Sunday, January 31, 2016

Limited Cycle Monitoring: Both a Blessing and a Curse

Our treatment plan for now is IUIs with limited monitoring. This is truly both a blessing and a curse, For our situation, our RE didn't think it was necessary to have multiple monitoring ultrasounds or a trigger shot, since my cycles are so regular and our diagnosis is male factor. He reviewed my charts and saw that I had a positive OPK reliably the day before ovulation. This meant I was suitable for the limited monitoring IUI treatment plan using only OPKs to time the IUI.

On one hand, this is excellent. Less monitoring means less appointments, less ultrasounds, and less blood draws. Since there is a lot less involvement from the RE's office, the price reflects this. It's only $549 for each cycle, including 1-2 ultrasounds, any necessary blood work, sperm washing, and the IUI procedure. At the start of each cycle, I get in touch with my nurse so they can be aware of when my cycle started and about when the IUI will be.

The extended monitoring plan includes as many ultrasounds as needed, plus all blood draws, sperm washing,and the IUI procedure. These extra ultrasounds check to see how your follicles are growing, how many you have, and can help time the IUI more exactly. But this extended monitoring plan costs $1499, which is quite a lot more than the limited plan. We've had a total of 4 IUIs, which cost $2196 in all. Comparing this to extended monitoring plan, there is a huge savings! 4 IUIs with extra monitoring would have cost $5996. So being able to do limited monitoring is indeed a blessing, especially since we have had each one perfectly timed.

But being on limited monitoring has its disadvantages as well. I always worry that we will somehow miss my LH surge and get the IUI timing wrong. As I'm just a couple of days away from our 5th IUI, I'm already starting to feel the anxiety growing about the IUI timing. I also am really hoping for multiple follicles to increase our chances, but I won't find out how many follicles I have until I am just about to have the IUI. I also worry (irrationally) about my lining thickness. If I was having more monitoring, I would know exactly how many follicles I have, how my lining is growing, and when they are mature enough for the IUI so it can be timed exactly right.

So today, my OPK has gotten really dark, but not quite positive.

What does this mean? Time for me to stress out :)

Is it just not quite positive because I've drank too much water? Or has my surge not truly started yet? What if I miss my surge and then miss our window for the IUI? All of these thoughts are going through my head as I write this. I'm starting to feel increased pressure in my ovaries, meaning ovulation is indeed nearing. But the big question is, when?! Tomorrow or the day after? It's pretty important to get the timing right.

I've gotten a positive OPK on CD 12 for the last 4 IUIs,, but so far it's almost 8pm on CD 12 and no positive yet. I'm testing once more this evening just to be sure. I definitely have an uneasy feeling since this is deviating from my normal pattern.

Really just crossing my fingers and hoping for the best!

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Thursday, January 28, 2016

How to Talk to Your Family About Infertility

Infertility is an incredibly difficult topic to talk about. It's a very private thing and everyone feels different about how open they want to be. As for us, we kept it to ourselves for quite a while. It was only after our second IUI failed, and we were sure we were destined for IVF, that we decided to tell my family.

Truthfully, this was one of the hardest conversations I've ever had. Just gathering up the strength to open my mouth and finally say it took me hours. You don't quite know how someone will react, so you can't really plan the conversation out fully.

If you're considering telling your family or someone else close to you about your fertility struggles, I have some tips to share.

Gathering up the strength to finally tell someone is the hardest part.

It's normal to be nervous before starting a conversation like this and sharing something so private. But once you start talking, the weight is lifted. You've done it! You've worked up the courage to share. 

Choose a private, comfortable place for this conversation.

Be sure to have enough time to talk, so if you have an appointment in an hour, it's best to wait. This type of conversation shouldn't be rushed, and you or your family may get a little emotional at times.

You get to decide how much you share.

There may be some aspects of infertility you do not want to share or discuss, for whatever reason. You do not have to share anything your aren't comfortable with sharing. This is your situation, your feelings, and your life. It is your right how much you keep to yourself and how much you let others in. An easy response to a question you don't yet want to answer is, "We're just not ready to discuss that just yet" or "We've decided to keep that private for now".

Ahead of time, decide how much you are comfortable sharing.

Before sharing any aspect of your infertility, make sure to have a discussion with your partner about what you both are comfortable sharing. You may have different feelings on what is appropriate to share, and it's best to discuss it prior to telling anyone.

