Double Dootie: IVF

Showing posts with label IVF. Show all posts

Monday, October 4, 2010

Life In A Test Tube

Today the winner of the 2010 Nobel Prize for Medicine was awarded to Robert Edwards. I don't know this man, but he has profoundly affected my life. He pioneered the science behind In Vitro Fertilization and thus made it possible for Finn & Belle to call me 'Mama'.

I struggled early in our IVF process with the moral principles of fertility treatment (check this post). Did science overstep it's boundaries by making it possible for humans to birth 'litters' of children? Did we defy God's will by conceiving through 'unnatural' measures or was it God's will for Dr. Edwards to develop IVF?

I don't know these answers and really could care less where the truth lies. One thing I do know, now that I've experienced motherhood, is that life is the real gift. Whether you adopt, foster or create, raising a human life is a beautiful thing (well, at least today it is . . . while they're napping).

So, thank you Dr. Robert Edwards for giving Dave and I the opportunity to love Finn & Belle.

Thursday, October 2, 2008

No One Leaves Empty Handed

Dave and I went to injection training class today. They gave us a gift bag (we're still trying to figure out why). All it contained was our injection paperwork; a folder would have been more practical.

Starting on Oct. 13th I get injections of various hormones mostly in the morning and/or evening. Today taught both Dave and I how to give those injections safely. We'll also receive a detailed medication protocol sheet complete with dates/times for each injection.

The big scary injections are the intramuscular ones that I'll have to take after egg retrieval. Dave administers those into my backside, the needles are longer and bigger. We were told to practice on a grapefruit or an orange (apparently they have a similar feel as my backside. . .).

Friday, September 12, 2008

Beware the Ides of October

Talked with my IVF nurse yesterday. We scheduled the trial transfer and sonogram for Friday, September 19th. In Dave's best attempt at sympathy he politely reminded me he would be out of town that day on his annual golf trip (lucky Dave). The trial transfer/sonogram should be fairly routine.

The doctor also created an IVF treatment calender for me. I begin the stimulation phase on October 15th; that's the 8 - 13 days of 3 - 4 shots/day using follicle stimulating hormones (beware the hormonal lady on campus). This means I'll do egg retrieval and transfer sometime the last week of October or first week of November (right around midterms).

These dates are simply rough estimates. I can't begin the stimulation phase on October 15th until the doctor is comfortable the endometriosis is properly suppressed. Keep your fingers crossed for my body to cooperate.

I'm off to the beach to rub a big, fat belly for the weekend! And wishing my Meigh didn't live so far away, since the big, fat belly belongs to our oldest friend from junior high.

Tuesday, September 9, 2008

East meet West. West meet East.

I met with my acupuncturist today. We did a consultation and treatment session. Now, some call acupuncture a 'very expensive nap' (I, myself, do tend to fall asleep during the sessions). There are also claims that no relationship exists between acupuncture and an increased success rate for pregnancies in IVF patients.

I'll tell you what I've been told by Western doctors and my acupuncturist, as well as the limited research I've done on the topic.

My fertility doctor's view on acupuncture:

Dr. Skywalker doesn't mind if I use acupuncture. However, he did reference an article released this summer claiming acupuncture has 'no effect' on IVF pregnancy success rates. I found something similar in the UK edition of THE TIMES. While the findings are compelling, I'm sensing a hesitation from my doctor to tell me 'yes' or 'no' (therefore, I'm ignoring the article).

I was asked NOT to take Chinese herbal supplements while doing IVF treatment. His rationale being the introduction of too many unknown medications make it difficult to follow my body's reaction to the hormonal injections (very logical, I willing follow advice).

He did NOT want me to do an acupuncture session directly after IVF transfer. He wants me to go on strict bed rest as soon as I leave the clinic (who doesn't want to be treated like a princess for 48 hours, I willing follow advice. Bring over some movies Ash!).

My primary care physician's view on acupuncture:

He is aware of research that does promote the use of acupuncture for allergies and carpal tunnel syndrome. He is not aware of compelling research on the benefits for IVF patients (fair reply).

While he wouldn't endorse the use of acupuncture for IVF patients, he was willing to endorse the fact that acupuncture is harmless. Basically if said patient (that would be me) wanted to spend the money, he said research shows no harm in using acupuncture (Ah, just the nudge I needed to schedule my acupuncture appointment).

My acupuncturist's (obviously biased) view on acupuncture:

She recommended acupuncture once a week for pain management issues associated with the suppression phase of IVF treatment. For me, that would be working to counter my existing side effects of the Lupron shots which are currently: fatigue, headaches, mild pelvic cramping and night sweats (session 1 complete and I feel great).

