Here we go again- IUI #2

Here we go again…

 

 

After waiting all of this time to get started, I’m just excited to get going again.  The faster we get started, the faster I’ll get pregnant… The faster we’ll be painting a nursery, and the faster the baby will be here!

 

The docs had some different ideas this time regarding medications.  The other medication didn’t work until they added a microdose of HCG, so the thought was to switch me to a new type of medication called Menopur.  The benefit (hopefully!) of this drug would be that it contained the same types of medication as last time, but it included some HCG.  Sounded ok to me, anything to help get me through the follicle stimulating process quicker than last time.  The idea that I might be able to be doing another IUI in 11-13 days was beyond exciting.  I spent the afternoon calculating when my due date would be.

 

I went to the pharmacy in the clinic to buy the new type of injectable medication.  (I’ll discuss costs at some other point to give a general idea of what you are getting yourself into by stepping in the clinic).  Expecting another needle pen, I was surprised to see the new way in which I’d be giving myself needles.

 

This time, I was given little glass containers that were sealed and had a white powder inside them.  There was also a small glass container with clear liquid.  What they explained was that I would be drawing up the liquid (it was saline) from the one vial, then adding it to the power to make the medication.  The good news was that it didn’t need to be refrigerated, the bad news was that dependant on the dosage, I’d be mixing different amounts in various vials.

 

Great- I’ve now gone from a non-nurse injecting myself to a non-chemist mixing medications.  I was a tad overwhelmed as this was more intense then simply dialing the twist knob to a specific number, but I can do this!

 

That night, at exactly 7pm, I started mixing my drugs.  Dan and I thought it was hilarious as now as it actually looked as if I was some needle drug addict.  I had the big needle and I’d be mixing the different dosages, swirling them around until they mixed properly, then adding more.  Cue me flicking the needle to get the air bubbles out, then jabbing my stomach.
Menopur

 

As I did the first injection, it appeared there was more bad news… this needle hurt like hell!  The last type of needle was this tiny little thing.  This new needle wasn’t so tiny.  It actually indented and pushed your skin in before you could get it to pierce you.  Great… this lead to more blood and a whole lot of bruising.  I was started on 70 units.

 

5 Days later I had to head into the clinic for my first new round of monitoring appointments.  Cycle Day (CD) 5 didn’t have any exciting news to give us.  No growth.  But this time, I readjusted my expectations.  I know last round was ridiculously long, but because of the changes, the hope was I’d be on track to be (sort of) normal this time.

 

Every other day I went into the clinic between 0730-0930 to get a transvaginal ultrasound and blood work done.  This continued from CD 5 until about CD 15.

 

Nothing was growing… at all.  They kept increasing my meds every 4th day.  By now, I was on about 225 units of menopur and still hadn’t seen any results.

 

Well… no results as in follicle growth. However, I was having plenty of side effects: my abdomen was swollen and bloated and hurt to touch.  If one of my dogs brushed by me or knocked me into something it was enough to reduce me to tears.  Oh… the tears.  Yep, I was an emotional madman again.  Grey’s Anatomy and any other show where a person (or animal for that matter) could potentially die or get hurt was now off limits in our home according to Dan.  You know he feels bad for you when he actually lets us go for ice cream trips more than once in one week.

 

I held it together for the most part until about CD 15.  That was breaking point.  Seriously though, what the heck was wrong with me.  PCOS patients often took a little longer than some to grow follicles, but this was not average.  This was torture.  I wasn’t supposed to have a fertility issue!!  I just had a bleeding disorder…

 

Well it appeared that we could also add a fertility issue to the list of medical things wrong with Adele.  Great, cause the list was looking a little short by now (*Cue rolling of the eyes here).

 

CD 17: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 19: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 21: Transvaginal Ultrasound and blood work.  Nothing growing.

 

Ok, seriously.  I’m a wreck.  I’m now hiding in my office at work trying to keep myself from crying the days away.  Even the days in between the monitoring appointments where I could normally talk myself into a good mood, weren’t as sunny anymore.  This was seriously hard.  If I wasn’t growing follicles, what do we do next?

