get more than 6 eggs even with high doses. So we decided to go for it. We have always had low estrogen which could indicate poor egg quality. But with this cycle they start you with a drug like clomid which also suppresses your estrogen levels. I was so freaked out when our estrogen levels were far below where they were before. They expect your estrogen to be at 200-300 per mature egg and the ultrasounds were showing 5-6 eggs and our estrogen was at 316. Our doctor stayed positive and said we only needed one good egg and he was surprised that we even had 5-6 showing up. We did end up having 2 extra ultrasounds and pushing out our egg retreival date for a couple of days. When we finally got to our egg retrieval they got out 7 eggs. 6 of them were mature and 5 fertilized normally. Then we had to wait for 3 days to see how they looked. They called us on Day 3 and said come down for our transfer that day. Surprisingly there was 1 embryo that was graded excellent, 2 graded good, and 2 graded fair. On our last go we only had fair-poor embryos so we were super stoked and hopeful. We transferred the excellent embryo and one of the good embryos. We grew the others to see if they could make it to the blastocyst stage. 1 of them made it and we were able to freeze it. The other 2 died before day 5. We had the transfer and I felt like I was pregnant. I started having weird dreams, was tired at unusual times, had to pee more often and had a general feeling of being bloated. I took a home pregnancy test 4 days before we were supposed to find out and it said positive. We were so shocked and excited, but the very next day I took another one just to be sure and it said not pregnant. Then the symptoms started to go away. I was so sad, but I was hoping I was wrong. I googled what a positive then negative pregnancy test could mean and it said it usually means it was an early miscarriage/chemical pregnancy. On Thursday we had a blood test to see if we were pregnant. If you are pregnant they like the level to be over 100. If you are not pregnant they want your level to be below 5. Ours was 8 which meant it was most likely an early miscarriage. They need it to be below 5 to make sure I didn't have an ectopic pregnancy. So just to rub in the fact that you are not pregnant you have to go and have another pregnancy test 2 days later to confirm that your levels dropped below 5. Hopefully this is a sign that we can get pregnant, we just need to right embryo. We have a follow up with the doctor in early April. Before this cycle he was recommending that we go to donor eggs. Because our embryos looked pretty good this time(he said they rarely see embryos that our graded excellent)he said he probably won't recommend going to donor eggs right away. We will see what happens.

Witch Doctoring

During this whole ordeal I have been doing endless research on how to give myself the best chance of getting pregnant. It seems that "western medicine" believes one thing and then there are the "witch doctors"! I have never been a big pill popper myself but it seems that I have suddenly turned into one. Since I am currently not injecting prescription drugs I might as well pop endless amounts of vitamins and supplements,right! I've been going to my favorite witch doctor once a week to get my uterus "adjusted". Sharon-the master herbalist provides an experience that is hard to describe. She has given me two tinctures to drink daily...women's formula and cayenne. I also am taking DHEA, L-Argenine, CoQ10, Vitamin E, Super B Complex, Prenatal Vitamins, Folic Acid, and Fish Oil. I have also switched to an all organic, dairy free diet. We should be getting back our test results to see if I have diminished ovarian reserve this week. We will see if this concoction helps my egg quality.

