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More Money, Less Eggs. (CD16)

Last week, we ended up needing more shots, equalling about $500.

We went in on Tuesday of this week (6/8) to see how many eggs were cooking.  Dr Q roamed around for a while, said, “hmm,” and roamed around some more.  His office is set up so the patient (me) can watch a wall-mounted flat screen of the ultrasound, and I could only see one big follicle.  Sure enough – only ONE mature follicle.

$1600.  One follicle.  This wasn’t what we wanted to hear.

He assured us it was okay, that our chances were still phenomenally better than any other cycle because the drugs make the egg(s) much healthier than my body would on its own.  He said my lining was super thick – which is good – and we were ready to trigger.

We triggered last night, and the ENORMOUS needle didn’t hurt so much after all.  Big thanks to the nurse at Dr Q’s office, who pointed to a spot on my ass so the Swashbucker could draw a circle and know exactly where to stick the intra-muscular injection.

Today is a great day – the day after the injectables have ended and before the IUI.  I have no shots to take today for the first time in a week and a half.  The IUI is scheduled for tomorrow morning at 10:15am.  I start progesterone suppositories on Saturday evening.  Not looking forward to that.

I’m still remaining optimistic, even with one egg.  I mean, it only takes one egg to make a baby.  And this is our sixth try!  It has to be our turn soon, right?  I’m clinging to the optimism because I know it will be much harder to maintain once the deed is done and everything is out of my hands.  The first week after the IUI is usually manageable, but as the 2nd week winds down, I become a FREAK.  I don’t want to be a freak anymore.  It will take everything in my power to spend the two-week-wait in a relaxed state, not over-analyzing every twinge and pain.  The trigger shot and progesterone both mimic pregnancy, so I will have no reason to think anything over the next two weeks.

I’m so ready for a baby.  So, so ready.

Running total:

Additional $500 for meds

2 more ultrasounds: $340

TOTAL: $8405

Hysteroscopy and polypectomy, hopefully leading to eventual baby-ectomy.

I just love how you can put “-ectomy” on the end of any word to denote the removal of said word.  I sometimes like to call “giving birth” a “baby-ectomy.”  It’s mildly funny.

Nurse Knock-up thought she saw a polyp, so Dr. Q took a look on Tuesday, CD7, via a hysteroscopy, which is basically where they stick a camera up-in-there to see WTF is going on in your uterus.  I opted for no anesthesia during this procedure, as I was assured it wasn’t necessary and that the procedure overall was not as bad as the HSG.  When I arrived, they put an IV in me and immediately my thought was – wait a minute… an IV for this?  I was directed to a “pre-op” room where the ibuprofen drip was administered.  Once they finally wheeled me into the “procedure room,” I started to worry that I should’ve insisted on the anesthesia.  They asked me if I wanted to see the screen, the journey into my uterus, and I was all about it until they had to give me four shots in my cervix.  This hurt as much as you think it would, although I did only feel the first 2.  Once that happened, I had to go into survival mode… concentrating on a point in the ceiling and just breathing my way through it.

Dr. Q did find a polyp and had to remove it… all told, the scope and removal took about half as much time as the HSG and definitely was less traumatic, despite the cervical block nightmare.  Still… if I ever have a polyp again, would I willingly do that procedure without anesthetic?  Probably not.

To add to the running total, here are some more estimated numbers:

Hysteroscopy – $675

Ultrasound x 2 – $340

Injectable fertility meds – $1150 (for one cycle).

Running total: $7565.

I wasn’t prepared for that question.

Yeah, I had to have an ultrasound today on the third day of my cycle.  Ladies, you can relate as to how gross this can be.

It wasn’t the thought of being naked, unprotected, while bleeding that made me nauseous this morning before the appointment.  No one had checked out my ovaries this early in my cycle, and if Dr. Q found something he wasn’t crazy about, no injectibles this cycle.

My body picked up on my unease and cut out the bleeding significantly during the ultrasound, which was pretty awesome.  Dr. Q, who I may have mentioned is a little too liberal with his use of the ultrasound wand, assumed the position and gazed at the ultrasound monitor.  “So what’s going on here?” he asked.  I reminded him that we’re checking the ovaries to get the medicine prescription correct.  He moved the wand around and said, “Oh, you have beautiful ovaries.”  I cried.  I’m a chump.

