The longest wait...

We went in on December 22nd for our first ultrasound we were 5 weeks 6 days and would get to see our baby for the first time!  My hcg was 3562 at this point and baby measured a small .16cm. The baby's heart was within 48 hours of developing and so we scheduled an ultrasound for the following week to see the baby's beautiful heart beat.

5 Weeks 6 Days

On December 29th we went in for our 6 week 6 day ultrasound and saw the most beautiful amazing sight, our baby's heart beat.  My labs were estrogen 406, progesterone 26, hcg 7407. The baby measured only .48cm.  We initially left the appointment feeling happy and again on cloud 9 that we saw the heart beat, baby was beautiful and growing.  An hour later I got a call from Dr. Maud herself (Usually it is the nurse we speak with). Her first words to me were "I don't like how this baby is looking", she went on to tell us things didn't look normal.  The baby should be much bigger than it was, and the hcg should be much higher than it was.  Although we saw a heart beat she didn't have a good feeling that the pregnancy would progress normally.  Her inclinations was that it was either a chromosomal issue again, or it was a insufficient placenta.  We were told there wasn't much we could do at the moment besides wait and see what the next week brought.

6 Weeks 6 Days

The week between these two ultrasounds was so crazy terribly hard.  One of the longest weeks of my life.  I tried my hardest to stay positive, but it was so hard to when I had the doctor who had gone over some pretty terrifying things, and didn't give us much false hope. I prayed harder than I had ever prayed before.  I knew in my heart that our chances weren't great for getting positive news, but was trying to hold out for the chance that there would be a miracle, that our baby had a big growth spurt, or that the measurements were wrong the previous week.

One week later on January 5th we went back up for our ultrasound at 7 weeks 6 days.  And I had tried to prepare myself for what we might see/hear but nothing could fully prepare myself.  As I laid there on the ultrasound table, Dr. Oakes one of the other RE (reproductive endocrinologists) came in to do our ultrasound,  we eagerly watched the screen and saw our little baby, I searched the screen for the flicker of the baby's heart beat but there was nothing moving. No flicker. No heartbeat. Our baby had died.

Dr. Oakes said "I am so sorry but your baby didn't make it, there is no heartbeat". And the tears started flowing.  How could this be us? How could this be happening? Why can't things work for us? Why did my baby have to die? I felt like we had been through so much over the past few months with such highs and now we were at our lowest of lows.  After catching my breath we sat there for 15 minutes talking and asking the doctor questions.

After the doctor left the room, we sat there stunned, holding each other, crying, wishing this was just a nightmare.  We had a lot to think about and had to go home to process what our next step would be for the baby that was still inside of me.  I held my tummy, wanting to give all the love I could to this little part of us that just died.

FET# 3

This one has to be our lucky time right? Lucky number 3?! I sure hoped so.  After our chemical pregnancy we stopped our medications immediately and waited for my cycle to start.  Unfortunately it took a while longer because my bleeding didn't really start until my hcg returned back down <5.  On November 14th we rechecked my hcg and it was 3, so we got the green light to start medications for a third time.

November 14-16: Estrogen pills 4mg
November 17-19: Estrogen pills 6mg
November 20-January 5: Estrogen pills 8mg
November 23: Ultrasound 9.8mm thickness
November 26-January 5: Progesterone 1mL IM

The morning of November 30th we got our typical pre-FET call and our embryo's looked good and survived the thaw.  That's right I said EMBRYO's! As in more than one!  We decided this third transfer to thaw and transfer two, knowing that it could increase our chances of one implanting.  The prior two transfers we had only transferred one knowing that Jackson's round he stuck and was the only embryo, and so we went with that mentality.

FET#3 2 of our 5 day Blastocysts

Once we got to Omaha everything went just the same as the other two rounds, we felt relaxed and somehow mustered up hope for these two little embryos that they would implant and become our little babies.  After the transfer we came home and took it easy for the rest of the day, Derrick went back to work that afternoon because they had a lot of big projects that were all coming due around the same time.

During our two week wait I really felt about the same as the other two transfers.  So I yet again tried to not read into any symptoms that I was having.  I tried my hardest to remain positive and pray for these little embryos.  We thankfully had a lot of our friends, family and co-workers praying for us which I really think helped us, and comforted us to know that we had all of the extra prayers.

