Thursday, October 6, 2016

Fertility Update | IVF Consult & Early Stages

Obviously if you have been following along with our journey you already know that we have successfully gotten pregnant. We have been blessed with this pregnancy, but I wanted to share everything we went through to get there. I am hoping that I can reach someone who needs to read about fertility treatments, just like I wanted to when we were going through it all. If you need to catch up on previous posts, here they are:
The Beginning 
First Visit with Fertility Doc
Round of Clomid
IUI with Femara

Again, I wrote these posts back when we were actually going through this. That way you can see what was going on back then, before I was ready to share everything.

Written April & May 2016

After a failed round of clomid and a failed IUI + femara, my doctor wanted to have a meeting to talk about what was next.  We had to schedule the appointment for a time that Richard was not able to make because he was going to be out of town for his annual conference. Before he left, we had very in depth conversations about all the different scenarios my doctor might suggest trying and we talked about what we wanted so I knew what we were thinking before I even walked into the room with my doctor. My doctor basically told us that we could do another IUI, but she wanted to add some injectable medications so that I would ovulate more than one egg and increase our chances of pregnancy. Even with the extra medicine our chances were pretty low, at about 20%. Or we could move onto IVF (in-vitro fertilization) where the chances at our specific clinic are around 60%. With adding the injectable medication, the price of an IUI jumps quite a bit. I am not entirely sure how much, but with such a low chance of working it was not really worth it to us. Especially since our insurance covers fertility treatments so the price would have been close to the same since we would hit our out of pocket max pretty quickly once we start adding expensive drugs. So we decided to move forward with IVF. IVF basically works like this: they give you meds to stimulate your body to make all kinds of eggs, then they go in and retrieve those eggs, then they combine egg and sperm in a dish in their lab, then they let the fertilized eggs, also known as embryos, grow for as long as possible (about 5-6 days) and the last step is to put them back in your uterus and hope that the embryo will implant.

My doctor decided on a protocol that she claims will keep my chance of getting OHSS to basically zero. OHSS, Ovarian Hyperstimulation Syndrome is a reaction in your body when your ovaries get over stimulated. In IVF, they stimulate your ovaries to produce a whole lot of eggs so that they can go in and retrieve them for fertilization. OHSS happens when there is too much stimulation and your body basically freaks out. My doctor however is very hopeful that will not happen with the medication she prescribed me. Also, the plan is that once they take my eggs and fertilize them, they will immediately freeze them for a transfer (putting the embryos back in the uterus) a few months later. This will give my body a chance to reset and calm down again before they transfer the embryos, in hopes that the transfer is more successful. So we are doing this process in two distinct steps, first egg retrieval and then embryo transfer. The actual transfer will not take place for another two months after the retrieval.

So I got my information packet and I headed on my way with a whole lot of information filling my head and a whole lot of information to read up on. Luckily, the first step for me was to start with almost three weeks of birth control so I had time to process everything. I had to fill my prescription at our local drug store and the lady behind the counter gave me all kinds of crap. She at first did not like the prescription I brought in saying it was a order form and was not a legit prescription. Then she tried saying that the birth control that was being asked for was a pack with a quantity of one instead of the normal 28. I argued that it meant one pack of birth control. I thought it was pretty obvious. She was going to make me wait before she filled it until I told her I needed to start taking it immediately and she lightened up. But then the birth control was free which I find funny because my insurance is covering a drug thinking that it will prevent a pregnancy when really I am using it to get pregnant. Also, it feels counterintuitive to take birth control as a part of IVF, but I guess it helps calm your ovaries before they stimulate them so they get better results.

While I was on birth control, I had to have another test done where they filled my uterus with saline and they do an ultrasound so that they can see the shape of my uterus and to check for any cysts. Also, they do a "trial" embryo transfer where they basically just figure out where to place the embryo during the actual transfer. The test felt pretty similar to the HSG test I had to do and almost as painful as that. I was not expecting it to be painful so that just made it worse. Everything came back normal so we were good to go. Also, both Richard and I had to have a full STD screening done per the government prior to doing IVF. This was the first time Richard had to give blood so it was funny to see him in the chair instead of me.
About 5 days before I started my injections, I had to stop taking my birth control. I counted down the days because I really despise birth control. The few days leading up to my injections I was super nervous. I had read quite a few different blogs about someone else's experience with IVF, so I was a little nervous to start the injections. I had heard that some of them burned or that people had different remedies to make the process easier. I decided to stop (as much as I could) reading other people's experiences because it made me feel like people rarely had success stories and it was not helping my mentality at all.
Before I started my injections, I had to make a whole bunch of phone calls and coordinate everything so it all went smoothly. I started out with calling my insurance company to find out what medication was covered and not covered. Insurance companies really suck. Once my doctor submitted all the different drugs I would need, I called the insurance company to make sure everything she listed was covered. I am glad I did that because there were a few drugs that were preferred over others that would then make them cheaper. All of the drugs required a prior authorization, which apparently is standard for fertility drugs so my doctor already had the authorization in the works before I knew that was a step. Then I asked the doctor if I could switch over to the preferred drugs and she agreed because they are essentially the same drug. Here are all the dugs I ended up being sent and why:
Menopur- This came in little vials that had to be mixed each morning. I started with one vial a day (75 IU) before they bumped me up to 2 vials towards the end. Menopur is one of the two drugs that stimulate the ovaries to develop multiple follicles (follicles have the eggs in them). I took this drug for a total of 11 days.

Gonal F- This medicine came in a pen device that held a few days worth of medicine in each pen. The pen needs to be refrigerated at all times. I took this injection at night and before I took it, I would have to let it sit on the counter for about 30 minutes. Then we just had to dial up the dosage amount on the pen and inject. I started with a 200 u dosage that they increased at the end. This does the same thing as the Menopur, it stimulates the ovaries to develop follicles. I took this drug for a total of 11 days.

Citrotide- This drug comes in a pre-assembled package that would require me to mix before giving the injection. This drug was taken at night with the Gonal-F and also had to be refrigerated. The purpose of this drug is to keep my body from ovulating on its own. That way ovulation can be timed for when they are ready for the retrieval. I did not start this drug until day 6 and then I continued it for 5 days total.

Lupron- This drug comes as part of a two week kit since most people use it to prevent ovulation. My doctor explained that a little Lupron prevents ovulation, but a high dosage triggers ovulation. It comes in a vial with smaller needles so all you have to do is draw up the exact dosage you need, no mixing required. My doctor wanted me to take it as my shot to trigger ovulation, aka trigger shot. Usually, HCG is given as a trigger shot, but my doctor said this is a newer protocol and using Lupron as a trigger shot reduces the chance of OHSS. This shot is given just one time, 36 hours before my scheduled retrieval.

Z-pak- This is an antibiotic that both Richard and I were supposed to take 5 days leading up to the retrieval. The point of this drug is to make sure that neither of us have any kind of infection our bodies are fighting. This way our bodies can focus on making babies.

This is all the medicine I need for the first part of our cycle. I will need to do a whole other medicine load for when we do the transfer. I also had to order a little more of both the Menopur and the Gonal-F towards the end of injections. I would go into the doctor every few days and they would check my hormone levels and look at my follicles and adjust my medicine based on the results.
I will give a more detailed day to day look at our retrieval and transfer cycles in future posts. They can get a little long so I decided to break it up into smaller posts.

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