Close, but Not Quite

So, we have a plan...sort of.  The plan is basically what it was before we went to the appointment today.  IVF is our best option.  He said that he's not concerned with my AMH enough that he would be against 3 months of Clomid IUIs, but he wouldn't recommend injectable IUI for us.  If we do 3 months of clomid IUIs at a 3-8% chance (new ballpark based on recent SAs) without a BFP, we'd then do IVF, but the clinical trial wouldn't be available to us then.  And, it turns out that the savings from the trial is more than we officially heard.  Kind of becomes a no-brainer at that point, I guess.

The big frustration is that they can't tell us how much it will cost until after January 1 (when my new insurance takes affect).  We're 99.9% sure that we can make this work, but it's hard to know for sure until we really know the cost.  So, we almost have a plan...but not quite.

I'd like to try to get a general understanding of how much the meds will cost.  They told us to ballpark $3-4k without insurance.  With my insurance, we're looking at closer to $1,500, but I can't make the math work out to $3k to begin with based on the Freedom Pharmacy phamphlet they gave us.  What am I missing? (I should say that I don't have any actual protocol yet, so I'm just trying to get a better understanding of the meds and general costs.)

All in all, I'm excited and I do feel much closer now that I've calmed down a bit from the initial frustration.  But, I'm still feeling monumentally overwhelmed by the financial pieces, especially since we can't get answers on that for another 30 days or so.

Today is "Plan Day!!"

Well, hopefully it is, anyway...

We go back to the RE today after our month of diagnostics.  In my mind this day is "Plan Day," the day we walk out of the RE's office knowing what treatment(s) lay before us.  My brain needs this plan so that it can obsess about only one path.  However, I think that my soul is already prepared and aware of the path we're meant to take.

It is my hope that we've done enough research, educated ourselves enough and talked about this enough that when Dr. K gives us his opinion on our best odds, we're ready to take it.  I feel that the appointment could go one of a few ways:
1) Dr. K comes up with more tests for us to do that spill over into December.  This only equals more waiting.  This is bad (for my psyche, anyway).

2) Dr. K sees something in the results that isn't inherently obvious to us (after all, the SA results from early November were not in the IUI range he discussed with us in October...and he cancelled the second SA later in the month) and encourages us to start with IUI.  Theoretically, we could leave the office with an IUI on the books for January.  But, this would take quite a good sales pitch for Hubby to go for it.  He's pretty anti-IUI at this point; wants to put our effort, money and emotion where we'll have the highest odds of success.

3a)  Dr. K confirms what we've suspected for awhile now, IVF w/ ICSI is our best chance.  By some miracle (seriously, because based on my scale I have another 3 pounds to go), I've dropped the remaining few pounds I need to qualify for the IBSA clinical trial and we officially enroll for IVF #1 in January or February.

3b)  Dr. K confirms IVF as the best route.  I'm still a few pounds away from the IBSA requirement, so I keep chugging Slim-Fast, eating sensible meals and exercising like crazy.  We have more time to talk this out...more time for me to obsess about the money...and more time for me to drive Hubby crazy.  Sometime next week, I go in for the "official weigh-in" and the IVF ball starts rolling.

Of these choices, I'd say that I think that 3a or 3b are most likely.  So, given that we feel pretty strongly right now about moving on to IVF and focusing our efforts on best case chances, I've been struggling a bit with perception.

I know that there are many (some that I've talked about here before) that might say that we're moving too fast....that we should start with IUI or just be more patient.  Often these are the people who have never experienced this island, but it doesn't seem to hurt any less when they say it.  We have thought (actually, I have probably obsessed) about starting with IUI just to check that box and say we did it...just to be sure that it wouldn't be all we need.  We've also thought about the emotional toll of thinking that we had a real shot, when it really wasn't much more of one (Dr. K told us last time that he gave us less than 7% odds of a Clomid IUI working for us...and an injectable IUI seems risky with my AMH numbers if we're going to end up at IVF soon anyway).  And, then there's the fact that we'd be spending the money we're saving for IVF on an IUI with much lower odds. 

