live and let dye

our appointment monday went very well!  we were scheduled for 7:00 a.m.  for me to have my hsg test.  we of course arrived at 6:15 and i have to give props to my husband because although i know he was dying to say something, he refrained.  after we checked in, they sent us to outpatient radiology where we actually had to turn the lights on when we entered the office.  no joke.  when the receptionist walked in she looked at us and said "wow."  that's it.  wow.  needless to say, josh had a sly grin on his face and was completely satisfied with himself.  hey, how was i suppose to know how traffic was going to be?  my hsg was totally normal, tubes are open and uterus is anatomically correct.  this was very good news because had there been a blockage it would have meant more tests to try to repair them.

the test is actually pretty fascinating after you get past the fact that they are inserting radiopaque dye inside of you.  it was designed to check for damaged, blocked or partially obstructed fallopian tubes that can impede egg transport from the ovaries to the fertilization site.  This damage can be a result of congenital deformities, surgical scarring, or endometriosis.  the hsg provides the doctor with information about the fallopian tubes and the uterus.  a small tube (catheter) is passed through the vagina, the cervix, and into the uterus.  radiopaque dye is injected into this tube and into the uterus.  since it is radiopaque, the dye is clearly visible on a x-ray machine.  the dye fills the uterus and flows back through the fallopian tubes.  sequential x-rays are taken and if there is a tubal obstruction, or complete blockage, the dye is stopped at that point and is seen on x-ray.  likewise, abnormalities in the uterus, such as fibroids and polyps, can often be seen.  I have included a picture below to give you an idea of what it looks like.  the black triangle is the dye in the uterus and the squiggly lines out to the side is the dye in the fallopian tubes.

while sitting there in the doctor's office waiting for them to take me back I was once again fascinated by the relationship that josh and i have.  i am sitting there in my hospital robe all wrapped up in warm blankets (they really do take good care of their patients) not freaking out, but definitely experiencing some nervous energy  and I look over at josh who is reading a book on composting.  i am about to have this crazy procedure and he is brushing up on his composting techniques.  i couldn't help but laugh at the strange way our relationship works.  we really do seem to balance each other out.

things are pretty relaxed until april 20th when i go in for my suppression appointment.  they will do another ultrasound to confirm that my ovaries are adequately suppressed and if they are satisfied with the result i will begin hormone injections the next day.  this is where things get interesting.  if i haven't said it already, i will apologize in advance for my behavior...i assure you it will be completely out of my control:)

i have been officially without wine for 5 days now and have only had a few diet cokes over the past week.  i am technically allowed one glass of wine per evening, but honestly i think that is worse than not having any.  besides, their idea of a "glass" of wine is much different than mine.  it really hasn't been that bad, i actually went to the winery last night with emily and it was a lot of fun!  picturing our twin babies certainly makes it a lot easier to abstain.

anyway, josh and i both are very excited to get this process underway.  it finally feels like things are beginning to happen.  i don't know if i will have much to report over the next few weeks but if i get any new information i will be sure to post.  i hope everyone one is enjoying this lovely spring weather, i know we are!

isn't it ironic...don't you think?

wow, yesterday it was 65 degrees and sunny and today it is snowing on the first day of spring! i know it is easy to complain about the ever-changing weather but when i really think about it, it is one of the things i love most about missouri, otherwise affectionately known as misery. i love having four seasons, one coming just about the time you get sick of another. honestly, if i lived on the coast or in the mountains where would i go for vacation? when i think about the weather here in missouri it is quite comparable to the process of in vitro...always changing, totally unpredictable, and absolutely no way to control it. i think it is the control that is probably the root of all of my fears going through this process. maybe this is the universe's sick way of teaching me that even i cannot plan everything. it is just extremely difficult for someone, who by nature, likes to find solutions to problems to learn you just have to roll with it. so, roll with it i will.

