WUT?

So can we talk about this? Because WHOA:

I have peed on so many, many dollars over the last few years, but never has THIS happened. And let's be clear -- I am certainly not operating as though this means we'll actually be bringing a baby home come May. If this is indeed accurate and not just a chemical (first beta is Tuesday), I am at a mere 4w1d. There is still so very much time in which things could go wrong.

I am dangerously, wantonly hopeful, though; I just can't help myself. We did so much to get here and I think I was just expecting it would never actually work. I feel like hope is reckless at this stage, but alas, here we are. And fucking Pinterest, you guys. The siren song of its trove of nursery photos is irresistible; I mean, imaginary decorating is MY THING. I'm not pinning anything, of course, but ohh how I look and ponder themes and paint colors. I also had a conveniently timed shopping trip to pick up a baby shower gift and was promptly overwhelmed by Buy Buy Baby. There is so much CRAP; I could research from now until May just trying to figure out what is actually necessary. It makes reading about this stuff so easy to justify when I should really just back away and ignore the fact that our whole world has shifted.

I think imaginary decorating and reading about baby gear is just my method of distraction, because the limbo never really ends, does it? First I was anxious it wouldn't work, now I'm terrified something will go wrong. The really scary thing is that, if we're unbelievably lucky, it's only going to get worse. In the best case scenario, I'm going to spend my whole life, God willing, worrying about something happening to this little person. Right now, I'm just hoping I'll get that chance. 

I can't drink, so I'm soothing my nerves with pictures of Jenny Lind cribs and nautical stripes. It'll have to do for now.

Limbo

*Still rambling about reproductive matters. As always, feel free to avert your eyes.*

I'm horribly impatient, which makes the waiting for the first beta torturous. My sunny and optimistic husband just puts it out of his mind and goes about his day. My innards are still a bit jacked, so even in the rare moments I can forget, I'm reminded by the pain every time I have to pee. Or sit on my lumpy, PIO'd ass. If it didn't work, it didn't work; I JUST WANT TO KNOW. My test is scheduled for the 17th, but I am 100% a home test cheater, so maybe Thursday. We'll see -- I'm trying to hold out as long as possible. 

Did I tell you about the transfer? It was such a strange experience. They bring you into a dark exam room to wait for the doctor, then there is a lot of repetitive ID bracelet checking and name/birthdate/social recitation, first with the nurse, who also checks your photo ID before putting on the bracelet, then with the doctor, and finally again with the embryologist. We had to say why we were there and verbally consent to the single embryo transfer and sign the consent form. The embryologist went back to her bench and trained the camera on the embryo that had been voted Most Likely to Succeed, displaying the image on a tv in our procedure room. At this point, the doctor started describing what we were seeing and why they chose that embryo as she, um, set up shop. It was kind of weird because this was only the first time I had seen my doctor for an actual medical procedure. She works out of the main office, which is a hike for me to get to. I go there for consults with her, procedures requiring the ASC, and occasional monitoring appointments if I have to go outside of the satellite office monitoring hours. For my regular monitoring appointments, I go to the office that is on my way to work and I am a frequent flyer to the staff over there. My doctor coordinates my protocol, though, and has been wonderful to work with. She is super no-nonsense, yet still quite sure we will eventually have success, but in a very matter-of-fact way. I never, ever get the sense that she is blowing sunshine. We also went to the same small college. Although I was there about five years after she graduated, I feel like it makes her my people in a way. 

But I digress. (Ha, that should have been what I called this blog.) After setting up shop, the doctor looked around for free fluid, given my increased risk of developing OHSS. The ovaries were still swollen, of course, but I appeared to be fluid free otherwise, so she felt good about giving a thumbs up for transfer. She opened a door into the lab and requested the embryo by an ID number. The embryologist brought in the catheter, it was positioned by the doctor, and just like that, the transfer was done. The embryologist brought the catheter back to the microscope to make sure they had gotten the embryo out, and that was it. My doctor was lovely, taking a minute to chat afterward and thanking us for being so patient over a long road, saying how hopeful she is that this is the one and how confident she is that we would have a strong group left to freeze. (We did! Six!) She is super smart and very much a scientist, but she is also an excellent caregiver. This clinic sometimes gets a bad rap because it is so huge; people complain about feeling like a number. However, that has never once been my experience. Even visiting multiple offices, I still feel like they all know me and genuinely care about our experience and getting us to an eventual success. We're several cycles in, child-free, and I would still recommend these people without the slightest hesitation. 