On December 8th, Jackson and I went to the lab and had my blood work done. I brought our folded piece of paper home for Derrick and I to open together.  We opened it over lunch and it was 39... I felt so depressed and worried, it seemed low and I was so sure that it was going to be another Chemical Pregnancy just like the previous cycle.  But after speaking with the nurse she assured me that it is a good number to start at with a frozen cycle and that we do beta testing early at only 8 days after a 5 day transfer (8dp5dt).  The frozen embryos often are lower hcg to begin with and it is all about how the number doubles.  So we waited...

Saturday December 10th we did our second beta and it was 85!! Oh my goodness that number more than doubled! We were so over the moon excited and shocked.  We were official pregnant and everything looked perfect.

FET #2

Well here we go again, we decided to not take time off in between and soon after stopping my estrogen/progesterone from the previous failed FET I started my cycle.  We jumped right back in and started a very similar protocol like we did with the first transfer.

October 10-12: Estrogen 4mg pills
October 13-15: Estrogen 6mg pills
October 16- Nov 9: Estrogen 8mg pills
October 21: Ultrasound lining looks good
October 21-Nov 9: Progesterone 1mL IM

Ultrasound of my uterus thickness 9.22mm

October 25th we got the call in the morning that our one embryo had thawed well.  Up to Omaha we went for our second FET, and everything went as well as it could.  We were excited thinking that this second time we would be safe.  I took things extra slow and easy the few days following.  We had Jackson go to preschool a few extra days so that I could keep my feet up and keep from lifting and chasing him around.  I felt relatively the same as the last cycle with the same symptoms, however this time I tried to not read into it at all knowing it most likely was just the progesterone side effects.

FET #2- 5 day blastocyst

Our first beta hcg test was on November 2nd, I had my labs drawn at Bryan and brought them home for Derrick and I to open over his lunch.  I had told Derrick anything over 5 meant we were pregnant but obviously the higher the better.  Derrick opened the paper and said to me "I hope you have a list of baby names going".  We were so excited but then I saw that the hcg was 48.  This freaked me out knowing that our son Jackson was 78 at this point and that 48 seemed low.  After hearing from Dr. Maud's office they confirmed we were pregnant and that it is all about how the number doubles in 48 hours.  We would have a repeat hcg draw in two days and then we would know how the baby was looking.

I worked Friday the 4th of November, when I went down for the blood draw at Bryan,  I folded it in half and took it to our Women and Children's 1st floor where I found a quiet room to sit in and call Derrick so that I could tell him it as I opened it.  The number was 80.  So it didn't double but it went up.  I immediately wanted to talk to the Doctor but I wanted to not seem to eager so I waited for them to call me.  Later that afternoon they called and we discussed that it could be a slow growing baby and that it just needs some time to take off.  They suggested rechecking our hcg in 5 days on November 9th so we waited the long 5 days, hoping and praying that those numbers would be big and beautiful at the recheck.

Finally the 9th came around, and sadly I was at work again (not the ideal place to be when finding out such crazy emotional provoking information). I went down and had my blood drawn but decided instead of getting the results from the lab that I would wait and have the office call me so that I would keep from driving myself crazy with information I couldn't interpret.  That afternoon Dr. Maud called me and told me sadly the hcg had gone down to 70.  We had lost the baby very early.  It is called a chemical pregnancy or a early term miscarriage.  To learn more about chemical pregnancy's look here: Chemical Pregnancy

We were devastated.  We were so happy to be pregnant just to have the news drawn out, feeling like we were sitting on a ledge not knowing which way we would go.  During that period of time we hoped and prayed and dare I even admit I tried to bargain in my prayers for this little baby, if only God would let us have this little baby.  But for some reason this little baby didn't get to stay with us.  We talked yet again with Dr. Maud and she again thought that the baby had a chromosomal abnormality. We discussed taking a break but in the end all Derrick and I wanted was a baby, we didn't want to wait we wanted one now.  We asked if my body physically could take back to back to back transfers and have just as good of chance, and Dr. Maud said that we would be fine to do whatever we mentally felt okay to do, so we decided to go for it...

FET#2 Cost: Ultrasound $78, Labs $40, FET: $4190, Medication $30

FET #1

For frozen embryo transfers (FET) a baseline ultrasound is not necessary, so once my cycle starts I am able to jump right into estrogen pills to help grow my lining.  So when I started my period on September 14, 2016 we called the office to hear what the plan was for our medications.  Our medication/ultrasound schedule is as follows...

