What's the plan, Stan?

Yesterday we had our final meeting of Dr. B(alls). Wisehubby will continue to go to him to be monitored for his hormone therapy, but we have beaten down the limited doors available to us on the male fertility end. Dr B(alls) admitted that although so many things have improved for Wisehubby--his ratio of estrogen to testosterone, count, motility, density--the morphology issue is likely to remain a permanent one, even with an otherwise mostly successful varicocele repair. He says that Wisehubby's case still indicates IVF with ICSI, and referred us back to our reproductive endocrinologist (RE).

I think Wisehubby is still disappointed that he went through so much pain and suffering, and we are still in the same place we were a year ago. I get the sense that he sees this as his problem that I must pay for with my body undergoing harsh procedures. Of course, that's not how I see the whole thing--it's OUR problem that we must work towards fixing through every possible treatment--but my opinion is neither here nor there.

Wisehubby is dreading the return of the twice daily sticks and frequent transvaginal ultrasounds because he loves me dearly and would gladly go through varicocele repair again if meant that he could spare me the pain and discomfort. Fortunately, after eight years together, I love him more deeply than ever, so I am down right eager for the twice daily sticks and frequent transvaginal ultrasounds because I know that the pain and discomfort is something that I can do to help us both achieve our dream of a family of three (or maybe even more!).

That brings me to today, where we met with our RE, the male Dr. B, to plan for our second IVF cycle. He remembered that we're both teachers, and made a point to honor our time and financial limitations in the creation of our plan. He spent time carefully reviewing the spreadsheet of medicine that Wisehubby had compiled so as to not spend money on unnecessary prescriptions; he "donated" some progesterone gel to us. We felt better about his bedside manner this time around, but maybe we're just used to his gruff, matter-of-fact nature. Maybe we were just so ready for a new plan that we over looked his less pleasant features.

So, what's the plan, Stan?

Our new plan will start with a fresh mock transfer, an ultrasound procedure done with a full bladder. There was a looming threat of some sort of uterine "stretching" which I hope does not come to bear. After that, it will be a waiting game for my next menstrual cycle, where I have my blood drawn for my FSH levels and then start on birth control to regulate my strangely short periods, and blood thinners to protect me from blood clots from my Factor V disorder. About three weeks later, I will start lupron to prevent ovulation. At the onset of my second menstrual cycle from now, I will stop birth control and start two different daily stimulation injections. We're going lower and slower with the dosing this time to avoid the hyper stimulation that lead to the removal of many immature eggs that did not lead to good, healthy embryos. After about ten days of stimulation, I will stop the lupron and blood thinners, and take one shot to trigger egg maturation. 36 hours later, the male Dr. B will remove about 15 eggs (the sweet spot amount) for fertilization in the lab, via needle. At that time, I'll start back on the blood thinners and add vaginal progesterone gel to my regimen--no progesterone in oil this time! Huzzah! Hopefully, about a week and a half later, a blood test will confirm that I am pregnant, and we will begin to plan for a pregnancy and then for a baby.

Did you follow all of that? Can you keep track? No? Honestly, I'm impressed that I can follow it myself.

My suggestion? Stay tuned to my Twitter and blog for updates as we go! If I've learned anything, it is that our quest for Wisebaby is full of twists, turns, and surprises. Let's just hope that this fall, we don't have our house coming down on top of us!

Seven Months Post-Op Visit

We visited with Dr. B(alls) a while ago about Wisehubby's latest semen analysis at his seven month post-varicocele repair visit. The news was mildly more encouraging than last time. Wisehubby's numbers have bounced in most of the major categories into a normal range. Only his morphology is holding on at a big, fat goose egg.

As a reminder, morphology is the shape of the sperm and is important because it can effect the sperm's ability to penetrate reach and penetrate the egg. A man only needs his normal count to be 4% or greater to be considered fertile, so the standard is set pretty low. Unfortunately, 0% normal morphology is considered to be just about terrible; you get a "Do not pass Go; report straight to IVF with ICSI" card when those are your results.

Dr. B(alls) counseled again that we be patient, as we were seeing improvement in Wisehubby's numbers, but the wait is not too far off at this point. He is hopeful that we may be able to get Wisehubby's normal morphology up to .5% or even 1%, which could mean less painful, invasive, and expensive ART treatments. How great would it be if we could do an IUI instead of IVF with ICSI?

