Monday, April 28, 2014

Cycle Day 2 and Decisions

Well, AF showed up in full force yesterday.

Any hope that I had was officially ruined.

So now, the tough decisions start. My RE can't get me in for a WTF consult until NEXT wednesday (grr!) so I guess I won't be cycling this month. Which is probably a good thing. I need a mental break- and really our decision is already 99% made regarding switching to IVF.


Do we stick with our current clinic? Do we go to another clinic? Do we do Donor Embryo? Do we give traditional IVF a shot first? Do we move straight to adoption?

I hate this. Too many decisions, too much hassle. Too many concerns.

I spent awhile this morning looking at SART data. This is the < 35 data for my current clinic for the last 10 years

  Cycles Pregnancy Live Birth cancellation Twins
2004 294 38.8 35 9.9 35.1
2005 248 46.8 43.1 6.5 28.4
2006 270 55.6 47.4 6.7 26.6
2007 224 53.6 47.8 3.1 33.6
2008 218 51.4 48.2 8.3 32.4
2009 209 50.7 45.5 6.2 35.8
2010 308 42.9 37 11.7 32.5
2011 275 41.1 32 10.9 30.7
2012 312 41.3 36.5 10.9 32.5

The decrease in live birth rates from 2009-2012 really has me concerned (going from 45% down to 36%, WTF) and it also puts their most recent year below the national average. Since we are 100% Out of Pocket this could add up VERY quickly.

So I did a bit of comparing between clinics. I looked at a handful of clinics within a 6ish hour drive of where I live now, that also are near friends or family that I could stay with.


Cycles Pregnancy Live Birth cancellation Twins
Clinic E 55 63.6% 58.2% 5.5% 46.9%
Clinic A 338 50.9% 45.6% 6.8% 29.9%
Clinic G 403 51.4% 45.4% 4.0% 33.9%
Clinic B 67 44.8% 41.8% 0.0% 35.7%
Clinic D 58 43.1% 37.9% 6.9% 18.2%
Current Clinic 312 41.3% 36.5% 10.9% 32.5%
Clinic H 97 41.2% 36.1% 930.0% 34.3%
Clinic C 59 40.7% 35.6% 11.9% 52.4%
Clinic F 100 42.0% 33.0% 5.0% 36.4%

Clinics A and G are my front-runners. Unfortunately I'm too fat for any of the money-back guarantee programs.


There is also our Option C- IVF in cancun. The clinic I'm looking at (IREGA) has a 65% pregnancy rate (but no stats on live birth) they offer a free FET cycle if your IVF fails, and the cost is $5600+ meds. Yeah, there would be the hotel cost and airfare on top of it, but the cost of IVF+airfare+2 weeks in an all-inclusive would be the same as one cycle here in the states. Not gonna lie- getting a 2 week vacation out of the deal sounds appealing to me.

Thursday, April 24, 2014

NIAW Day 4- If you were paralyzed...

#NIAW Day 4: 

"So, what do you think people would say to you if you were paraplegic instead of infertile?" (author unknown)

1. As soon as you buy a wheelchair, I bet you'll be able to walk again!
2. You can't use your legs? Boy, I wish I was paralyzed. I get so tired of walking, and if I were paralyzed I wouldn't have to walk anywhere!
3. My cousin was paralyzed, but she started shaving her legs in the other direction and she could walk again. You should try that.
4. I guess God just didn't mean for you to be able to walk.
5. Oh, I know exactly how you feel, because I have an ingrown toenail.
6. Sorry, we don't cover treatment for paraplegia, because it's not a life-threatening illness.
7. So... when are *you* going to start walking?
8. Oh, I have just the opposite problem. I have to walk walk walk - everywhere I go!
9. But don't you *want* to walk?
10. You're just trying too hard. Relax and you'll be able to walk.
11. You're so lucky... think of the money you save on shoes.
12. I don't know why you're being so selfish. You should at least be happy that *I* can walk.
13. I hope you don't try those anti-paralysis drugs. They sometimes make people run too fast and they get hurt.
14. Look at those people hiking... doesn't that make you want to hike?
15. Just relax, you'll be walking in no time.
16. Oh do my legs hurt, I was walking and walking and going up and down the stairs all day.
17. I broke my leg skiing, and was on crutches for weeks, and was worried I'd have a permanent limp, but I'm 100% healed.
18. I'd ask you to be in my wedding party but the wheelchair will look out of place at the altar.
19. You're being selfish, not coming on the hike with us, and looking at all of my track & field trophies.
20. Don't complain, you get all the good parking places.
21. If you just lose weight your legs will work again.
22. If you would just have more sex, you could walk!
23. You don't know how to walk? What's wrong with you? Here let a real man show you how to walk!
24. You are just trying too hard to walk. Give up, and then you'll walk.
25. Here, touch my legs, then you'll walk!
26. Just take a vacation, and the stress-break will be sure to get you walking!

Please, before you offer well-meaning advice, think about how ridiculous you might sound.

Tuesday, April 22, 2014

NIAW Day 3: Why don't you just adopt?

NIAW Day 3: Why don't you just adopt? 

