46XX and 46XY

The good news is in: DH and I are chromosomaly "normal"!  I love the word "normal".  It's all relative, isn't it?  We have all of our 23 pairs (46 total) of chromosomes.  46XX for me (I'm a girl!) and 46XY for DH (he's a boy!).  Besides confirming our genders, the karyotype test let us know that we do not have any chromosomal abnormalities.  This is actually a huge relief to me.  At least we now know that our embryos weren't destined to quit growing on Day 3 because of faulty DNA.  There is hope.

The other test results DH got was the IGF1.  This is the Insulin-like Growth Factor 1.  IGF-1 is a hormone similar in molecular structure to insulin. It plays an important role in childhood growth and continues to have anabolic effects in adults (think steroids). Last time he was tested (prior to quitting smoking) DH's number was 81.  This time (after a month of non-smoking) his number was 109.  Normal is 131 to 333.  So it is still low.  Better - but still low.  This hormonal problem is outside the realm of infertility hormones (but may play a part) so DH is being referred to a metabolic endocrinologist.  This way, my insurance will not look at this diagnosis as an infertility issue, but a hormonal/growth factor issue.  Solving this IGF-1 problem may or may not have any effect on DH's fertility, but may improve his overall health. 

There is only ONE metabolic endocrinologist in my town, so we scheduled the first available apointment - in mid July!  Waiting over 6 weeks for an appointment of any kind is sort of ridiculous.  But, it so happens, that my mom is a nurse at this particular clinic.  I've asked her to throw her weight around and see if they can squeeze us in earlier.  She may not be able to do much about it, but it's worth a shot!

So...now we wait around for another test in mid-June to see if the HCG shots are helping the testosterone.  We are still testing, testing, testing.  No wonder people jump right into IVF.  This process takes FOREVER!

Hot Shots!

On Monday, DH and I took the afternoon off to go to our appointment.  We both had blood drawn for karyotype genetic testing.  We'll have to wait up to two weeks for the results.  The nurse taught us how to administer the HCG shots to my husband to improve his testosterone and semen analysis results.  The lesson was a little unnecessary.  We already know how to mix the stuff - I think if I count them all, I've received and/or given myself about 11 HCG shots in my life.  That's a lot of triggering!  The only difference for DH is that he gets a lower dose (2,000 IU instead of 10,000 IU), he has to do it 3 times per week, and the shots have to be administered in his butt (rather than my belly). 

So, on Monday, the nurse gave him the shot.  And when I got home from work on Wednesday, DH had already given himself the shot.  I'm relieved to not have to do it, because I'm sure if I did it, he would complain about how I did it!  He'll continue to give himself shots on Mon, Wed, and Fridays.  After one month, his testosterone will be checked.  After 3 months, his testosterone and semen will be checked.  If the HCG is doing its job (and all of our chromosomes are in good order), then he'll continue taking it until we're pregnant.  God-willing that will be sooner rather than later!

A Start of a Plan?

We have the start of a plan from our second RE and more information to digest! After a month and a half of testing, we still are an enigma as to WHY nothing has worked.  The big question is why our embryos did not grow beyond day 3.  The primary focus has been on DH.  My clomid test was a success (apparently my ovaries just LOVE clomid!).  And out of all of the testing that DH did, which included semen analysis, blood testing, urine testing, and an MRI, the results were either normal or were as expected.

So what do we do now?  We had a phone consult with the doctor this afternoon.  I'm so glad he saved us the gas and time to drive to the clinic by letting us do it over conference call!  The goal is to get DH's count, morphology, and testosterone into normal range - or at least higher/better.  The plan is to start him on HCG shots (in the ass!), 3 times per week for as long as it takes to get pregnant (ha! - not me!).  After one month, we'll test his testosterone levels.  After 3 months, his semen and testosterone will be tested again. 

The doctor did some research and found a case in Chicago where they found out that the woman had a rare chromosomal issue with her eggs after doing IVF twice and no embryos surviving past Day 3.  That story did not give me much hope as it sounds so eerily familiar.  I pray that isn't our problem.  So, we are going to do genetic testing - specifically karyotype testing.  Because if there is a chromosomal issue with my eggs, then whatever we do for DH isn't going to make much of a difference.  I say rule it out.  Insurance will probably pay for it, but it will apply to my annual infertility limit - which I'm sure we're running low on by now. 