Sept 15-17: Estrogen 4mg pill
Sept 18-20: Estrogen 6mg pill
Sept 21-Oct 8: Estrogen 8 mg pill
Sept 26: Ultrasound to check lining, start progersterone shots 1mL nightly
Sept 26-Oct 8: Progesterone 1mL IM

Progesterone nightly shot

Ultrasound for lining check 

On Friday Sept 30th we were to arrive at 10AM to have my labs drawn and to go back into the surgery patient rooms.  When we pulled into the parking lot I was instructed to take one Valium tab, Valium helps to relax my body along with my uterus which will keep it from becoming irritable from manipulation.

Earlier that morning around 5AM the embryologist along with the help of Dr. Maud pick out one of our best looking embryos to thaw.  They carefully handle and thaw it over a few hours.  We get a call around 8AM with an update saying that our embryo has thawed well and that we are on track for the transfer.

FET#1 5 day blastocyst

Once we get settled and changed into our scrubs/gown we are wheeled back into the OR where they view our beautiful embryo on the TV and pull it up into a catheter and then while I have a very full bladder (this helps to push my uterus into the perfect spot) they insert the catheter and with ultrasound view see the catheter enter my uterus and deposit the embryo.  Afterwards we go back to the surgery patient room and wait flat for one hour.  I laid flat the whole drive back to Lincoln in the back of Derrick's truck, and then stayed on the couch all afternoon/evening.  We had Burger King, super yummy and the same food that I had after my transfer with Jackson.

We then had to wait that dreaded period of time, before we could test.  Throughout my wait I had all of the pregnancy symptoms of vivid dreams, cramping, sore breasts, increase sense of smell.... sadly all of these symptoms can also be a symptoms of the progesterone shots.  MEAN MEAN MEAN.

Our beta hcg test was due to happen the morning of October 8th at Bryan Hospital, however I was also scheduled to work this day.  I didn't want to work and find out either good or bad news that day.  If it was good I wanted to celebrate, if it was bad I didn't want to be surrounded by happy families that just had their own newborns.  So I decided to test early...

I tested Friday October 7th, I laid in bed until I heard the garage door shut and I jumped out of bed once I knew Derrick had gone to work.  I pee'd on the stick and waited to see the beautiful two pink lines... The only thing is the second line never appeared.  I broke down.  Laid in a ball on the floor of our master bathroom in a puddle of tears.  I was in shock, we were so sure that this baby was going to take, but for some reason baby didn't stick.  I called Derrick and gave him the news and updated my parents.

I ended up taking the next day off of work to take my blood hcg test that the office wanted me to take, to verify.  Yet again negative.. HCG <1.

We spoke with the nurse and discussed why the embryo possibly didn't implant, Dr. Maud's opinion was that it was a chromosomal abnormality, that this was a possibility out of all of our embryos that a few could be chromosomal abnormal.  Knowing this, we felt a sense of peace knowing that God wouldn't give us something we couldn't handle, and that maybe this negative although it seemed devastating maybe it was our answered prayer in that if something was seriously wrong with the embryo that it was mean to be with God and not us.  So picked ourselves back up and prepared to move on.

FET costs: Ultrasound $78, FET $4190, Labs $30, Medication $34 (These costs were out of pocket after insurance deductible was met, Insurance doesn't cover the actual FET procedure)

Here we go again... on to baby 2!

After we had Jackson we knew we wanted more children but we weren't sure on a timeline. Throughout my breastfeeding Jackson I didn't get my cycle back until after a year of nursing.  Even when I got it back it wasn't very regular which I attributed to both hormone fluctuation with nursing and my PCOS.  We added a new medication called Metformin 750mg daily on in December 2015 after my Hemoglobin A1C (which looks at your average blood sugar over 3 months) continued to go up from the years prior in to the lower end of pre-diabetes range. More on Hemoglobin A1C here: Mayo Clinic- A1C

Once we started the Metformin my cycles became slightly more normal in that they would range from 35-50 days, still quite long but better than every 8 months.  So we did the for fun baby making, and sadly no pregnancy.  So we decided to start everything back up again with our frozen embryos in Omaha.  This time we kept this all a secret, the only people that knew that we were going to do another round were my parents and Derricks. We wanted to surprise everyone with a baby, little did we know the long process that we would go through again.

My little merman, enjoying the ocean

Family vacation in Hawaii 2016

Paddle boarding in Hawaii

We enjoyed the start of our Summer by going to Hawaii for a family vacation celebrating my parents 35th Wedding Anniversary.  We made a lot of amazing new memories as a family.  It was nice to get to spend time relaxing and taking it easy, knowing that we had busy months a head with getting ready for a frozen transfer. 