She recommended acupuncture twice a week during IVF stimulation phase. This is to help increase follicle/egg development as well as promote blood flow to build a thick uterine lining for implantation (here's where the West/East debate really begins).

She recommends one session the afternoon before egg transfer; in addition she'll give me some beads to place in my ear during day of transfer to promote relaxation. She agrees with the bed rest post-transfer. (Interestingly enough, she says there are public misconceptions concerning IVF and success rates. Namely, she cautioned me to remember there are 2 ways an IVF patient can use acupuncture and consumers don't always pay attention to which method is cited in a given study. First, is a series of treatments before and during the 4 - 6 weeks of IVF. Second, is two sessions one directly before transfer and one immediately following transfer.)

We did not discuss post transfer treatment plans.

The book in the waiting area's view on acupuncture:

It's called Acupuncture & IVF: Increase IVF success by 40 - 60%. It pretty much agreed with my acupuncturist (imagine that). It did cite a German research study done in 2002 showing increased success when acupuncture was combined with IVF treatment. This study also pointed out more research was needed to determine if the success was physiological (the needles) or psychological (the expensive nap).

The book also claimed acupuncture was helpful post-transfer to prevent a certain type of miscarriage. However, the book points out of the 3 types of miscarriages, acupuncture only helps with 'threaten miscarriages' where there is uterine bleeding during a pregnancy but the cervix is still closed (if you are curious about the other types of miscarriages check out the American Pregnancy Association's website).

Alright folks, there you have it. A not-so-clear view on whether acupuncture will increase my chances of a successful pregnancy. As I said to Dave (when he asked how much this would cost), 'I am a desperate woman who does not want to be told No!' (kidding, I didn't really say that).

Here's where I'm mentally standing:

In the end, my acupuncture sessions will amount to roughly 3% of the total cost of doing IVF.
If our first attempt at IVF does not work, I really don't want to deal with the mental baggage of 'what if I had tried acupuncture?'
If later studies continue to confirm acupuncture has no effect on IVF pregnancy success but simple relaxation techniques like yoga and meditation do; well, I'm planning to read those while playing with my babies (i.e. I don't really care).

Wednesday, September 3, 2008

Are you there God? It's me, IVF.

Yes, we've recovered from the sticker shock. In fact, for some bizarre reason we seem perfectly okay with the cost. I couldn't think of a better way to spend $20K on an investment that really would be priceless if things are successful.

So, what have I been stressing over instead? Oh, the usual like 'What does God think about IVF?', 'What do other religions think about IVF?', 'Will I get fat on all those hormones?' etc.

While I don't know about the weight gain, I did do some research on how different religions view IVF. Since I'm Methodist and Dave's Catholic (and also an associate member of the Methodist Church) I only focused on these two viewpoints in my Christian search.

Apparently, the United Methodist Church is okay with IVF based on their Book of Resolutions, specifically the Ethics of Embryonic Stem Cells. They offer some guidelines for embryo production quantity and care.

Now, what about the Catholic Church? (Does anyone remember Monty Python's Meaning of Life . . . more specifically the sacred sperm song?) They have a different view on IVF issued directly from the Vatican. It's called Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation. They do not agree with IVF mainly because a third party is used in the conception process (i.e. the embryologist and Dr. Skywalker). So, does this mean Dave must sin in order for Clan Donovan to win? (What's a few more Hail Mary's, right?)

As for other religions (not being completely familiar with their terminologies) my research findings were limited. I did enjoy reading an article from the Jewish Virtual Library. It actually referenced scripture verses and stories of infertility from Genesis, apparently Rachel used fertility herbs to assist in conceiving (a true pioneer in fertility treatment).

Muslims generally believe in IVF, as do Buddhist, Taoist and Confucianist. However, like the afore mentioned religions each has its own views on appropriate uses of IVF (mostly concerning embryo creation). For those of you curious (or perhaps bored if you actually take the time to read this blog) then you might find these articles interesting:

Making muslim babies: IVF and gamete donation in Sunni versus Shi'a Islam.

Sociocultural dimensions of infertility and assisted reproduction in the Far East.

Overall, it seems IVF is okay for us, as long as we only use our own eggs and sperm (no donors) and every effort is made to not overproduce embryos or destroy them (mainly through research). We can all rest better, right? Now I can stress about reading three chapters on Latin American colonial rule by Monday.

Monday, September 1, 2008

How much are you worth?

