And one step back

Geez, I'm the worst IF blogger in the world. I haven't had a chance to blog about Friday's appointment, because I was processing it over the weekend, and I'm working this freelance job during the week where I have no privacy. But my boss is out today, so here I am!

Anyway, the upshot is that after much discussion, we decided to do one cycle of very low dose injectibles before moving on to IVF. Mostly because my husband and I are still a little leery of doing IVF--and my Catholic-school hubby is suddenly having some discomfort with the idea of freezing embryos, discomfort that he can't really pinpoint or explain, so I think we need to deal with that before going forward.

Also, Dr. SF feels that since IUI/injectibles clearly worked well for us last time, it's worth giving it one more shot, this time doing a lower dose (starting at 75 IU instead of 100 IU like last time). And we are very clear that if there is any more than one good-looking follicle, we cancel. I said several times, "I would rather not be pregnant at all than be pregnant with twins," so he definitely got the message. I asked if he would ever convert an IUI cycle to IVF, and he said that while he knows other doctors do that, he prefers not to--he thinks you just get better results with IVF if you start off with that protocol from the beginning.

As far as IVF goes, he said that doing IVF instead of IUI would definitely be "easier" for him (meaning more control), and normally IVF has a higher success rate than IUI. But since we are doing single-embryo transfer, the success rate is about the same (since the higher success rates for IVF are based on transferring two or three embryos).

The other plus of doing an IUI cycle first is that since my insurance will pay for meds for IUI but not IVF, I can stockpile now (they gave me a Gonal-F script with 6 refills for just that purpose) and either use the meds for IVF later, or donate them if I don't need them. Then the only meds I'll need to pay for are Lupron and maybe the trigger shot.

We didn't get into all the details of IVF protocol once we made the decision to do IUI, but we covered the basics--birth control pills, then Lupron, then stims. Dr. SF said he'd expect me to get around 25-30 eggs (!) but warned me (as K pointed out on my last post) that out of that number, we'd expect only 4 or 5 to make it to blast, and maybe 1 or 2 to freeze. ("There are some super fertile women who get 10 or 12 embryos, but that's really unusual," he said.) We would definitely do a day 5 transfer, because of the single embryo factor. He pointed out that really the only difference between IUI and IVF are the suppression phase and the retrieval--the stims are essentially the same, and transfer is just like an IUI, from the patient's perspective at least.

I asked how soon after the IUI we would be able to do IVF, and he said that if we canceled before trigger, I could start BCP immediately and we could start as soon as my ovaries calm down. If we go to trigger, then it would take a little longer. But basically we're looking at October at the latest.

So I'm on Provera this week (because I still haven't gotten my period since I was on Clomid in June), and assuming my period arrives next week, we begin. Deep breath.

IVF questions

Just realized I am totally unprepared for our IVF consult with Dr. SF on Friday. I know generally some of the questions I want to ask:
-Since we are doing single embryo transfer, can/should we aim for day 5 transfer rather than day 3?
-Do you normally freeze leftover embryos in straws of 2 or 3, and if so, if we have any left over, can they be frozen singly, so that we have the option of thawing one at a time?
-Can I do progesterone inserts instead of PIO? Because my husband and I are both intense needle wimps and if he has to give me an IM shot every night for two weeks we will both flip out and we might as well just call this whole thing off.

But obviously there are a lot more questions I should be asking. I'm going to Google around, but I know some of you guys did "what questions should I ask?" posts way back when. If you did, can you remind me, and tell me roughly when the post would have been, so I can find it in your archives? Thanks!

Inching forward

I talked to the finance coordinator at my clinic, and apparently my $10K in insurance will definitely cover at least one full cycle of IVF, and depending on what procedures etc. we have for that first cycle (PGD, for example) there might even be some left over for a second cycle. Not including $750 for the anesthesiologist, who doesn't take insurance, and cryopreservation, for which I need to give them a credit card number. But I'm relieved to know that I'll at least get one cycle covered. We've got an appointment with Dr. SF next week to talk details.

*****

We spent a long weekend at the beach with friends who have a 4-year-old and a 10-week-old. Bat Girl was pretty cute with the baby (when she wasn't ignoring him, that is), though I just realized a lot of her "Hi! Hi baby!" is pretty similar to what she does with the cat. Hmm. Anyway, seeing our friends manage with a preschooler and a newborn made me feel more comfortable with the concept--like, hey, maybe we could actually do that too!

*****

This post is all over the place. I'm just trying to get some thoughts down before I go to bed, since I won't have a chance to blog this week...