We're also in the extremely fortunate position to have access to the clinical trial (which includes a discount), health insurance (which covers 50%) and Hubby's HRA (which covers the rest).  In the end, we will owe very little...the problem, of course, is with fronting the large sum at the beginning, but that's where all the blessings of last week come in.  The availability of the reimbursements, and lack of debt at the end, is quite a blessing in itself. 

Since we were "lucky" enough to have known long before we were TTC that there would likely be a problem...And, "luckier" still to have known from 5 months in that there really was, in fact, a big problem, we've both had awhile to come to terms with the need for ART.  Likewise, we've had enough doctors tell us that the odds of us needing IVF were high, that we've had time to accept that likelihood.

I took a stroll through the Stirrup Queen's blogroll yesterday...the MFI room, in particular.  Have you ever noticed how many of the MFI bloggers now currently pregnant or parenting got there through ICSI?  Or, how many of the still TTC'ers are currently doing or nearly pursuing ICSI?  When we got the first SA results back, I took a stroll through the blogroll and remember being grief-stricken at how many ICSI's I saw (though, hope-filled by the number of ICSI BFPs).  I still held onto the notion of natural conception back then.  I've since let that go (not the hurt at the loss of it, yet, but the idea).  We go through the motions every month because miracles happen...but, my soul seems to know that our baby will join our family through a slightly different path.  And, I also believe that amazing opportunities and blessings find you when they're meant to find you.

So, here we sit at this crossroads today where we finally begin to walk down that path.  Diagnostic poking and prodding moved aside, we embark on whatever plan has always been laid out in front of us.  It took us time to find it, but it was always there.  And, in our heart and soul, we both always knew this was the path meant for us.  I think that's why, despite the fact that our journey is sometimes comparatively short, we are comfortable...scared and overwhelmed by the process, the money, the possibility of more BFNs, but nonetheless sure that it is the path we're meant to be on. 

I hope that after today, the specifics of that path become much more clear.  I also hope that there is understanding, from those that (secretly or not so secretly) hold those views, that the path we're on is the path we were always meant to be on.  And finally, but definitely not least, I hope that I can learn to care less about what these "other" people think!

I will update this afternoon...

SA #5 (Updated!)

Update:  The DNA Fragmentation came back at 12%!  That's apparently "exceptional" according to both the RE and the resources many of your provided (thanks for those, by the way!).  Yay for something about the swimmers being a-ok!  So, that's the good news.  The bad news is that they ended up not running counts, motility or morphology, much to my dismay.  We had even specifically requested it after the confusion at the lab that morning.  They still decided not to run them.  Not too happy about that miscommunication/misunderstanding.  But, very pleased about the DNA Fragmentation results.  RE f/u in 4 days!

I hate SA days.  Hate is a strong word, but I think it fits.  DH prefers to do his "collection" at home rather than at "the room."  And, he prefers to do it without help.  Only once have we had "technical difficulties" that required a reschedule.  Nonetheless, I head off to work on the morning of SAs full of anxiety about misjudged distances and the like.  Then, there's the waiting for results...

I'm happy to say that there were not any technical difficulties.  The sample is safely at the RE's office this morning.  I expected for Hubby to call with count and motility numbers like last time (the DNA fragmentation and morphology will take longer).  No dice.  They didn't give him the numbers and it was Hubby's understanding that they were really just focusing on the morphology and DNA fragmentation.  The sample intake form clearly states that we're paying for DNA fragmentation with full sperm analysis.  We had to pay $25 extra for the morphology.  Though I don't understand what part of "full sperm analysis" doesn't include morphology, I'm fine with the extra $25.  It's worth it to know if we're sticking near 2%, or if 2% was a fluke.  Hubby made a good decision there.

Then, the RE's office called back to say that we already had morphology done, so we didn't need another one.  WTF?  Thankfully, Hubby made another good decision by saying that we'd like to go ahead and have it run anyway.  Whew!  Point for the Hubby; Fumble for the RE!  Seriously...