We're also going to re-test the one unexpected blood test result for DH.  The IGF1 (Insulin Growth Factor)number was 81 where normal is between 113 to 297.  If this had been a problem since puberty, my husband would be a shorty.  But at 6'2", he is definitely not considered short.  We're going to retest this hormone just in case the low number was a fluke or if there was a lab issue, but also because DH is in his 4th week of NO smoking!  That may have an impact on this number.  The doctor was so proud after hearing of DH quitting smoking - almost ecstatic!  So, we're hoping that this IGF1 number improves - otherwise, we may have to look deeper at DH's endocrinoloy and DNA - even beyond that for infertility, but for his general health.  yikes.

The doctor indicated that we could take the next 2 and 1/2  months of being smoke-free to see if non-smoking alone improved our situation.  If it didn't, we could then start the HCG for the next 3 months.  That would put us at waiting 6 months before finding out if we should do IVF again.  We weren't fans of that plan.  I've been waiting over 4 years to have a kid.  Please don't make me wait another 1/2 year.  We also are not getting any younger.  So we're going to do both at the same time, and hope for the best. 

Again, we have a lot to digest.  Not sure when we will be doing or starting all of this, but I hope soon.  The nurse will be calling in the next few days to set everything up.  It feels good to at least have some sort of plan.

Easter Memories

Every family has traditions especially around certain holidays.  Easter is no exception.  My family had the Easter bunny to bring the kids treats and a small gift.  But we didn't get gifts like it was Christmas like other families did.  Some years we had dyed eggs and egg hunts.  Other years we had kites and chocolate.  But no matter what, we always had fun!

These days, Easter is not as 'fun' as it used to be.  I know, I know.  The true meaning of Easter isn't necessarily the "fun".  But still.  My family gets together and there are no little kids running around.  There are no kites.  My mom did get some chocolate for me, so that was good.  The great thing about having children around during holidays is that adults can be kids again, too.  It would seem silly if all of us adults dyed eggs and then went on a hunt for them.  But throw in a 3 year old and all of sudden, it's a family affair! 

So, today on Easter Sunday, my family and I ate [a lot] and hung out and talked and watched TV like adults do.  It was nice, but not necessarily "fun".  Someday my kid(s) will be there to put some fun into the day.  I can't wait for that someday!

Positively Bloody

Looking through my past posts, I seem to be giving off a bit of a negative vibe.  I don't mean to.  I think I mostly try to stay positive in my real life so much that the rest of it gets jotted down in this blog.  Unfortunately, when I do that, there's not much positiveness left to write about.  So, I'm going to try to be a bit more positive in this post - or at least use more exclamation points!

I went to the RE on Friday to have my Day 2 ultrasound.  It's funny because this process is SO routine for me.  When the staff at the clinic asks if I've had an ultrasound before, I almost laughed.  When the PA asked if I've taken clomid before and if I understood the risks of multiples, I just smiled and said that I've been there.  I feel like such an old pro!  I'm also getting pretty good at driving in really crappy weather.  A spring snowstorm can't stop me from getting to my ultrasound on time!

On Saturday, I went to the hospital's lab for some blood work.  Again, I'm a pro at this too.  My veins don't always cooperate, but I can handle the needle.  The girl (who looked about 19) got me on the first poke.  After a few twists and turns of the needle, two vials slowly filled up.  Cotton ball and tape and pressure and I was on my way.  As I walked out of the room, I pulled my sweatshirt sleeve down and I felt something wet on my arm.  I was bleeding all over from my arm, through my sweatshirt and dripping down my arm.  I turned around and said, uh, I think I need a new bandage.  The girl was very apologetic.  It happens. 

Tomorrow I start 100mg of clomid for 5 days.  Then more blood work on Saturday at the hospital.  Hopefully next Saturday's blood draw doesn't ruin my sweatshirt!

Patience

The last couple of weeks have been okay.  Day by day.  I consider myself a pretty patient person, for the most part.  People often comment that I'd have to be very patient to put up with my husband!  And that man can aggravate, that's for sure.  Joking aside, however, infertility has put my patience to the ultimate test.  Time just goes on and on and on.  Working on one thing after another, test after next text, phone call after phone call, ultrasound after ultrasound, doctor bill after doctor bill.  Pretty soon 3 months have gone by.  Then another 6 months, or so.  And you're still right where you started.  You haven't gotten anywhere.