 

We had a meeting with our RE and he decided to add in a bit of the old medicine I was taking before.  I was now on 263.5 units of Menopur AND 200 units of Puregon.  Let’s just say this was quite the powerful cocktail.  There were serious concerns about monitoring me carefully due to the massive amounts of medications, so I was now required to come into the clinic every morning.

 

CD 22: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 23: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 24: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 25: Transvaginal Ultrasound and blood work.  Nothing growing.

 

This was now unbearable.  I was a pin cushion for blood work.  My veins suck for giving blood on a good day, and now they were basically waving the white flag… no more!!  We were trying to use different veins in different places, but I seriously looked like a heroin addict (its heroin you inject, right? LOL).  Just to make the whole drug addict persona every better, I was always feeling sick to my stomach and had massive aching throughout my body.  I was now walking at half speed and my hands had the shakes.

 

I was now walking into meetings with employers and they were asking me if I was alright.  “Yes, thanks”, I’d say, but I was making quite the scene.  Not really wanting to share what was going on with random people, I tried to come up with a decent excuse for what would cause this.  Ultimately, I was working with medical professionals and tricking them is harder than you think.  But alas, I continued on.

 

Perhaps at this point I should have taken some time off work, but I had already taken a total of 9 sick days for various testing and procedures.  And hoping for another IUI meant that there would be more sick days needed.  I didn’t want to push my workload onto my colleagues who were already bending backwards, so I just kept pushing.

 

Giving yourself injections at a specific time took a lot of planning.  I now had Puregon again so that needed to be chilled, and the Menopur had the various vials that needed to be mixed.  Dan and I became pros at needle jabbing.

 

I did encounter the odd issue with the needles:

 

One night we pulled into a gas station to park. I drew the line at shoving 2 needles into my stomach while in a moving vehicle.  The poor gas station attendant apparently watched me mix the drug then start injection myself and handing over the garbage to Dan to deal with.  The poor guy had his mouth completely open and could not believe what he saw.  He glared and shook his head in disbelief.  Yah buddy, I’m just injecting myself with illegal drugs in your parking lot and letting you watch.

 

Another interesting needle day was when my friend Janica and I went to see The Wizard of Oz Musical in Toronto.  During intermission I had to run to the bathroom to inject myself.  The bathroom was packed and the line was giant… We decided I’d just go in the corner in the bathroom and do it.  Insert a zillion female gawking eyes and whispers… I finally just said, listen, it’s not drugs, it’s medication to the entire bathroom.  They all continued to stare at their feet after that.  The real problem was my cute white shirt I was wearing didn’t fair well as my belly decided to bleed the whole rest of the production so I had a nice blood spot on my damn top.  Grrrr.

 

So here we are 25 days into a cycle on a massive amount of meds and the RE calls us back in to have another quick meet to discuss.  He suggests canceling my cycle.  Canceling means exactly that, we just give up and start again.  But due to the amount of medications I was taking and my non-response, he felt that it might be wise to think about our choices for next time.  Did we want to continue with IUI?  We could try, yet again, another medication.  But it appeared it wasn’t the medication, it was my body causing the problems.  The other option was to look into In vitro fertilization (IVF).  The doc thought we might be good candidates.  He gave us a bunch of information to review and told us to come back and we could chat about what to do next.

 

We made the decision that day that we’d continue with this cycle a little bit longer.  At this point, I was injecting hundreds of dollars per day of medication into my system.  How could we just stop?  We’d put all of this money, time, and energy into this cycle.  I couldn’t just give up yet.  I told him CD 30 would be the end.

 

CD 26: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 27: Transvaginal Ultrasound and blood work.  Nothing growing.

 

CD 28: Transvaginal Ultrasound and blood work.  Nothing growing.

 

By now, Dan and I had taken the time to review all of the options given to us.  I went out and bought “Infertility for Dummies” and it was actually super helpful in explaining the different processes in simple terms that even we could understand.  Based on the information we had, we decided that we would move forward if this round didn’t work with IVF.  This was a big decision as IVF meant a whole lot (more!) of money, and was pretty much the end of the road for artificial reproductive technologies.  However, acting on our RE’s advice and our intuition, we thought this was the way to go.  I let the RE on duty for CD 28 know that was our decision and she informed us that prior to doing anything to do with IVF, we were required to attend an information session held by the clinic.

