Thursday, July 12, 2012

IVF and the Fertility Roller Coaster

Thanks to an anonymous BCPMA member for sharing your story about the ups and downs of fertility, infused with honesty and a healthy dose of humor.

2005 IVF Recap
Supermario and I have been trying to get pregnant since we got married, actually I've been taking pre-natal vitamins since I first found out how seriously Roman Catholic he is like 4 years ago; and I quit taking the pill as soon as we got engaged. I'm eight years older than he is, but I like to think we don't show it; we're both in good physical shape, he's tall and has great hair, and I'm half Asian and dye mine. After being married and not pregnant for six months, I hurried to the OB-GYN in March of 2005, having just turned 39. We were lucky to have super fabulous insurance coverage, so at first it was like we weren't even paying for it ourselves; and I have a naturally high tolerance for pain, so though I read about others having skin sensitivity and allergic reactions, I had no problems giving myself shots, and painlessly for the most part, wheee!

I can't find my notes from my first LH, FSH, TSH, HCG, E2 and Progesterone levels, but I remember the doctor murmuring in a concerned tone, me researching online, and freaking out. I don't know if it was fear or naivete, but I decided not to go back to the doctor with all my questions and instead just pretty much opted not to deal with it. In retrospect, I see that as a waste of valuable, quality egg time. But in my own defense, I had just completed a graduate degree, we were juggling two very stressful real estate transactions, and I was distracted by our search for the perfect puppy.

To my credit, I did start to track my ovulation, even though it took me a few months to figure out how. Then I waited until self-diagnosing a couple chemical pregnancies before going in to see the doctor again. At that point, my sister, Supermario's cousin and his brother were all expecting babies at once, and I was starting to panic. It was like, "Hi guess what?! We're buying a house! ...oh wow you're pregnant again, really?? Omg congratulations, okay well nevermind, bye! (click)". Luckily for me the doctor I'd seen before was on vacation, and the one I saw instead was much more proactive. At his urging, both Supermario and I went in for fairly uncomfortable tests (HSG for me, semen analysis for him) and tried to stay optimistic. Everything everybody told us was that all was in working order. In preparation for our first IUI, I  underwent weekly acupuncture sessions in addition to the daily Follistim injection regimen (schlepping it around on vacation, asking B&Bs to refrigerate it, or hiding it in the back of relatives' fridges) but ultimately the result was negative. We tried again a couple months later, another failure.

At that point, my nice pro-active OB-GYN referred us on to an IVF specialist. At the initial consultation I got the distinct feeling that this doctor thought I was retarded. I was concentrating really hard, and I think the more I listened to him and got offended, the less I spoke, and maybe he took me for a non-native English speaker (I'm half-Japanese)? Or maybe his lecture about my tired old eggs vs the glory of donor ones is the reason I hated the sound of his voice and found his tone so condescending; but his office was right down the street from both of ours, and they took our super fabulous insurance. The Smarmy Doctor recommended a more aggressive approach to the IUI (Follistim and Menopur) and more daily needles, but even that didn't work (in fact that time I didn't even produce enough follicles to get the HCG trigger shot). And thus ART soured the holiday season of 2005. Fa la la la la, la la la laaaaaaaa. 

Early 2006 IVF Recap
For a while I had a cousin doing IVF I could talk to, but after she got pregnant we stopped calling each other. In the beginning when people used to ask us all excitedly whether we were planning to have children, I used to mention we were seeing a specialist, and whine they'd ask me to "keep them in the loop" I'd say yeah sure, not intending to actually bore/burden them with anything so depressing. Now I sidestep the children planning questions altogether. When Our Smarmy Doctor told me my eggs are no longer viable and that I'd have to use donor eggs, it sucked but I resigned myself to it after a bit of an existential meltdown (anguished Japanese ancestors, yada yada how sad for my family to not be included in my baby's genetic makeup)... But then I remembered my Pretty Baby Formula (like Lainey's Celebrity Baby Theory only different) that basically states half Asian babies and three-quarter Asian babies are prettier than quarter Asian babies, and happily selected a donor agency specializing in Japanese eggs. The donor coordinator I talked to even told me most of her Japanese clientele select on the basis of blood type and never mention the donor issue to their families ever. Classic!