It's been almost a month since our initial consult with our new RE.  Still no real plan of action has been put in place, but a heck of a lot of tests.  All of the latest blood tests and urine tests that DH has been subjected to have come back "normal".  Whatever that means.  They were waiting on one more test result, but I'm guessing that will be "normal" too.  I don't know if they will decide to put him on hormone therapy to improve his testosterone or what.  We'll see.

AF decided to rear her ugly head again today.  Full force.  This month she was on time like clockwork, showing up in 29 days.  At least it didn't mess with my head by being late.  So today is Day 1 for my clomid test.  Not exactly sure what the point of this test is, except they want to check my ovary function through a blood test on Day 3 and Day 10 and taking clomid somewhere in between.  Ok.  I'll do it.  Whatever you want.  So, I get to take off of work early to get an ultrasound tomorrow - while on my period.  I hate those.  Luckily, they are letting me do the bloodwork at my local hospital instead of driving all of the way to the clinic two Saturdays in a row. 

In other news, DH has been on Chantix for over 2 weeks.  His official "quit day" of smoking was Monday, April 11th.  He's cheated a little bit every day - having about 1 cigarette each day this week, but this is seriously the best he has ever done in the attempt to quit.  And coming down from a full pack a day is not an easy feat.  The house is smelling better along with his breath!  Also, the extra $6 per day is already adding up.  I hope this sticks.  We're only on Day 4 of this, but I'll keep shelling out the $140 per month for chantix (not covered by my insurance) as long as it takes.  It's cheaper than smoking!

So, we'll wait for the test results for DH.  We'll wait for the test results for me.  Then we'll wait to see if the non-smoking has any effect over a 3 month timeframe (puts us to July).  Then we'll see if any other therapies have done their job.  Then we'll see.  Patience.  Patience.  Patience!

The Elephant in the Room

It's been a difficult week with my little brother's announcement.  I've received calls and a visit from my mother. Outside of the first phone call, we simply are not discussing the elephant in the room.  I don't bring it up and she doesn't bring it up. I love the communication in our family: unpleasantness is avoided like the plague.  Mother wants to know all about what we're trying to do to get pregnant now.  I guess I gotta keep pace.  I've received a few texts from my brother, but definitely not about the so-called elephant.   I also ran into my uncle while out to lunch with DH this week.  "Great news about your brother, right?", he says.  "Yeah", I say.  He responds, "Maybe they can have two and send one up your way."  "Yeah", I say, "A regular baby factory".  He meant well anyway.

I told a few of my co-workers about my brother's great news.  The ones that know our predicament (if you want to call it that) had sympathy written all over their faces.  I only almost-cried one time when my co-worker said she wanted to give me a hug when I told her.  I hate hugs.  Nothing but emotional trouble.  I said thanks and promptly turned around to my computer and suddenly became engrossed in work.  Ugh.  I just want to curl up in bed and ignore everything and everyone.  But, alas, life goes on.  One must eat, sleep, go to work and make an effort.  Put on a [relatively] happy face.  So I do. 

In other news, DH's MRI scan of his pituitary gland came back completely "normal".  Whatever that means.  This is good, in a way.  At least if there was something abnormal with it, we could have found some sort of a culprit.  The DNA results of his semen analysis came back as expected: kinda crappy.  They test the damage and they test the immaturity of the DNA.  They want both to be less than 15%.  DH's damage was at about 16% and immaturity was at about 22%.  Not surprising since the immaturity goes hand in hand with morphology - and his sits at 1%. After telling DH all of this, I laid it out there:  I'm willing to go through IVF one more time, but after that, I'm done.  We'll look to donor sperm or something else if the IVF doesn't work again.

That being said, DH had bloodwork drawn on Friday and then gets the exciting task of doing a 24 hour urine test tomorrow, Sunday.  He has a big, orange jug that he gets to piss in all day.  He then will slug and slosh the jug o' pee up to the lab on Monday morning.  Ah, what we put ourselves through.  It still boggles my mind.  The nurse I talked to said they would review the results next week and come up with some sort of "plan of action" for us.  We'll just have to wait and see what they come up with.

