Day 7 Check-in: Follicles Growing!

Yesterday was our Day 7 check-in with the baby doctor. Still not there yet, but the follicles are growing!

As soon as we see the ultrasound, it's an immediate difference. My ovaries look kind of like a honeycomb, full of nicely developing little caverns. There's still one big one, measuring around 17mm now. We're hoping that another 8 - 10 catch up.

Estrogen levels are rising... today's number is 405. I'm also starting to feel the ovaries stretching, which is a welcome but not so comfortable side effect. It kind of always feels like I've just eaten a big meal. I feel full, and am a little swollen. The mirror doesn't lie, and neither do my jeans!

It's getting harder and harder to stay out of the numerous chat rooms. With every new thing that my body does, I'm tempted to google.

And the ever growing pharmacy is taking over my kitchen.

The truth is that we won't know until we know. We're expecting egg retrieval to happen between Wednesday and Friday of this week. We'll just have to wait and see if enough follicles develop at the right time. Fingers crossed!

Day 3 Check-in

Three days into the meds, I return to the office for another ultrasound and a round of blood work. Our doctor doesn't expect to see much yet.

Our goal: see a nice group of follicles starting to develop at roughly the same pace.

The ultrasound reveals that my 10 follicles have grown slightly, but not much. Happily, they are developing at the same pace, except for one large follicle that is sitting at around 11 mm. It's amazing. I usually can't really see what the doc sees on the blurry image, but this one stands out loud and clear. It looks like a dark hollow cavity. In reality, it's the fluid building up that will allow us to retrieve the egg.

All is looking good, but the doc suspects that we will want to bump up the meds. I might also need to start cetrotide before I see her next. Cetrotide is a med that prevents me from ovulating, so that the large developing follicles stay put without releasing any eggs.

We've gotten our routing down. Early morning doctor visit, then hang out around the corner at Starbucks while we work and wait for the nurse to call. In the afternoon, I finally hear from Pam. We indeed need to bump up the meds. Tonight, I'll increase to 300iu follistim and 300iu menopur. Tomorrow, we'll add cetrotide.

Friday, we'll head back to the office to see the results. Hoping that we see 10+ nicely developing follicles, and that the added menopur doesn't sting too much!

Started the meds!

Three days ago, we stared a regimen of 300iu of follistim and 150iu of menopur, injected nightly. I've never given myself an injection before. It's strange, to be honest.

Step 1: Mixing
First, you must carefully mix the meds, pulling the syringe in and out of each vial until the perfect cocktail is achieved. This bit is kind of fun... a throw back to my inner mad scientist.

Step 2: Mental Game
The injection is all about the mental game. You stand there, heart racing, cold syringe in hand, trying to convince yourself to jab a one inch needle into your stomach. I went back and forth a few times, even piercing the skin once. I finally gave up. It's counter intuitive, and, rather than fighting it, we came up with a new plan.

Rather than jabbing myself with the needle, I let my wife do it. After all, she's has more experience than me. True, it was mostly on animals, but I figured it's more than me.

I turn the needle over to her. It's till a bit of a dance. I pick the spot and pinch my stomach with one hand, while squeezing her shoulder with the other. The right side isn't that bad. The left side stings like crazy. Not looking forward to tomorrow when we have to go back to lefty:/

Step 3: The Dance
I decided that the best way to get through the madness of injections and hormones is to dance it out. It helps release nervous energy and takes my mind off of the left side sting! So... after the injection, we dance it out in the kitchen. My wife is awesome. She always joins in.

Tomorrow we go back to the baby doctor to find out how things are going, adjust meds, etc. Fingers crossed that all is heading in the right direction.

Baseline

Today's baseline tells us if this will be the magic month for egg retrieval. I'm not going to lie.. this week has been nerve wracking! When it comes to upping your chances, it's all about egg quality.

For the past two years, I've been on vitamins and supplements to help increase egg quality. We added even more to the mix about a month ago. Our nightstand looks like a pharmacy. At 39, you'll do whatever you can to improve your chances.

To add to the edginess, I've also been on a regimen of birth control this week. It's all about controlling your system so that it will do what we want -- produce a bunch of eggs at once! A few days ago, I started spotting and today I seemed to start a light period. I went in to the doc's office convinced that this wasn't normal. Turns out that it totally is! When you stop taking the pill and the hormones drop, it causes a period. Menses 101... but it's strange since I just had a period 2 weeks ago. Weird.

Before starting the hormones, the doctor basically wants four things to happen: calm ovaries with a nice group of follicles developing, thin uterine lining, a little bleeding, and the right estrogen level.