July 12, 2016 we went back to Dr. Maud in Omaha for another SHG to check my uterus and fallopian tubes for any changes.  We wanted to make sure it was a favorable environment for the embryo.  We also did pre-screening labs to make sure I was nice and healthy for everything we were about to start. 

Derrick and I are kinda freaks about planning, or shall I say I am for both of us.  I knew that if we tried to do a transfer in August that would give us a May baby and May is busy enough for us between Derricks birthday, Jackson's birthday, my mother in laws birthday, and my birthday.  So we opted to sit out one month and do a round of birth control to calm any cysts that might be there and start in September for a June baby. 

We now just had to wait for my birth control to be done for us to start our process of growing my uterine lining.  Since we already had the embryo's we just had to create a nice plush lining for them to implant and then transfer them similar to the fresh IVF transfer we had done with Jackson.  

More on Frozen Embryo Transfers (FET) here : Shady Grove - FET

At this point we were so overly hopeful, we were so confident that this first transfer would take right away and we would go on our happy little way and have a June baby.  Afterall, Jackson had an uphill battle being transferred when my estrogen levels were so high that it made implantation difficult and less likely.  We assumed we had it in the bag.  They say that the success rates for a frozen transfer actually are much higher for a person with PCOS, because my body doesn't have the stress of growing all of the mature follicles. During the weeks leading up I scaled back on alcohol, exercise and caffeine intake. 

Grow baby, Grow

The following weeks we went up a few times for ultrasounds to see growth, see the heart beat and see our beautiful baby growing and loving its new home.  The wonderful thing about having IVF is the frequent monitoring after conception.  We went every two weeks for ultrasounds and blood work. At 10 weeks after our ultrasound looked good we were released back to Dr. Friesen in Lincoln.

6 Weeks .26cm crl

8 Weeks 1.66cm crl

10 Weeks 3.21cm crl

Each ultrasound we were looking at the baby to see growth, one of the main signs of good growth is measuring the crown to rump length of the baby.  More on crown to rump length here: Ultrasoundpaedia
At 6 week ultrasound on September 10, 2013 we were able to see the heartbeat, it was still to early to hear anything as the little heart is so tiny but we could see the flicker of the light on the screen.

Our 8 week ultrasound we were able to hear the heartbeat on September 25, 2013.  We were doing well and they allowed us to taper off of our progesterone shots around 10 weeks.

Once we were released back to Dr. Friesen we had a 12 week ultrasound on October 23, 2013.  Our normal OB pregnancy doctors appointment continued and we went on to have a very normal rest of our pregnancy.  We were blessed to have a great smooth pregnancy.

12 Weeks

The Greatest

The two week wait is a really really terrible thing.  It's the longest most excruciating days because you are waiting for life altering news.  The waiting consists of over analyzing every single feeling, things you aren't feeling, every emotion, every hope, every dream that you have for the little baby.  During my two week wait I had cramping, I had sore breasts, I had increase in my sense of smell. I held out and was so strong during the two week wait and refused to pee on a stick because that darn single pink line and I didn't get a long. I didn't want to see that horrible horrible thing, so I boycotted the stick.  The morning of August 27 I went into Bryan Lab to have my hcg drawn, I went bright and early hoping to get results back asap, but the call didn't come.  I waited over lunch still no call, I waited mid afternoon still no call.  Eventually I went back to the Bryan Lab and had them print out my lab value.  I knew I needed a higher number but what exact number I didn't know.

I wanted to save the paper until I was home but for some reason walking down the hall of the Women and Children's tower I opened that white piece of paper.  My eyes searched the letters and numbers for the hcg lab value I needed.  That's when I saw it.... 78! I WAS PREGNANT!! Oh my goodness, oh my goodness, is this really happening.  I barely remember my drive home (probably not safe), and then sat and waited at home for Derrick to get home.  I had about two hours to spare so I decided to get dressed up so we could go out to celebrate.

Many months prior (back when I thought this whole getting pregnant thing would be a breeze, haha), I had the same caricature artist who drew our engagement proposal make a baby sketch for me to surprise Derrick with.

Derrick came home and came in the door to the caricature waiting on the counter, with me standing close by with our lab numbers.  Those moments, that look, those tears, made it all worth it.  The sense of relief was incredible.  Derrick and I were parents.  We were going to have a baby.  We spend the rest of the night going around to tell our parents, and close family. We then went to celebrate at Old Chicago for pizza and nachos.