I’ll admit I was saving this for later in the week, but I decided that after last night’s post that it would be a good follow up. As an adoptee, many people have asked us “well, why don’t you just adopt?” I appreciate where people are coming from, but “just adopting” isn't exactly a practical solution, nor is it a solution to infertility.


Adoption is a cure for childlessness. It does not cure infertility. You will be a parent after you adopt, but you will not be fertile.

Let that sink in for a second. 

Many people go through incredibly long, heartbreaking, and expensive journeys with their infertility. When all is said and done, and hope for a biological pregnancy has come to an end, many couples have spent $50,000+ in their medical attempts at pregnancy over the course of dozens of months. “Just adopting” isn't always a realistic option after spending that kind of money.

 Domestic infant adoptions cost anywhere from $10,000 to $30,000+ and sometimes more. After going through medically invasive fertility testing and treatments, you find yourself going through emotionally invasive homestudies, and being at the mercy of expectant mothers. 

Depending on your openness to medical situations or trans-racial placements, your wait time from application to finalization can be anywhere from 8-36+ months, with no guarantee of a child. I personally know of a woman who had 3 matches, and the birth parents changed their mind last minute. I cannot even begin to imagine their heartbreak.

International adoption is a changing frontier. Not only are you looking at a minimum cost of $30,000, but thanks to organizations working to strengthen families in developing countries (a good thing!) there is a decrease in the number of children under the age of 2 available. 

This isn’t the late 90’s when you could apply and be on a plane home with your healthy Chinese/Russian/Guatemalan baby in less than 9 months. Most of the children waiting for adoption overseas are older, are part of a sibling group, or have special needs. And if you’ve ever been on anti-depressants or seen a therapist, you can automatically rule out about ½ of the countries that the US has adoption agreements with. If your BMI is over 24, you can rule out another ¼ of the countries. And if you’re under 25 or over 40, or you have not been married at least 5 years, you can pretty much rule out any other country.

And let's just think about what happened with Russia. A hasty decision was made in a matter of weeks to close their borders to adoption from US couples- leaving many couples in limbo. These couples had already made a substantial financial commitment to their adoption, and suddenly they were out of hope, out of luck, and out of money with no refunds. That could happen in any country at any time. 

Which leaves us with the last adoption option: adoption from the foster care system. From a financial standpoint, this makes the most sense. It often costs nothing, or very little (less than $2,000) for the official paperwork. There are ALWAYS children in need of foster homes. There are over 100,000 children in the US who are legally free for adoption. The downside is that these children are in foster care for a reason- they’ve been through trauma that you and I cannot even begin to imagine. And most of them are older (over 5) or have medical needs. 

If you’re ready and able to parent a child with emotional, physical, psychological, or learning disabilities adoption from the foster care system is a great option. But again, it’s not a solution to the “I want to raise a baby” problem facing infertile couples. It’s a difficult road- I’d challenge you to read the book “Our Own” and ask yourself if YOU would honestly be able to welcome a hurt child into your home. 

So recap: Adoption costs anywhere from $2,000- $50,000. It takes anywhere from 8 months- 5+ years. It requires a federal background check, a thorough home inspection, interviews of your friends, neighbors, and family members. It requires an agonizing wait, and at the end of the day there’s no guarantee that you’ll have a child.

 All of this after spending tens of thousands of dollars and hundreds of hours of emotional energy on infertility treatment.

Furthermore, saying to “just adopt” is degrading to adopted people. It’s like “oh, your parents couldn’t have a biological child, so they ‘just adopted’”. Adoption shouldn't be a backup option or a second-tier way of family building, and a child who has already experienced the loss of their first family deserves the dignity of knowing they came into a family through love and prayer- not because they were a 2nd best option.

 Don’t get me wrong- adoption is amazing, and for DH and I personally it will most likely be a part of our family building story. But it’s not as easy as “just adopting”. So before you tell someone with infertility to “just adopt” please think about the implications of what you’re saying.

Monday, April 21, 2014

National Infertility Awareness Week: Day 2

I've decided to blog my NIAW posts this year as well- so many people that I know are coming out, and I'm realizing what a valuable resource it is to have an archive of NIAW posts.

NIAW Day 2: "Just relax/have a drink/take a vacation and you'll get pregnant". 

People mean well when they tell a friend with infertility to "just relax" or "have a few drinks" or take a vacation and they'll get pregnant. For the 1 in 8 couples who are struggling with infertility, this advice is an insulting slap to the face. Infertility is a diagnosed medical issue. It is not a result of being "too stressed" or "too busy", despite what Cosmo might tell you. There are women in war-torn nations fleeing for their lives who still get pregnant even under extreme amounts of stress.

Telling someone with infertility to relax is just as inappropriate as telling someone with clinical depression to just cheer up. You wouldn't tell a diabetic "hey, skip that insulin and just have a drink. You'll be fine, it's all in your head".

Trust me. We relaxed. Lord knows we've taken plenty of vacations together. We've had plenty of drinks. If I took the relax, take a trip, and have a drink advice every time it was given I'd be a well-rested, well-traveled drunk.

