Thursday, May 23, 2013

Two on board

So today was transfer day.  My call was for 12 noon with a full bladder, arriving 15 minutes before.
I was up early although I had gone to bed really late.  I was doing packing and getting stuff tied up for recycling last night and wanted to get it done.  Plus I was watching the last few episodes of season 4 of True Blood.

Anyway, I let the house about 10 minutes later than planned for no good reason.  Traffic was normal and so I arrived about 11:55am, so that 10 minutes made me late.  But I still was Zen.  I had been told by the business manager to stop stressing about money and just be Zen.  So I paid attention. :)

I arrived at the IVF suite and got changed into those lovely booties, and two gowns.  I had chugged about a litre of water as I was driving down but I wasn't getting the full bladder feeling.  I signed the form they gave me with the instructions following transfer, handed in the signed consent form (even though they had a scanned copy) and waited perhaps 10 minutes at which point the nurse came back and said "ready to go into the room"?  Sure.  Apparently the doctor was on his way over. So he was definitely on schedule and it sounded like I was the first procedure.  I saw another woman waiting with her husband when I went in for my transfer but he wasn't there when I came out so she must have been in for a retrieval.  

I assume the position.  There really is no way to describe just how naked you feel when he's got you all exposed and legs in the stirrups. LOL.  The ultrasound tech came in and was quick to get in position.  And my concern about not having a full bladder?  Gone as soon as she pressed down.  Definitely a full bladder.

One of the three didn't survive the thaw, so we had two to transfer.   He had the embryologist show my name on the dish and then show me the embryos on screen (I didn't have my phone so didn't get a photo). These were three day embryos.   I didn't ask how many cells because it wouldn't have made a difference.  They were going in and I was staying Zen. :)  But he did say they were excellent and they did look really good to me.   So, it was but a few minutes later when he said "all done, perfect transfer".  And that was it.   I lay there another 10 minutes and that was it.

I've taken it easy today.  I know the rules - no heavy lifting, no strenuous exercise (no worries there), stay on all meds.  Beta is June 6th.  If we get a positive, then when I'm back for the second beta I'll do another intralipid infusion.

So let the two week wait begin.  Hopefully there will be enough distraction. LOL.