Two days later we had our second beta hcg test and the number came back at 209. It was perfect.  HCG numbers in the beginning of pregnancy has to be greater than 5 to be pregnant but then that number should double every 48 hours.  Ours had done that and more. We were on cloud nine and so in love with the little numbers that were growing quickly. More on hcg and doubling times here: American Pregnancy Association- HCG

Court Jones out of California is who has done our caricatures, he is a very well known caricature artist and does amazing work.  You can check out his page here : Court Jones- Caricatures

IVF the road to Jackson

Once we decided to do IVF we were so geared up, so excited, so full of hope.  But scared. So scared it was so much money that we were investing into something that had no 100% success rate.  Prior to starting the whole stimulation process we did another round of birth control pills to return my ovaries and hormones to a good baseline.  August 2nd we had our baseline ultrasound, everything looked good and we had the green light to start stimulation's once my cycle started.

August 4-9: Injection 225iu Follistim
August 9: Ultrasound
August 10-11: Injection 225iu Follistim & Ganirelix injection (To prevent ovulation)
August 12: Ultrasound & Trigger Shot

August 14th, we arrived at Dr. Maud's for our egg retrieval.  They took us back into the surgery area to prep me for surgery including starting the IV, signing paper work and relaxing as much as we could prior to removing our big beautiful mature eggs. Dr. Maud was happy with how everything went and we were happy to start the process.  Over the next few days we went home to rest, and wait to hear how our embryos were growing.  Every two days we would get a call to hear how our embryos were growing and how many had made it vs. how many we had lost.  Due to my PCOS and our stimulation I was able to produce 34 mature follicles that we removed.  They inseminated many of them and we were lucky to have a good quantity to take into the IVF transfer and enough to freeze for future children in the years to come.

This little embryo became our little boy Jackson

During this entire process we prayed, we hoped, we loved.  We had friends, family, co workers praying for us, hoping for the best and hoping for good news.  We started progesterone injections instead of vaginal suppositories.  Every night Derrick would give me my progesterone shot in the lower back/hip area, he was such a trooper with learning these new skills and dare I say he might be better than even some nurses out there.

The weekend after we retrieved our eggs while we waited for them to grow we learned that Derricks Grandpa Jack was not doing well and was put on hospice at his farm.  We made the trip down to see Grandpa Jack and to say our love and good-byes.  I fondly remember that during the months leading up to Grandpa's health declining, we had seen him in the hospital and told him that we were trying to conceive, we told him that if we had a son we wanted to name him Jackson.  I remember Grandpa Jack saying "That's pretty good".  I think he was happy to hear of our plans.

Monday August 19th we were ready to go back in for our transfer, however we got a call from Dr. Maud that my estrogen level was sky high due to the stimulation's.  One of the risk of stimulating on such a grand magnitude is the risk of OHSS (Ovarian Hyper Stimulation Syndrome), this is a very serious condition that can lead to hospitalization.  Dr. Maud had me watching for signs and symptoms along with watching my urine output. More on OHSS here: Mayo Clinic OHSS  Dr. Maud wanted us to postpone and reschedule our transfer, due to our high estrogen levels.  She said that the high levels could hinder the implantation.  Because of a gut feeling and pure excitement we decided to continue and head to Omaha to transfer one 5 day fresh blastocyst.

Once we were in Omaha they took us back into the surgery area where we both changed into our scrubs/gown and waited for them to wheel us back into the OR.  Once our nurse took us back into the OR I laid on the OR table with the bright lights shining on my nether regions.  The nurses, and doctors surrounded us and directed our attention to the large screen TV that was hanging on the East side of the OR room, below the TV was a sliding glass door that held the room where our little embryo was waiting.  The embryologist zoomed in with the microscope in on the dish holding a tiny round dot.  As she scanned the bottom of the dish it read my name and number.  Then zooming in more we finally laid eyes on the big TV of our tiny tiny little embryo, the one chosen to be our first IVF transfer.

Once they had the speculum in and ready and the ultrasound on my tummy Dr. Maud called for the embryo to be drawn up into a catheter, and then it is delicately brought into the OR room and Dr. Maud inserted the catheter past my cervix into the uterus, on the ultrasound screen we could see the tip of the catheter enter my uterus.  Then on the screen we saw a little white bubble of air that they put after the embryo to ensure it is deposited.  As that little white air dot started to float around in my uterus we knew that meant the little embryo was home... home in my uterus, now it was completely up to God.  They removed the ultrasound wand and wheeled us into the Surgery patient room while we waited and stayed flat for an hour prior to them letting us go home.

