Most Improved

Awards season is upon us!  The Golden Globes will be here before you know it, and guess what - Jared and I deserve a couple of awards too!

At the end of our orientation session with Dr. K, before he handed us off to a nurse for some detailed instruction on medications and injections, he gave us an update.

Even though I was slightly terrified to do so, I had asked Dr. K to order an AMH test to potentially determine my ovarian reserve.  Last year, when my ob/gyn tested my AMH, it came in at 0.1 - VERY LOW.

Interpretation	AMH Blood Level
High (often PCOS)	Over 3.0 ng/ml
Normal	Over 1.0 ng/ml
Low Normal Range	0.7 - 0.9 ng/ml
Low	0.3 - 0.6 ng/ml
Very Low	Less than 0.3 ng/ml

(via this site)

This reading generally drops as you get older - you run out of eggs, your ovarian reserve goes down, your AMH goes down.  Pretty straightforward.

Except...

Fifteen months later, my AMH level tested at a 0.6.  IT WENT UP.  A test indicating my ovarian reserve went up to Low, bordering on Low Normal.  I can't even express how excited this makes me.  Honestly, it's just not supposed to happen.

My shock and confusion was obvious, but Jared turned to me and said simply, "Stress."  And Dr. K agreed.  The ridiculous amount of stress we were under last year, with me in a new job, financial issues, trying to conceive, and learning that we were dealing with infertility, clearly took a toll on my hormone levels.  But I had no idea that the difference would be so drastic. 

Even better?  Jared's sperm count improved as well, so we're in great shape for our IVF cycle. 

2011 has been tough, because we decided to take the year to keep trying for a baby on our own.  We weren't mentally prepared for IVF at this time last year, and it seems like our bodies weren't ready either.  We're that much better off now, and that much more likely to be successful.  It's been really difficult to believe the old adage that 'everything happens for a reason' throughout this process.  I haven't been able to come up with a reason why we're dealing with infertility.  But there is a reason why we didn't do IVF in 2011.  We were meant to do it in 2012, when we're Most Improved.

Chain of Custody

Last Thursday was our IVF Orientation appointment.  Unlike the previous (stirrup-related) appointment, I wasn't nervous for this one, just curious.  We were scheduled to be at the hospital from 8 AM until noon, which seemed like a long time, but clearly, there was a lot of information to go through.

The first third of the appointment was spent with our RE, and he went through a checklist of items.  It seemed to be a risk overview more than anything, which was good - but a little scary.  Overall, our chances of conceiving are about 70%.  Our chance of  miscarrying is no greater than with a normal pregnancy.  There is an increased risk of multiples, which means a high-risk pregnancy, but we're okay with that.  If I have to spend the next ten months in bed, so be it.  Whatever it takes for a healthy baby.

At the end of our conversation with Dr. K, he brought up the topic of custody of any potential frozen embryos we may have at the end of this process. The first question wasn't so bad:

"There will inevitably be embryos which aren't viable for transfer.  Would you be willing to donate them to the hospital for research purposes?"

With a bit more explanation, we replied yes.  We are having IVF done at a research and teaching hospital, so this makes sense to us.

Then he broke out the biggie:

"If you two get divorced, who gets custody of the embryos?"

Um, what?  I had no idea this was coming, and it wasn't something that Jared and I had talked about. I was honestly shocked into silence.  My amazing husband turned to me and said, "She gets them.  But I get the house."  Oh, that joker.

Then the inevitable, "What if one of you passes?"  We decided that the other would take custody - done.

"What if you both pass?"  Another biggie.

We decided that if we both were to pass away, that we would want to donate our frozen embryos to other infertile couples who may need them.  I would like to think that this is standard, but I really have no idea.

These custody decisions were the right ones for us, but I can fully understand how other couples may not want to do as we do.  We have closely followed the debate surrounding the Personhood amendment, and we feel strongly that life does not begin at fertilization.  And that's all I'm going to say about that, because it feels like I'm cracking open a can of worms.

I'm glad we were forced into a conversation that wouldn't have occurred to us otherwise, because I think it's moments such as those where your marriage grows - where you find yourself surprised, impressed, or dismayed by your spouse's reaction - and all of those feelings are valid and meaningful. 

Stirrup Appointment #1

From what I understand, I'll be spending a lot of time in stirrups over the next several months, and stirrup appointment #1 went about as well as could be expected.

I was nervous, as I generally tend to be, particularly when there are plans to insert various foreign objects and liquids inside my body.  Anyway, I didn't sleep very well the night before.  I was up until 2:45 AM catching up on Homeland, which Jared has been telling me to watch for weeks now.  It could probably go without saying that watching multiple episodes of Homeland in the wee hours of the morning did little to calm my nerves.

7:30 AM at the Reproductive Center is kind of weird.  There are actually a lot of people there, and I had to wonder who they were and why they were there.  Were they recently diagnosed with infertility?  In the early stages of treatment, like me?  Visiting daily in advance of their retrievals?  Coming in for Beta testing after getting a positive test at home?  I was most intrigued by the ladies who the nurses seemed familiar with.  How long will it take for me to be a familiar face?