 

We talked to reception and they informed us that these only happen every other month.  It was a free session held at the clinic, but was several hours long.  It would explain the costs, the procedures, the chances of success, the ethical issues and answer any questions we might have. Great we thought, sign us up.  The problem was that the next session was that evening and was already over-booked.  She was going to have to put us in the session 2 months from now!

 

I was visibly upset, we were having the fertility rounds from hell, nothing was working, and we finally had an idea about how to move forward… and we had to yet again, just wait.  The receptionist, who knew me very well by now, asked me to wait a minute.  She made a couple calls then called Dan and I back up to the desk.  She had got permission for us to attend- tonight!  We couldn’t have been happier.

 

18:30 Dan and I arrived with pens and paper to the IVF information session.  There was some snacks and beverages and about 15 other people.  Most of the people here ranged in age from 30-40.  Dan and I were probably the youngest in the crowd.  We sat down and session began.  We were walked through the process of IV.  There are different types of protocols, but here is the basic idea:

 

1) You start to take suppression medications to suppress your ovaries from creating any follicles/eggs.  I didn’t think this one was going to be a problem for us. 😛

 

2) Take simulating medications to get your ovaries to produce as many eggs as possible.  The goal is to have as many mature follicles (btw 18-22 mm).  Follicles under 18 would be unlikely to have an egg ready, and those over 22 or so, would be over ripe (for lack of better medical terminology!!).

 

3) Once you have as many as possible between the ‘ready’ stage, you take a shot of medication to make the eggs mature.  This normally, if you want long enough, would make you ovulate, however, the clinic has to cath them before they ovulate, but after they are mature.

 

4) Next, is an egg retrieval.  Essentially they go in with a giant needle from down below and push it through your uterus into your ovaries.  Then they suck out all of the eggs.  Yep- it hurts and sucks as much as you are cringing now.

 

5) At the same time, Dan would produce a sperm sample.  Once the eggs are out, the lab takes them and puts the eggs and sperm together.  Hopefully they fertilize!

 

6) The lab grows the now little embryos for a specified number of days… normally 3 or 5.  During these days, the lab updates you with info on them, and you take progesterone to trick your body into thinking you ovulated.

 

7) Embryo transfer day!  You lay on a table and the RE, guided by a normal ultrasound on my belly, puts in a catheter into my uterus, and very carefully places the embryos in.  Any left over embryos, you have the option of cytogenetically freezing them to use again for a future round.

 

8) Hopefully, they implant into your uterine lining, and ta-da! 14 days later you find out you are pregnant.

 

 in vitro

 

So we learn all about the lab, all about the processes and timelines, and then all about the costs.  I attached a cost sheet here to give you the idea of costs for my clinic. Remember, this does not include the annual monitoring costs, nor the medication that you need to take.

 

 

Dan and I learned a ton from the info session and felt we had a really good idea about the process.  And better yet, the odds were definitely in our favour.  Continuing with IUI meant odds around 30% per round, where with IVF (being under 35) we had chances in the high 60’s% that it would work.  I cant recall exactly, but somewhere around 68%.

 

This was all great news… the harder part was the ethical implications that we needed to discuss.

 

We were essentially creating life in a petri dish… What did we think about that?  Would we freeze the embryos left over?  If we didn’t they would ‘arrest’ aka die.  What did that mean?  When did life start?  If we freeze the embryos, then both of us died, what would we want the clinic to do to with the embryos?  Let them arrest?  Donate them for research? Donate them to another couple? (remember this would genetically be our kids!).  What happens if we get pregnant and have left over embryos that and don’t want any more children? What happens if one of us dies- would we give each other permission to use the embryos after death? So if Dan dies, could I still try to get pregnant with our kids?  What if I died?  Who would carry the baby?  Were we okay with this?  And last, but not least, what would we do with the embryos if were separated?

 

Not easy questions…. at all.
Two more cycle days left before we call it all off… and lots of hard questions that we really need to figure out.  Please let this work!

 

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