The ultrasound reveals calm ovaries and thin lining. We have around 10 follicles measuring 5mm+ and a few more slightly smaller ones that might join the party. We already know about the bleeding. Now just need to see about the estrogen levels. A little blood draw and we are out of the office and heading to the fertility pharmacy.

A few hours later, we get the call -- good to go!!! Tomorrow, I'll start three meds: an antibiotic as a precautionary; follistim (300iu); and menopur (150iu). The follistim and menopur will be mixed up into a little cocktail and injected into my lower abdomen - ouch! I hear it's not as bad as it seems. We will see:)
 

Go time!!!

The rails are off! Things are moving quickly now. Three weeks ago, we went in to hear the results from our initial appointment and discuss next steps. Everything looks great and we were cleared to start the ivf process.

I travel -- A LOT! For work. volunteer. fun. It sometimes consumes my life and always consumes planning. I went in with a travel calendar, mapped to my cycle, to try to understand which windows of opportunity might be available.

To add one more tiny complication... the lab periodically closes for cleaning, so we also need to factor in that schedule. The ivf nurse is amazing. Like a wizard with her wand, she somehow magically pinpoints the best window. She gives a grin and says that we'll be busy, but we can start this month if we want to!

Our baseline ultrasound is scheduled for Feb 24. We immediately put things into action. To do list:

• Travel to Mexico for work and volunteer duties 
• Coordinate finances to be prepared for Feb 24 baseline
• Schedule saline sonogram / additional STD testing / injection training
• Research pricing for meds and choose pharmacy
• Review consent packet (no small feat!)
• Consult attorney on reproductive rights
• Finalize sperm donor selection and order sperm

The nurse is right ... the following three weeks are intense. We hit a few bumps, but, with the help of our village, we sail through them. Here's how we fared on the to do list and a few tips to share from our journey for those who might be trying ivf themselves:  

Mexico: CHECK! 

Pro Tip: If you are traveling to a Zika zone, women should wait at least two weeks before getting pregnant. For men bringing their part to the party, it is much, much longer.... something like 6 months. You can ask your sperm bank their process for screening and testing sperm for Zika. 

Finances: CHECK! 

Pro Tip: We are financing half, paying for half out of savings. Our doctor gave us a list of financing companies and some feedback on each, along with a pricing sheet. They discount for couples who are doing genetic testing. In the end, ARC Fertility is footing our bill as the lender. Double-check that the financing company's package and your doctor's package match. If we hadn't paid attention to detail, we would have overspent by $1,000+

Saline Sonogram: POSTPONED:/ 

Pro Tip: Attempted saline sonogram and practice transfer revealed that I have a bit of stenosis in my cervix and need a procedure to correct it before we can go forward. My tip? Do the practice transfer!! You never know what you'll find. This was never mentioned by my previous doctor and was unexpected. Since we are doing genetic testing and previous tests have not raised any concerns, we decided to postpone the test. When I am under anesthesia for egg retrieval, my doc will go for it again.

Additional STD cultures: Check!

Pro Tip: Easy breezy. 

Injection training: Check!

Pro Tip: This is a little overwhelming. As the nurse starts to speak, her words blur in and out, like in a movie. Once I do it a few times, I think it will be pretty simple. Going through all of the steps, it's a lot to remember. I am leaning on my wife who has given herself and many animals injections. Maybe not the same thing... but I'll take it!

Choose a Pharmacy: Check!

Pro Tip: You'll need a special fertility pharmacy. Each one offers different discount programs on different brands. Some ship meds; others have pick-up hours. We choose the fertility Walgreens (yes - it's a special one... not just any Walgreens!). We were told to prepare for $4,500 - $6,000 in meds. In the end, we will likely be around $5K (update: new meds added - heading towards $6K).

Review consent packet: Check!

Pro Tip: This takes a while and requires a conversation between both partners. We completed 3 - 5 pages per day over a period of about a week, asked questions about the content during our injection training, and then finished the final signature at the baseline. It took about 2 weeks to complete. 

Consult Attorney: Check!

Pro Tip: We looked for an attorney who not only specializes in reproductive law, but also advocates for LGBTQ families: Barbara Katz. Once we are actually pregnant, we'll schedule an appointment to create a host of documents that outline what should happen in case something happens ... to me, the baby, or H.   

Order sperm: Check!

Pro Tip: Go with your gut! But get your paperwork in order and start early. Before they will ship, they might need a physician's authorization on file with the bank. It's different for each state. We requested the form at our injection training, so we had it in place for the order. As soon as it's processed, they will ship the little vials all the way to Atlanta where they will hang out in the freezer until it's time. You can rush shipping, but we preferred to save money and go with standard shipping. At the advice of our doctor, we ordered two vials. We really only need one, but just in case something is wrong with one when they defrost it, we decided to have a second one on hand. It's a bit more expensive, but in the grand scheme of things - worth it!  

