Monday, November 26, 2012

"Advanced" Maternal Age

What ugly words.

In a few weeks time, this Mama will be 35.  The dreaded age in the fertility world.  Is someone going to flip and switch and overnight, my ovarian reserve will decline and my chance of having a child drop dramatically?  Somehow, I don't believe it'll be that sudden, but 35 is the age when pregnancy and live birth rates drop. 

I certainly don't feel old or "advanced".  Most days, I'm still trying to figure out what I want to be when I grow up.

At 20, when I was struggling with absent menses and the inability to conceive (because, duh, ovulation is a requirement), I never really thought of it as a permanent problem.  I certainly didn't have the emotional upheaval I've had this time around.  Perhaps that's because for the vast majority of those cycles, I didn't ovulate so I never had to POAS and hope for two lines.  I simply went in for a blood draw on CD21, got the news I hadn't ovulated and was started on Provera to get menses flowing.  Repeat. Repeat.  Repeat. 

Once I was switched over to an RE. . . we had a backwards cycle of suppression to knock the clomid out of my system.  It seemed odd, but it worked.  I didn't do blood draws, instead I was told to monitor my cycles (my education wasn't very good, but thankfully I'm neurotic and visited the library checking out every book on BBT charting I could find).  Dr. RE told me to chart my temps and if I had a rise in temp for 18 days, I was likely pregnant and should test.  I did exactly that. . . so I didn't test until Thanksgiving 1999 when I had a BBT rise for 18 days.  It was positive.  It was only my 4th ovulatory cycle, but of course, I'd had an HSG the cycle before (who knows if it helped?), we were young, my husband had great swimmers, etc. . .

Anyway, the point is. . .back then, with primary infertility and age on my side, I didn't really worry so much.  I was naive enough (and wasn't on the computer sharing stories) to assume it would happen eventually.  Thankfully it did.

So, now the question is. . . are we not conceiving merely because I am 34 years old and hubs is 41?  Are my eggs old and not easily fertilized?  Is it just because my lining is too thin that we aren't implanting (hence the longish LPs)? Is it because we can't get our timing right and so we don't have enough swimmers on fertile day?  Is is because my cervix is still too damaged from the surgeries?  Is it because I don't have much in the way of CM?  Is it a combination?  Ugh. . .

And now, I feel old. . . and yet, I don't feel old at all.  Weird, that.

Sunday, November 25, 2012

Suck Suck Suck

Beginning cycle scan today revealed. . . (drum roll please). .  a huge CYST on my right ovary.  No No NO!

What this means-

We have only the month of December to get this show on the road because as of January 1, my insurance benefits will be exhausted and we cannot afford to continue on our own at this time.

At first, my RE was all "we'll let you cycle on your own next time and then start the injections, blah blah blah". With tears in my eyes I informed him that would mean we are out for the time being as we can't keep going after the first of the year due to financial constraints.

So, the plan now is to take BCPs for 2-3 weeks.  I return on the 9th for another scan and we are hoping that the cyst will be gone.  Our other option is to aspirate the cyst with a needle inserted through my vaginal wall.  Dr Awesome informed me that he doesn't like doing that but since "you are hardy" he would feel comfortable doing it.  We didn't go straight for that because there is a risk of infection and the BCP could work.  As long as we are ready to start injections around the 16th, we should have enough time to get the monitoring and IUI in before year end.  *Fingers crossed and praying like a mad woman*.

I left the clinic with my tail between my legs and my boxes of injections in my hands.  There was no lesson in giving the injections or baggie of syringes to go with. . . I'm praying these injections don't end up going to waste, it's not like we have the option of returning them.

I also received some other wonderful news today, I'm too old for shared IVF (where some other lucky lady would receive half my eggs in return for help with the cost of the cycle) and we have no apparent reason to not be pregnant yet as we are both now textbook "fertile".  24 cycles people. . . even at my "advanced maternal age of nearly 35" that's not normal.  What's the statistic?  Something like 85% of women "my age" conceive within two years.