Oh! The funniest part! (It's dark humor; bear with me.) So once the doctor leaves, they have you stay lying down on the table until one of the nurses comes in with your follow up instructions. As I was lying there, the embryologist came back with a card that had a picture of the embryo attached. It just struck me as morbidly hilarious, perhaps because detachment is an excellent defense mechanism. It was just like those cards you get when you take kids to see Santa or the Easter Bunny, except inside was a picture of our widdle blastocyst. What does one do with this? Hope for the best and save it to paste under "Baby's First Photo" in a future baby book? I couldn't help but think about what I was supposed to do when the clump of cells dies. Label it "Our First Little Crushing Defeat" and tuck it away to reminisce about those two weeks we spent hoping it would live and wondering who it would become? For now, I am going with hide in purse and try to forget it's there.

It totally has my inner cell mass. 

One hell of a weekend...

...with "hell" being the operative word there. 

*As always, here is your TMI warning to avert your eyes. Talk of the lady parts ahoy.*

Let me back up. When we last chatted, I was well into stims for this cycle and things were progressing nicely. It looked like there would be about 15 follicles, which is a nice number for ensuring success without venturing too deeply into risky Ovarian Hyperstimulation Syndrome (OHSS) waters. I was having daily monitoring appointments last week, and on Wednesday, they estimated another two days of stims before trigger. That was perfect timing-wise, as we had friends coming to spend the weekend, so a Monday retrieval was ideal. That would also bring us to a Saturday transfer, so minimal time out of work too. 

Enter Murphy's Law: At Thursday morning's appointment, we were up to about 18 follicles and the leaders had jumped into the 21-22 mm range. The sonographer had me talk to one of the nurses, because she was 99% sure I would trigger that night based on the looks of things. I got all of the instructions from the staff nurse, then awaited the post-bloodwork call from my regular nurse. It turned out that my estrogen levels had doubled overnight and were ridiculously high -- just over 5,000, so yeah. Time to trigger. Because of my PCOS diagnosis, the original plan was to use a dual trigger -- a lower dose of the traditional hCG trigger, plus Lupron. Where hCG is a driver of OHSS and it has a very, very long half-life, the traditional all-hCG trigger was a bad idea for me. However, with the discovery of the sky-high estrogen levels, the team decided that the dual trigger was also too risky and decided to go with Lupron only. Lupron can be dicey, as it causes a surge of LH from the pituitary to mature the eggs prior to retrieval, but in the rare case where there is no LH in reserve, the trigger failure could result in a cancellation. I was very worried about this potential, as the ovaries were suuuuper uncomfortable at this point. (It is very weird to be able to feel your internal organs bumping around in there.) 

Friday's bloodwork revealed that the Lupron trigger had done its thing, so we were good to go for the Saturday retrieval. I was both anxious to get it over with, but also frothed into a terrified lather over the possibility of OHSS, especially with the fast rising estrogen and my nurse's urging to start a high protein/sodium diet and switch to drinking Gatorade. (I may also have broken the 1st Commandment of The Internet: Thou shalt not google potential medical complications.) Anyway, I bought out the processed meat and fruit punch Gatorade sections at the supermarket and we immediately embarked on the high blood pressure express. Since Thursday, we have had cheeseburgers, kielbasa, hot dogs, a quattro carne pizza (pepperoni, sausage, meatball, AND bacon), a boatload of tater tots, and I have had two lunches of Baja Fresh. I'm also deep into my third barrel of Gatorade. It is surprisingly horrific (I would kill for a salad right now), but if it keeps me from developing issues? Bring it on. 

Saturday was pretty awful. I woke up starving, which I never do, likely because I knew I could neither eat nor drink. We had to be at the doctor's office by 11, at which point the anxiety began. I was straight up SCARED. I am a terrible patient to begin with, and not knowing what to expect was killing me. They got an IV started to rehydrate me after the pre-op fast, then we had a bunch of informed consent nonsense. I have loved almost all of the nurses at this place, but the one in charge of informed consent? OMG, awful. She was incapable of deviating from her script, even for questions. At least the others were all great. I was also put tremendously at ease by the doctor. Once they were ready to go, things went really quickly. They walked me into the procedure room, had me get situated on the table, then the anesthesiologist hit me with the versed. I remember laying down, then I have a vague recollection of scootching to the gurney when they were done. I think I apologized in case I had snored (such is life with effed up sinuses), then they brought Mark back. I kept telling him to sit, but he insisted on standing next to me and holding my hand. Things were getting painful the less groggy I got, so they shot some fentanyl into my IV. It didn't do much, but the Queen o' Bedside Manner had scared the bejesus out of me earlier, talking about women who refused pain meds and ended up in the ER from the pain. (THANKS, DONNA.) What has two thumbs and isn't a hero? THIS GIRL.  