All of this led up to today's baseline!:)

Baby Daddy

Let's be honest: sperm banks can be confusing, and can a little creepy. We were happy with the bank that we used before and feel confident in their policies, so we are going with them again.

After several nights of surfing through baby photos, family medical history, and celebrity look alike photos, we've narrowed it down to three options.

Our philosophy is that since it's my egg, it's really my wife's job to bring the sperm to the party, if you will. We want a donor that resembles her and has some of her characteristics... artistic, kind, smart, etc. We veto features that we couldn't imagine on our child. My wife is peculiar about noses. I'm picky about eyes.

At the end of the day, medical records are the trump card. I already have cancer running in my family, so no need to add any more of those genes. Some things stand out as immediate disqualifers, especially if it impacts a sibling or close relative. Others highlight longevity, like a common age-related disease diagnosed at age 90. That sounds more like a positive, than a negative to us.

Finally, we have our top three.

Baby daddy #1: Might just be the perfect donor. His childhood photos look a lot like my wife. His celebrity look alikes are dreamy. His health record is clean. We call him freckles because of his cute sprinkling of spots across his nose.

Baby daddy #2: A strong choice, but slipping into the number two spot. He is cute, smart, ambitious, with a passion for travel. He's also Jewish, like my wife, and has a clean (enough) health history.

Baby daddy #3: Easily removed due to his sister having a severe peanut allergy. Might seem silly, but it's one hassle we'll avoid, if given the choice. Anyway, if the baby inherits my food allergies, it will already have enough to deal with:)

It's a tough decision. You want to pick the perfect specimen, literally speaking. You want to give your child the best possible gene pool, especially since it's a choice. I go to sleep thinking about it. I wake up thinking about it. Baby daddy #1 keeps bubbling up to the top. He's my wife's first pick, which also makes him easy to favor. 

We need a few more nights to sleep on it, but I am pretty sure that we've found our guy!

First Appointment: New Doctor

Monday's appointment was everything that we needed it to be. We arrive at a small satellite office, which opens two days each week in a co-op space that the practice shares with other doctors. Walking through the door, there is an immediate difference. The office is smaller, less lavish, more practical. The staff is knowledgable, friendly, down to earth. The doctor spends over an hour with us reviewing our history and potential next steps.

By chance, timing is actually good for my first round of tests. The nurse starts blood work for both me and my wife. The doctor performs an ultrasound to count how many eggs I could potentially have. This is always the fun part... where they say things like "good for your age" to remind you that time is ticking. After we laugh, the doctor adds... "good for anyone's age, really." Promising. We schedule a follow up two weeks from now to review results and make a plan.

Four new tidbits of information came out of this appointment.
1) I still have a good number of eggs! Yay!
2) It turns out that having a friend as your donor (which we were considering as a new option) is more expensive and takes longer than using a bank.
3) Since we are switching to ivf, my CMV factor is no longer an issue.
4) We've been encouraged to look at all blood types for donor selection.

What does all of this mean anyway?

CMV: I tested negative for CMV. This is a virus that affects a high percentage of the population. Once positive, you stay positive. For most, it is not really a big deal; however, if you contract it while pregnant, it can cause all kinds of problems and birth defects (think Zika). I tested negative, which means I would not want my donor to be positive. Since we are doing ivf and not actually sending the little swimmers into my body, I can use CMV positive sperm in the petri dish without risking an infection.

Blood type: It turns out that I am part of the very small population that has B negative blood. So what? If I choose a donor with a positive blood type, then the baby will likely be positive. If this happens, I can actually have an allergic reaction to the baby in womb and it can cause all kinds of problems. The remedy is easy, I am told. It just requires extras shots during pregnancy. Additionally, we were previously encouraged to consider a donor that matched Heather's blood type. This would allow us to both be able to be blood or organ donors to our child, should he or she ever need it.

Given these factors, the choices of donors are very slim. Our new doctor encouraged us to explore all options. The choices went from a handful of options to hundreds.

As you can imagine, we spent Monday night googling egg counts, reading blogs on ivf, and surfing through all of the donor photos that we've hidden over the last five years. Welcome to the pool ... now accepting applications!

Going Back

In preparation for our appointment with our new doctor, we needed to collect our medical records. I decided that the easiest thing to do was to swing by our old doctor's office and pick up a copy.