Old Lady Eggs

As you may have heard already, we are not pregnant:( It has taken me quite a while to say that without starting to cry and even now, 12 days after we found out I still get teary just thinking about it. I have read so many other people's stories about infertility and never really thought ours would be that complicated. Boy, was I wrong! I thought our only issue was getting the sperm to the eggs. Apparently there is more of an issue than that. I might just have old lady eggs at the ripe old age of 31. Who would have ever imagined that once you hit your 30's life is down hill from there! I had no idea, just a couple of months ago I was telling John 50 is the new 40:) So what's next...Of course I am constantly researching what I can do next. The day I got the not so good news I was on the phone with another clinic setting up a consultation appointment. Apparently my coping strategy is to make plans for the next step. I also started looking into in vitro with a partial money back guarantee. For these you have to qualify. The doctors look at your medical history and decide what they think your chances are of getting pregnant. They then put you in a tier if you qualify based on how easy they think it will be to "knock you up". The doctors haven't gotten back to me yet on what they have decided and we have a consultation appointment scheduled with a different doctor at the end of November. When I married an older man people were probably thinking that he was going to be the one whose body wasn't up for a little baby making. Much to my surprise as well, my body seems to be the one that is not performing "up to par". The beginning part of in vitro where you do all of the follicle stimulating hormone injections is called superovulation. My body didn't respond ideally in the first cycle that we canceled. It also didn't respond ideally in the second cycle with at least double the doses. This response to the meds indicates that there is probably either an egg quality issue or that there are just not many eggs left (diminished ovarian reserve). So yesterday we went in for a blood test that will tell us if we don't have many eggs left. Who knows why we didn't do this test before we did two in vitro cycles!!!??!!! This blood test is fairly new and is called anti-mullerian hormone. We won't find out what the results of the test are for a while....so I started doing more research! I thought I would be done with all the research when I got my master's degree. I know I said I didn't want to get my doctorate but I am starting to think I should get one in infertility as it seems to be the only thing I read about lately:) What I found out is this is a pretty amazing blood test to know about if you don't have kids, are thinking about postponing having kids for a few years, or want to know if you're still a "fertile myrtle:)" Because so many women are starting to have babies later in life this test could save them tons of heartache later on. If you want to know if you can wait and be fine you just go get this test done! It wouldn't have changed anything for me since I didn't have my wonderful husband when I was in my ideal child-bearing years:) which are apparently the younger the better, but it does make me think twice about how I might have lived my life differently if I would have known the info from this test.

Hesitation

The pictures are of Aunt Lynnette giving me the HcG shot and LuAnn holding a sign saying "Here We Come"--that is from the eggs point of view. The other picture is of our two little embryos that we had transferred back to their "Happy Place" on Wednesday morning.

I have kind of hesitated to put on the latest happenings in our IVF story because of the fear of it ending with no pregnancy. I know that I have to think positively. (John read "The Secret" and now if a doubt ever passes through my lips I hear about it:) Plus I know hardly anyone reads this so what the heck!

We started another round of IVF about a month after we canceled our last cycle. This time we increased the doses of the Follicle Stimulating Hormones to see if we could get a better response. We went from a dose of 125 of Follistim to a dose of 300 nightly(not sure what kind of units those are.)

Unfortunately that didn't seem to make a difference. From what I've read this could be because of low egg quality. We ended up with a slightly lower estrogen count than when we were on the lower doses:( Because it was our second time trying and the meds didn't seem to make a difference we decided to go ahead with the retrieval even though we had low estrogen counts. We had the retrieval on Sunday October 9th. They also did a testicular biopsy on John that day and found great sperm! They were able to get 7 eggs from me.

On Tuesday (Day 2) They called and told us out of the 7 eggs we started with, 2 of the eggs were not mature but 5 of them fertilized! This was great news to me. They said they would call us the next morning and if two of them looked better than the others we would do a day 3 transfer. If not we would wait for a day 5 transfer and come in on Friday.

They called us Wednesday morning at 7am and said that two definitely looked better than the others so we needed to be there by 10am to do the transfer. Pretty exciting:) When we got there, they got us right in. Of the 5 embryos remaining the two that we would be transferring had 8 cells, one had 6 cells, one had 2 cells and one had 12 cells. They said the one with 12 cells could have some genetic abnormalities because it was so far ahead of the rest. They will let the three we are not transferring grow until the blastocyst stage on Friday. If they make it that long and they look good we will be able to freeze them.

They gave us a picture of the 2 embryos that we would be transferring and 2 valium to make me relax:). When you look at the picture you can see that one of the eggs is more fragmented than the other. The more fragmented they are the lower the quality. Dr. Johnstone said that the younger you are the less worrisome the fragments are, but it could be a sign that my eggs are low quality. They transferred the two embryos with 8 cells through a catheter into my uterus. We got to watch it on a tv screen:) Then I had to lay flat on my back for 30 minutes in their office.

They said at least one day of doing absolutely nothing. From what I've read doctors prescribe anywhere from 2-5 days of bedrest...We want to give those two little guys the best chance we can so we are going for the 5 days of bedrest until I have to go back to work on Monday. Only 80 hours left:)

Grow embies grow!

