New Doc, New Plan

We had our phone consultation with Dr. Zed yesterday afternoon and I feel very comfortable that he knows what he's doing. We discussed the immature egg issue and his thinking is that the protocol was incorrect. He felt strongly that based on my age and my antral follicle count (which is between 10-12), that I still have a pretty good chance and that I should've been placed on a microdose flare protocol (which, by the way, is what Dr. P recommended for IVF #2) with an initial higher dose of meds. And, where Dr. P thought that the BCPs oversuppressed me, Dr. Zed feels that if I start on a higher does of meds, the BCPs shouldn't be an issue and that the the liklihood of having a lead follicle or uneven follicle growth is too high without BCPs. He also thinks my lining needs a bit of beefing up with means that I'll be doing estrace priming.

Overall, the recommendations were very similar to what Dr. P had suggested for IVF #2, which makes me feel more comfortable. The main difference between the two seemed to be their level of experience/confidence. When Dr. P was making his recs, he seemed a bit hesitant and explained that he really hadn't encountered a case like mine before. However, Dr. Zed told me that he had encountered many cases like mine in his 25+ years of practice and he seemed very confident in his recommendations.

Now, that could all be BS, but I have to believe in something to make my decision? So, based on all the information I currently have, we're going to go with Dr. Zed.

As for timing, I'll be starting on BCPs with my upcoming period and I'll also be doing my first ultrasound. Since we're on vacation during the last week in May, we'll start the stims at the beginning of June and then do the retrieval/transfer mid-late June.

It's such a relief to have a game plan set up! Let's get this show on the road.

It's On Like Donkey Kong

As you can probably tell, I'm feeling a bit better than I was yesterday. Thanks to all you lovely ladies for giving me a boost with your comments. I swear, this blog has been the best thing for me and it's far easier on the wallet than actual therapy.

The other thing that has my spirits a bit higher than yesterday is that my phone consult with Dr. Zed is on for tomorrow. I got a call from the coordinator and she said there was an appointment for tomorrow afternoon that opened up due to a cancellation! Hooray! So, my May 12th phone consult is now scheduled for tomorrow.

The sooner we get the second act on the road, the better. My first IVF was done through the big K HMO (for those of you in CA, you'll likely know which one that is) and although they did all the tests, I'm not sure if Dr. Zed will want to do some again because they're old and they were done at the big K. If we do tests again, it'll take a few more weeks than we anticipated, so I'm anxious to start as soon as possible.

I'm also excited to hear what Dr. Zed will say about my protocol and what he'll recommend. Dr. P (from IVF #1) recommended estrogen priming with microflare protocol and no birth control pills. I've read that Dr. Zed also uses estrogen priming, so I'm thinking he may recommend that, but you never know. Wish me luck!

IF Funk

Ah, man...I got the IF blues. If I had a harmonica or a guitar (and I knew how to play them), I'd be singing the blues right now with a tear in my beer.

Usually, I do ok with keeping my IF blues in check and I can typically convince myself that one of these days I'll have that elusive baby, but today I can't quite get my mind to be optimistic. I think the blues set in yesterday, after I went to my close friend's baby shower. This is only the second baby shower I've ever been to because most of my friends aren't even married yet (yes, they're slow bloomers).

I've spent a lot of time with this friend and I was even there when she announced her pregnancy (they got pregnant on their honeymoon) and although it has been difficult, I've never felt this type of nagging insecurity and funk. It's like all hope has been sucked right out of me.

I'm so scared that IVF #2 will be unsuccessful and we'll have to continue with another and another and another. I hate knowing that everyone is wondering why we're not pregnant. No one has blatantly said anything, but I feel the underlying questions and I hate it!

What I wouldn't give to see, just once, a positive pregnancy test. Just a glimmer of hope to signify, yes, I can get knocked up. Right now, I'm all out of hope and I can't seem to muster up anymore.

Not IF related

Ok, in case you don't figure it out, this post is in no way IF related. It's more just something that I thought I'd share since it's one of those pet peeve things.

See, the thing is, I really enjoy going to the gym and getting my sweat on, and up til about 3 weeks ago I wasn't able to enjoy this past time because I was doing IVF. Now that I'm back on the wagon again, I've been spending some good quality time at my gym.