Close to Home

I've had a few days to marinate on this post, so I'm not as hopped up as I was initially when I wrote this.  But I thought I'd post my initial thoughts anyway:

I don't know how to put my feelings into words.  I am happy and ecstatic.  But those feelings are being overcome and crushed by sadness, anger, and jealousy.  If we weren't trying with all of our might and money to get pregnant or if I already were pregnant or had a child, I would just be plain excited.

I am the oldest sibling of 3 kids on my side of the family.  I have 2 younger brothers that are 2 yrs and 6 yrs younger than I.  As oldest, I've had the privelege of doing most things 'first' as we were growing up.  The first to be able to cross the street to get the mail, the first to go to school and then to college, the first to drive, the first to get married.  I always pictured that we would get pregnant and be able to give my parents their first grandchild.  First. 

Instead of being thrilled with the fact that I will be a brand new aunt (and I am thrilled about that), it is being overcome by bitter sadness and tears.  Why?!  My brother called from 1,000 miles away to tell me that he and his wife are 10 weeks pregnant.  It took them 3 months to get pregnant.  He was afraid to call me and I was the last in my immediate family to know.  I fought back the tears while talking to him and said all the right things like "I'm happy for you guys" and "Congratulations".  But I know I didn't exude the joy that I normally would have had my own circumstances been different.  That pisses me off because my brother deserves more than that from me.  He had told my parents while they were visiting him 2 weeks ago.  Of course, my parents didn't breathe a word to me.  Maybe that irks me most.  Everybody tip toeing around us.  They can't be excited about it in front of me.  I hate being in the dark, and it really upsets me that this news should upset me and that eveyone knows it.  I don't want to feel this way.

It's not like we haven't gotten these types of calls before over the years.  DH's siblings have called at least 3 different times with 3 different pregnancies with the same news.  We currently have 7 nieces and nephews and one on the way on DH's side.  Close friends have called at least 5 different times.  That's 8 kids that nobody wanted to tell us about right away because they didn't want to upset us.  And I have never felt as crappy with those announcements as I do with the news from my little brother.  I knew it would happen at some point.  Maybe it is just hitting a little too close to home.

There isn't much I can do about our infertility situation.  It is what is is.  DH consoled me in that we're doing all we can.  I should be happy.  Happy for my little brother.  He deserves this.  And I know that.  My brain most definitely knows that.  Maybe if I just keep telling myself, the good feelings will overcome the crap feelings.  I am happy.  I am happy.  I am happy.

Testing 1. 2. 3.

My bloodwork came back normal. DH's test results came back semi-normal.  The SA results and bloodwork were as such:

density count: 18mL (want > 20)
total count: 41 million (want > 40)
% motility (moving): 57% (want > 50%)
% morphology (shape): 1% (want 5-15%)

testosterone: 181 (want 200-500)
LSH/FSH: normal

The morphology number is not good.  This would indicate IVF w/ ICSI as the solution.  Obviously, we've done that.  Twice.  However, the testosterone level concerned the doctor most.  Low testosterone can indicate a problem with the testes, which is the primary failure or it can indicate an issue with the pituitary gland or hypothalamus.   Our previous RE tried to treat the testosterone levels with Clomid for 3 months.  That might have worked if it had been a testes problem.  Because the LSH/FSH were normal and not elevated leads our current RE to believe that the testosterone issue is not because of the testes but because of a problem with the pituitary gland. 

DH will be going to the hospital on Monday for more bloodwork and he will have to do a 24 hour urine test.  I had never heard of that one before.  Basically, he has to collect his pee in a bag for a full 24 hours to be tested.  I'm so glad it's not me being poked and prodded this time!  Also, he has to get an MRI of his pituitary gland.  This will rule out tumors, growths, or any wierd things going on with the gland.  Who knew one of us would need an MRI to try to have a baby?!

With hormone therapy, the testosterone levels can get to normal.  In cases of trying to get pregnant, DH may have to take HCG shot 3 times per week until we're pregnant.  After that, he could take testosterone to keep "normal".  The craziest part of this whole thing is that the doctor indicated that if this is the main problem, it could be possible to get pregnant on our own.  I told him that would be unbelievable.  Literally, I don't believe it.  Please don't say things like that to me unless it can really happen!

TMI

Talk about information overload.  After our 3 hour 2nd opinion consult this morning, my mind is a whirlwind of big words, tests, and thoeries.  This infertility cyclone involves genetic testing, chromosones, smoking, semen analysis and SCSA, karyotype test, and clomid challenge test.

