I Can't Laugh

....or cry.  or sit.  or stand.  or cough.

.....or do much that requires the use of my lower abdomen without cringing in sheer pain!

Why?
There are two orange-sized ovaries in my body...carrying 24 gigantic follicles with eggs.

just a really cute picture of
 almonds and a sliced orange

Let's put things in perspective for you:

• In a normal cycle, those ovaries would be the size of almonds.  ALMONDS!  So imagine the abdominal pressure.  
• and yes, theoretically, I'd be pregnant with 24 babies if each of those eggs were fertilized with sperm.
• do that math on THAT childcare bill!

So here's the timeline:
1.  Each of those follicles are measuring an average of 15mm
2.  They'll keep growing and we'll consider them mature around 22mm or so....any day now.
3.  Once that happens (ultrasound will show this), I'll inject myself with a trigger shot which will cause them to release the eggs.
4.  35 hours later, I'll go in for an egg retrieval surgery.
5.  ***still on the fence about how I want them fertilized during this period***
6.  Go back in for surgery 5 days later for embryo transfer
7.  Wait.......


No seriously...wait for an update ;)

Access Denied!

Dear Patient,
We're writing to inform you of a coverage denial. 
This request is denied as not medically necessary because: there is no available documentation of a current problem you or your partner have that indicates you meet criteria for needing intracytoplasmic sperm injection (ICSI), which is generally required if there has already been a problem with fertilization during in vitro (IVF).  Your partner's only recent semen analysis is normal.  Therefore we cannot approve ICSI for you at this time.

.. my insurance company wrote that in a letter to me this week.  Bast**ds!

So, remember in 2012, we discovered a Crohn's Disease maintenance drug produced toxic antibodies in his semen?  Well, we ditched that drug and he went for a biologic that not only kept the disease at bay (remission) but has no effects on reproduction (that we know of).  Latest semen analysis is normal.  POOOOF!!! goes the male factor!

But, there's still the question of the quality of my eggs....since I had aggressive chemotherapy treatments at 25 years of age.

Since it's 'unexplained' infertility....the lovely insurance company won't cover the ICSI portion of the procedure.

Luckily, we're in a research hospital so get the benefit of most of their cutting edge science without additional costs.  Nurse responded back to my text about the coverage denial saying "we'll eat the cost, because we feel you're a perfect candidate for this".

Now we just have to decide if it's worth it.... is it?

I'm huge...

after a week of 3 daily injections
(2 in abdomen below belly button and 1 on thigh)

Routine ultrasound yesterday showed my right and left ovaries have produced huge follicles....hence the semi-pregnant, bloated look and feel on my otherwise flat belly.  Next week, they'll mature (hopefully no later than Monday so I can go on a previously planned vacation....more on this topic later!)

So, you probably have a ton of questions....one being 'what the heck is a follicle and what does it have to do with IVF?'  

Remember you (a woman) are born with all the eggs you'll need for a lifetime....about 5 out of 6 million disintegrate while still in your mother's womb (science hasn't figured out this weird phenomenon ...yet).  So we're down to about one million....and you've hit puberty and now menstruate monthly.  At the beginning of every cycle (day 1 of your period), you have several immature follicles that will start to mature - which means they develop an egg inside them) -- at some point one will become the dominant follicle and make it all the way through ovulation.  The non-dominant follicles eventually disintegrate and produce a bunch of odd hormones your body needs, i.e. progesterone. 

But when you're on ovulation-inducing meds for fertility treatments, instead of one follicle being dominant and reaching maturity, there'll be several.  A mature follicle means it's a follicle ready for ovulation -- the developed egg is ready to be released in hopes of fertilization taking place.  Once the follicle reaches a certain size (maturity size), it'll release the egg -- ovulation  -- around day 14 after your period.  If there's sperm present, they make sweet love...and you're stuck with childcare bills for a longgg time!  

*cringes at childcare bills....ughh!*

Where were we? 

Oh yes....mature follicles! 

So with IVF treatments, my medical team will determine a comfortable maturity size for those follicles (probably around 15mm+), then instruct me to give myself a trigger shot (hCG) to cause ALL mature follicles to release their eggs.  Within 12 hours of the shot, I'll be in surgery for egg retrieval.

to ICSI or not to ICSI...

"Hello?"
"Dr. **** here.  Got a minute?  Let's chat.  I reviewed your history with the team and the consensus is you two should undergo ICSI.  You don't have to make the decision now...talk it over with [him] and you can change your mind as late as the morning of your embryo transfer".

So a few weeks ago, we were in a mandated IVF educational session with four other couples.  This 5+ hour catered session was facilitated by the Chair of the department and a very well respected, accomplished, and published OBGYN.  This particular fertility institute prides themselves in the partnership between patient and doctor -- at each juncture in the process, a discussion between all parties is held and a decision is reached no matter how difficult.  At no point does the medical team impose or force their recommendations on a patient unless the alternative is deemed medically unethical.  [This was not the case in our dealings with the previous fertility clinic]  In the session, we learned everything one needs to know about IVF -- and since we're in a research hospital, we also learned their particular techniques and madness behind their unique methods.