Sadly, our super fabulous insurance doesn't cover the cost of a donor (about $19,000 including administrative, screening, and legal fees, plus her meds). So, we'll just keep on driving our 7 and 8 year old Honda and Mitsubishi til their wheels fall off. After weeks of poring through photos of donors, translating their questionnaires about family backgrounds and interests and whatnot, and weeding out those with different blood types than ours and those who didn't meet Our Smarmy Doctor's stringent requirements (b/w 22-27 yrs old, having already successfully donated over 15 eggs per cycle at least once before) we were left really with only one candidate who happened to be available at the time, and while she wasn't really all that attractive, she was wildly fertile. I liken it to the Las Vegas Buffet that doesn't taste good, but is all you can eat!!! So we got her scheduled, evaluated, and approved by Our Smarmy Doctor, and were just waiting on her and my cycles to get synched, when all of a sudden I realized... I was really late!

I took a bunch of HPTs and they all came out positive, went back to my Proactive OB-GYN who I love (it was like the whole office remembered me, happiness and hugging, nothing like at the Smarmy Doctor's), did the blood test, came back the following day for another blood test, called for the results and was told my levels were good, hooray!! My mom came to visit and I wasn't going to mention it, but my grandmother (her mother) was dying a thousand miles away and we were so sad, I just had to share my good news with her. It was so nice for a few hours. But literally the next day we rushed to the doctor's office with spotting and cramps, and it turned out my Proactive OB-GYN who I love had inadvertently switched my day 1 and day 2 levels, so they'd actually halved and not doubled as I'd been told. So, that sucked.

Late 2006 IVF Recap
By the time we finished our little miscarriage, I'd already released the Vegas Buffet Donor, and she was booked immediately by someone else. A couple months later, when I went back to the Asian egg donor agency, we actually got some good news: our top choice (gorgeous AND fertile BUT unavailable) who had a painful first retrieval experience and so was not willing to donate again, had since changed her mind and done a second successful and far less painful round!  We wanted to book her right away but she had plans to go home to Japan for the summer, so we had to wait three months for her to come back. And then it was a constant hurry up and wait, for the screening and approval processes, to get the legal contracts drawn up and notarized, to hand off $7k cold hard cash, and to do more synching of cycles. We bought $3k worth of meds at the end of September, but the retrieval and transfer didn't finish until two whole months later.

So we basically spent 2006 in "pre-conceive mode," meaning not drinking alcohol, not drinking caffeine, not eating junkfood, not eating much sushi or raw eggs, me struggling to elevate hormone levels while Supermario coped with resultant emotional side effects, and both of us trying to remain optimistic and relaxed under constant stress, while not communicating to the outside world about our source of strain and tension. And of course the outside world was out there having great sex, getting pregnant, and having healthy babies: Britney Spears, Bennifer, Gwen Stefani, TomKat, Branjelina, everybody in my family, everybody I work with, everybody I glance at in the street - pregnant and/or holding baby, glowing, resplendent, successful at it.

Gorgeous Fertile Donor Girl produced 23 eggs for us, they were able to ICSI 13 of them (2 were fertilized abnormally, and 8 went unfertilized). We did a day-5 transfer of two "great looking" blastocysts, I did two days bedrest, and we achieved implantation, hooray! But unfortunately they didn't stick. I got a "borderline" pregnancy result on Monday and had to wait three days for a second blood test to compare to, BFN the week we hosted our first Thanksgiving dinner for my mom and my sister and her husband and their perfect baby, who serves to heart-wrenchingly illustrate for me my Pretty Baby Theory: my half-Japanese sister + her half-Japanese husband = half-Japanese Pretty Baby.