I put together on a one page document our entire infertility history.  This list starts in late 2006 with going off of birth control, includes 2 HSGs, multiple day 3 blood tests, too many SA's to count, working with an OB and an RE, a visit to a uroligist, 6 clomid IUIs, 3 injectible IUIs, and 2 IVFs with ICSI.  This little document was a lifesaver since we not only spoke to the doctor, but 2 nurses and a genetic counselor individually.  They all asked most of the same questions and it was nice to hand over this one-page sheet of paper to give them most of the answers they needed without having to repeat myself or forget something.  I did most of the talking as DH gets pretty quiet during these meetings.

We arrived 30 minutes prior to our appointment.  Yes, too early, but I wasn't sure what to expect in terms of traffic, parking, or paperwork.  Fortunately, I had already done most of the paperwork and had mailed it in prior to the appointment.  I asked if they had received my records from my other doctor(s).  The receptionist specifically remembered my records because they summed up to the size of a large novel! 

I think we peaked the doctor's curiosity about us, though.  That's a good thing.  Give him something to think about.  To say the least, we have been on a very LONG road in the way of infertility with no BFPs.  The ultimate question is why?  It doesn't make sense.  Based upon our individual history and tests, something should have worked at some point in the last 4 years.  Particularly disconcerting is that the embryos during IVF w/ ICSI are arresting on Day 3.  The doctor was going to have an embryologist look at my records, but he mostly wants to take a closer look at DH.  He even mentioned referring us to some doctor friends in Boston/New Jersey if we end up doing ICSI again.  Apparently they are the best in the nation at ICSI.  Oh boy.

Like my previous RE had said, day 3 is crucial because the embryo is trying to survive on its own.  How I understood it, is that up to that point the embryo is thriving on the woman's chromosomes and then trying to "mix" with the man's chromosomes on Day 3.  The embryo may be arresting at Day 3 during this process because there may be sperm DNA fragmentation. DNA fragmentation could be causing the embryo arrest on Day 3 and could cause miscarriage if we did get pregnant.  You can't SEE DNA fragmentation or a chromosomal issue during ICSI, so even if they pick out the perfect looking sperm, there could be issues on the inside of the sperm or with the egg itself.  The only way to prove that it may be a chromosomal issue is to do a karyotype test.  The cost is nearly $1,400 per person, not covered by insurance, and according to the doctor and the genetic counselor the chance of this being 'the problem' for us or the reason for DNA fragmentation is very low (less than 15% in those with male factor infertility and less than 5% in those with general infertility). 

In all likelihood, if the problem is from DNA fragmentation of the sperm, it is probably due to smoking.  My husband has smoked since he was 18 years old (at least he waited until it was legal) and he currently smokes about a pack a day.  That's 15 years of smoking.  I don't see how that wouldn't have an impact on his swimmers and I've told him that from day one.  Smoking may not affect the count or the shape of the sperm, but the insides of it.  Kind of like in humans.  You might not be able to see the immediate affects of smoking from the outside, but it sure is doing a number on your insides. 

Now, I'm sure you all are rolling your eyes at us, because why hasn't this been called to our attention before?  Why didn't we do something about this habit before 9 IUIs and 2 rounds of ICSI?  All I can say is that we all know that smoking is bad for us, but people do it anyway.  It is addictive and it is hard to quit.  Your brain tells you one thing - that you should quit and that it is bad, bad, bad - but your body craves more and overtakes your brain.  Smart people can get sucked into this addictive spiral.  DH (and myself) are no different.  He knows its bad, but by now it is an addictive habit and denial of its negative affect kicks in. 

We're thinking chantix is in order.  DH already has a prescription for it, but has been reluctant to fill it.  He really doesn't want to quit and the drug is not covered by our insurance either.  I can't make him do it.  His own doctor has urged him to quit due to his high blood pressure and cholesterol.  Still he hasn't quit.  Now, our infertility doctor is saying that this could be "the big reason", and I'm not sure what he'll do. 

Bottom line: I don't think we should try any more major infertility treatments until he has quit.  And he has to quit soon because it will take 3 months to get all of the affected sperm out before the unaffected sperm will hit the surface (so to speak!).  The doctor mentioned that they could take unaffected baby sperm directly out of the testes for ICSI, but that in most cases a man would rather quit smoking than have a big needle shoved into their balls!  He mentioned that we could bypass all of the questions and costs by considering donor sperm.  We've thought about it, but haven't decided on it.  Not sure if we're ready for that yet.  We've come so far already.