Once he removed the wand and allowed me to sit up, he asked us casually, “So how many eggs should I shoot for here?”  I thought as the fertility specialist, it was up to him to let us know how many eggs would be good for us.  Nope.  He wanted us to make the call.  The wife looked at me and I looked her and we shrugged…

“Um… how many is normal?”

Dr. Q: “I can do whatever you want… if you tell me 8, I might say no, but it’s really up to you, your faith, your beliefs… because there is a chance that all of them will take.”

Swashbuckler and I have already had the conversation about selective reduction.  Dr. Q assured us that while it’s definitely a possibility that more than 2 eggs will turn into a viable pregnancy, it’s a remote possibility.  I have it in my head that I would be overjoyed with twins, and I would be terrified at triplets or above.  And it’s not because we can’t take care of that many children, although that’s a very valid argument.  I feel like I would be putting all of the babies at risk by trying to carry more than two.  I would also be putting myself at risk, which isn’t fair to the children or my partner.  While the thought of terminating one or more of the pregnancies is devastating to me, the urge to have a family is much stronger, so I want the best chance possible without being irresponsible.

We agreed on 3-4 eggs.

Shots start tomorrow… stay tuned.

And so it begins. (Or… the one where I talk about my period.)

Yesterday was CD1.

I started taking Synthroid about two months ago to get my thryoid in an optimal conception range.  Up until I started taking the medicine, my cycles were fairly regular.  I would ovulate on day 20-21, and my cycle would start anew 14 days after that.  This time, I think I ovulated on day 20, but cycle didn’t start again until 18 days later.  EIGHTEEN!  Also – last month’s period was 2.5 days (it’s usually 5).  I’m okay with all of this, but it was testing my patience this month.

We have our Day 3 ultrasound tomorrow, and provided everything looks good, we start shooting me up with drugs on Saturday to help my ovaries along.

Are you ready, ovaries?  IT’S GAME TIME.  We have two tries left – LET’S DO THIS.

Calm before the…

I’ve never been more excited for my period to start.

We took this cycle off of insemming, so there’s no stress about the period coming or not coming.  However, we did have a consultation with a fertility specialist, who I’ll refer to as Dr. Q (which admittedly isn’t a very decieving nickname, but whatever), and we have decided to go full tilt boogie with fertility meds this upcoming cycle.  What exactly will mean?

  • I definitely should not have named this blog “fivegrandbaby.”  This will push us well into six grand.
  • On the day my period starts, I’m to call the clinic.  On Day 3, they will do an ultrasound to check out my ovaries and see what my dosage will be.  They’ll order the dosage and I’ll start taking it on Day 4.
  • The medicine will be administered by the Swashbuckler via shots, once a day for 10 days.  Before this 10 days is up, Dr. Q will perform a hysterscopy, wherein he will insert a camera into uterus area to check out a possible polyp that might be hanging out there.  If he sees it, he’ll remove it, and he assures me my lining will heal in plenty of time to welcome a baby.
  • Once the 10 days and 2-3 ultrasounds are passed, Dr. Q will determine that the follicles are ready to be released.  Cue shot #11 – the HCG trigger shot, which will tell my ovaries to get rid of any and all mature eggs.  Ideally, 3-5 eggs will be produced, but the important thing is, the *quality* of these eggs will be the best they can be, so even if there’s only 1 or 2, we’re doing everything we can to make sure the quality is at its highest.
  • 36 hours after HCG will be the insemination.  I’ll return to Nurse Knock-up, who has our swimmers, and she’ll inseminate me.
  • The day after my insemination, I’ll start on progesterone supplements.  Nurse Knock-up feels that I should get my progesterone tested around 8 days after the IUI to see if I NEED the progesterone supplements, but Dr. Q says I should just go on them from the day after the IUI.  There are two schools of thought on who to trust here: Dr. Q is… well, a Doctor… and Nurse Knock-up is not.  He probably knows what’s better for me.  On the other hand, Nurse Knock-up is a woman, and Dr. Q is not.  Why does this matter?  The progesterone supplements come in the form of vaginal suppositores that I will have to, uh… administer 2x a day until doctor tells me to stop or I have a confirmed negative pregnancy blood test. If I get pregnant, when will doctor tell me to stop taking the progesterone?  Oh, probably not until 10-12 weeks into my pregnancy.  I’d rather be safe than sorry, so I’m going with Dr. Q.  Bring on the progesterone!  One thing that does concern me is that I really have been firm about no longer taking pregnancy tests unless I know I’m pregnant (i.e., my period is a week or so late).  I’ve seen too many negative results.  On progesterone, however, I will have to take a test on probably day 15.  If it’s positive, HOORAY!  If it’s negative, I need to get a blood test confirming the negative, because once you stop taking progesterone, your period starts, even if there’s an embryo in there.  (Clearly this changes as the pregnancy develops, but early on, if you start taking progesterone, you can’t just stop willy nilly.)