Once I was back with the program, they brought me a giant diaper pad and said I could get dressed. My favorite nurse of the day walked me around to make sure I was steady enough to get to the car, then came in to tell us the egg count. Turns out they got TWENTY-EIGHT, HOLY CRAP. This is both awesome in that I could potentially not have to do another egg retrieval, but also ups the risk of OHSS (hola, Gatorade, old pal!) Apparently something about the number of eggs collected also caused them to switch me from the progesterone suppositories they originally prescribed to the dreaded PIO injections. They gave me a vial to bring home and drew helpful little targets on my ass for Mark. Unfortunately, they only had GIANT needles instead of the normal huge needles, but luckily I was able to draw on my stash at home. The shots really don't hurt in the moment (although Mark's needle phobia means he needs to steel himself with a scotch before stabbing me), but now I feel like I have big bruises on my butt. Lovely. 

Now for the ugly business:

-- Despite all I read, I was not quite prepared for the pain. You don't realize all of the small movements you use your lower abs for until that region is all aflame. For example, to sit in the recliner, I had to have Mark pop the chair open, slowly raise the footrest, and push down the back. I bounced back quickly, though. I've been proudly operating the recliner all by myself since mid-yesterday. 

-- I stayed on top of the pain meds, but was totally blindsided by the pain of --TMI-- a full bladder. Oh! And, embarrassingly enough, gas pain. With all of the swelling and inflammation in the area, there is just no room for anything else to move around without paaaaain. By the time I realized I had to pee, I was in such pain that Mark had to lift me out of the chair and walk me with little, shuffling steps to the bathroom. That? That was a low point.

Less ugly was the call from the office with the fertilization report -- 22/28 fertilized and were growing as of yesterday; we'll see what happens today. 

Other than overdoing a bit yesterday when the friends we had to cancel on came by to visit (their son ADORES Mark and talks about him all the time, and the feeling is totally mutual, so we were determined to see them before they went home), I have been taking it easy and trying to stretch out the intervals between pain meds. I am really grateful for the long weekend because there is no way I'd be up for going to work today. I am totally going to shower though. Way to aim high, overachiever. 

I vant to be alone. You know, just for an hour or so.

I am the epitome of an introvert. I prefer small groups to big ones, I haaaate idle chitchat and would sooner hang myself than attend a networking event, and I 100% require quiet time at home in order to recharge. When we do vacations with friends or my inlaws where I am with non-immediate family 24/7, I end up spending day 4 or 5 holed up in bed because I just can't be ON for another second or I will die. This is unfortunate, because I have pretty much spent this entire month traveling away from my personal recharging station (aka "home"). I met up with college friends for a long overdue girls weekend of wine tasting, we went to Boston/the Cape for my birthday weekend, I had a work trip to the San Francisco area (during which I had my first IRL internet friend meetup in which Emily (@pantalonesfuego) introduced me to Mission burritos), and I returned home to greet my mother in law at the airport for a visit to check out the new house. All of these things are really fun (well, meetings aside), but still SO draining. I am counting the minutes until I am home in an empty house next Wednesday, and I'll have to enjoy it while it lasts, as we have friends arriving on Friday to visit for the long weekend. I AM READY FOR SUMMER TO BE OVER. 

In other news (and feel free to avert your eyes here), we are well into the stims portion of the first IVF attempt. We ended up moving up the schedule after I had three migraines with aura in one week and realized that they were being triggered by birth control. The only other aura I ever had was back in April when I was on the pill after the cycle that was cancelled for overstimulation. I think this is day 9 of shots (Gonal-F and Menopur), and at my monitoring appointment, there were about 10-12 follicles in the 9-10mm range. I am hoping everything will keep progressing, and keep equal pacing with each other. Still waiting on the bloodwork and dosing call, but the ultrasound tech thought it all looked good. I am mildly optimistic (I have moved on from yesterday's fretting about having to move to MA for IVF coverage after we exhaust our allotted attempts here), though I will take any good thoughts you can spare. Next appointment is Monday morning. 

Ok, I have to go. I snuck away to "take a shower" about a half hour ago, so I should really get on that. I already had to lie about my whereabouts this morning so I could sneak off for monitoring. Ahem, I mean, have coffee with a friend. Ugh, this month can bite me. 

Feel free to avert your eyes...