I was pleasantly surprised to be brought back to the ultrasound room by one of the doctors who had won me over on our first visit to this practice.  She's actually a resident at the hospital, specializing in Reproductive Endocrinology, and she truly could not be any more pleasant, caring, or compassionate.

She performed a few procedures on me, with the assistance of another resident:

1. Vaginal ultrasound to check out developing follicles.  I hadn't had this done in a year, so they wanted to take another look.  No biggie.  The wand is a little weird, but it is what it is.
2. Trial transfer to measure my cervix and uterus and figure out which instruments to use for future procedures.  This was very much like having a pap smear.  There was some pressure, but no pain.  Strangely enough, the second resident also performed an abdominal ultrasound during this procedure.  I guess to get a better view from all angles?
3. Finally, the sonohystogram, or saline ultrasound.  I was warned about some cramping during this procedure, since the doctor actually inserts a catheter through the cervix, fills the uterus up with saline, and then inserts the vaginal ultrasound again.  NOT PLEASANT.  It wasn't anywhere near as bad as the HSG, which was my main fear going in to this appointment.  Still, there was a distinct feeling of "there's something in my body that isn't supposed to be there, and I want it out NOW."  I started to sweat, and I thought for a couple of minutes that I might pass out.  Deep breaths and intense scrutiny of the ceiling tiles was about all I could focus on.  Finally, after about seven or eight minutes of mild to moderate discomfort, I was finished.

The doctors didn't really give me much detail about what they saw, although the doctor I like did say to me that everything looked completely normal.  There was also a couple of minutes of conversation during the sonohystogram about a shadow in my uterus, and they weren't sure what was causing it.  They seemed to finally agree that some debris from my uterine wall may have come off when the catheter was inserted, and that was casting a shadow.  I'm seriously hoping that's the case, and not that we're looking at the added complication of cysts or polyps. 

So, that's all we know until next week, when we have our IVF orientation.  I'm looking forward to getting all of our information, setting up a schedule, and NOT putting my feet in stirrups that day.  Until then, work and social life have me buried, so hopefully my anxiety won't be as bad.

Anyone else out there had both an HSG and a sonohystogram?  How do you think they compare?

Return to the RE

Last week, we went in to see our Reproductive Endocrinologist.  It had been a year, and obviously, nothing has changed, so we let him know that we are ready to move forward. 

He re-ordered tests for both of us, since our previous tests were done more than a year ago.  Ten vials of blood for me, three for Jared.  (Hey, at least it wasn't eighteen for me!)

Jared also had the pleasure of handing over a semen sample, after which said to me, "I hope to never have to do that here again."  My response?  "Um, I think you're going to have to do that at least one more time."  Yeah, he completely forgot about the most important time.  Too funny.

And we made appointments.  A saline ultrasound and trial transfer for me.  IVF orientation for the both of us.  We're moving full steam ahead, hoping to have this procedure complete by the end of February.

...
You will never be as young as you are today and your chances will never be as good as with an IVF cycle.

I read this somewhere recently, and I decided that I had to mark it down to remember it, every single day. I'm only getting older, and IVF is our absolute best chance to conceive. There shouldn't be any doubt in my mind.

A Conversation

Now that we've decided to accept my parents' offer of assistance, all systems are go for IVF.  But first we had to have the conversation.

My husband and I were both seriously dreading it.  I mean, come on.  Nobody likes to talk about money...especially if you're asking someone else to give you some.  It felt a bit like saying, "We tried and we failed - will you pay for us to try another way?  A really super expensive way?"

We arrived a couple of nights early for Thanksgiving, and we went to dinner with my parents.  We all knew it was coming, and so our pre-dinner small talk just felt weird.  Inconsequential.  Pointless.  Finally, right before our entrees were served, I gathered together every ounce of determination I had, and I blurted out "Okay, we really need to talk about this.  We've agreed to take you up on your offer to help with the financial obligations of IVF."

It's not like it was out of the blue.  Everyone knew it was coming, but it still felt like the hardest thing in the world to say.  Luckily, I have two of the most generous parents in the world.  I think my dad would have been fine to end the conversation there, with a "Sounds good.  Just let me know who to make the check out to."

However, hubs and I had to talk through some of this.  We had to tell them why it took us a year to accept their offer of help.  We had to outline exactly how much this (and potential subsequent) procedure could cost.  And we drew a parallel.

The cost of IVF roughly equates to the cost of a car.  One cycle = a compact economy car.  Multiple cyles = a luxury car.

My dad's response?  "I have a car.  I could buy a new one.  I don't want to.  I want to spend my money on this instead."

Like I said, I am so incredibly lucky.  With my parents' blessing, we went home and made an appointment with our Reproductive Endocrinologist.  We were going to have a plan, and soon.