We're not really hopeful that things are going to get much better; we are prepared mentally, emotionally, and financially for another round of IVF.  However, the increase in the rest of his numbers does at least make us feel as though the decision to pursue the varicocele repair was the right one. As Dr. B(alls) pointed out, science does not yet know what makes the inside of one sperm more viable than another when creating an embryo. Since we were able to improve quantifiable things about Wisehubby's little swimmers, then maybe the crazy mutants are healthier now than they used to be! This could help us have a more successful batch of embryos; we might even get to freeze a few. This could also help the transferred Wisebabies implant successfully, something that did not happen with our first round of IVF.

All in all, we are in a better place now than we were in a year ago. Yes, IVF is still looming on the horizon, but we're older, wiser, and varicocele free.

Would you like my leftover meds?

Today I got to visit with a friend of mine who has been battling infertility for over seven years; let's call her my Infertile Warrior Friend, or I.W.F. for short. She and her husband had just finished a long year of unsuccessful infertility treatments and moved halfway across the country. Just when they weren't looking, they conceived naturally. A lucky, but painful, cyst on her ovary helped keep her progesterone levels up to help support the early pregnancy and avoid yet another heart breaking miscarriage. Her HCG levels have risen well, and they've even been fortunate enough to see the little nugget on ultrasound. I.W.F. is not out of the woods on this one by any means, but she's creeping up on eight weeks of a healthy pregnancy. All of this is making me so very hopeful for our own story.

This week, I.W.F. is in town visiting family. As an act of faith, she brought her spare meds with her to give to me for my upcoming IVF cycle. Since prescriptions for infertility are a horribly expensive (not covered by insurance) part of the process, I gladly accepted this beautiful, generous gift. Right now, Wisehubby is cataloguing our stash of meds (I.W.F.'s and our own) so that we can take it to our appointment in September with the male Dr. B.

I tell you all of this because I am so grateful to have a growing network of support in my real life. It is hard to open up about infertility, but once you do, you might just be surprised by who in your life can help to hold you up and provide realistic hope when things are tough.

When I put all of our IF questions on the back burner this spring, I didn't stop my campaign of honesty. Through that, I learned that a friend from church had struggled to conceive her two beautiful baby boys. When it seems like everyone at church is trying to overpopulate the planet, she'll sometimes lean in with a snarky or sweet comment that hits the spot. These infertile friendships have meant more to me than most anyone could ever know, except for maybe the brave women who have opened up with me.

Pay it forward might seem cliche, yet I look forward to a day in the near future when, after conceiving and seeing my own little Wisebaby (babies?) on ultrasound, I can take my own leap of faith, call up Dear Friend and ask her, "Would you like my leftover meds?"

Time off for good behavior

After my last post, Wisesister called and suggested that my coping mechanisms weren't doing the trick. She commended me for using Twitter and Blogger to express my feelings, but pointed out that I was becoming increasingly negative and hopeless. She suggested that I take a break from the internet, talk to a counselor, and focus on the positive things while we waited for Wisehubby to heal. I was skeptical at first, but Wisesister gives the best advice, so I took it.

Wisehubby and I called the male Dr. B's office and asked for a referral to a counselor. We set up an appointment with Ms. B--no joke, we found another infertility medical professional with a last name beginning with B. It was a good visit, and it served to ease our fear that we were not communicating or handling our struggles in a constructive way. She commended us for being on the same page, and recommended that we try to take some time off to focus on our relationship. Our homework was to spend our summer vacation relaxing together, setting aside time once a week to have infertility check up chats. Her advice sounded shockingly like Wisesister's, so I felt a little silly for needing to spend some money to hear a second opinion.

We did great with focusing on our relationship this summer. Wisehubby and I have had little pool parties where we watch trashy TV or the Olympics several times a week. We went to movies and made new recipes. We drove 2,400 miles through Texas, New Mexico, and Colorado, camping for four days where we could not get cell phone reception.