The Swashbuckler and I are really excited to start this process.  It will be the most control we’ve ever had over a cycle.  The only bummer is that it still doesn’t guarantee any success.  However, I’m optimistic.  It’s certainly not going to DECREASE our chances.  This will be our sixth try – the luck has to be on our side soon enough, right?  And in this case, we’re removing as much margin of error as possible.

Dr. Q told us that the hardest part of this whole process is for us to just calm down.  He likened it to a roller coaster – there are ups and downs, but you make it out okay, and he said, “I’m confident you’ll make it out a mom.”

We love Dr. Q.

Hysterosal-what?

When we first started trying to get pregnant, our nurse, who I will refer to as Nurse Knock-up, assured me that there was no reason she could see that I wouldn’t be pregnant within three months, and if it didn’t happen in three months, she’d be investigating and possibly putting me on drugs to get me preggers. Three months came and went, and in the process, she discovered some sort of cyst on my left ovary. She sent me to a specialist, who ruled it an endometrioma. He didn’t tell me this meant I had endometriosis, but he didn’t tell me that it didn’t mean that either. He suggested before inseminating another round, I get a hysterosalpinogram (HSG) to make sure my tubes weren’t blocked. I live my life on the cut of Occam’s razor, whereby the easiest explanation to a problem is usually the right one. I didn’t want to sit out an entire cycle when I didn’t feel like I had any issues. So we inseminated that cycle (#4) and didn’t get pregnant. Nurse Knock-up ordered an HSG.

Please skip the following paragraph if you are weak-stomached: An HSG is a procedure whereby they insert a very thin catheter into your uterus via your cervix and shoot contrast (dye) into the uterine cavity. Ideally, the dye flows up through the uterus and out of the fallopian tubes, thereby proving to the doctor who is taking the picture that the tubes are indeed open. If your tubes are not open, and the force of the dye does not manage to open them, IVF is your only route. IVF, at about $12,000 per cycle, is not really an option for us.

Now, my insurance would have paid 50% of the cost of this HSG. I would’ve gone to a very nice medical facility with the best equipment and some of the best doctors. The only problem was that the medical facility would have charged my insurance $3000, so my out-of-pocket would have been $1500. Nurse Knock-up “knew a guy” who could do the same procedure for $285. I had been inseminated four times at this point and had been prodded and poked in my nether-regions enough that I wasn’t at all afraid of a discount HSG. It did concern me a little that this procedure is done between day 8-10, when your cervix isn’t necessarily open for business, but I figured I could handle it.

I did a lot of research about this procedure and found that the literature compares it to a pap smear… maybe a little bit more uncomfortable. They suggest taking ibuprofen before the procedure to reduce the risk of pain. I couldn’t really understand how it would be that much differnet from my virtually painless inseminations, so I passed on the Advil and showed up sober. This was not my smartest move.

The first sign of trouble came when the Swashbuckler was not allowed in the room with me. She’d been with me for every poke and prod before, and I’d been counting on her being there for this one. Nope. Because this is essentially an x-ray, only “necessary personnel” are allowed in the room. I find her very necessary, but they didn’t agree. Once I stripped down, I was led to a very old exam room with a very, very flat table, a table you’d rent from a church for a graduation party. The “stirrups” were nothing more than knobs that were placeholders for my feet. The doctor was a young Asian guy, not the best with the English, but he seemed nice enough. I’m not sure if he was gay or very inexperienced, but he did not know his way around a vagina.