Egg Retrieval

John just went in for his biopsy and I am waiting for the doctor to get here for my egg retrieval. IV is in and we are ready to go! A fun girls weekend at the cabin holding baby Charley and learning to crochet beanies(thanks for being such a kind and patient teacher Megan) was just what I needed to get that estrogen flowing:)

Let the emotional roller coaster ride begin...again:)

I am happy to be lucky enough to be starting this unbelievable emotional Ivf journey again. I have been on birth control for almost two weeks now and we will be starting the Lupron injections again on Sunday. The Lupron will make me go into "menopause". It suppresses your reproductive organs so you don't ovulate. We are going to save those little eggs up til we have a "basket" full! Here's to hoping we can get a few more mature ones this time around.

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.

NeEdLeS!!

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.

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.

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.

In Vitro Fertilization

Our path to in vitro has not been as stressful yet as the many stories that I have read, but who knows what will happen. I am going to start the story from the beginning so I don't forget it. John had a vasectomy about 10 years before we got married. We had talked about having kids and we waited until about a month after we got married to have the vasectomy reversal. We went back to the surgeon who did the original vasectomy. He told us at the time that after 10 years there was not high percentage that it would work, but if we were planning on having multiple children it might be worth a try. If it didn't work the next step would be IVF. Some background information on vasectomy reversals...When a man has a vasectomy his body can sometimes create antibodies that kill the sperm, so even if the reversal "works"(the tube is reconnected) sometimes the sperm come out dead. After the surgery, the doctor told us that the reversal went well. One side had scar tissue, but the other side looked great. About a month after the reversal we had a semen analysis and the doctor was surprised at how many swimming sperm he saw. We were so excited that John didn't go through that painful surgery for nothing. He told us if we weren't pregnant by Christmas(this was in August) to come back. Well, needless to say we weren't pregnant by Christmas. Instead of going back to him we thought it would be a better use of our time to go to a doctor who could help us with the next step. We assumed that would be in vitro. We needed to have another sperm analysis done, but we figured we should have it done at the University of Utah where we would have in vitro done if that was really the next step. We made an appointment for a in vitro consultation at the University of Utah Center for Reproductive Medicine. More to come...

First Anniversary-June 17, 2011

Well, we have been married for one year and things are going great. It's so funny that I haven't added to our blog once during that whole time! I spent most of that time finishing up my masters degree and playing. We have had a fun year getting to know each other and traveling. This year we went to San Francisco for Valentine's Day, Acapulco for Spring Break, Lake Powell last week, Napa wine tasting next week and Turks and Caicos islands on July 15th. John sure took me seriously when I told him that traveling is something that I really want to do! One other thing I told him that I wanted to do was have a baby. We already have two wonderful kids, Dylan and Dakota and I can't imagine better teenagers. I know that he is an amazing father because how else would you get such amazing kids? John recently read a book that encouraged him to write every day and of course he thinks I would be good at this. I'm sure that the subject I am going to be writing on will be a little personal at times, but as we have been trying to get pregnant I have found it helpful to hear other people's stories so I am going to try and write down mine as well.

Fairy Tale Engagment

The proposal was simply amazing. The final wax of the ring had been approved, but I told the jeweler not to call me when it was done because I wanted to be surprised. Boy, was I surprised! I was on my way home from the gym and I stopped to get groceries because John was coming to Logan and we were going to make dinner. When I got home he told me that I should probably change into something a little cuter(he knew I would be pissed if I was in my gym clothes for the proposal). I changed and I was touching up my makeup as he was asking....Are you ready yet? He told me we were going to go on a little ride. We walked outside and there was a limo in the driveway. I knew what was coming and I couldn't wait to see what he had in store. The limo started driving north and I thought we must be going to mom and dads house, but then we turned. The driver took us to the Logan airport and up to the helicopter hangar. We went inside and the pilot took us to our little helicopter....we forgot the camera in the limo. When we got in the helicopter there were 12 individually wrapped long stem red roses. Each one had an envelope taped to it with a number on it. John had planned the flight plan to match the cards. Each one had a reason why he loved me written on the enclosed card. We flew all over Logan with corresponding cards. We flew over my parents house and they were outside waving....and he passed me the card that said I love you because your family is so important to you, We flew over USU and he passed me the card that said I love you because you are well educated, etc. It continued that way for 12 roses. After the roses were done we ended up flying in circles over what is now Smith's Market Place. John asked me if this place had any significance to me, I said no(looking for some message in the parking lot). He preceded to tell me that my dad had proposed to my mom in this parking lot. He had called my dad and got the entire story....can you believe how sweet that is? Then he asked me to be his wife...of course I said yes. The rest of the fairy tale follows:)