So, I'm not sure if we'll be getting count and motility later in the day when they call with the DNA fragmentation results...or not.  And, I'm not sure if morphology will come then or seven days later, like last time.  I'm confused.  And, I don't like being confused on SA days (or in general, really); they're crappy enough as it is.  Yep, I still hate SA days!

Request: Can anyone point me in the direction of good information on this DNA fragmentation test?  I want to have an idea of what to expect when they call with the results.  Thanks!

Perfect Uterus!

...now we just have to figure out how to get a baby or two in there!!!

Cross the hysteroscopy off the list.  We're one step closer to whatever treatments are coming our way.  Dr. K said that my uterus looked perfect and, if we go that route, he should have no problem doing the transfer.

The RE has a surgery center right at the clinic.  And, the surgery staff really did renew my faith in the entire RE's office.  They were absolutely wonderful! 

On that note, I told Hubby about my concerns with the office, but between him talking me into staying and the surgery experience today, we're going to hang on a bit longer.  Hubby reminded me that, while it's a little further from home (though he showed me a shortcut on that today, too), it's closer to work which will be hand for lunchtime monitoring appointments.  He's also resistent to switching because he doesn't want to get the "we need an SA from our own lab" speech again, especially if we're just going to switch back in a few months time.  So, for now, the RE's office should consider themselves on warning, but we're not going anywhere.

I was feeling really good in the recovery area, like suprisingly good!  About the time we were getting home, though, I definitely started to feel the anesthesia after effects.  Four hours later, I woke up and am feeling pretty much fine now!  This was so much easier than the recovery after my laparoscopy in March!

Sorry this post was a bit all over the place...we'll blame that on the anesthesia, too! ;-)  Here's a pic and a chuckle to end this post...my colorful toe socks were a big hit at the surgery center today!  They said bring warm socks and these were the warmest I had.  Plus, they make me (and apparently everyone else) smile!

Mostly Uneventful Pre-Op

Just got back from my pre-op for tomorrow's hysteroscopy.  It was uneventful, except that they took more blood.  I'm beginning to realize this is just part of going to the RE...if they can draw your blood, they probably will!  I think I'll be a pro at this by the time we're done!  In fact, after I got back from my first RE appointment where they had taken 8 large vials, I was talking to my preggo boss about it and she said, "Oh, just wait until you get pregnant, you'll be a pin cushion."  I laughed and assured her that I'd likely be a pin cushion long before that!

I know that my body doesn't like anesthesia very much, so I expect to be pretty groggy and weak for until at least sometime Saturday.  Should be a relaxing, recuperating weekend and then back to the grind on Monday.  Next up is the 11/25 SA followed by a yet to be scheduled follow-up, "finally get the plan" appointment, which should be sometime in early December.

Meanwhile, I'm contemplating changing REs.  Yes, I'm ridiculous, but here's why.  The only reason we picked this clinic was because of the clinical trial(s).  We're passing up the current  trial and the next trial isn't slated to start until second quarter, at the earliest.  I think I've probably said before that I'm willing to cut this clinic a lot of slack because I know that, if we can do a trial, it will be so much cheaper.  That said, if we know we're not doing the trial now, we can find a good RE closer to home who's IUIs are a bit cheaper. 

More than that, though, I just don't know that I'm pleased with the "feel" of this clinic.  The nurses are wonderful, for the most part, and Dr. K is very knowledgeable with an "ok to good" bedside manner...but, everyone else is sort of non-responsive.  In the beginning, I had to reschedule my initial consult, so I called the new patient coordinator and left a message asking her to call me back.  After waiting four days, I finally asked the front desk if they could reschedule it instead.  Luckily, they did.  At the initial consult, there were some things that left me less than pleased after our discussion with the billing specialist (unanswered questions after repeated attempts to get them answered).  More recently, I realized that I didn't know what time my hysteroscopy was scheduled for, so I called the surgery coordinator and left her a message.  Never heard back. 

Those kinds of things are unacceptable to me.  The nurses and doctor are great, but if the team isn't strong, the patient experience isn't either.  So, I'm just wondering...if we change to a smaller clinic, closer to home until the next trial starts if it will be worth it.  Or, more trouble than it's worth for just 6 months or so.