Not content to settle on a bitter Thanksgiving only, I insisted on gambling on our merry Christmas and happy New Years Eve as well.  I communicated to Our Smarmy Doctor that I was emotionally stable and convinced we should proceed as quickly to the FET as possible. This time we resolved to do everything better: I would do acupuncture again (even though our formerly super fabulous insurance didn't cover that cost; in fact also not covered was the cost of donor eggs or anything remotely adoption related, thus no longer qualifying as Super Fabulous or even Worth Mentioning); Supermario would not be allowed to leave the city limits (he'd left the country for five days the first time and look what happened); I would do three days bedrest, and I asked for progesterone in oil shots instead of the suppositories I'd used before (assuming for some reason that there would be one or maybe two of them over the course of a month or so, administered by a nurse at the doctor's office).  It turned out Supermario got the job of shooting the PIO in an alternating butt muscle every night, and it turned out PIO in butt muscle hurts a lot a lot more than anything else I'd ever shot into my stomach. And after the initial sting, it kind of settles into a dull roar that lingers for hours, and bites every time you sit, stand or lie down. And it turns out it has to be continued daily for the entire first trimester, what?!! But as the acupuncturist noted, "it doesn't matter how painful any of it is, if it gets you a baby you'll do it, and gladly".  We had 3 viable morulas left for the FET, and my lining was way better than it had been for the previous attempt. But despite all our hopes and best efforts, BFN. On Christmas. Ho Ho Ho, not so much.

Another Fresh Start, 2007
Having used up most of our insurance infertility coverage, and virtually all of our personal funds earmarked for the IVF Baby, I was under the assumption that the next step would be adoption. I read up some on embryo adoption and got all excited about the cost savings, but when I brought it up to Supermario, I realized he's totally nowhere near ready to consider a non-Supermario baby as an option. At first I resented his not following our initial plan (to try IVF until the allotted money ran out, and then proceed to Plan B) but when I put myself in his place (32, viable sperm, eldest son, etc.) I realized the only reason I'm open to adoption is the same reason I'm open to egg donation: I can't produce a genetic mini-me anymore. And Supermario still can, so we'll try IVF again. This time we decided to use our funds earmarked for the New Car. When that money runs out, I suppose we can dig in to the retirement savings. It took Brooke Shields 7 rounds of IVF before she got pregnant with her first child. If I'm 50 when we finally have a baby, we'll have to cradle him in the trunk of my '99 Honda Civic, which is what we'll be living in.

So now we're trying to square financials away with the Smarmy Doctor's clinic, and as soon as I'm sure we've received whatever spare change they owe us, I'm demanding my medical files and taking them somewhere new. I've contacted several doctors referred by my OB-GYN's office, and we picked the two nicest ones to meet with in person; coincidentally they also happen to offer complimentary initial consultations. Their offices are three times farther away than the Smarmy Doctor's is, but feh. We'll also have to go back to the Asian donor agency and pick a new Japanese donor from scratch, as neither the Las Vegas Buffet nor the Gorgeous Fertile Girl are available anymore.

Although failing at IVF and the FET totally sucked, it has been nice to drink and eat whatever I want again. The serene doctor I arranged for us to meet with today told me it's good that I have an appetite, rather than losing it to depression. I actually liked hearing that, I liked the office interior, the free parking, and for some reason I liked that the nurses didn't all have ridiculously perfect manicures. This consultation even included a free ultrasound, and I was super surprised to see my lining measured 8.4mm. For the FET, the Smarmy Doctor had to prescribe an extended, aggressive dosage of Estradol plus I was going to the acupuncturist twice a week, and here I am all on my own, without any medication at all, achieving quality results (the procedure requires a minimum of 7mm)! So now more than ever I'm convinced that my aversion to smarminess had a lot to do with my body's non-responsiveness, and I'm hopeful that things will go better this year. Next week we meet with the nice doctor Supermario selected, and then we make a decision and we're back into Pre-Conception Mode!

Stress Rage and Cope, Repeat
I forgot to take the antibiotic I was supposed to the night before and morning of my $550 hysteroscopy, called home to see if Supermario could uh, I don't know why I exactly I did that. I guess just because that's where the Doxycycline was? And I was in a panic? Or maybe I wanted him to offer to look up online what the risks are of going ahead with a hysteroscopy without having taken the antibiotics beforehand as recommended, or maybe I thought it would be nice if he could call the doctor's office and ask them about it while I drove home like a bat out of hell. Or maybe I just wanted him to listen and sympathize? But definitely I didn't call home to sound stupid, or to sound irresponsible, or to irritate him; and definitely I could have done a much better job of communicating what would have been helpful instead of getting so hurt and resentful.