He dug around for about 15 minutes, looking for my cervix. As I mentioned before, up to this point, I’d had a lot of professionals lay eyes on my cervix. I knew it was there. I knew it wasn’t that hard to find. But this guy couldn’t find it. He finally called in for his dad, who owns the practice apparently, and who speaks less English than his son, to come in and find the pesky cervix. He looked for another 20 minutes or so and finally found it. So at this point, I’ve had a speculum inserted and pulled out and re-inserted for the past 35 minutes, and we still haven’t seen my uterus.

Finally – jackpot – the nurse insisted, “yes, that’s it!” and the doctor inserted the catheter. So far so good. Once the catheter was in place, he began to inject me with the contrast. Immediately, pain washed over me. It was not remotely gradual. It was fine, and then it wasn’t. You can imagine, that part of your body isn’t made to accept THAT much liquid, so once it’s there, your body starts contracting to push it out. It’s basically like you all of a sudden have some of the worst menstrual cramps ever and you can’t curl up, you can’t get the heating pad, you can’t pop a vicodin. You have to lay still so they can take x-rays of the very area that is screaming with dull, throbbing pain. At this point, I’m already on the verge of tears from the pain, and he’s looking at the monitor and in his very broken English, he says, “The dye is not going through your tubes. If your tubes are closed, you can’t get pregnant except a test tube baby.” I cut him off: “Yes, I know the implications. You don’t have to tell me.” Luckily for him, he kept relatively quiet after that.

He forced a little bit more dye, and had me roll from side to side, and finally, the dye pushed quickly through my left tube and spilled out into the area surrounding my baby makers. I imagine the next most beautiful sight for me, after clearly seeing my open fallopian tube, will be when I finally see my baby’s heartbeat. This was definitely a good thing. However, he was unable to see my right tube. He assured me the x-ray would give him a better idea of what was going on there, but he did say, “You only need one open tube to make a baby.” He then said, “So when you’re ready to have your second baby, make sure you come back and we’ll do this again to make sure you’re open.” On one hand, it was a relief to hear him say that he was confident I’d get pregnant… on the other hand, he still had the catheter in me and I was still in a lot of pain, so I said, “Let’s just concentrate on one baby for now, okay?” I took a vicodin as soon as I left there and spent the rest of the day in a comfortable buzz.

It was a long five days before I got the results of the test. He noted that the right tube was initially not visible, but upon further forcing of the dye, it seemed to open up. Nurse Knock-up’s reading of the report was that the doc is 99 percent sure both tubes are open (100 percent sure on the left, 99 percent sure on the right). Your chances of getting pregnant increase greatly in the 3-7 months after this test is performed. This is also good news, but the cycle immediately following this test was not successful, and we only have two tries left with our known donor. Still, I’m remaining optimistic.  Stay tuned.

Really? Five grand?

My girlfriend, who from here on in will be referred to as the Domestic Partner, the Wife, or the Swashbuckler, has been trying to make a baby for longer than I have been trying. She started trying 12 years ago with her husband. No luck. I started trying eight months ago with my wife. Still no luck. They say you’re not considered infertile until you’ve tried unsuccessfully nine times. My math isn’t great, but at $360 a pop (on the low end), that’s a few thousand dollars.

We are working with a known donor (KD). Here is what we have paid so far, roughly:

Initial visit with clinic, March 2008: $200
Initial donor screening: $1500
Initial donor deposits: $600
Basal body thermometer: $15
OPKs for practice: $15
OPKs for first cycle: $44 (the first brand didn’t work for me, so we had to buy a second brand)
Cycle 1: $360
Pregnancy tests: $15
OPKs for second cycle: $22
Cycle 2: $410
Pregnancy tests: $15
OPKs for third cycle: $22
Ultrasound: $200
Pregnancy tests: $15
Cycle 3: $410
Ultrasound followup: $170
OPKs for cycle 4: $22
Cycle 4: $360
(no more pregnancy test purchasing)
HSG (will explain this in separate post): $285
Antibiotics following HSG: $16
OPKs for cycle 5: $45 (could only find the 20 pack)
Cycle 5: $360

Grand total: $5101. I could have bothered to be more accurate when naming this blog, but Five Grand Baby just sounded better than Five Thousand One Hundred and One Dollars and Counting Baby.