If and when we get to the point of ICSI again, the doctor did say they would look at a different drug protocol for me.  I didn't press as to what that might be because he seemed more concerned with getting the answer of why this is happening first.  We'll cross that bridge when we get there.

Lastly, there is a genetic test we can take that costs around $300 per person that can test for over 100 different genetic diseases.  It's a spit test and is pretty easy to do.  It's just another cost that we can decide to incur.  It is up to us, but the office wants to let us know our options.  Our previous doctor never even mentioned genetic testing to us.  I think we'll consider it before we go into ICSI again.  The genetic counselor also mentioned our mental/emotional health and wanted to make sure that we get what we need in that area, too.  Again, more than the previous RE ever offered in that department.

So, where do we go from here?  First, DH had an SA today with SCSA testing.  This is to determine if DNA fragmentation is an issue.  If it is, quitting the smoking is a top priority. Secondary would be to consider the karyotype test for DH even if the risk is small.  I could take the test, too.  I'm not sure if we want to incur those costs or not.  I had some bloodwork drawn and so did DH.  They're going to do a panel of a variety of things, among them testosterone for him and prolactin for me.  Then, I'll be doing a clomid challenge test during my next cycle.  This is to test my ovaries.  I've done 6 IUIs with clomid, but they never took blood on day 10 to check how my ovaries had responded.  I don't think there's an issue with my ovaries, but ya never know.  Why not?

So, like I said, this appointment was information overload.  I feel like we're starting over.  I am 26-27 years old again and trying to figure out what to do about this not-being-able-to-have-a-baby thing.  I'm pretty numb to it all at this point.  Overall, the entire office was very nice, as was the doctor.  In my mind though, actions speak louder than words.  I'm thinking we'll stick with this guy until we can get some more definite answers.

Short Post

I got to day 40 before the evil AF decided to make her appearance.  It is what it is.  DH said that at least I have some pregnancy tests on hand for the real thing.  2nd IF opinion is tomorrow.

Day 37

We were planning on having our 2nd opinion appointment right after our vacation on Friday, the 11th.  Prior to leaving for vacation, the office called to reschedule for the 21st.  What's another week I guess?  Also, in my last volleyball game, I fell and sprained my ankle.  The spike was beautiful, but blocked.  Go figure.  I hobbled through half of our vacation with a bruised and swollen foot.  Then I was expecting AF in full force by the start of vacation.  The worst is having to fly all day with that.  The week was seemingly off to a great start.

Now, we're back from vacation and we actually did have a great time!  Lake Tahoe was beautiful - we got some great pictures.  Our lakeview cabin was nice and cozy with a fireplace. Snowmobiling and driving through the mountains was the best part. 

On top of the mountain (9,000 ft or so) on a beautiful, clear sunny day!  Isn't Lake Tahoe crazy blue?  It mirrors the sky.

Emerald Bay and the little island in the middle.  I can't remember what it is called.  We were even in a mini-avalanche on the drive up!

Then, Reno was Reno. We stayed at the Atlantis which is probably one of the nicer casino hotels in Reno. 

We had fun gambling - to a point.  DH bowled, too.  Then, back home again.

But the wierdest thing since my last post is that I'm currently on day 37 of my first full cycle since the IVF.  WTF?  I am a 28-30 day girl, through and through.  AF was scheduled to ruin my vacation, but never showed up.  I had a suitcase full of "feminine hygiene products" and no use for them.  I (and DH!) was happy for that, but curious about the lateness.  The longest unmedicated cycle I've ever had was 36 days, which was years and years ago during the first 6 months of being off the pill.  I waited until we got back from vacation on day 34 to do a pregnancy test leftover from probably a year ago.  I did it the night we got home because I couldn't wait till morning.  Negative.  What else should I expect?  But seriously, what is going on?  Was it the altitude in Nevada that is messing with my cycle?  Is it God playing a cruel joke on us?  I bought a couple of more tests yesterday, but I hesitate to take them.  I've been down this road more times than I can count.  I know what the result will be.  I'll take them.  They'll be negative.  Then AF will come.  I might as well skip the agony and the hope and just wait for it to come like it always does.