My brain is always contemplating something...

RE Recap

Here's the "quick and dirty" version for tonight.  CRAZY day today...have barely caught my breath, ,but want to get this written down before I forget!  More soon...

Today: internal sonogram (one cyst, Dr. K apparently not worried; low follicle counts...4-5 on both sides), AMH blood test (because of the low follicle counts), thyroid test (normal), contagious disease testing

Tomorrow: Talk to Trial Coordinator about enrollment, insurance transition, payment plans, etc., to see if this is even an option due to timing.

Saturday: Hubby's 4th SA (to confirm counts, particularly morphology, and baseline), contagious disease tesdting

mid-November: Hysteroscopy

November 25: Hubby's 5th SA (DNA Fragmentation)

early-December: F/U to discuss treatment plan

Miscellaneous Notes:
- Borderline acceptable BMI to qualify for the trial as of today. Time to get my tush in gear! Talk about motivation!
- DH optimistic that we could afford treatment as early as the December cycle. I'm not sure it'll be that soon, but nonetheless it is close!

T-Minus Hours

Questions written down.  Insurance plans printed. Google Maps directions sitting by the door. 

We're officially in the "hours" countdown to the RE!  The nerves I've felt for weeks have temporarily subsided (though, I'm sure they'll be back in the morning).  At the moment, I'm excited...it ocurred to me at some point today that tomorrow we'll have a plan for starting our family.  We'll go from "trying in futility" to "trying with a plan" overnight.  The latter should feel much  better in the long-term!

Of course, tonight's excitement will probably yield to nerves in a few hours followed, perhaps, by sadness or anger at the finality of hearing the necessity of treatments from the mouth of the RE.  I guess that's why I'm writing this down when I really should be going to sleep in preparation for the very early wake-up call in the morning (RE at 7:15 with an hour drive there!)...I want to write this down so that even if I feel worse in the short-term, I'll be reminded of why I should feel better in the long-term.  Tomorrow morning is the beginning...again.  But, this time, at least for now, the beginning feels filled with more hope than despair.

Disclosure and Request

This probably isn't the first time I've mentioned this (in fact, I know it's not), but it's a valid truth: I'm an analyst by day and a planner/worrier by night. Life is all in the details and the what ifs for me. I've done lots of research on REs and what to expect, but I still find myself with questions and wonderings.

So, while I know that I'll have plenty of questions up until the appointment next Monday, it also occurs to me that my blog friends might be able to help! I suspect that many of you might have posted about your first RE appointment. I'd love it if you'd link back to that post in the comments! It'll help me pass the time this week...and fewer surprises generally means less stress for us!

Thanks so much!

The New Two Week Wait

So, we're 5 days into the current two week wait until AF is due (er, until I can test...if AF doesn't beat me to the punch, that is)...I try to be positive this month, but I'm not making much progress, I'm afraid. We're also 2 days into our newest version of the two week wait: the countdown to our initial consult with the RE (at the Cen.ter for Assist.ed Re.pro.duction (CAR)).

I'm excited and nervous, but mostly immensely ready to have a plan. And, I'm hopeful that we'll walk out of the appointment on 10/26 with a plan and a timeline. In fact, I have an IRL friend who has beautiful 9-month-old twin boys after doing IVF at CAR. She says that if I walk in and tell Dr. K that "I NEED A PLAN!" that I'll leave with a plan.

Guess what I'll be saying? Can it really be that "easy?" Plans have seemed rather elusive lately...

(Thanks to the HC and Jenny for the new blog awards! So sweet! Will get them up shortly...just a drive by posting tonight!)

Friday Frustrations

I wish I could say that I was feeling great headed into the weekend. Unfortunately, I'm feeling frustrated. A lot of things are adding up to create that feeling. And, even though there's a great deal of hopeful, "almost there" sort of things going on right now, I can't seem to get past my general feeling of annoyed frustration on this dreary, rainy Friday.

House
We were supposed to be the proud owners of only one house, officially, as of today. Instead, we have two houses for one more week. The closing on our MN house got moved to next Wednesday. Not the end of the world. It's still on the calendar and it's a bank issue, not a buyer issue. Still, it's annoying. After 17 months on the market, though, what's one more week?