It hit me softly at first, and then like gale force winds as I entered the door. I had returned to the scene of the crime. It had started so innocently all of those years ago. I remember sitting in the waiting room, giddy with excitement. Then, a realization washed over me. Nothing had turned out as we planned.

The staff were their usual, kind, selves, greeting me with a smile. I sat in the waiting room while the documents were prepared. It struck me that we never actually inseminated at this office. It was the place that I liked most. It felt warm and welcoming. The other office is "where the freezer is" ... so that's where the procedures take place. I had all but forgotten how the waiting room here feels like a friend's living room.

Finally, my patient care coordinator appeared with a package. There it was. Our entire baby making journey summed up in a manilla envelope. It drew me in. I could barely wait to get out of the building to open it. I walked around the corner to a sandwich shop. I stood thumbing through the pages for a few minutes before I even realized that the store was closed. I found another spot where I could grab a bite and read the reports.

There it was in black and white... my numbers:
6 iui cycles, 4 with letrozole
1 biochemical pregnancy
recommendation: ivf

It all feels so far away. Like a lifetime has passed since we were young, clueless, and just starting out on this journey. Now, I sit with a new feeling. It's not quite giddy, but it is hopeful, laced with a bit of fear and a ton of emotion.

Changing Teams

It's time to move forward. After sifting through CDC fertility success rate reports and user reviews on yelp, we've selected a new doctor. We really need a fresh start and this is the first step.

Our first doctor was great - informed, kind, convenient. The practice is multi-office group where you meet with your doctor for consultations, but then receive care from the first available doctor when it comes time treatment. One the one hand, this means that they are available when your body says it's time. This is amazing since your cycle doesn't take time off for holidays or weekends. On the other hand, our doctor never actually performed any of our inseminations. The other doctors were fine, but unfamiliar.

The handling of our miscarriage was most surprising. I assumed that since the staff were so incredibly knowledgable and encouraging about making a baby, that they would also be the same if something went awry. I assumed wrong. I was given very little support beyond basic medical testing requirements. They failed to warn me that that I could become severely dehydrated from blood loss, which my primary care provider and wife helped me through. They didn't even provide a bit of privacy when I came in for blood work over the weeks that would follow. The waiting room was filled with aspiring moms hoping to get a positive pregnancy test; I was waiting for my numbers to drop far enough to confirm that my little sesame seed had passed and would never get to see the light of day.

After the miscarriage, we tried one more iui, which failed. During our next consultation, our doctor advised that we move on to ivf. We needed time. To think, to grieve, to come up with the incredible financial resources required to move forward. While our doctor said that she understood, the accounting department did not. We missed our final payment of $200 and, within a few short weeks, our file was whisked off to collections. I didn't even realized we had a balance. After the thousands of dollars we'd spent, we were turned over to collections for this small oversight, and amidst an incredibly difficult time. The mark on our credit surely will not make it easier to qualify for loans to fund the ivf.

So, here we are two years later. We've spent this time healing. We also had some tough discussions about values and choices, and whether we were prepared to spend so much money on making a baby again, even though there's no guarantee. We've also wondered what life could have been if we had just gone ahead with ivf in the first place. Where would we be? Then, we coped with the realization that you can't go back. You can't wonder. You can only move forward.

So move forward, we did. A year ago we knew that we wanted it, but weren't financially prepared. We have been focusing on career and finances and are ready to move. On Monday, we have an appointment for a consultation with our new doctor, and we can't wait for the adventure ahead!

A little history...

Nearly 5 years ago, my wife and I set out to make a baby. We are a same-sex couple, two women missing just one little ingredient. A problem easy enough to overcome, so we thought. We found an incredible doctor, passed all of the medical tests, chose the perfect donor. I was 35, healthy, ready.

The first appointment is now a blur. I remember getting the negative result and optimistically reassuring myself that it was no problem. That it would happen next time. But there was a problem. Getting pregnant was not going to be the simple 'just one drop' formula that has been engrained in my head since adolescence.

Fast forward. Today, I am 39 years old, about half way to 40. I can feel the window of opportunity closing. I'm mad for taking so much time in between attempts. Still sad, but opening up, about the miscarriage I had two years ago. Happy for the many friends who have brought children into their lives. And compassionate for those who have struggled like me.

We've been through so much on this journey already, financially and emotionally. It's time for the final run. Today, we are making an appointment with a new doctor. It's time to start fresh, get aggressive, and see where this journey takes us.

Throughout the process, I've found it incredibly insightful and comforting to read other people's stories. So, I thought I would share mine.

Hopefully it's helpful for others, and maybe even a little cathartic for me:)