Where as IVF generally involves exposing harvested eggs to motile sperm in a dish hoping for fertilization, ICSI takes it a step further.  An embryologist selects a single sperm from the sample, clips off the sperm's tail and injects it directly into the egg, then monitors the progress hoping for fertilization within 2-3 days.  If it takes, they let the egg mature (another 5 days) then transfer the blastocyst into the woman and hope it implants -- if so, you're pregnant!  This process is usually recommended for a number of reasons...in my case, because I have unexplained (or undiscovered) fertility.  If you recall, I had chemo at 25 years of age without having harvested my eggs  --- could they have been fried? (pun totally intended....lighten up people!!!!)  The quality of my eggs is unknown at this time...

ICSI sounds like a no-brainer!  Why come this far and not afford yourselves the best chances for success?
---------------------------
This juncture....this science.....is a huge point of contention in the field, the doctor added.  There's great debate on whether this process leads to higher rates of birth defects.  He added that normal IVF pregnancy birth defect rate is 1-2%, but with ICSI it's 2-4%.   Are one's chances indeed doubled? Or is the sample of IVF patients so small and that of ICSI even smaller for this statistic to be noise-worthy?

I love DRUGGGS!

Scroll down.  A little lower.  Yep...that's today's cocktail.....DRUGSSS!    Nurse called yesterday with results of blood test.  My estradiol levels are sky high -- apparently I'm responding very well to the hormones, so time to adjust one set of meds and add more.

1.  Ganirelix:  peel pre-filled syringe, tap and push out air bubble, find sweet spot on thigh, cleanse with alcohol wipe, stab thigh, push drug, enjoy the high!    Ahhh....air bubble on thigh.  Someday I'll get it right!
2.  Untwist cap, take doxycycline -- wait...remember the incessant vomiting spell on Saturday? Oh no, not falling for that again.  Spit out pill. Run downstairs for food....anything...ahh, a boiled egg.  Inhale boiled egg, grab water, try again....pill swallowed.  Success!
3. Hours later, adjust dose on Follistim pen, find sweet spot on lower abdomen.  Wait....did I inject on the left or right side last night?  Shyt...I can't remember.  Pick a spot, wipe with alcohol, insert needle cap onto pen, pinch skin, stab!  Ok...that stings!
4.  Pull out long needle from new syringe, discard in cute biohazard container.  Twist plastic cap, insert in liquid menopur, pull  liquid, then insert in powdered vial, mix, pull mixture, replace syringe with smaller needle, find sweet spot on abdomen......yet again.....stab, push medicine....try not to flinch!
5.  Take another doxycycline pill.
6.  Carry on with the day.

FYI:  I'm deathly afraid of needles.   Ha!  Gotta love God's sense of humor!
How do I feel today?  Crazy!  I'm pretty convinced half these drugs are stimulants and totally suppressing my appetite and the other half are depressants and make me want to eat chips and ice cream (specifically ice cream sandwiches) between the hours of 4:15pm - 6:35pm daily.   Weird!

While chatting with nurse, she asked if I watch the Lifetime Network (really awesome tv network full of sappy woe-is-me movies, great for a good cry after a nasty break up, and a sad depiction of Tori Spelling's train-wreck of a life....omg have you seen that show???  poor girl. anyway....I digress).   In any case, she cautioned against it, or making any important life decisions in the next 2-3 weeks, or engaging in emotionally charged discussions.  "The drugs will make you crazy.  Think about what's happening...we're completely manipulating your body with drugs, stopping it from undergoing normal processes in any given cycle, telling it when to produce eggs, how many to produce, how large to make them, and oh by the way, don't ovulate until we say so....you're not yourself, so don't try to be.  You're undergoing a major, albeit temporary, change and you'll feel and act out in ways you never have.  Best advice for [him] is to respond 'yes dear' to every single request for the next two weeks."

Ha!  This is going to be torture FUN!
The possibilities are endless....new shoes, new car, endless massages, breakfast, lunch & dinner in bed, ICE CREAM IN BED.....maybe even a new house....HA!    *insert evil laugh here*

Why IVF? ...a lil' background

You're probably wondering why a perfectly healthy 32 year old needs IVF to conceive, right?  No?  Well...I'll tell you anyway.

I'm 32, 5'4, 136lbs, in good health -- what gives?  Well, it's much more complicated than that.