By the time I got home (it takes half an hour to get anywhere in LA traffic) I was a sweaty stressed out ball of hellfire. Although I hadn't instructed him specifically to be waiting on the driveway with my meds in hand, and knowing full well he would never think to do that in a million years, irrationally I was furious at him for not doing so. The front door being locked, my keys being left in the ignition, and the drugs not being where I'd left them - each thing intensified my outsized frustration and rage... The details of the ensuing breakdown and tirade are too embarrassing to get into. Suffice it so say that it was hideous. And Supermario hid in the bathroom the whole time, and then I didn't take his calls all day.

And I can't tell anybody I know about any of that, because I would simply drop dead of mortification. It would be so awesome to tell a total stranger every detail, and have them respond all blase like, "Oh no biggie, that happened to me last year, I got arrested and all our drapes are destroyed and most of his good leather shoes, but y'know what? They had this amazing chasteberry tea at the prison and it put my levels right off the charts!  We got pregnant the day I was released!  Want the precinct number?" That would be so totally awesome.

I just signed up online at Resolve: The National Infertility Association. "Provides education, advocacy, and support for people facing infertility, multiple miscarriages or having a difficult time with conception." I think support would be great. My difficult time is killing the good in me.

We decided to go with the serene new doctor, kind of by default. After really liking him being soothing and his nurses being friendly and his billing person being competent and his office being stylish, we had one other offer for a free consultation. But, after sitting the requisite half hour in traffic to get there and then sitting another hour and ten minutes in the waiting room, without even getting in to see the doctor... we figured our decision was made for us.  Serenity.

So I made it in to the Serene New Doctor's today for the hysteroscopy. Turns out it's fine to not take the Doxycycline the night before. It took maybe ten minutes and was painless. It went well, I guess. Very glass half empty half full. I was like "O yay, he didn't find anything wrong!!  But no wait, if he HAD found something wrong he could've maybe fixed it and we'd get pregnant... so I guess boo?"

Also, I've been back to the Asian egg donor agency, and unfortunately it looks like we have another three month wait ahead of us. We're first in line for a 27 year old from Tokyo, about the same size as me, who's donated successfully once before. Like us she has poor vision, O blood type and a love of travel; and she differs from us in two beneficial regards: cheerleading and thin hair. We're pretty introverted people Supermario and I, with entirely way too much thick hair on us, and all over our floors. All that bodes well, but she's in cycle now so we won't know her results for another couple weeks yet, and then assuming all goes well it won't be until May that we can get her to do our cycle. So that's a lot of waiting and stressing time.

Our Happy Ending to 2007
I went and attended my first Resolve meeting, in fact it was my very first support group meeting of any kind; and I found it profoundly beneficial. Being able to talk about all *this*, with a room full of others who not only understand but are actually in the midst of it themselves, was so comforting.  To anyone struggling with fertility, I wholeheartedly recommend checking out

In a very dejavu sort of way, Supermario and I subsequently got the go ahead for the Japanese Cheerleader's eggs, and I was on my way to meet with the lawyer at the Asian egg donor agency to pay the first lump sum when it occurred to me yet again, that I was LATE.  After all we'd been through - chemical pregnancies, BFNs, miscarriages - my initial reaction was no longer joy or hope, but just extreme and immediate pissiness that this was going to lose us another donor, and fear that the agency would deem me irresponsible and put us on some kind of black list. 

The nurse at my OB-GYN's office that I love actually chastised me for my bad attitude, as she checked my blood and listened to me complaining.  My levels were super borderline, and never spiked, but they never dropped either.  Even after my OB-GYN who I love showed us a second heartbeat (yes, free babies!) at that point I was freaking out about my hormones being no good, if the levels were low for a singleton, they should be twice as high for twins right?  But whatever, the fact is I didn't miscarry and our twins were born in September 2007.  They are healthy now. I'm not going to fault those four different doctors for telling me my eggs were no good anymore, I'm just happy that they ended up working fine for our purposes.  I was wrong too, about my Pretty Baby Theory.  My quarter Asian daughters are every bit as beautiful as any half or three-quarter Asian out there.  Rather than ART and IVF, joining Resolve ended up being the best most effective measure I ever took.