When I used to go regularly, I would see the same people day-in, day-out and you get used to seeing them. Since I've been gone it seems that there have been some new members that have joined on. Don't get me wrong, I like seeing new people working out, but there are some things that I just don't like or that just baffle me and takes away from my workout experience.

I'll list them below for your reading pleasure (and because I have nothing better to do right now):

- Mullet Man: There is a new man in my spin class with a very interesting mullet. It's still business in the front, party in the back, but he also has a bald patch right at the top-back part of his head, so essentially there's all this hair everywhere except for a nice little bald ring in the back. Now, how do I know this? Because I spent the better part of an hour in my spin class studying the back of his head since he came in late and sat on the bike right in front of me. In addition, he was wearing his shirt inside out...maybe that was done inadvertently because he was running late, who knows? But, the bald-mullet, I'm not so sure.

- Ass Cracker: Yes, there was a woman in spin class who decided to wear her low-rider shorts...It was not a pretty sight and unfortunately, she was sitting next to Mullet Man and so I was accosted by a view of her ass crack for the better part of an hour.

- Stinky Man: One word - Shower.

- Grunter: I get it. The class is tough, but grunting only makes me want to hit you and that would probably make you grunt even louder.

All of these people and so much more have invaded my sanctuary of sweat and I feel violated. What happened during the weeks I was gone? Was my gym invaded and all the normal people replaced with weirdos? It's a sad, sad situation...

ICLW...Already?

Wow! I can't believe it's already been one month? Where does the time go?

Welcome to all new readers! This is my humble little blog where I rant and rave about marriage, life, doctors, and basically everything under the sun, but mostly about infertility and how much it royally sucks.

To give you a little background, I've been TTC since February/March of 2009. Not too long compared to a lot of other women, but almost right off the bat, I knew something was not quite right, so after about 4-5 months I started on herbs and acupuncture.

Not too long after that, in September 2009, I decided to get checked out by an RE and started doing some real testing. All the blood work came back clear...no issues with anything. Doc (my DH) also tested and passed with good numbers. I did an HSG and ultrasound at that time and my tubes were all clear with no signs of cysts or polyps. Official diagnosis: unexplained IF.

So, we did one cycle of clo.mid which thinned my lining to a wonderful 4.5 at trigger -- obviously a BFN. Then we did two cycles of letra.zole with IUI. Both were BFNs. At that point our RE gave us an option to either move on to injections + IUI or go to IVF. We decided IVF.

In February 2010, we started IVF #1. The RE at the clinic (different than the RE whom we did the IUIs with) did a antral follicle count and found approximately 10 follicles which indicated a slightly diminished ovarian reserve (DOR). Average for my age at 34 would be more like 12-15. So, he placed me on a more aggressive antagonist protocol with a slightly higher than average injectable dosage.

Unfortunately, what he didn't realize would be that I reacted a little too well to BCPs that I was place on prior to the stims and ended up oversuppressed. During the first 4 days of stims, my E2 rose from less than 20 to a little over 100 (normally at that point the E2 should be well beyond 200). After the first 4 days, my body started acting normally and the E2 values and my follicles started to grow nicely. However, the long stim probably didn't help the egg quality.

We retrieved 10 eggs, but only 3 were mature, and only 2 fertilized with ICSI. I did a 2-day transfer and ended up with a BFN at the end of the 2WW. No surprise to either Doc or myself.

We'll be starting IVF #2 (hopefully) in June with a new RE/clinic and I'm hoping that this does the trick. After this last IVF, I'm thinking that I probably do have some issues with both DOR and egg quality, so I'm taking supplements and still going to acupuncture. Hoping and praying that this next IVF will be it!

It's a Peak!

Finally, the ever elusive egg has appeared on my monitor this morning. Perfect timing because tomorrow morning Doc leaves for his conference, so we'll get one at least, maybe two shots in before he goes on his jetplane.

Talk about delayed ovulation...I haven't been keeping exact track of my cycle days, but I think I'm about CD19 or 20. In my past non-medicated cycles I almost always ovulated on CD16-17. I wonder if the meds have messed with cycles or if it's the exercise?