Hello again! I've kind of been buried in unpacking (it will NEVER END, will it?) and work and daily life crapola. It's amazing how quickly the weeks slip by, isn't it? Anyway, with all of these weeks slipping by, it seems my month of freedom is over and we are back in the reproductive technology saddle, and HOO BOY is it different this time around. To sum up, after giving ovulation induction plus timed intercourse the old college try, I was ready to eliminate some variables. Given the particulars of our situation (many antral follicles making it very difficult to mature only 1 or 2 follicles, no male factor), IUI would not have increased our odds of success and it came with a hefty price tag. This left us with IVF.

I could write a dissertation on the b.s. that is our health insurance racket industry, but I'll sum it up quickly. Our insurance covers diagnostic testing for infertility, but generally excludes treatment. This means that for ovulation induction cycles with timed intercourse, we were paying out of pocket for the meds, but all of the bloodwork and ultrasounds were considered diagnostic and therefore covered for the regular "specialist" copay. However, if you add in just the IUI procedure, the same monitoring bloodwork and ultrasounds are no longer just diagnostic; because there is an end therapy in mind, they are considered treatment and excluded from coverage. I guess this is pretty common because my clinic offers IUI cycles for a flat fee that, while still including a comma in the number, was not much more than I was spending on injectables alone. The one exception to the general treatment exclusion is IVF. Because my husband works for a Maryland-based company and Maryland is blessedly liberal on these issues, our health insurer is obligated by statute to cover three IVF attempts per live birth. For this reason alone, we have access to the treatment option best suited for our needs AND it is costing us significantly (significantly) less money than less invasive treatment options, never mind what it would have cost us out of pocket. It is a game changer to say the least; I'm not sure we could have done this without insurance coverage. At best it would have been a decision between buying the new house and trying for a baby. Needless to say, I am feeling beyond grateful these days. 

The gratitude is taking a backseat to feeling completely overwhelmed, however, when it comes to the actual protocol. It's Day 13, and we're in the Birth Control Holding Pattern. I had the mock embryo transfer on Monday, and I think it was actually more painful than the HSG. (It was either someone's first day on the job or they were using a speculum made out of two shivs. Unpleasant!) Next appointment, for the pre-IVF evaluation, is on my birthday and obviously getting spelunked is totes how I had hoped to ring in #34. After that, we're heading to Boston for the weekend, then returning home to start shooting up. I nearly died when this arrived at my door last week:

Behold: An entire cycle's worth of meds for the price of maybe a dose or two out of pocket.

Because it is totally cool for multiple follicles to mature this time around, we do not have to be quite as cautious as before, so everyone is very hopeful that the injectables portion of the process will be well under the 17 days of stims I had last time. This does not mean that there is not intense monitoring; there totally is. In fact, this cycle's super fun drama (to date) has revolved around the scheduling of my first post-meds monitoring appointment.

My appointment is on the 22nd, and that is a hard date -- no wiggle room. I have a business trip scheduled for that week, but I figured it would be no big deal. I told the colleague booking our client visits that I needed to be back in DC on the 22nd. We had only three visits to make, so I figured Monday/Tuesday/Wednesday, fly home Wednesday night, and we're good to go. Easy, right? I still cannot fathom why, but the colleague scheduled our appointments for Tuesday/Wednesday/Friday. When I asked that he reschedule the Friday appointment for Wednesday or earlier, he rescheduled it for Thursday. While I wanted to rip my hair out in frustration, I was cool about it. I mean, people undergoing IVF surely have to travel on occasion, so I asked my doctor who they could work with in the San Francisco area. I found a clinic near my hotel that my doctor could work with and that also had doctors considered in-network for me. My nurse sent them an order for the procedures I need, they scheduled everything, and all was well. Well, at least until I spoke to the finance people at the SF clinic. It seems that their policy is to require non-patients to self pay, even if there is a doctor there who is covered by their insurance. Self payment was going to be many dollars for basic monitoring bloodwork and ultrasound. I called my insurance to see whether they would reimburse me and they said, "Sure! Our negotiated and contracted rate is [less than half of that outrageous amount]." (Note to clinic: if a health insurance company thinks your policy is unfair? YOU'RE DOING IT WRONG.) At this point, I threw in the towel and decided to attend the last of the client visits via conference call because COME ON. 

Anyway, I have typed too many boring, rambling words (as usual), so I shall shut it now. Assuming all goes well (haaaaaaaa), we're anticipating an early September retrieval and a 5-day transfer. Cross some fingers and think good thoughts if you wouldn't mind, ok?