Your family may not understand infertility.

If no one in your family has ever dealt with infertility, they may know almost nothing about it. They may have more questions than you realize. Don't expect them to understand right away. It might take time for them to come to terms fully with what infertility is. Many people that haven't experienced any fertility issues and don't know others who have, simply do not realize how common infertility is.

Don't expect them to absorb it all right away.

When I talked with my mom, she was simply stunned. She was so surprised and sad for us, that the next day she told me she didn't remember half of what I said. When you are experiencing infertility, we get exposed to a whole new world of "infertility things", and it becomes routine and normal to us.

Don't get angry if they tell you, "just relax and it will happen".

Our society seems to have this idea, that if you just relax enough, you magically get knocked up. We've all heard it. Everyone, everywhere seems to say it and it's a phrase we've all heard, or maybe even said ourselves a time or two. Your family members are no exception and might not realize that infertility is truly a medical issue, not a relaxation issue. They will come to understand this.

Be sure to tell them how common infertility is.

If you're like me, I had no idea just how many people actually struggle with infertility until it happened to us. 1 in 8 couples have difficulty getting pregnant. That's millions of people! Infertility is often not shared publicly, so many of us don't realize that it's happened to many people around us.

Finally telling someone will be a weight off your shoulders.

You may have wanted to tell them sooner, but didn't know how or just weren't ready. Once you have finally been able to share, you will feel that some of the burden is lifted off of you. You don't have to go through it alone.

Tell them how they can best support you and your partner.

Many family members will immediately want to help you in any way they can. Be sure to tell them what they can actually do to support you. If you just want someone to talk to, tell them. If you'd like them to be involved in your treatments, tell them. If you prefer that they never talk about it unless you bring it up first, tell them. 

If you're struggling with the decision to share your infertility diagnosis with your family, remember that there is no right answer as to when you should speak up. Listen to what you and your partner are comfortable with. You may really need the support of your family or maybe you think you'd be happier having more privacy. Both options are valid! 

Have you shared your diagnosis with your family? Feel free to share in the comments. We'd love to hear from others going through this difficult situation.

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Thursday, January 21, 2016

Our Fourth IUI...

After my longest cycle ever, I was pretty happy when my period finally showed up. I started off the cycle with renewed hope. We were successful last time.. there's no reason we shouldn't be this time! I felt very positive. I took my 100 mg Clomid, as scheduled on CD 3-7 and again had no issues with it.

I was beginning to get quite used to this routine: Get period, call nurse, start clomid, take OPKs, get positive OPK, schedule IUI, have IUI, then the dreaded two week wait! So really it's beginning to feel quite routine at this point. And just as with the last three, a positive OPK appeared on CD 12. Time to schedule the IUI for the next morning!

I was eager to find out how many follicles I had. I wasn't feeling any definitive pressure on my ovaries or anything to let me know where things were happening. After dropping off our sample in the morning and heading back for our appointment, it was time for the ultrasound. My lining was good again at 8.8 mm and I had two follicles again, and another one that looked like it had just collapsed. So a grand total of THREE follicles! We couldn't get an accurate size on the one that had already collapsed, but it was on the left ovary. On the right ovary, I had two follicles, one at 21 mm and the other at 24 mm. Perfect size!

Our post wash sperm count was good again, at 33 million but a bit lower motility at 36%. But we still had way above where they wanted us to have! We had less abstinence time for this IUI so we weren't sure how it would affect the numbers, but it worked out just fine. So our hopes were pretty high again!

But after our IUI, I suddenly stopped feeling hopeful. I immediately had the feeling that this cycle just wasn't going to work out. I knew it was silly to feel that way, since we had a perfectly good chance. Even if you know your thinking is irrational, it still doesn't change how you're feeling. I was comparing my pregnancy chart to my current chart.. way too often.

I had decided to take a different philosophy on testing for this cycle. I usually would test somewhere around 10 or 11 dpo, and then maybe again on the day my period was due. But I decided to start testing at 7 dpo and just dip a internet cheapie strip each morning. This always seems like a much better idea before you get started. Once you start accumulating negative tests, it's not much fun.

As I already knew deep down, I wasn't pregnant and my period showed up right on time. At some point during infertility, we all realize that hoping really hard for something really doesn't help. I was pretty sad and felt quite a lot of anxiety after knowing this IUI didn't work. I'm not sure why, but I definitely felt it more this cycle.