We brought Derricks truck to Omaha so that I could lay flat on the hour drive home to Lincoln.  I was also instructed to remain completely flat for the next 24 hours, the only time I could get up was to use the bathroom. Movie and nap day here we come!  I felt good afterwards, physically.  However emotionally, mentally I was terrified that we made the wrong choice to transfer when the doctor had suggested to hold off due to my high labs.  This uncertainty would follow us and linger over us during our two week wait.

Our Fresh IVF Cycle costs: Ultrasounds $133, Medications $1442, Labs $115, IVF $9,024 (The costs for our fresh IVF cycle were out of pocket after deductible was met)

IUI or IVF the debate

Dr. Maud called us to talk about our options after our second negative following our second IUI.  We had some choices to make and some new procedures to learn about.  At this point we could either continue down the road of injections with IUI's like we had done the previous two months.  Hoping that it was a matter of time before we would be successful, however we also knew that with PCOS we ran the risk of having multiple mature follicles each cycle which could put us into a tough spot.

Our other option was to look into IVF (Invitro Fertilization). Finally the thing that I had thought was so scary, so unnecessary for us, something that we would never have to do.  We sat down to learn about the procedure and made our list of pros/cons for why this might work for our family.

IVF procedure is more involved, more detailed than the IUI.  IVF starts similar to IUI, in that injections are used to grow multiple mature follicles, with frequent ultrasounds for monitoring.  Once these follicles are of mature size with plentiful amounts we would do a trigger shot and then come in for our retrieval day. Retrieval day consists of surgery for me, I would come into the office, they would take me back to the surgery patient rooms where I would get an IV, Anesthesiologist would come to visit me and prepare me for the procedure.  After waiting they take me back alone into surgery where I am put under by general anesthesia and then Dr. Maud goes through vaginally with a needle to aspirate and collect all of my mature follicles.  The mature follicles are then looked at and inseminated with ICSI which is a insemination assistance where they inject a single sperm into the egg if needed, if the sperm quality is good enough they will allow the sperm to inseminate on their own.  After this process they watch the fertilized eggs continue to grow they watch to see if cells divide, if they grow and mature.  There can be 3 or 5 day embryos at which point they can transfer 1-2 embryos to the mother (Fresh transfer) or they can be frozen for a FET (Frozen Embryo Transfer) to be used at a later date.

If a fresh transfer will be used the woman comes back in on day 5 and goes back in to the OR (thankfully the daddy can be present during this time since there is no anesthesia). The mother lays on the OR table and they prepare the embryo and insert it via a catheter past the cervix into the uterus, and allow it to implant by itself.

http://americanpregnancy.org/infertility/in-vitro-fertilization/

More information on IVF here : American Pregnancy Association- IVF

After learning about the IVF procedure it seemed a little less scary.  It seemed like we would have more control.  We decided the pro's for doing the IVF for our family included:

• Greater control over quantity of eggs that were inseminated to be back in
• We would be able to have hopefully extra embryos that could be frozen and used for future children
• Higher success rate

Although we knew that IVF was considerably more costly ($9,025 for the actual procedure, not including ultrasounds, labs, medications).  In the long run it would be a good investment. So we pulled the trigger and decided to jump into IVF.

IUI #2 in Omaha

Finally a few weeks later our round of birth control to regain our baseline was complete, the cysts had gone away and we were excited and ready to try another IUI.

June 12, 2013: Baseline ultrasound (Cycle day 1)
June 13-18: Injection 150iu Follistim
June 18: Ultrasound- Largest follicle 11mm
June 18-21: Injection 150iu Follistim
June 21: Ultrasound (8 Mature Follicles at 17mm) HOLY SMOKES!!
June 21: Trigger shot
June 23: IUI #2

http://www.montereybayivf.com/infertility-services/ivf-process/injections-of-follistim/

The large number of mature follicles we had was all because of my diagnosis of PCOS.  The normal woman with non PCOS would not respond with this many follicles.  This was good but it was also bad, we ran the risk of multiples, and a possibility of extreme multiples.  This scared us but we knew our chances were fairly small of all of them taking, or so we hoped.  We started the same progesterone vaginal suppositories as the last IUI cycle.