In other news.  I feel like I'm not allowed to be sad about our sub fertile status or mourn the baby we lost. . . because we have children.  Yes, we have children.  I have three and I am eternally grateful for them.  Hubs has two and we are eternally grateful for them.  This doesn't change the fact that I want a child with my husband.  I fear losing my husband and not having our child to see him in (irrational, maybe).  I am finally married to the man God intended for me.  My life is pulled together.  We are happy, moderately successful, and at least have enough money to make ends meet (and pay for things like orthodontia).  It is incredibly unfair that we cannot have a child.  I look around me and see all kinds of girls and women in bad situations having babies and laughing "don't drink the water!".

Am I greedy to desire this child?  I don't think so.  When I look into my amazing daughters faces, I see myself but I also see the man who hurt me in too many ways to count.  I know I can't erase that (nor would I if it meant sacrificing those girls!), but I want to look into my child's face and know it was born of love. . .

Saturday, November 24, 2012


I've known that my November cycle was a bust for 5 days. . . but, of course, my LP was 17 days AGAIN.  It's torture to know there isn't a baby growing and to have AF not show up.  The mind starts playing tricks, "well, maybe you ARE pregnant. . . maybe the tests were wrong. . . ".

And then, AF finally shows up.

I have 20 vials of HMG Lepori (European generic for Menopur/Repronex) waiting. . . but I was praying and hoping I wouldn't have to use them.  I honestly thought I had purchased them as a safeguard. . . I was wasting the money, but I was okay with that because a viable pregnancy was worth it.

So. . . knowing my cycle failed. . . having AF show up. . . has brought torrents of tears.  I'm scared.  Having the injections here and actually using them are two very different things.  I'm a bit worried about giving them to myself (in my rear, no less) but I've had no issues giving myself the HCG injection, so I'm sure I will be fine. 

I didn't know (until I researched more) that the menotropins are made from the urine of menopausal women.  Strange isn't it that we use a hormone from women who are done with their childbearing years to trick our bodies into being more fertile. 

My fear also involves what ifs. . . what if the injections work too well and I end up with too many eggs to continue with an IUI cycle?  We can't afford to switch to IVF if that happens and this is our last ditch effort since we will be out of funds for the foreseeable future after this cycle.  I also worry that if this cycle drags out too long, we will hit the point where our 50% copay comes back (Jan. 1).  We've already hit our out of pocket maximum this year so for the December cycle our insurance will cover 100% (excluding the injections) until I reach our lifetime maximum for infertility.  After this cycle, our insurance benefit will be maxed out and we have already exhausted our medical savings account.  So, it'll be back to the drawing board to figure out what's next.

I wish I had the option to convert this cycle to IVF if the need arises.  I don't know how much it would cost to convert at the point of retrieval (full cycle is $8,500 + meds).  My insurance might cover $2,000-$2,500 (depending on what's left of our benefit).  I'm guessing we'd still need to pay $5-7k for retrieval, fertilization, & transfer (more if ICSI is needed or if there are embryos to freeze).  Sure, we *could* charge it, but we are in the middle of refinancing our house to buy our in-laws out and we are carrying two mortgages (until we can sell the other house) and we are trying hard to pay off debt (my husband, the teacher man, just realized that over the last 15 years he has paid $32,000 toward his students loans. . . his original loan balance was $28,000 and we still have a balance of $20,000.  He doesn't qualify for the federal pay off program of $17,500 even though he's taught both special education AND worked in a poverty level low income school for 15 years, guess why?  Because he graduated a year too early for the program, so his slightly younger co-teachers are debt free and we are still slaving away at it, but I digress).  We also have one child who just started round one of braces and two more about to start.

What I'm getting at here. . . yes, we could *technically* charge the cost but it would be irresponsible to do so.  I wish I could wave a magic wand and figure out how to materialize the needed $.  We don't qualify for scholarship programs because each of us has biological kids (just none together).