Tuesday, April 15, 2014

All the symptoms. UGH

Welcome to 4DPO

Pull up a seat and take off your pants- because that's what I want to do right now


In my head I knew how bad this was going to be because everyone always talks about their symptoms from crinone (progesterone cream you shoot up your hooch) and from the estrace (estrogen you put down the food hatch)

But holy fucking shit I was not prepared for this.

1) I'm so bloated I legitimately do not fit in pants. I've been wearing dresses to work the past few days because of the bloating, but today I had to put pants on because I woke up to 3 inches of snow. In April. FTS!

2) Edema. I've got a mild case of OHSS, and I'm dealing with significant edema in my legs- like my pants would not fit over my calves the other day, and last night I wish I would have taken a picture of my cankles because I could barely believe them myself.

3) Gas. I'm crop dusting my entire department several times a day. At least I take them candy while I crop dust, LOL.

4) Hot flashes. I couldn't fucking sleep last night. DH turned the thermostat down to 65*, I had a fan blowing on me, and I was only sleeping under a sheet, and I still woke up soaked in sweat.

5) Sore tits. I'm wearing a sports bra with a 3 piece suit today. If that tells you how bad the girls hurt. Yesterday I closed my office door and just took my bra off half way through the day and refused any visitors, saying that I was in meetings.

I am trying oh so desperately to hold off on testing until 11DPO which would be 4/22. I don't want to disappoint myself by testing sooner than that. We'll see if it works.

Thursday, April 10, 2014

The facts will kill you

So since we got the go-ahead to trigger I've been obsessing over researching IUI statistics.

And generally driving myself crazy.

To recap: 1 blocked tube, borderline motility, 4% morphology, and annovulatory cycles.

So I keep finding research that gives me hope. Not all of my source links direct straight to the research. I apologize.

So there are things I find that make me smile.... Like this:

"The pregnancy rate per cycle was similar, 17.3% for the unilateral tubal occlusion group and 16.5% for the unexplained infertility group. The rate of miscarriage (11.1% vs. 23.3%) and ectopic pregnancy (11.1% vs. 6.7%) was similar between the two groups. The pregnancy rate was higher in patients with proximal occlusion (25.0%) compared with distal occlusion (13.9%) or unexplained infertility, but not statistically significant."  (SOURCE)

Or these:

Four follicles IUI: Success rate of 23% (SOURCE
Number of cycles: IUI success rates are highest in first one or two cycles depending on study (SOURCE)
And even tips for increasing IUI success rates like these:
  • Try progesterone luteal phase support: boosts IUI success rate from 14% to 24%, 13% to 21%, 6% to 19%
  • Perform IUI on a full bladder: boosts success rate from 7% to 14%
  • Perform IUI using ultrasound guidance: boosts success rate from 14% to 23%
  • Minimize abstinence period before sperm collection to 2 days or less: boosts IUI success rate from 3% to 14%
Of course there are the scarier studies about the risk of multiples (and Higher Order Multiples)

  • For age <32 years, HOMP was 6% for three to six follicles and 20% for seven or more follicles (SOURCE) 
  • Approximately 30% of pregnancies resulting from gonadotropins are multiples. While most of these pregnancies are twins, up to 5% are triplets or greater due to the release of more eggs than expected. (SOURCE)

So I've concluded that I'm looking at a 20%ish chance of pregnancy this cycle, and if we're pregnant, a 1 in 4 chance of twins or more.

So there's no point in stressing. The horse is out of the barn, and what is meant to happen will happen. 

Wednesday, April 9, 2014

Houston, we have FOLLIES!

We have FOLLIES!


Triggering tonight. First time my body's made it this far with more than one follie without having to cancel . And holy shit am I excited.

Monday appointment:

Right ovary- 1@ 13.5
Left Ovary 1@12.5
E2: 2086 (hello- that should have been the indication that we're moving)


Today's appointment:
Right (blocked) ovary: 1@16, 1@15, 2@13, 10@10-12
Left Ovary: 1@16, 2@14, 2@13, 4@11-12
E2: 3657


We're triggering tonight (40 units of lupron) at 10:15PM for a 10:15 AM IUI on Friday. It's looking like we'll have somewhere between 5 and 7 mature follies at ovulation, depending on if the 13's catch up or not. With my E2 levels, my RE seriously thinks that the 13's have a real possibility of maturing between now and then.

Which meant we had the incredibly difficult conversation about fetal reduction today. I can't even get pregnant with one baby on my own, and we had to have a serious come to Jesus talk about potentially killing off one or more of our future children.

But I know all too well the risks of a higher order multiple pregnancy, and I will do WHATEVER it takes to have one or two healthy babies- even if that means having to reduce.

Please don't judge me. My RE has compared my ovaries to Ka.te Goss.elin's on multiple occasions- he knows quite a bit about her case (not her doctor, but knows her doctor). I refuse to birth a litter, but at the same time we can't get a controlled response to injects, and I don't respond to oral meds so this is our last shot before IVF. 


I just hope that DH's swimmers hit one of those 5 targets.

My 2WW starts today. I refuse to test before 11dpIUI which is 4/22. Earth day. The anniversary of my favorite grandmother's death. It's got a cliche circle of life feel about it.

So here goes nothing......