On July 7th I yet again woke up early, quietly I took the test then while waiting for the results, I brought the test into the room that we had always planned on being the nursery.  I sat there, I prayed and hoped even more, thinking we had 8 mature follicles one of them had to of been cracked into and made into a baby... When I looked down at the test the wicked eye game began.  I sat there and although in my heart of hearts I knew it was just one line, my eyes wanted to see two lines.  I swore to myself that I saw the faintest second line, that it was there.  There was hope for a little baby growing inside.  I had us get up and make it to the Omaha office by 7AM for the beta hcg (pregnancy hormone), that would be a blood test that is official.

I was hoping that my double vision was even just slightly correct.  I didn't want to stop my progesterone and medication until I was 100% positive there was no baby, knowing that if I stopped my medications I would lose a baby if we happened to be pregnant.  Sadly that afternoon I got a call from the office that I was NOT pregnant.  No baby.  Still barren.

Cost for IUI#2 in Omaha: Ultrasounds $221, Medications $918, Lab $43, IUI $300 (These costs are out of pocket after deductible)

IUI #1 in Omaha

April 16th, 2013 we had our "baseline" ultrasound,  this was always a ultrasound at the start of my cycle usually day 1 or 2.  This would tell us how my ovaries look prior to any stimulation.  The medication that we were started on to help grow my follicles was an injection called Follistim... Here is the following schedule we did...

April 17-21: Injections 75iu Follistim

April 22: Ultrasound

April 22-24: Injections 100iu Follistim

April 25: Ultrasound (cycle day 11)

April 25-27: Injection 150iu Follistim

April 28: Ultrasound (3 follicles measuring 15mm- wooohoo!!)

April 28: Injection 225iu Follistim & Bravelle 150 Injection

April 29: Trigger Shot

May 1: IUI #1

Towards the end of stimulation we wanted to make sure that the 3 follicles that were getting close to mature size pushed into the mature 18mm size, so we added one more medication called Bravelle.  On the 29th when we were ready to release the mature eggs from the follicles we did another injection called a "Trigger Shot" this does exactly what it sounds like it releases my mature eggs and they start their decent down the fallopian tubes.  Since there is a bit of a distance that the mature eggs have to go we release about 12 hours prior to our IUI.  We then arrive and perform the IUI procedure with the "washed" sperm and lay there after the procedure for 15 minutes to allow things to settle.

http://www.sandiegofertilityspecialist.com/fertility-services/iui-intrauterine-insemination/

After this point we head on our merry way and then we start the fun (but not so fun 2 week wait).  During this time we started vaginal suppositories of progesterone.  Progesterone is a hormone which helps to sustain pregnancy.  Progesterone is vital to a healthy long pregnancy and not all women can produce sufficient amounts of progesterone during pregnancy.  This is where hormone supplements come into play.  In many reproductive cases they add in progesterone just to assist and even prior to knowing if there is a production problem. 

On May 15th we took our pregnancy test.  I remember waking up before Derrick was up, I was so excited to test, so excited to deliver the good news.  I snuck into the guest bathroom and followed the instructions, while I sat there and waited the two long minutes, I hoped, I prayed.  Then just to see one line, one stupid stupid line.  Back to the drawing board....

A few days later I was feeling pretty uncomfortable, I was full and puffy.  Due to the stimulation's I had grown many follicles although with the trigger shot we released the mature follicles there were still other medium sized follicles that had continued to grow into large cysts.  I had another ultrasound on May 18, 2013 to find many cysts, the solution for this was to start a round of birth control pills that would help to return my hormones to baseline, along with my ovaries, as a sort of 'restart'.  Although I didn't want to sit out a cycle in between I knew due to the cysts that I would feel better getting those resolved before starting again. 

Costs for IUI#1 in Omaha: Ultrasounds $295, Medications $695, Labs $64, IUI $300 (these costs were our of pocket costs after deductible was met)

Gearing up for IUI in Omaha

On March 13, 2013 we went to Omaha for a SHG (Sonohysterogram).  During this procedure they place a small catheter past my cervix into my uterus and inject a small amount of saline.  During which time they are watching through ultrasound to see if my fallopian tubes are open and if there are any blockages that they could see along with a few malformations of the uterine lining.  Thankfully we had the all clear from the SHG that my tubes were open, my uterus was clear.

During this same time we did another sperm analysis on Derrick to see on their testing if anything had changed that might inhibit our fertility process.  At this point Dr. Maud was willing to try IUI with us for a few rounds, hopeful that injection stimulation would be what we needed to have a successful conception.