Some say, "why don't you just adopt".  I would, if it were that easy. . . we have numerous factors against us.  First, the cost ($20-$30k).  Secondly, we have five kids between us and previous marriages, so those are both strikes against us in the selection process.  Third, my husband is over 40 now which is the age when parents become less desirable in the matching process.  Fourth, I came from an extremely difficult childhood. . . I've found the home study process for foster care to be so emotional grueling that I don't know if I can weather any more.  I put away all my old wounds and allowed them to scar over. . . the home study process is like slicing open those scars and letting things fester again.  I need to be emotionally healthy for the children we have and the children I take care of every day. . . I can't go through a traumatic process that may cause me to slip into a depression or have trouble focusing on the day to day obligations and needs of the 12-16 kids I care for every day.

I am seriously considering foster care adoption (if I can get beyond this emotional trauma part). . . it won't cost us much or anything.  But, I won't get a baby and while I will open my home to as many children as God sees fit, I need a baby.  I want my children to bond from infancy. . . I want to breastfeed. . . I want to watch my husband snuggle our little one to sleep (having watched him with the babies in my childcare makes my heart ache). 

I can say without a doubt that if someone handed me $20,000 and said "this is for adoption", we would find the baby that is waiting for us.  My husband has already stated over and over that he doesn't feel it's financially responsible to seek out adoption until we've paid down debt.  That's why I state we'd have to be given funds for that purpose only. . . as we all know, that will never happen.  So, in the meantime, I sit in this twilight zone. This place where I can't get pregnant and almost don't believe I ever will.

I keep having dreams that I suddenly find myself pregnant at 40 or 50, when my youngest is in high school (she's almost 8 now) and it causes me to question being open to children forever.  How would I react to the news that I was starting over after my children were almost grown and I was looking forward to grandparenting years?  My conviction is that I will remain open to children as long as I'm living. . . obviously, nature will play it's hand in time and I will no longer have the option of conception.  My husband, already 41, is on the fence about his age and having babies in the house.  We keep reminding ourselves that God has a plan, which we can never know, and He knows better than us in all things. 

Monday, November 5, 2012

What Infertility Looks Like

Today was trigger day.  I'm sooooo looking forward to the next cycle in which I get to inject myself daily with awesome hormones that will make me a raving lunatic.

Despite the blood, this was a painless injection.  The previous injections have been done by either my husband or a nurse at the clinic.  This was the least painful injection. . . as in didn't hurt a bit and no bruise/lingering sting like I've had before.  Just some bleeding.  I've noticed that I'm bleeding more lately with pokes. . . my flu shot bleed like crazy last month.  I'm not taking aspirin, so it's a bit odd, but not anything to worry about.

BTW- despite my complete failure to produce a living child these past two years, I'm considered "proven fertility" and "it's just a matter of time".  This should make me feel better.

After our BMS tonight, I placed the order for 20 vials of Menopur.  There's nothing like shelling out a whole lot of money to make an infertile dance a jig. 

Saturday, November 3, 2012

CD11 Scan

I went in for a scan this morning to see how my follicles are developing.  OPKs are unreliable for me and timing is a big concern for us so we decided early was the way to go this cycle.

My ovaries look great.  I have four good sized follicles developing on my right ovary (otherwise known as my "good" side).  I didn't pay perfect attention to the follicle sizes, but I know they were all between 14 & 18mm today.  Monday afternoon I should trigger, we are thinking two more days of follicle development should put most of them around 21mm and hopefully allow my endometrium to thicken (it was only 6.3mm today).

This is the last clomid cycle for the foreseeable future.  My lining isn't doing well and obviously I'm not getting pregnant on clomid.  I'll place my order with on Monday for 20 vials of generic menopur.  December we will do injections only. . . and that will be our last treatment cycle.  We will have used up our insurance benefit and our medical savings plans.  We can't afford the cost of an IVF cycle which would be the next step.  (Wishing I had some great skill, like making beautiful quilts or stained glass so I could auction off items to help with the costs.)

I hate the idea of shelling out the money on injectables while I'm still in the middle of a cycle that *could* be successful.  I guess if that happens, I will be so happy that donating the meds to the clinic won't be an issue.   The good news is that by ordering the meds overseas through saves us a LOT of money.  My RE says many women in the clinic use meds from there and they are all the same as meds in the U.S., except a whole lot less expensive.