RE
I posted earlier this week about my call to schedule the initial consult at the RE. I talked with the new patient coordinator on Wednesday afternoon and got an appointment set-up for the morning of 10/26. Awesome! We wouldn't have to wait too long to get a plan. Unfortunately, I woke up in a startle on Thursday morning when I realized that somehow I'd failed to realize that I had an all day meeting at work on 10/26 and would probably need to reschedule. I immediately called the coordinator yesterday morning...still haven't heard back. I imagine she's off and I'll here from her on Monday. I was making every effort to schedule the appointment for first thing in the morning or last thing in the evening to appease my office. But, I have sense decided that I'll be much better able to participate in my boss's baby shower on November 5 if we have a plan by then. Maybe that's silly, but I think it will help I'm annoyed at myself for scheduling it on the 26th in the place and growing increasingy annoyed that I haven't heard back (not at the coordinator, just in general that I can't get it confirmed on our calendars).

Depression and TTC
And then there's the big one. DH and I had the talk last night. He's right in the middle of a lot of non-TTC-related medical issues that investigating the MFI sort of dug up. He's dealing with severe fatigue...to the point of not being able to successfully complete once normal, daily tasks. Now that his hormone levels are back to normal (testosterone and estradiol are in normal ranges per the blood work we received from the uro this week!), his thyroid panel came back clear and his CPAP (for sleep apnea) has been cleared as working normally, we're beginning to wonder if it has something to do with his depression meds. The very thing we were hoping to avoid messing with now needs to be messed with. So, we had the talk...should we hold off on "advanced-TTC" until he's feeling better or continue to pursue getting him "back to normal" at the same time as we move forward with the RE. We decided to move ahead, but reevaluate before we start any treatments. A perfectly sensible resolution...but, I'm finding myself annoyed at the conversation in the first place. The depression, making it's presence known in yet another way, annoys me to know end. I digress and will save it for the next post.

To end on a lighter note...my mom is flying in this weekend. We're going to the Texas State Fair. I'll report soon on fair oddities (er, delicacies?) like fried butter and fried peaches and cream. Maybe tomorrow's feeling of "painfully stuffed" will outweigh (no pun intended) today's annoyance.

Cue the Butterflies

The strangest thing happened yesterday. I had checked into everything that I wanted to check into before scheduling our initial consultation with the RE (insurance, HRA, etc). I had picked the RE 2+ months ago at the first mention of us possibly needing IVF. I had been ready to make this call for awhile now.  That's just the way I process information. And, here we were finally (relatively speaking) at the point of getting the "higher impact" action plan I was writing about just last week.

Two months ago, I would have thought I would have picked up the phone, dialed the number and scheduled the appointment with wreckless abandon. Instead, I freaked out, my stomach full of thousands of tiny butterflies. This struck me as very odd. It was just a phone call. It was just a consultation. It would probably be a month or more away. And, I could cancel it if need be. What the heck had me all worked up?

More than any other call or appointment so far, this call...this call to schedule the initial consult that will determine whether we continue to wait it out, "try harder" with something like IUI, or jump straight to the end of the book with IVF w/ ICSI...this call makes it feel real. You don't end up at the urologist if the swimmers are Michael Phelps quality. Likewise, you don't make the call for the intial consult at the RE if your odds of getting pregnant naturally are high.

This is real. We are dealing with infertility. We are currently infertile. Deep breath. Butterflies remain. But, the freak out faded. It's just an apointment and I can cancel anytime if I change my mind on the clinic, or we decide to wait it out a bit longer, or whatever the reason may be. It's just a consult....albeit a consult with bigger, better ramifications than any appointment I've ever had.

So, I picked up the phone, dialed the number and said the words: "I'd like to schedule a new patient consultation." And, after all that, I hung up the phone empty-handed. My clinic requests that I fill out the new patient paperwork and then they call me to schedule. After all that! The paperwork is ready to go and I hope to get a call with an appointment later today.

This is real. I'm scared, nervous, excited...ready.