Sunday, May 19, 2013

We have ignition and are moving towards liftoff

I was back at the clinic on the 16th for cycle monitoring and the Intralipid infusion.
I was booked for 8:30am for the intralipid so I needed to get in before that for ultrasound and blood work.  Their process has definitely improved since I was last there.
I got down a bit later than I had planned only because I left a little later and didn't know what the traffic would be like.  So I was in the clinic about 8:15am.  I signed up on the doctor's list and marked that I would be over in the OR for the Intralipid so he wouldn't see me until later.  I then signed up on the ultrasound list and took my  number (23) and walked over to sign in for blood.  I think I waited maybe 5 minutes before my name was called.  I went back over to wait to be called for ultrasound. It shouldn't have been more than 15 minutes because I heard them call "19, 20, 21, 22, 24)....what???  Where's 23?  Turns out my file was over on the OR side so they had to go get it before they could call me.  It was about another 10 minutes before I was called and told to wait by one of the U/S rooms.
By the time I got over to the OR for the Intralipid it was about 9-9:15am.
One of my favourite nurses from 2010 is now the manager over there, so it was nice to see her.  She didn't think I'd remember her. :)
Anyway, they went through the necessary steps to get the IV in and get me all hooked up.  I'm sitting in one of their reclining massage chairs.  I got it positioned with my feet and head back to a comfortable position and turned off the massage and settled in for the next 2 hours.  I just wanted to be comfy to watch my Tr.ue Blo.od episodes on my iPad.    It's a painless process.  They hooked up saline first and then hooked up the Intralipid which is this white soy/egg based product.  They asked me 3 times if I was allergic to either (I'm not) and then it was going.  I had a blood pressure cuff on the whole time which took my pressure every 15 minutes.  Once it was done, they ran saline through the line to make sure it was all through.   Then I was disconnected from the IV and headed back over to the other side to see the doctor and the nurse.
It was about 11:30am when I got back over and barely busy.  I checked back in at the desk so they knew I was back and went to sit down.  I saw the Doctor in an office finishing up a file  so I'm thinking "great, it won't be too long".  Next thing I know I see him at the desk and then watch him head over to the OR.  Damn!  He's gone to do a procedure or two.  So I head back to the desk and express my displeasure that he didn't see me before he went over because it could be another 1-2 hour wait for me.  Apparently the person I checked in with had gone for lunch and not mentioned that I was waiting so he didn't know.    In any case, my rather frustrated tone got my point across that I had been there since 8:15am and doing the intralipid so waiting wasn't acceptable.  Turns out he had a retrieval and a transfer and at that time he was almost done the retrieval.  So my wait was about 15 additional minutes before I saw him. 
We set transfer for the 23rd (they'll call with a time) because he's in surgery on the 24th and he said my lining was good.  It was 12 and as I said to him, I've never had an issue building my lining.  So then I headed back out and ran into my  nurse who I had to see next. 
She really is awesome.  She's made every effort to get it set up so that I could buy all of my meds through the pharmacy rather than through the clinic.  In the past I've always had to buy the progesterone in oil from the clinic because it was specially formulated for them.  It still is, but it's made by the pharmacist who is in the pharmacy in the building.  So, I was able to go down and get all the meds I need.  However, it turns out that because the PIO is a compounded medication, I still had to pay for it and will have to submit for reimbursement.  That's okay because I can buy the number of vials I need if funds are low that week.  Each vial is 5 injections so I can time it as needed. 
So, I'm still taking 4mg of Estrace three times a day, and 5mg of Prednisone twice a day.  I am still doing the 81mg low dose aspirin, plus I take 5mg of Folic Acid, 100mg B6 and 1000mcg of B12, and I've added a multi vitamin.
She's now added, starting on the 20th, 100mg of Doxycycline twice a day for three days.   This is a standard antibiotic that is used before all transfers.  I'm to take 16mg of Medrol once a day for 4 days starting on the 20th as well.  They had just started using Medrol when I was there in 2010 but I never got the chance to see if it would help us.  It's used to aid in implantation.   Also on the 20th we're starting the PIO, 2ml once a day.  In the past, I've never been told that there is a time in the day that would be better to do the injection so I've always had V give me the shot before I head to bed as there is more time.  However, she told me that she recommends that it be given in the morning because you're moving around for the rest of the day, rather than relaxing or going to bed, so it's easier for it to dissipate.  I still have to look up the best ways to "prep" the area before the shot. LOL.   And finally, I'm going to be adding 2500iu of Fragmin (which is the same as heparin) starting the day of transfer. 
I did find out from our benefits companies that mine won't pay for the Intralipid at all (not a surprised) and V's says no but seems to have a way it might be covered.  The Canadian Drug Association says it has to be administered by a hospital to be covered which means the hospital covers it.  However the clinic is part of the hospital system here, so I'm going to get a letter from them stating this in the hopes we can get these infusions covered.  At $330 per infusion, it would be really good to get it covered.
So I've had the first infusion which is given 7-10 days prior to the transfer date. So because we did the the intralipid on May 16 it would be optimal for the embryo transfer to take place between May 23 and May 26.   So we're set for the 23rd.  If pregnancy is achieved, the second intralipid would be scheduled within 2-5 days of a positive blood test.  I'm hoping we reach that point and then I'll try for a Saturday infusion so I don't have to be late for work. The intralipid are then scheduled at 6 weeks, 8weeks, 10 weeks, and 12 weeks. 
I've also spoken with the business manager and arranged a payment plan which spreads the payments out over three months...four really based on when I asked her to hold the second payment to after June 28th.  She offered to wait until after my billing date.  :)   My first installment needs to be paid before transfer.  Normally I would have stopped in just before transfer but she won't let me. LOL.  I will send her an email this week to have her charge my card and she'll leave me a copy of the receipt.  And she told me to be zen. LOL....not let any stress get to me at all.
I'm trying not to let hope creep in yet.  But it's hard.  Everything is just falling into place this time, like it is meant to be. 
All bits are crossed.

Tuesday, May 07, 2013

And so it begins for a final time

We are at the commencement of our final DE FET cycle.
I was at the clinic yesterday for what they called a follow up appointment, even though it's not really.  They booked me that way rather than as a new patient, even though I probably still had the same blood work done.

So I arrived for my noon appointment, on time.  Went through about 10-15 minutes while they tried to figure out where my chart would be since I was last there June 2010.  Yep, three years almost exactly.  In the end they found it down in their archive department.

So, as usual, I took up my seat in the waiting room because I needed to see him first.  However, nothing has changed in the three years.  Did I really expect it to?  Nope.  Anyway, as before, at that time, he's basically finished seeing his daily monitoring patients, with just a few still lingering. So he is back and forth between the OR and the offices as he performs retrievals and transfers, seeing patients in between.

I had arrived with a full bladder as requested.  About 12:30, I knew it would be a wait so I went to "pee a little".  At 1:30pm I went to ask how much longer because at this point. the bladder is full again.  They were going to call over to the OR to see how long.  I went and "peed a little" again although this time it was a little more than before.  Ah, sweet relief.  Do you know how hard it is to stop peeing when you need to go?    He finally saw me at 1:45pm.  This is why I didn't bring V to this appointment.  It really wasn't necessary.  I knew the drill.  And besides, he works nights, so he was supposed to be sleeping.