I haven't really exercised strenuously in almost 2 months. No running, no spinning, no lifting weights and right after the BFN, I started up again on everything. I've been sore for about 2 weeks off and on and I feel great! However, I think with all the exercise, I probably threw my body off it's lazy cycle and the consequences are a delayed O. Well, at least that's my layman's hypothesis.

Anyway, I mentioned that Doc will be at a conference until next Monday, so I'm on my own for the next few days. I know I'll miss him, but I'm actually looking forward to being on my own. I have dinner dates and brunch dates with a lot of my girlfriends -- it'll be great to catch up.

Sometimes, I miss my single days when I could make plans based on my schedule alone. It's nice sometimes to just be that single girl again, hanging out with the girls and not feeling bad about ditching Doc. So, beginning tomorrow morning at 7am, I am "single" for 5 days.

Status Quo

Nothing new to report here. I'm still waiting for my monitor to tell me that it's time to start the humping marathon (humping...I haven't used that word since middle school). But, alas, the box is still showing that one little bar and it's CD17. Who knows what's going on?!

Doc's been asking me each day for a monitor status report. He's more worried than I am that we'll miss the window, particularly since he's going to a conference this week and will be out of town until next Monday. Poor guy...he's a lot more optimistic than I am that this unmedicated cycle will have a chance.

So, if we haven't been humping and I haven't been shooting up, what have I been doing with all my free time? Well, I'm a little bit behind in the tech curve, but I just bought a Palm Pre Plus from Verizon! Yes, my first smartphone. I've been holding out, hoping that the iPhone or the Nexus One would come to Verizon, but enough is enough. So, I finally broke down and bought the Palm Pre Plus.

I can't believe I've been missing out on all this technology! I've become slightly obsessed with downloading apps and patches, customizing and syncing songs, downloading new ringtones. It's been a great way to keep my mind off all this TTC. Granted, I thought about downloading a BBT chart (can't break old habits), but I was able to restrain!

Usually, Doc is the tech-obsessed one. It drives me crazy when we're watching something on TV and he's surfing the net and then every ten minutes he'll ask me to give him a recap on what just happened on the show. Now, the roles are reversed and it's me doing the asking. :)

I just have to say...I can never go back to a regular phone. And this is with a Palm Pre. Can you imagine me with an iPhone?!

Not Created Equal

I know, I know...Two posts in one day. I guess I'm making up for not posting for the past few days. Anyway, I know I've posted about this before, but it's been bugging me a lot, particularly after my failed IVF and I just had to put it out there again.

This from the Kaiser Health Network:
Asian, Black Women Have Lower IVF Success Rates Than White, Hispanic Women, Studies Say
[Oct 20, 2004]

Asian and black women who undergo in vitro fertilization have lower rates of success than white or Hispanic women, according to two studies presented on Monday at the annual American Society for Reproductive Medicine convention in Philadelphia, the Philadelphia Inquirer reports. Dr. David Grainger, an infertility specialist at the University of Kansas-Wichita, and colleagues analyzed IVF clinic records between 1999 and 2000 for more than 75,000 patients whose race and Hispanic origin were reported (McCullough, Philadelphia Inquirer, 10/19). The average live birth rate among all women who underwent IVF using eggs that had not been previously frozen was 25.7%. However, black and Asian women had lower birthrates -- 18.7% and 20.7%, respectively -- than white and Hispanic women -- 26.3% and 26.7%, respectively, Reuters Health reports. In addition, black women had the highest rate of miscarriage -- 22% -- compared with 13.9% for white women, 16.4% for Hispanic women and 16.2% for Asian women. The reason for lower success rates for Asian women is unclear because Asian women do not have high smoking or overweight rates, according to Reuters Health. However, the researchers speculated that the increased rate of overweight and fibroid and uterine disease among black women might contribute to lower IVF success rates among black women, according to Reuters Health (Kerr, Reuters Health, 10/18).