We received our IVF estimate this weekend (drum roll, please). Total IVF treatment estimate is about $19,350.

Here's a break down of the costs.

IVF Estimated Fees:
Anesthesia: services and meds $800
Oocyte retrieval physician fee $1,800
Embryo transfer physician fee $720
Cycle management fee $300
Embryology IVF with ICSI (11+ eggs) $5,730
Monitoring during stimulation $2,300

Trial Transfer $600
Cryopreservation initial fee/storage for 1 year $1,100
Medications $3,000
PGD (pre-implantation genetic diagnosis) $3,000

Okay, so we were off by about $9,350 (I guess now, more than ever, we really do want twins). We're currently researching our financing options (Dave is searching the couch for loose change).

Friday, August 29, 2008

Whoa there, Endo!

Well, we met with our doctor yesterday. I wasn't feeling too hot, I've been menstruating for 17 straight days (sorry for creating a TMI moment). He did an ultrasound and apparently my ovaries are responding too much to the stimulation phase of the Lupron shot.

If you're wondering Lupron has two distinct phases. First, a stimulation phase which increases production of estrogen, specifically estradiol. Second, a suppression phase which dramatically decreases my estrogen levels. This is similar to what happens during menopause (hello, hot flashes!).

My endometriosis is still very aggressive and loved the stimulation phase a bit too much. The doctor prescribed a progesterone-type pill to stop the stimulation. It must be magic, overnight I've almost completely stopped menstruating.

Now for the IVF update. We've signed all the consent forms and legal agreements. I get my next shot of Lupron on September 19th. Then we move into the medication phase of IVF. Here's some of the questions we asked Dr. Skywalker yesterday:

When specifically do we start IVF?
He hasn't decided that yet. He wants to see how my endometriosis is responding to the Lupron on September 19th. Then he will make a calendar for shots, egg retrieval, transfer, etc. With no specific date, we are looking at mid to late October to begin the process.

What is our personal success rate?
He cautioned us that success rates were tricky because they are based on a population of couples and realistically every couple has either a 0% or 100% chance of getting pregnant (I thought of my dear Shannon when I heard this; she would love the practical logic).

Basically, he is looking for more than 10 follicles during IVF stimulation phase and at least 8 eggs for retrieval. If we can achieve this, he feels we have a good chance at implantation and successful pregnancy.

Am I at risk for miscarriage?
Since I've never conceived, we don't know if I'm prone to miscarriages. He feels we have a good chance at a healthy pregnancy. He doesn't think my endometriosis will cause a miscarriage; partly because once the embryos implant the body will start producing hormones during the pregnancy that naturally suppress endometriosis.

Any suggestions for health and diet?
Aside from the standard, eat a balanced diet and exercise regularly, there was not much else he recommended we change. I'm taking a prenatal vitamin, a calcium and an omega-3 fatty acids supplement.

He's not opposed to acupuncture; he just hasn't come across a place here in Charlotte that he likes enough to recommend. I will probably go back to Charlotte Acupuncture and Wellness Center. I went there for 6 months last year. I found them through a referral while visiting my sister in Boulder (the alternative medicine capital of the world).

We still haven't received our financial estimate for the procedure. There is a program called Shared Risk Refund Program offered by our clinic. Basically it's an insurance policy for IVF. Under the program we pay the cost for 2 IVF cycles (roughly $20K) and get 3 IVF cycles. If we do not have a successful birth after all 3 tries we get 70% of our money back.

I don't think we are going to do this program (at least I think we aren't, not sure if Dave and I talked this one out yet). We did agree to do cryopreservation of any healthy embryos left over from our first egg retrieval. Cryopreservation (freezing and storing embryos) will cost about $1200 initially and then roughly $600/year to store them.

Dr. Skywalker recommended saving any healthy embryos. I'm assuming in the world of infertility, healthy embryos are very precious and the hardest hurdle to jump in the fertility race. Not to mention if we do additional IVF cycles, we can skip the egg retrieval and harvesting/hatching phase including the associated costs (roughly a 30% savings).

There you have it. Our IVF update.

Wednesday, August 27, 2008

Plan B

Because the world can never have enough plans, here's some ideas I've worked up in the unlucky event IVF does not work for us.

Clone Lavender and Bailey (with enhanced features like built-in potty training).

Buy a Vespa (Dave recommended this one, he said the side car is for Lavender and Bailey).

Trade current home for uptown condo and adopt lifestyle of carefree nights and exotic vacations.

Save my future teacher's salary to purchase Dave and I a second home at the beach (I did say teacher's salary).