Then, back at work on Friday, when we were supposed to be at my infertility consult, the 26 yr old girl in my office that we just hired not even 2 months ago reveals that she is pregnant.  She had told my boss and coworker while I was on vacation.  She's due in September.  She sits right next to me 40 hours per week and - for lack of a better term -  is my assistant.  I congratulated her and played through the pain, but I almost couldn't handle it.  The rest of the afternoon, I concentrated on my computer screen with tears in my eyes, going back and forth to the bathroom to regain my composure.  No one saw.  I'm sure my other co-worker felt my grief as she knows my story and the new girl doesn't. It's not fair.  I felt so sorry for myself.

But wouldn't it be ironic?  We spend thousands of dollars and drive hundreds of miles to do IVF twice unsuccessfully - just to get pregnant all on our own?  It's a nice thought.  I don't believe it.  I'm jinxing it even as I write this.  I'm willing - daring  - AF to come at any moment.

Getting Ready...

...for vacation!  I've been spending my February working per usual, finishing out my indoor volleyball season (the final tournament is this week), and getting ready - oh so ready - for a vacation.  I'm so glad I decided to go with my husband to the national bowling tournament as an excuse to get out of town and have some much needed time off.  I debated because for one, plane tickets are expensive and if I went it would be double the cost.  More food, more hotel costs, more everything.  And with the cost of IVF looming, I didn't want to spend any more money.  However, if he went without me and just went with his buddies, he probably would spend just as much money without me being there to hold the purse strings.  At least if we are going to spend it anyway, I might as well have some fun, too!  And with our recent IVF failure, this is a good break from reality.

We're going to Lake Tahoe,NV for the weekend first.  We'll be doing a "winter" vacation of sorts - snowmobiling one day and a scenic cruise on the lake another day.  But it couldn't be a dinner cruise because DH is susceptible to motion sickness.  We learned this on our honeymoon taking a boat on the ocean to Margaritaville in Jamaica.  I don't want to call him a wuss, but I'm just callin' 'em like I see 'em!  Anyway, we'll do some exploring around the lake, too.  We heard that Tiger Woods has a mansion around there somewhere - so maybe we'll do a little celebrity stalking, too.  The California side of the lake has some beautiful, expensive homes that will be cool to see, too.

Then on Sunday, we'll return to Reno, NV and explore all of the activities that this little Vegas town has to offer.  Which, from what I've heard, will only consist of gambling, drinking, gambling, and bowling.  Woo hoo.  This is where my baby-sitting skills will be put to the test!  I'm sure we'll have fun on the penny machines and I've suggested a night at a karaoke joint to distract us from the roulette tables.

DH will bowl for two of the days in Reno.  Singles and Doubles one day, and the team event on another.  Don't be impressed by the words "national bowling tournament".  You don't have to actually be good to bowl in it.  Heck, I could bowl in it if I wanted to (and I'm not good).  You just have to pay the fee on time with your team and show up on the right day.  If you actually bowl extraordinarily well, you could win some money, but it is pretty doubtful.  Over the course of about 6 months, this tournament hosts over 15,000 teams or about 75,000 bowlers.  We have used this little excuse to go on vacation before.  In past years, we've been to Corpus Christi, TX and Las Vegas and DH has been to Baton Rouge, LA, Albuquerque, NM, and of course, Reno, NV - all in the name of bowling.  It's as good an excuse as any!

Thank you to a Second Opinion

I want to thank everyone who has commented on my blog and our infertility woes.  Your words have been so supportive and have really made me think about what our next steps should be.  I decided that you were all right in that a second opinion can't hurt.  Knowledge is power.  I've made an appointment with the second RE for 2 days after we get back in town from our vacation, on March 11th.    It was the first consult appointment they had.  The next appointment would have been in April!

My husband wasn't necessarily too keen on the idea of getting a second opinion.  I think he is afraid that sending my records to RE #2 will make RE #1 not so happy and could mess with what could be IVF #3.  I assured him that this type of thing is probably pretty common and they won't think twice about it.   We've been seemingly treated like a number with them, so word that tranferring records probably won't even get back to the doctor, and if it does, it probably won't register with her who we even are.  I also assured him that if we don't like what RE #2 has to say or if he agrees with RE #1, then we can stick with our original clinic if we want.  No harm, no foul.