*****

Bat Girl seems to have grown up in leaps and bounds in the last few weeks. Her vocabulary, sentence structure, and expressive ideas are suddenly more sophisticated, which happened in the space of a week--my brother even commented on it when we saw him for our weekly Sunday brunch. My husband told me that the day before we left for the beach, she was talking about how she would play with one of her favorite toys at the beach, then paused, thought for a moment, and said, "No, I would probably lose it. I better not take it." She's interested in everything, and is constantly asking, "What's that?" and then "How it helps you?" (meaning, what does it do or what is it for?).

In the last week or two, she's suddenly into a new level of pretend play, too, where she will say things like, "I'm a monkey, and you're the mommy monkey!" or "I'm fishing! I'm going to catch a whale!" The whole let's-pretend phenomenon is fascinating, and it really came out of nowhere--one day she wasn't doing it, the next day she was. She's into drawing a lot more, and will fill a page with crayon scribbles (until recently, she would scrawl a tiny doodle then lose interest). She pretends to write too, making a line of scratch marks while "spelling" out loud: "G, H, J, B, E spells Bat Girl!"

At nearly 2 1/2, she finally has enough hair for pigtails, which make her look like a big girl instead of a baby, and she's grown what seems like half a foot (but what the growth chart in her room says is only an inch or two) since her birthday. Yesterday, driving back from the beach, I looked back at her, all pigtailed with her long legs dangling over the end of the carseat, munching on grapes and swigging from her water bottle, and I said to my husband, "Would you look at this big kid we have here?"

Back in the bitter

So, the facts first: My husband and I had a long talk Wednesday night, and we decided to go straight to IVF. I played phone tag with Dr. SF all day yesterday, and finally connected with his nurse, who is going to put me in touch with the IVF coordinator. I'm also supposed to schedule a consult with Dr. SF so we can discuss the IVF plan in more detail. I have a call in to the finance department to try to figure out exactly what my insurance will cover. (I have $10,000 in IVF coverage, not including meds which for some reason are covered for injectible IUI but not IVF. Not clear how many cycles--or what percentage of one cycle, given how pricey IVF is here--that would cover.)

Emotionally--bleah. The whole detached, not bitter, not caring too much thing I had going on? Quickly disappearing. See, given the fact that we want a second child but are not desperate to have one, if I were normally fertile we would just let nature take its course, and if I got pregnant, great, but we wouldn't feel this pressure to Do Something About It. Even if I were anovulatory but didn't have a fucked up uterus, we could feel comfortable risking another injectible IUI. But no--the only good option, given the necessity of avoiding multiples and our strong desire not to selectively reduce, is to do IVF. We could try another round or two of Clomid, but given my historically poor response to Clomid, we'd probably just be wasting time and money. And so even though just a week ago I was saying to myself that I didn't know how far I was willing to go to try to have a second child, the fact of the matter is that if we want another child, we pretty much have to plunge into an expensive, invasive, emotionally rocky course of treatment.

And yeah, I resent the hell out of that.

Alexa and JV mentioned letrozole, which to be perfectly honest I had completely forgotten about as an option (see how well the detached not-caring thing was going?). I'd had one follicle on the sole letrozole cycle I did four years ago, but that was at another clinic. I don't know what the latest is on letrozole--I remember I did that one cycle and then a study came out linking letrozole to birth defects and so my RE at the time decided better to be safe than sorry. But at any rate, I did ask the nurse and she said letrozole cycles are uncommon at my current clinic, but they have been done, so I will at least ask about that as an option when I have my consult.

In the meantime, here's a question for those of you who have done IVF: How much did your big box o'meds cost you, if you paid out of pocket? My insurance covers fertility meds for IUI but not for IVF, so I'm on the hook for that. The Follistim from my IUI only cost me $70 last time ($35 per vial, 1 vial of 600 IU and 1 vial of 300 IU), so I about had a heart attack just now when I went online to see how much it costs out of pocket.

Nope

Nothing over 8 mm at today's scan (CD16). The doc who did the u/s (one I'd never seen before, a youngish guy) declared that it was probably time to move on to injectibles or IVF (but hastily added that I should discuss it with Dr. SF).

I do feel a little deflated (and annoyed that I once again dragged out the stupid Ovidrel, which is currently sitting in several layers of paper bag in the office fridge where I'm currently freelancing). But I'm not really feeling ready to jump into IVF just yet, so I'm prepared to give Clomid at least one more cycle, even if it's just spinning my wheels. Of course, between the co-pays and meds, even this canceled Clomid cycle is costing me almost $200, so it's not like I can afford to burn this off forever.

I guess I'll see what Dr. SF says. Right now I'm sort of feeling numb. And tired--I actually forgot that I had to leave the house at 6:30 a.m. today, until about 11:30 last night, when it was too late to get a good night's sleep.