Second Study
In a second study, researchers at the University of California-San Francisco who analyzed 1,200 IVF attempts at their own clinic, 27% of which were among Asian patients, found that Asian women had lower pregnancy rates than non-Asians whether the implanted embryos were fresh or frozen, the Inquirer reports. "Being 35 and Asian was equivalent to being 40 and white," UCSF researcher Karen Purcell said, adding that they did not know why this was true (Philadelphia Inquirer, 10/19).

And there are even more articles:

Standford University resarch - Reuters article

The American College of Obstetricians and Gynecologists article

Several different studies show that Asians have a lower rate of success with IVF. Being of Asian descent, this is a real concern. Not only do I have to worry about my impending AMA, but on top of that I also have to deal with my race placing me at disadvantage compared to others. What else could be next?

Limbo

That's where I am right now. Just sort of waiting to see what happens. Trying not to stress and seeing if I can go with the flow.

Yeah, right, like that ever happens when you're TTC and all you can hear is your freakin' biological clock ticking.

I'm not sure if this is a good thing, but I can honestly say that I'm not as neurotic as I was before IVF when I was checking my CM, taking my BBT, using OPKs AND using a fertility monitor. Yes, I was doing all that and don't ask me how I had time to do anything else like work, sleep, eat. Now, all I'm relying on is my trusty fertility monitor and here I find myself (yet again after 6 months) waiting to see that damn egg and a peak day.

Although I'm happy that I'm a bit more laid-back about the whole situation, I sincerely don't believe it's because I've become a more relaxed person. Sadly, I think it's because I know deep in my heart that even if we do "our thang" during the peak window, we have almost no chance of conceiving. It's a futile effort, so I'm not going to agonize over whether or not I've actually ovulated.

My hopes are all on IVF #2 and that being said, I've started on my next obsession which is to better prepare my body (my eggs included) by taking a full arsenal of herbs and supplements. So, here's my list based on info from fertility sites, boards, and books.

CoQ10 as an antioxidant
Royal jelly with propolis for general fertility
Prenatal
Wheatgrass for egg quality
Calcium with vitamin D for overall bone health
B50 complex for energy
Herbs from my acupuncturist

For awhile I also tried out DHEA, but that was just giving me knarly headaches, so I gave that up.

Hopefully, something does the trick. Whether it be the herbs, the supplements, or just IVF. I don't think I can handle a #3.

Fortunate Fool

Sometimes I forget how fortunate I am for all the things that I do have. It's too easy to focus on the bad things, like dealing with insurance and getting sucked into the TTC vortex. Bitching is sometimes so much easier than being positive. There are times, though, when something happens and you realize. Holy! My life ain't so bad. Actually, it's pretty damn good. Yesterday night was one of those moments.

Doc got a call from an old friend of his (let's call him Dude). We haven't seen Dude since his wedding in August of 2008, so he hasn't even been married for two years yet. Anyway, when he got married and we met his wife, both Doc and I thought to ourselves: Wow...They're very different. I wonder what they have in common? Anyway, Doc and I thought, they must love each other and love conquers all, so let's be happy for them.

Dude is a guy's guy. A bit on the particular side, but likes to snowboard, hang out with his buddies, watch action flicks, grab a beer, etc. Dude's wifey on the other hand is a classically trained musician. She grew up very sheltered and is very, very quiet. Doesn't enjoy anything athletic and pretty much just likes staying at home.

So, now here we are, not even two years later and Dude is calling Doc because his marriage is falling apart. He asks Doc how often do we fight? Doc and I have had probably less than 6 full out arguments in during our 4+ years together. Two of those were when we were planning our wedding and another 1 was during my crazy hormonal mood swing while taking IVF meds. Anyway, Dude tells Doc that on average they fight 1+ hours/day and 7+ hours on the weekends. WTF?!

When Doc was relaying this to me, my jaw just dropped. How does someone even have the energy to fight that much? Out of exhaustion alone, I'd just give up, crawl away and let the other person win. Life must be absolutely miserable.

I felt horrible for Dude, but at the same time I felt so much love for Doc. I realized how lucky we are. Sometimes I take it for granted and it takes moments like these to make me realize that I have something very, very special. Doc and I can spend weeks together 24-7 (like on our vacations) and we will never have even a minor spat. It takes work and patience, but it's so worth it. Having Doc in my life is the best thing that has ever happened to me.