When we were off of the grid and seeking shelter from an afternoon rain storm in Mesa Verde National Park, we talked about what our life would be like without kids. We could travel, spend time volunteering, give ourselves over to our students and Godchildren, spoil our dogs rotten, and generally have a good time. I think that talking specifically about how we could not just survive but ENJOY having our dream of children permanently deferred allowed us to relax about the future. We still want to conceive more than anything, but we know that no matter what, we've got a happy family, just the two of us.

We're nearing the end of summer, which brings new challenges to our plate. I'm at a new campus doing the same job next year, and Wisehubby is starting a new position after two years of chasing that promotion. We're also looking at the nine month post-op mark at the beginning of September, so I scheduled an IVF planning session with the male Dr. B today. It brought back a whole flood of feelings, but it wasn't overwhelming or depressing in the way it was four months ago. After all, taking time off for some good behavior was just what the doctor (Wisesister) ordered!

Now what

Today we got some news that has left me without direction for the first time since we started down the crazy rabbit hole of trying to conceive. Wisehubby visited Dr. B(alls) and found out that despite his surgical repair three months ago, his count, density, and morphology all stayed the same--bad. His motility rose slightly, but it is still well below normal, as well.

Originally, Dr. B(alls) told us that we could think about IVF six months after the surgery. Today, he recommended nine. NINE! That means that the soonest he recommends trying again based on Wisehubby's recovery is September. That will be almost full year after our first IVF try, two and a half since we started actively trying to conceive, and three and a half years since I went off of birth control pills.

On top of everything else, I don't even know if we could do September. I am a school teacher, and my work schedule is very inflexible. It was incredibly hard and painful to work through my last cycle, both physically and emotionally. I do not know if I want to do it again. Part of psyching myself up for a second, more aggressive, round of treatment was the knowledge that I would be doing it from the comfort of my living room on vacation; I could wallow with my swollen ovaries all day long.

That means that, if we follow the advice of the man who knows best, we may not get a chance to conceive until summer 2013. The thought of that GUTS me.

All of this to say, now what? Where do you go from here?

To bed.

Taxing

Throughout the last year, I knew that we were throwing a lot of money at our fertility issues. Because I was so desperate to make our dreams come true, I didn't stop to see exactly how much it was costing us until it was time to itemize our medical bills for our taxes.

As it turns out, IVF is a very taxing process, in more way than one. Since we did IVF last fall, we spent more than 14.5% of our income on medical bills, after insurance paid out: prescriptions, doctor visits, dentist visits, and lab work. That is over double the amount you need to claim an itemized deduction on your federal taxes. We did just that, plus we itemized our charitable giving and educational expenses (graduate school). We ended up getting a return big enough to pay back the loan we had received from my in-laws last fall to help soften the blow of paying for IVF in cash. I can't wait until it is processed.

The point of this is to say, please, please, if you are reading this, living in the United States, and seeking fertility treatment, be sure to keep bills for all prescriptions and lab work. As for doctor and dentist visits, I found that the easiest course of action was to call each office and ask for them to mail a year end statement to us. That way, we didn't have to sort out the dozens of visits to the male Dr. B, on top of several visits for Wisehubby and I to Dr. P and our dentist, Dr. H, each.

IVF is taxing, but you may get a little bit of relief at tax time if you remember to itemize!

Factor V

I've been joking about having a mutant baby for so long that I had begun to forget the horrible truth behind it all. I dismissed Wisehubby's morphology issues as mutant sperm because I was using humor to hide from the pain. Now, I have only to look at myself to find a *real* mutant.

That's right, I have a Factor V mutation. I didn't know a lot about this today when the male Dr. B delivered the news unceremoniously over the phone, so I once again was left reeling by his news. After reading a bit about it, I have a ton of questions, many of which I will get answered by my primary care physician, Dr. P--thank goodness, she's not a B!

Depending on the severity of it all, I might even have to find myself a hematologist, which is a ripe kind of fun because a dear friend of mine is applying for fellowships in hematology/oncology--his wife calls him Dr. B, but that's his first name.

From what I can tell from Dr. Google, I'll have to take injections of blood thinners throughout any future cycles, as well as throughout any pregnancies. This means that you have to be very closely monitored at all stages of the pregnancy, and many women have induced labor or scheduled c-sections to avoid placenta problems.

I'm just starting to soak all of this in, so this was a pretty dirty post. If you know anything about this stuff, please HELP! I'm a mutant, but I feel so powerless.