Still trying to remain positive... we have two more IUIs to go! There is no reason that it shouldn't work, so we're going to keep our fingers crossed!!

Want to hear about our other IUIs? 

Friday, January 1, 2016

Questions to Ask at Your First RE Visit

Visiting an RE, a reproductive endocrinologist, can be overwhelming. On one hand, you may feel eager to get started on the path to your future little one, but you also might feel fear, apprehension, and lots of uncertainty about what the next steps are. It's easy to feel like you are suddenly in over your head!

On your first visit, lots of things will be happening. You'll probably talk to a few different nurses and possibly even a few different doctors. On our first visit, we met with two different nurses and two different doctors. You may have blood work done and will most likely have both an internal exam and a vaginal ultrasound. So suffice it to say, a lot will be going on!

With so many things happening all at once, it's easy to get overwhelmed. That's why it's best to write down all of your questions ahead of time and do a little research so you can really understand what your doctor is telling you.

Here's a list of some ideas of what to ask your doctor:

What further testing do you recommend? And why?

Each case is different, so testing that is ordered for you may be different than what tests were ordered for your friend. Don't hesitate to ask your RE why a certain test is being ordered. Also ask what is truly necessary. In most cases, genetic testing is offered - but this can be expensive. It may not be needed in all cases, especially if you have no risk factors. 

How do my labs look? 

In many cases, by the time you've made your way to the RE's office, you've already had some basic fertility testing done by your OB/GYN. Be sure to bring these labs along to share with your RE. It may even prevent you from repeating tests you've already had. Ask your RE if anything jumps out at them from your previous lab work, because understanding your results helps you to understand your diagnosis.

What are my treatment options?

In some cases, you will be given a diagnosis at your first appointment. If this is the case, you may be able to have a complete treatment plan drawn up that day. Be sure to share your feelings on different treatments with your doctor. If you don't feel comfortable doing something, speak up. For example, we decided against doing any injectable IUI cycles, because we feel like we'd rather put our money towards IVF. Our treatment plan reflects our wishes because we've made our feelings known to our RE.

Do they accept your insurance or offer a discounted cash option?

Depending on your situation, finances might play a big role in your treatment decisions. Most people do not have fertility coverage, so may fertility clinics offer special discounts to cash only patients. But if you have coverage for fertility treatments on your insurance, you want to make sure you take advantage of it. The costs of appointments and bloodwork really add up fast! Confirm that your insurance is both accepted as is "in network" with your insurance company.

If you have questions later, who should you call?

In many cases, you will be assigned a nurse in your fertility center. Any time you have questions or concerns, you will call her. But every clinic is different and knowing who to get in touch with is very helpful.

When and how are test results given to me?

Knowing ahead of time when to expect your results can save you a lot of stress. Some clinics also have a cut off time for blood work. For example, if I have my blood drawn prior to 9 AM, I will get my results in the early afternoon. In some cases, a nurse will call you with your results, but other clinics use patient portals to relay test results.

Can you take a look at the supplements I'm taking?

Many of us going through infertility try different supplements. Be upfront with your doctor about what you are taking to ensure there is no negative reactions to medications they may prescribe. In some situations, such as my husband and me, the doctor will actually recommend specific supplements.

What is our chance of success?

This is a difficult question for some people to ask. We might not want to hear the answer, but it's better to know what you're up against. It may also help you to decide which treatment is the right choice for you. If you have only a 10% chance with IUI but a 60% chance with IVF, that might sway you in one direction.

What are the side effects?

If you have been given a prescription for any medication, even if it's just Clomid or Femara, ask your doctor what to expect and if there are any safety concerns.

What are my risks of multiples?

This is an important question to ask, because carrying multiple babies significantly increases the complication rates in the pregnancy. Your risk of multiples will also factor into your treatment. If you are doing IVF, your RE may feel very strongly about transferring only one embryo. If you are doing an IUI, your RE may not want you to have more than 2-3 follicles.

You may have lots of other questions, but this is just some ideas to get started with. Don't be afraid to take notes at your appointment because there will be a lot of information to take in. If you partner can go with you, that would be a big help as well.

Have you already visited a fertility specialist? What questions did you hope to get answered?