Frustration!

I probably shouldn't be complaining since we're fortunate enough to have coverage for this, but I'm so frustrated!

I have $1000 worth of acupuncture coverage through my insurance, so I've been going to acupuncture since last July, but I switched acupuncturists in January of this year. With my prior acupuncturist, I always self-billed the insurance company myself -- paid cash to the acu and then got reimbursed by the insurance company. A slight pain in the ass, but no big deal.

Anyway, with my new acupuncturist, I was going to do the usual self-billing. Her rate is $85/session, so very reasonable, but she told me that she had a great insurance-billing company and that they could do the billing, no problem. I jumped at this because it would save me some paperwork. However, she neglected to tell me that the insurance rate was way more than $85!

I didn't find this out until the insurance company screwed up and sent me the reimbursement checks which should have gone to her. I looked at the claims and each session was billed at $270/session!! I emailed her and basically said WTF?! After 4 sessions my $1000 coverage was all used up.

She emailed back and said that her billing company had screwed up and they should've billed $170/session because that is her insurance rate and her cash rate is $85. Had I known that her insurance rate was 2X her cash rate, I would've just done the billing myself!

All of this seems a bit fishy. Can a doctor bill the insurance 2X as much as the cash rate? How the hell did she initially bill the insurance company $270/session? Why didn't she disclose how much she was billing the insurance when she knew that my coverage only covered up to $1000?

I'm pretty pissed about all this. I tracked all the sessions and the payments and made sure that I didn't exceed the $1000 limit. Right now, I'm refusing to pay anything else out-of-pocket. I'll give her what the insurance company paid me, but that's it...nothing more.

Her Name is Rio

Once upon a time, when my life wasn't filled with blood samples and vagicams, Doc and I used to go on vacations...real vacations, to far away countries. Twice a year, we'd pack our bags and take a flight to some pretty remote places. The more remote and random, the better. (I've posted a few of our pics from different vacations).

Doc has always had wanderlust. He's been to over 50 countries and typically plans all our vacations -- no tour groups or organized trips. So, really, all I do is pack my bags and show up. Prior to dating Doc, I had been to Japan, India, France, Mexico, Germany, and Switzerland, but my country count definitely increased once we became a couple.

We are not the relax-on-the-beach-and-drink-mai-tai vacationers. Our first year together, we took our first trip to Vancouver Island and spent a week camping and kayaking with orcas (during their migration). Six months later, we took our next trip to Barbados and Dominica (not to be confused with the Dominican Republic), where we went scuba diving and hiking for 2 weeks.



Mongolia

In our second year together, we took our most adventurous trip which included Korea, China and Mongolia (this was the adventurous part). Korea and China were pretty standard, however, Mongolia was something else. Although, there wasn't much to see in terms of sights, the people and the vast expanse of land were amazing. Mongolians live very much like they did 1,000 years ago. Many of them are still nomadic, moving with their herds and pitching their gers (or yurts) wherever there is food for their animals. There are no roads outside of Ulaanbaatar, so we'd drive over hills and across the plains hoping that we weren't lost and we'd get to our ger camp. From there, we'd have meals of lamb and more lamb and even more lamb...morning, noon and night. No vegetables, just lamb. Let me just tell you, it gets old very quickly. But, it was a trip that Doc and I still talk about, even now.



Indonesia - Borobudur

Our second trip that year was our honeymoon to Malaysia, Indonesia and Singapore. We had a great time. Malaysia had some of the best diving we have ever experienced. Singapore had wonderful, delicious food! And Indonesia (Bali) was so relaxing -- beautiful beaches and warm ocean water. We'd go back in a heartbeat.



Dubrovnik, Croatia

We spent a good part of our first year of marriage traveling. In the spring/summer we took a month to travel in Central/Eastern Europe. Starting off in London, we made our way to Hungary, Italy, Slovenia, Croatia, and Bosnia. It was an amazing trip, but the highlight was without a doubt, Dubrovnik in Croatia. Right on the coast of the Adriatic, it is one of the most beautiful cities I've ever seen.



