Monday, December 31, 2012

"Advanced" Maternal Age

Manic Mama turned 35 on Saturday.  I don't feel any different. . . but, I've now attained that dreaded label- "advanced maternal age".

Huh.

In other news, I'm 9DPIUI (11DPT).  Chugging along just fine, thank you. 

My breasts hurt.  Not sore or tender. . . we are talking PAIN.  I've had cramping off and on for the last 3-4 days (especially with O).  What does this all mean?  Maybe nothing. . . Maybe everything.

I'm wondering if the breast pain is related to the gonadotropins?  I am on progesterone but in the past that hasn't caused this kind of discomfort.

My cervix still feels high, slightly soft, and closed. My BBT is still 97.7+ (when I take it).

My favorite part of Christmas- when I was updating my Grandma on our fertility cycle, she proclaimed, "well, if I knew it was possible I'd have more kids with Celiac, I wouldn't have any more, what a burden!".  Are you kidding me????  I believe she called it "food issues" not Celiac, but whatever.  My children are not a burden.  I enjoy the challenge of finding new, healthy, innovative ways to eat. Sure, some days it'd be a lot easier if we could eat SAD food, but then, we would be far from healthy and likely spending more in medical costs.  But I digress.

Sunday, December 23, 2012

Two Week Wait

After my CD7 scan revealed 4 mature follicles (17.6mm-19mm), we did one more injection of 225iu HMG/Lepori.  On CD8 at 10pm, I did the trigger injection (10,000iu Pregnyl).  At 9:30am on CD10, we went in for IUI.  Swimmers looked great (post wash- 34 million, 93% mobile, 3.0 progression; our pre-wash count @ 91mil/ml was the best we've had yet! I'm convinced that the 60 hour mark for abstinence is our best bet for the swimmers. . . we also did better the week leading up to IUI and was on a every other day pattern vs our normal every day).  The IUI itself took a bit of time (and discomfort) once again, thanks to my messed up cervix.  Finally, the catheter found the path in and all was good.

 I was given instructions to start progesterone suppositories on CD11 (today) but I'm waiting until tomorrow because we are at a water park and the thought of ooey gooey oozy progesterone suppositories + swim suit + public pool. . . well, you get the idea.  Normally, one would start progesterone at three days past ovulation anyway, so I'm not concerned, especially since my BBT was sky high today (97.83) confirming strong progesterone following ovulation.

I didn't realize that progesterone support was standard protocol following a gonadotropin cycle.  Something about messing with your bodies normal function, blah blah blah.  Progesterone is the witching drug if you ask me. . . although I shouldn't complain because at least Dr. A is kind enough to give us the suppositories vs injections of progesterone in oil (in the buttocks!).

I've spent the last 36 hours visualizing my eggs busting out, meeting up with the swimmers, and dividing as they travel down my fallopian tubes.  In a few days, prayerfully, one or more will find their way into the squishy lining of my uterus and continue to grow.

My instructions are to POAS 14 days from yesterday (January 4, 2013). . . we shall see if I can wait that long.  If I get a +, then starts the multitude of BETAs.

I feel really positive about this cycle. . . this is going to be in.  Things were perfect, including our timing and our swimmers. . . my lining is better than it has been in any previous cycle. . .

Part of me wanted to do another scan the morning of the IUI to confirm follicles and lining. . . but everything looked good on CD7, so there is no reason to think that would be different.  Dr. A is trying to help keep our costs down and not pushing for excessive monitoring.

Wednesday, December 19, 2012

Fast Responder!

Today was my CD7 scan to check on how the old ovaries were doing. . . I knew they'd started to wake up because I was feeling some discomfort, especially in the hours after my injection. 

When I went in to see Dr. Awesome this morning, I had taken 4 daily injections of generic Menopur (HMG/Lepori)  at 225iu, 225iu, 225iu, and 150iu.  We were planning on another 4-6 days of injections (minimum) before trigger.  Well, as luck would have it, I'm evidently very sensitive to this medication and I have FOUR mature follicles already.  Three on my right and one on my left, all measuring 17.6mm-19.1mm. RIDICULOUS.   My endometrium was already a healthy 8.2mm with a triple layer, so it should be a nice and squishy landing pad in a couple days time (this is better than I have had in the last several cycles on trigger day!).

So, the plan is that I would do one more injection of 225iu this evening, then tomorrow at 10pm (Thursday, CD9) I will trigger and we will IUI around 10am on Saturday (CD11).

Within an hour or so of my injection this evening, my ovaries started protesting. . . evidently they weren't happy with another dose of drugs.  My 9pm, I could barely stand up straight and had to hobble out to the car and swallow three ibuprofen.  I made it home and am now snuggled up with the heating pad on my belly.  Thankfully, the ibuprofen took the brunt of the pain away.  I hope this doesn't mean early ovulation for me, I'll temp the next couple of mornings just in case.  We are suppose to BD tonight anyway (thankfully the meds are working!) and then abstain until our Saturday morning collection time.

Here's to baby making!  With luck, the New Year will bring glad tidings indeed!

Sunday, December 9, 2012

Clear for Take Off



Scan this morning revealed ovaries doing exactly what they should be doing.  Yay!  This means no needle aspiration for me (at least not today).

Because of an upcoming long weekend trip, we are manipulating my cycle. . . I'll continue the BCPs until Wednesday.  Then on CD3, I will start injections of HMG Lepori (generic Menopur/Repronex).  We will do a step down protocol. . . 3 vials (225iu)/day for 3 days, then 2 vials (150iu) on the 4th day and a scan on the 5th day (or CD7).  Depending on that scan, we will decided to go up or down on the dosage.  If things go according to the norm (and when do I ever follow the norm?), we may be back at the clinic for hopeful baby making on Christmas day.

Dr. Awesome said, "remind me again how you feel about twins or triplets?".  :-)  And reassured me that even with 6 mature follicles the chance of conceiving high order multiples (and staying pregnant to the magic 10 week mark) was slim to none given our history.  However, we are slightly increased risk of triplets due to our past proven fertility but also have the fact working against us that getting and staying pregnant has been difficult. . . So, in a way we have a higher risk of being in that 10% triplet group and in another way we have a lower risk, especially of making it to the magic 10 week mark. He said to not be surprised even if we initially conceive three, if they don't all stick.

So, our plan is to proceed with up to 6 mature follicles at trigger (which reminds me, I need to order a refill!).  If I have more than 6, Dr. Awesome will do a needle aspiration to remove the extras (to reduce risk of high order multiples and NOT cancel this cycle).

That photo above. . . that's my life for the next couple of weeks.  I'm so excited to give myself injections. . . NOT. But, if it gets us a baby or two (heck, I'll even take three), then it's all worth it!

I feel really good about this cycle (ask me a week ago and I was ready to bag it all!).  If this one doesn't work. . . well, then we are out of the medical route for a while. . . if it does, I'll have conceived just under the 35 year mark. 

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

UGH.

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.