At 25 years of age, I was diagnosed with stage 3 colon cancer -- random abdominal pains during happy hour that grew increasingly worse over night and led to a trip to the ER whose CT Scans revealed an interestingly exploding tumor just above my perfectly normal appendix -- I managed to finish all 6 martinis before heading to the ER though....I just don't believe in wasting alcohol!  Colorectal surgery and a ton of chemotherapy treatments later (March - November), I was free!  I gave up 12 inches of colon, a full head of hair, lots and lots of brain cells (a good chunk of my long term memory found the exit door).....for a clean bill of health!  But one very tiny important detail that will come to [haunt] me later on in life:  I didn't get to harvest my eggs!
Why?  There was no time. Surgery was on Jan 29th, and I was given 8 weeks to heal and warned that chemo needed to start IMMEDIATELY after healing so I could have the best chance at killing the cancerous cells moving aggressively into my lymph nodes and towards my liver.  Chemo started on the 57th day after chemo....exactly 8 weeks later!

In 2012 a routine gynecology visit, reviewing my healthy history, my ObGyn suggested I visit a renowned fertility doctor in South Jersey to rule out any potential issues from my treatments that may prevent [us] from conceiving should we choose to in the future. It was a horrible experience -- very much a factory, little to no humanity in the staff's or doctor's dealings with us, and their methodology was comprised of antiquated medical practices.  For something so personal and sensitive, one needs a more ginger approach.

Despite the horrific experience at Dr. *****'s practice, we discovered one key issue:  a male factor!
My husband had been nursing Crohn's Disease for many years, having only 3 hospitalized flares (at the time) in his life (one upon discovery at 16, the second while defending his Ph.D, and the third a month after our wedding.....and no I was not a bridezilla!)  The disease was seemingly under control with the treatment of Azathioprine (an immuno-suppressant), so we thought!  But it wasn't!  It was producing antibodies in his semen that essentially made his sperm toxic to me.....and him!   It had devastating effects (unbeknownst to us initially) on our efforts to conceive.  He ditched that drug, and switched to a biologic. but not before one last flare on new year's eve 2012....oh yes, I watched the ball drop from a very uncomfortable hospital recliner as he fought for his life ---- FUN!

PS:
I'm African with no family history of colon cancer; father died of lung cancer (non-smoker), paternal aunt died of breast cancer both in their 50s, siblings are alive and healthy.  Underwent genetic testing, which revealed inconclusive mutation in my genes for colon cancer, not enough data to make an absolute determination on impact on future offspring, and 12% chance of breast cells becoming cancerous -- again, data is just in the noise; not enough to cause panic.
Husband is 38, 5'6", healthy BMI, African American, no family history of Crohn's or cancer.  Siblings are alive and healthy.

Quest for New Life

I'm not even sure where to start so I'll start with now....

After many ups and downs and disappointments and probably blessings in disguise...I'm here, the fifth day of my IVF cycle.  Let's take you back to the first day.  I drove up to the hospital (I was summoned by my medical fertility team) completely in a haze/daze/total confusion and probably in the middle of a mental breakdown after yet another unsuccessful IUI cycle -- a nurse (now my nurse) and a doctor (apparently my new BFF) propped me up on a table, spread my legs, inserted ....quite a few instruments -- minutes later I heard "great, the mock embryo transfer is done, now draw her blood".
Then I was in a room (not sure how I got there or even how long I was there) being shown how to inject myself with the various drugs I'll need over the next 2-3 weeks in preparation of an invitro fertilization.  "You have to return with [your husband] so we can show him how to inject your progesterone....you look like a deer in headlights.  Do you have a living will?  Did you both sign the consent forms?  Did you absorb anything we taught you today?"  I just nodded anxiously (or perhaps frighteningly).   Everything was a blurr.

That afternoon....I returned my girlfriend's call, not because I was in the mood to talk or share ....but because I needed an escape from my torturously loud and disruptive thoughts racing a million miles per hour!  She was excited about her upcoming trip to Barbados and went on and on about her new hairdo and shopping and the anticipated lovely weather and the beach and the sunset...she probably heard the echo of my heavy tears splash on the tile floor of the library gallery I entered to hide from my reality....   She prayed with me.

At 10pm, I was to prep an injection pen with 150 units of Follistim and inject into my lower left abdomen.  ...but not before holding the needle dangerously close to my abdomen (accidentally stabbing myself a few times and drawing blood) as I trembled and wept for a good 35 minutes....out loud...while my husband stood by me, helpless.  He couldn't rescue me from this one....I had to learn to self-inject, as it would be one of many in our long journey ahead.  It would be one of many daily trips to the hospital for blood work and ultrasounds, to monitor my vitals and determine the injection dose for the next day -- sometimes up to 4 painful injections a day -- all working in tandem to stop my body's normal ovulation cycle, manipulate it to produce multiple follicles with multiple mature eggs, so they can be harvested, inseminated, then implanted back in my body.  By the way....that's essentially the definition of IVF.

Today -- I'm an emotional wreck.  The manipulation of my hormones has been quite challenging for me emotionally and mentally.  I'm sorrowful, tearful, half-present in conversations, depressed, incredibly tired often, vulnerable, paranoid (as hell), impatient, not confident....and the list goes on.  You probably need a little background...so please, tune in for more!