Manage my little sister's future American Idol career.

Tuesday, August 26, 2008

What are the chances?

In case you were curious here are the posted pregnancy success rates at REACH (our fertility clinic) for 2006. Of course, clause 11 of the IVF legal agreement has the following lovely statement:

"Even in normal fertile couples, the chance of pregnancy is approximately 25% in a given menstrual cycle."

These are numbers for IVF cycles using fresh embryos from non-donor eggs (that would be Dave and I) in women younger than 35 (REACH posts results for other ages, etc. on their website).

Number of cycles in 2006: 285

54.4% cycles resulting in pregnancies
46.1% cycles resulting in live births
51.3% retrievals resulting in live births
56.6% transfers resulting in live births
35.1% transfers resulting in singleton live births
36.8% pregnancies with twins
3.2% pregnancies with triplets or more
38.0% live births with multiple infants
2.1 average # of embryos transferred

What does all this mean? Dave and I have a roughly 56.6% chance at a live birth using IVF. Early on our doctor told us we had a 60% chance of success, so that's pretty close to the average.

Looks like we have a 38% chance at giving birth to twins. Not just fraternal, but possibly identical (Dave is totally pushing for twins). Here's a cool BBC News article explaining why IVF increases the chances of identical twin births.

Thursday, August 21, 2008

If the Jolie-Pitts can do it, so can we!

Who would willingly pump their bodies full of crazy hormones in hopes of having children? Well Dave and I for one, and apparently Brad and Angelina (now you know my guilty pleasure is celebrity gossip).

Of course we have absolutely NOTHING in common with the Jolie-Pitts (except for maybe in vitro). In the off chance you aren't interested in our IVF treatment procedure, just remember that Brad and Angelina might have done something similar (are you hooked?).

Most of this information came from our fertility clinic's information booklet.

The entire process takes 4 - 6 weeks (from the start of menses to pregnancy test time).
We are not allowed to schedule any trips or vacations during the 4 - 6 week process (sounds like we'll be spending Thanksgiving and maybe Christmas in Charlotte).

Pre-Screening Phase

Dave and I need to get tested for infectious diseases (like HIV, Hepatitis, etc.) prior to starting IVF (failing this one would be awkward).
We'll have to attend an injection teaching class since I'll have to take between 3 - 4 shots a day during portions of IVF (after a unanimous vote, Dave will be administering most of these).
In the next few weeks I will do a trial embryo transfer with my doctor (a full dress rehearsal, if you will, so he can make notes on how easy/difficult the transfer will be).

Ovarian Follicle Development & Monitoring Phase

Once we determine an IVF start date, I'll take gonadotropin injections for 8 - 13 days to stimulate multiple follicles in each ovary (follicles house the eggs).
During the 8 - 13 day time period I will visit the clinic frequently to monitor follicle development (this will be done via ultrasound and blood work).

Egg Retrieval Phase

Once Doc says I have enough mature eggs, I'll take Ovidrel to time egg retrieval.
36 hours after taking Ovidrel, Dave and I report to the clinic for egg retrieval and sperm depositing.
Egg retrieval takes approximately 1 hour. Apparently it's a painful procedure so I'll get a 'light anesthesia' (not sure if this is full sleep, light sleep, grogginess, etc. either way I've been assured I'll be out of it).
The embryologist then cleans the eggs and inseminates them to create embryos. The embryos strengthen in the lab for about 3 - 6 days (the longer the better, just depends on the quality of development).

Embryo Transfer Phase

I'll take an antibiotic and steroid after egg retrieval lasting until the transfer.
Additionally, I'll start taking a daily progesterone shot until the pregnancy test.
I've been told the embryo transfer process is relatively painless (but they will give me a valium for relaxation during transfer).
The embryologist will select the best 2 embryos for transfer (unless we request more); the remaining embryos will either be frozen for our later use or disposed.
I'm required to 'remain on strict bed rest for 30 mins.' post embryo transfer at the clinic, lay in the backseat of the car on the ride home and stay in bed for 48 hours once home (Dave started laughing when I told him this part. I think his exact words were 'I'm confident you won't have any trouble with the 2 days of bed rest').
After transfer we wait for 12 days before taking a pregnancy test. No exercising (except for walking) and no lifting (basically nothing to strain the abdominal area).

Pregnancy Test Phase

If we are pregnant and everything looks normal, we return to our obgyn for normal prenatal care.
If we are NOT pregnant we schedule a post IVF consult 2 - 4 weeks after the negative test results to discuss what happened.