For those who are unaware of the IUI process here is the short over view of how IUI works.  During IUI (Intrauterine Insemination) the sperm which has previously been collect is "spun down" and the best sperm are drawn up into a small catheter.  Then while in stirrups the small catheter is placed past the cervix into the uterus and deposited.  Some women can do a natural cycle with out stimulation (medications) of their ovaries to produce mature follicles/eggs, however with some such as myself we would need the assistance to grow the mature follicles and then help to release the mature follicle when we were ready.

IUI is often a good starting point and less invasive.  Although still pricey it tends to be a cheaper option compared to IVF.  Our actual procedure for IUI was $300, with usually 3-4 ultrasounds during the 2 weeks leading up to the IUI date to monitor growing follicle size.  Each ultrasound ranged from $125-$200. Thankfully our insurance helps to cover portions of our fertility journey.  Our plan would help to cover 50% after deductible of ultrasounds/medications/lab work.  However, insurance would not cover any actual IUI/IVF procedure. We were thankful to have at least a little bit of help when it came to the medical bills that were starting to add up quickly.

We were excited, we were hopeful that this IUI with injection stimulation would be what we needed.

IUI attempts in Lincoln

After trying to conceive naturally wasn't resulting in two pink lines, our OB suggested we try a common medication called Clomid.  We started in January 2013 and would take progesterone for 10 days to start my cycle then day 5-9 would take Clomid 50mg pill every day, after going in for two ultrasounds we found that none of my follicles were large enough to do anything with. So we stopped and cancelled this cycle.

The average woman in an average cycle will produce 1-2 mature follicles/eggs that are 18-30mm in diameter.  Although PCOS women have many follicles they are usually are very immature and even if they are released would not be large enough to be inseminated.

Knowing that I didn't respond well to the 50mg of Clomid we tried another round of Clomid in February this time bumping it up to 100-150mg.  Sadly, after two ultrasounds to measure my growing follicles, the largest one we had was 13mm, not big enough to do anything with.  We sat down with Dr. Friesen our wonderful OB that said he thought we might be to the point of needing injections to help stimulate my ovaries into producing mature follicles.  His hunch at that time was that we were going to need to do Invitro Fertilization (IVF) which at that point I was completely against and was hoping and praying we wouldn't have to go that far.  Not that IVF is against my beliefs, religion or I wouldn't do it, it just sounded so scary.  It sounded so expensive and it sounded so final.

Dr. Friesen encouraged us to make an appointment with a Reproductive Endocrinologist (RE) who is a specialist of conceiving one could say.  Thankfully a co-worker of mine had encouraged me a few weeks earlier to contact and get on the long schedule for a primary appointment with Dr. Maud Doherty a RE at Methodist Women's Hospital in Omaha.  After we had Dr. Friesen's blessing to go to Omaha we called weekly to see if there were any canceled appointments that we could snag so that we could get in and start the process earlier.  Much to our surprise we were able to get our first appointment with Dr. Maud on February 20, 2013.

PCOS What???

We first thought we might have troubles conceiving when my cycles were not regular.  I would often go 8-10 months between cycles and never thought much of it... I actually thought of it as a blessing at that time... ha what a JOKE!

After trying to conceive the good ole natural way with no luck we visited our OB in Lincoln.  Thankfully with my line of work I work along with these doctors and was able to find which doctor I thought best fit our personalities, our needs and who would work hard to support our dreams of having children.  We started at our OB office doing labs and an ultrasound.  My ultrasound along with lab work came back as PCOS.  Many of you are probably like what the heck do all of those letters mean? Even with working in the land of women and babies, I too had to re familiarize myself with in's and out's of what this would mean for us.

PCOS stands for Polycysitc Ovarian Syndrome.  Its a fairly common infertility hurdle that many women face.  There are a few different types of PCOS and women can present differently, There is a good link to the types of PCOS here: The Many Faces of Polycystic Ovarian Syndrome.

A short synopsis of what PCOS is, my hormones are out of alignment and my ovaries make many small cysts that make getting pregnant quite difficult.  Knowing that we had a uphill battle with my body we decided to do a sperm analysis to see if we had any male infertility factors.  Thankfully hubby's body was just fine and we would just have to focus on getting my hormones/ovaries and uterus to play nice.

My PCOS symptoms are: Irregular cycles, acne, increased testosterone, and ovaries that looked like this, with many small cysts.

More about PCOS here: Mayo Clinic- PCOS