I don't want to hate on my original RE.  She is a really nice lady when we get to talk to her.  The clinic is #1 in the state, if not the region.  I haven't had the opportunity to talk to many others that go there.  Infertility is a pretty hush, hush topic even in the waiting room of an infertility clinic.  The one couple that we know of that sees the same RE is still not pregnant after 2 years, but they've done one fresh cycle and two FETs.  All made it to transfer.  Their situation is completely different from ours.  The clinic's pregnancy rates and stats are pretty good too.  But one can only rely on those statistics so much because who knows what they are really counting.  They're probably not counting people like me who don't make it to transfer - twice.

As for the new RE, Dr. H, I've heard good things.  My cousin just had a baby after seeking treatment with him.  I'm not sure of the details or her situation though.  Again, not something that is broadcast.  And the woman I talked to on the phone to make the appointment seemed really nice. First impressions are important, right?  And her name was Melissa, also.  Maybe it's a good sign?! 

Finally a Followup

The doctor had called me the Thursday night of the unfulfilled transfer date to say she hadn't forgotten about us and that she was going to meet with the embryologist to go over my case.  She asked me how I was doing.  I responded that "it is what it is".  She said, "oh, honey" - like we are so close.  I hung up with her and I broke down crying.  Four days later, after the initial hurt has waned a bit, I finally received the follow up call from the doctor.  Not the quick turn around I might expect, but at this point, I'm no longer surprised.

She called me at work at the end of a very long Monday.  She mentioned that her car was warming up in the parking lot due to the nasty winter weather today.  Weather chit chat ensured.  Then, the long story short: I was given too few drugs (M2) for IVF #1 and given too many drugs (M4) for IVF #2.  Recommendation with IVF #3 is a happy medium (M3).

Apparently, I am not one of those women who respond perfectly to any combo and timing of drugs that are thrown at my ovaries.  I have sensitive, finicky, picky ovaries.  Lucky me.  I have to have the perfect cocktail to illicit the ovarian response needed to make nice embryos. I asked her if it was an "egg quality" issue that had more to do with the natural state of my eggs than the drugs.  She said no.  The quality of eggs that we got were directly related to the dosage of drugs.  With IVF #1, we went too long with the drugs and the eggs were exhausted.  But the embryos ended up progressing better and were of better quality than IVF #2, which were too 'slammed' with the M4 and the response was "lopsided".

I asked if we would consider changing up the Femara/Menopur combination to something else.  She said no.  She thinks that another type of FSH would stimulate my ovaries too much and the bigger problem would be the whole new learning curve of another protocol.  We have to get the exact right dose.  IVF is so individual and differs so much from person to person.  It is "not an exact science" and involves "guessing", "artistry", and "wiggle room".  All her words.  Not mine.

I also asked if the clinic really doesn't look at the embryos on Day 4.  She said that was true.  There are "delicate changes" that occur between Day 3 and Day 5.  It is better to leave them in the incubator undisturbed with as little extra environmental exposure as possible.  This is why they couldn't let us know about the cancelled transfer until pretty much right before the transfer.  Also, I know that her theory on Day 3 transfers is that if the embryo wouldn't make it to Day 5, it wouldn't end up in a BFP even if we transferred on Day 3.  So I didn't bother asking again.

So, here we are.  Here are my thoughts:

1.) Financially, we need to wait for all of these current IVF charges to go through insurance, etc. to see if we could possibly afford another round of IVF this year or if we should wait until next year, which we both really don't want to do.  It is only January!

2.) We are taking a trip to Lake Tahoe and Reno in early March, so we probably won't do anything until after that trip.  (We definitely need a vacation now).  Also, I am so sick of winter driving.  So waiting until spring/summer is here is obvious.

3.) We may consider a 2nd opinion.  This would be to mostly to see if RE #1 is full of crap or if she is on the right page now that she's been able to play around with my dosages (and fail) two times.  We don't know if we would make a permanent switch or not.  Even with all of the customer service issues, moving to a new RE would be like starting all over.  The new RE would have to "get to know" me and my cycles.  What if it takes two IVF cycles for them to figure me out, too?  The new RE's office is still an hour and a half drive away (in the opposite direction), so I wouldn't save much driving time in any case. 

We have some decisions to make.  But not this second.