Serengeti, Tanzania



In December of that year, we took a month and traveled to Africa, specifically: Reunion, Mauritius, Mozambique, Tanzania, and South Africa. We spent a good amount of time scuba diving in the Indian Ocean and another chunk of time on safari. We were lucky to be able to catch the wildebeest migration in the Serengeti. It's exactly like something out of National Geographic. Amazing is the only word that describes seeing miles of wildebeest and zebra in the natural habitat as far as the eye can see and watching the lions lying only feet away from our jeep. We loved every minute of our trip.



St. Basil's Cathedral, Moscow

Last year, because of our TTC ordeal we only went to "safe" locations and spent two weeks in Hawaii and another 1.5 weeks in Russia (St. Petersburg and Moscow). Our time in Russia was great -- very cold, but so interesting and nothing like we had imagined. All that Cold War propaganda while we were growing up really brainwashed us into believing that evil KGB agents were lurking around each corner. Instead, what we found was a beautiful country with very friendly people and tons of culture and history.

This year, we've also decided to take it easy with the trips because of you-know-what and so, our spring/summer trip will be to Puerto Rico. We're excited, but it's not technically international, so our excitement and sense of adventure are a bit subdued.

To make up for this, we made a decision this week that our fall trip would be to South America! We'll be spending two weeks in Brazil, Argentina, Paraguay, and Uruguay. I'll be singing Duran Duran until November!

I Want My Life Back

I think this is a perpetual theme in my TTC story. I constantly feel like my life has been hijacked by my (our?) infertility and now that IVF #1 was a bust and I've gotten over the initial shock and dismay, I'm actually somewhat happy.

I feel like I have my life back again, or at least I have a bit of my old life back. I had coffee this morning and sushi for lunch and this weekend I'm going snowboarding for the second time this season. But, most of all, I can exercise again. I went running last Monday night, right after I found out that the beta was negative and I went to spin class on Tuesday. I went running again this weekend and will hit the gym tonight.

But, in the midst of my happiness, I also feel guilty for being happy...Shouldn't I be wallowing in the pain of a failed IVF? Shouldn't I be crying every time I see a pregnant woman or commercials with Gerber babies? I feel like I've got it all wrong and that maybe I'm not taking things seriously enough. But, damn, the relief that I feel over not being a hostage to IVF (even if it is only for a couple of months) is so overwhelming that I can't really feel anything else.

Yes, I would be much happier if the IVF had been successful, but at the same time, this is what life has dealt me and I might as well enjoy it while I can. I know that all too soon my life will revolve around doctor's appointments, blood draws, and staying sedentary. Is it so bad to thoroughly enjoy this moment of normalcy?

What's Next?

We had our delightful WTF appointment with Dr. P yesterday and we discussed all the things that may have gone wrong and all the things that we could try for the next cycle, assuming that I stay with Dr. P.

First off, he told us that he's only had the immature egg situation happen to him one other time and the woman did not cycle with him for IVF #2, so he didn't know what was changed in the second cycle or even if she was successful.

As for my cycle, he said based on my E2 levels and the size of my follies, at least 7-8 of the eggs should have been fully mature instead of just three. There didn't seem to be an issue with fertilization since 2 of the 3 fertilized which is a pretty good rate. And he also doesn't think that there is an issue with my uterus because my lining was ok, not super thick, but fine nonetheless.

So, what are the changes he'd suggest? Well, first off no birth control pills because that seemed to oversuppress me, probably add estrogen priming to the beginning of my cycle, and then move me to a microdose flare protocol. Other changes he would make include: adding an hour between the HCG shot and retrieval and possibly allowing my follicles to grow for one more day.

I asked him about DHEA as a supplement for improving the quality of my eggs and he said that although there is some research out there that shows improvement with the inclusion of DHEA, there's nothing definitive. He doesn't think it will hurt, but he's still a bit wary of incorporating it into the cycle.

Now, I'm just waiting to schedule a consult with Dr. Zed and see what he says. We're going to a seminar tonight to see one other doc in our area whom I'll call Dr. Gruff (because he doesn't have the best bedside manner), but a lot of reviews say he's great.