There you have it! The basic outline for our IVF procedure. If all goes well we will have a very Merry Christmas. If not, I'm thinking a vacation somewhere tropical is in order (Dave is not aware of this idea yet).

Monday, August 18, 2008

Goodbye romance. Hello IVF!

Dave and I are struggling through 5 very dry, technical and legally redundant documents provided by our fertility clinic on IVF. Dave is napping right now . . . document #2 made him sleepy (this is Dave 'posing' for the camera).

So 4 of the 5 documents are legal agreements with such sizzling titles as:

Consent Form for In Vitro Fertilization/Assisted Reproduction

Consent Form for Intracytoplasmic Sperm Injection

Consent Form for Assisted Hatching and Fragment Removal

Agreement for determining Disposition of Embryos not transferred, etc.

Basically, these forms make sure we understand the scientific and political/ethical issues surrounding IVF. For example, we've got to decide what to do with any embryos we don't implant. . . do we freeze them for later use, donate them to science or dispose of them (frankly, I'm not sure I really want to think about that right now).

One thing is becoming clearer, IVF puts a damper on the romantic pregnancy daydreams for a young couple. I'm sure the '101 Ways to Romance Your Wife' does not include a chapter on how to give hormonal injections.

Then there are the inevitable questions from Junior (or Juniorette) about how they were conceived. 'Well dear, you started out in a petri dish in a climate controlled environment. Then you were placed in Mommy's stomach using a needle. Unfortunately, your brothers and sisters didn't make it; we couldn't afford the cyropreservation storage fees . . .'

Anyway, we meet with the IVF coordinator tomorrow at noon. I'm sure there will be loads to talk about after that meeting. Keep you posted.

Friday, August 15, 2008

Vegas in a test tube?

Dave and I scheduled an appointment with the IVF coordinator for Tuesday. This is a picture of the clinic we are using. Basically our doctor will outline all the needles, pills, pokes and prodding I will undergo during IVF. Most importantly though, we will meet with the financial counselor who will tell us exactly how much IVF will cost. We expect it to be around $10K for one try.

Here's the mental dilemma. . . $10K is A LOT of money (if by chance you disagree. . . let's talk about you donating to our 'make a baby' foundation). It's a lot to spend on one procedure that has only a 60% chance of success. It feels like high-stakes gambling (did I mention I'm not good at gambling?).

I know if we have a successful pregnancy the point is moot. But the morbidly negative side of my brain wonders how I will feel if we come up empty. Obviously not something to dwell too much on right now. . . trying and failing is much better than doing nothing at all.

Thanks to all for such positive feedback! More later.

Applying for Residency in the State of Denial.

Well, today was a pivotal day for Clan Donovan (this may be news for Dave-- I can never tell). We've 'officially' decided to start In Vitro (aka IVF) treatment to address our infertility issues.

Just what are our infertility issues? Here's a brief history of our quest to start a family:

2001:

I discovered I had endometriosis. I tried suppression therapy for a few years.

2005:

We did laparoscopy and the diagnosis was mild/minor endometriosis (the doc said my tubes, ovaries and everything else looked healthy. Yea, Em!).

2006:

Dave and I started trying to conceive around November 2006.

2007:

In August, my gyno recommended we try Clomid. Clomid is a fertility drug, taken orally; it promotes ovulation of both ovaries. We tried this for 6 months (the recommended trial period). Apparently, if you haven't gotten pregnant within 6 month on Clomid, continued use of it will not increase effectiveness.

2008:

In April, we were referred to the REACH fertility clinic. To my surprise, I was told I had Stage IV endometriosis. During an ultrasound the doctor found 2 cysts in my left ovary, 1 cysts in my right ovary and a polyp in my uterus (for those of you wondering, Stage IV is the most severe form of endometriosis--boo, Em!).

In June, I did laparoscopy to remove the cysts and polyp (Dave was a champ for taking care of me). Post surgery, my doctor wanted me to do 2 months of Lupron (a common suppression therapy drug) then move into IVF. He said we had a 60% success rate doing IVF.

Not feeling completely comfortable with this decision (let's just be honest, I was trying to avoid IVF), I opted to try a 'clomid-type' drug for a few months in hopes of bypassing IVF. The doctor said we had a less than 20% chance of success (then again, my sister told me 'it happens to someone, why not you?').

So here we are-- 2 months of fertility drugs later and no conception; a looming severe case of endometriosis that will only get worse with time and a possible 60% success rate if we bite the bullet and do IVF.

I made the call to my doctor today. We are going to do IVF! I'll outline what this means soon.