Anyway, in sitting down with him, I brought him up to speed as to why it took us so long to get back to do this cycle.  As you all know it's been predominantly funds.  We're finally at the point where we have the money to do the cycle.  There isn't any overage really.    He says the three donor embryos are good.  We shouldn't be concerned that they've been frozen since 2002.  The donor couple had four frozen but in 2006 they thawed one.  So I extrapolated and figure they were successful twice with this batch.  The were probably successful with their initial retrieval, or possibly a FET.  Then they thaw one and don't need the other, I figure two kids from this bunch of embryos.  We should have a decent chance of success.  He didn't say otherwise.  So, he goes through everything, asks where I am in my cycle (CD2) and then says, do you want to start now.  So I said sure, why not.  I supposed one more month wouldn't have killed me considering we're moving  in 3 weeks, and transfer would be around the 23/24th.  He mentioned we're going to do the usual 4mg of estrace three times a day, 5mg progesterone twice a day, and an 81mg baby aspirin once a day.  I've been taking 5mg folic acid, the baby aspirin, 100mg of B6 and 1000mcg of B12 every day for the last three years, so I'm already on the baby aspirin.   He'll also add in the 2500iu of Fragmin starting the day of transfer.  Plus he wants to add in Intralipid 20%.  More on that in a bit.  He wanted me to go for full blood work, full ultrasound, see a nurse, then him again, and also wanted me to get an ECG done.

So, I hit the vampire lounge.  She used a butterfly needle (they don't usually) and I didn't feel a thing. Seriously, not even the pin prick.  She then proceeded to fill about 16 vials.   Then, back to my seat in the waiting room.

On to the ultrasound. At this point I'm feeling comfortable.  I can tell the bladder should be okay even if she were to do it now.   About 10 minutes later I think, she called me back and did the ultrasound.  Mid point I was able to completely empty my bladder.  She even said dry dry. She didn't want anything in it. LOL.  I did my best.    Then it was back to the waiting room.

I've lost track of timing at this point but it's probably close to 2:45 or 3pm.  The DE nurse called me back.  I gave her the sad story of why we had taken three years to get back into the clinic.  She was sympathetic to the delay and understanding about the finances as I explained we now had the funds for the cycle.  She then goes over what the RE had said in regards to the meds.  She also gets me "compassionate" meds - a new bottle of the Estrace which will keep me going for just over 2 weeks and 7 syringes of the Fragmin as well.  I'll just get prescriptions for them later as they're covered on our plans thankfully.

So I am due back in on the 16th for cycle monitoring and will probably transfer all three embryos on May 23rd. When he asked how many we were transferring I said all of them. He said "are you prepared for twins?" I answered with a yes. And when we were out at the reception desk as he got the different requisitions, he mentioned selective reduction. I said we'd face that if we had the opportunity. So, I just want to get to transfer at this stage.

She then gets into explaining this Intralipid 20%.  Apparently there have been studies that how shown that it it makes the uterus more hospitable to the embryo aiding in implantation  The implanting embryo is being fought by the body's immune system, and this reduces that possibility. It is being used for those who have had repeat failures  but my RE mentioned it in terms of my age as well.  Another helpful article is this one.  She explains that it's administered intravenously and can take 2-3 hours.  So I would go in for cycle monitoring then held over to the OR suite where the procedures are done and have them hook me up.  So then she drops the bomb that I didn't even think of when the RE mentioned it.  The cost.  It's $300 per application.  The first one would be next week, May 16th which is the 10th day of the cycle.  And then, if pregnancy is achieved, it's every two weeks until 12 weeks.  So that means 5 additional applications depending on when they start.  That's an additional $1500 which was not budgeted.  So now the cost of this cycle has almost doubled.  And the kicker is that even though this has a DIN number, it's not covered under either of our plans and V has a really good plan.  So that's an out of pocket expense.  And it has to be paid for before they give it to you.

So now I'm back to we don't have the all money we need.  I know it's not something I have to do.  But the studies seem to indicate it's a good thing, and he's recommending it.  I don't think he suggests these things just for the hell of it.  I've also been reading on line on different forums that people have used it and been successful when previous IVF cycles haven't worked.

I know V.  He's looking at the overall cost, and I don't blame him.  We've budgeted for the cost of the cycle and the PIO (sort of) which is reimbursable.  So, what do I do?  I don't have money coming out of my butt nor do I have a money tree growing in the backyard (I wish).  On top of all of this we're moving in 3 weeks and may end up at my Mom's for a month while we fine a place.  We still haven't got anything to move into.  So we've got moving costs, storage expenses.  Do I contact the business office and see if they'll let me work out a payment plan of some sort?  If the expense had been reimbursable, I could have probably made some sort of payment plan knowing that the $300 was coming back to be applied to the next application. 

Sigh.....why does something always happen to us just when things seem to be going our way???