we got our first bit of not so good news (the word "bad" kind of scares me) about a week ago. my blood test for amh, the hormone that produces the little resting follicles found in my ovaries came back at a .7 and they like it to be above a 1 or 2. they assured me that this does not mean that we will not get pregnant but it does indicate that we will not get very many eggs. so, my ivf calender has changed a little bit because they will have to be more aggressive with the hormone treatments. i decided not to post it here because it sounds like it is very fluid and only my medication start dates will change, not the major appointments. plus i thought it would be a fun game for all of my friends and family to try to decide if my attitude is due to treatment or if i am just having a "jessica" moment:)

i have never been one to have a major pity party and can usually, even after a slight break down, find the silver lining, but the past few weeks have been a challenge. the day before i received the hormone news my car was broken into and my purse and ipod were stolen all in a 5 minute span that i entered a store in mid-afternoon in warrensburg. and i swear to goodness if one more person tells me i should not have left my purse in my car i will not even try to contain myself. i mean really, i know that is what people are thinking and if i am being honest that is probably what i would have been thinking had the story been told to me, but to verbalize it is like kicking me when i am down. you would think it ends there but i have developed a rash on my chest, stomach and back within the past few days. i went to the doctor this morning to learn i have pityrasis rosea. i think it is more than just simple irony that the first four letters are p-i-t-y. while the exact cause is unknown, my doctor believes it is stress related. of course it is. the good news is it is not contagious, the bad news is there is no real way to treat it and it typically lasts 6-8 weeks. of course it does. i have been concentrating so hard on keeping a smile on my face and remaining positive that i think it might be causing me more harm than good. maybe i should just give in to it a bit. i am not talking about spending days in bed without bathing but it just as i am writing this occurred to me that maybe i deserve to give in to the self-pity that i have been working so hard to resist if only for a brief moment.

anyway, i know this post is a bit heavy i just needed to clear some thoughts. my cycle is scheduled to begin this week so we are days away from beginning ivf. my uterus evaluation appointment is scheduled for march 29 but could change by a few days if my cycle is off. I will be sure to report what will hopefully be delightful news!

graphic details of josh and i making a baby...

good news, i don't have hiv or any other infectious diseases and my cystic fibrosis screening was negative. i was confused when i previously posted that we could start whenever we want, it actually does depend on my cycle. so, we have to wait approximately three weeks before we begin. i was bummed for a minute but now think it will be nice to have a few more weeks to prepare. i have posted the ivf calender from my doctor below, i am not sure if it will make things more or less confusing but its there for anyone who would like to take a look. omg, i am officially nervous.

IVF Calendar


• We often plan this calendar based on an estimated period start date. If your period is a few days early or late (and sometimes even a week early or late), this calendar will not change. We will let you know if it changes.

Getting “started!” Period start date: ~3-25
• Call or email your IVF coordinator with your period start date to confirm IVF cycle dates, schedule labs, etc.
•If you start on a weekend, please wait to call until the next business day.
•Please do not call the physician after normal office hours with a period start date!
• If you are considering PGD (embryo biopsy/genetic testing)…or Attain IVF through Integramed, you MUST let us know at this point. You CANNOT add it later in your cycle, it must be planned from the beginning.
• Take a home pregnancy test. Yes, we’re serious! It is actually quite common to mistake early pregnancy bleeding for a period. Unless you’ve had your tubes tied or removed, or your husband has had a vasectomy…humor us and take one before you start any medications. Thank you!
• You and your husband should start the Z-Paks (antibiotics): 2 days before HSG. Your husband’s prescription will be under his name at the pharmacy.
• Use a non-spermicidal condom throughout your IVF cycle to prevent accidental pregnancy (not necessary for tubal ligation or vasectomy patients).
• Continue taking or start taking a prenatal vitamin daily. It is also acceptable to take an over-the-counter multivitamin with 1-2 additional folic acid tablets.

Begin birth control pills:
• Please start birth control pills on day 1, 2, or 3 of your cycle; it doesn’t matter which day.
• Take one active pill daily until the stop date listed below. It doesn’t matter if you take them morning or night.
• Warning! You will likely take an odd number of pills; it may be more or less than one pack. You already have refills on your prescription at the pharmacy. Make sure you take only the ACTIVE pills, do NOT take the placebo / sugar pills! If you are scheduled for more than one pack, take the first 21 pills and then go straight into a new pack.
• Breakthrough bleeding is annoying but normal.
• If you have any questions about how to take pills, please let us know.


Uterus evaluation appointment: Mar 29, 31, or Apr 5 or 7, email Brandi to schedule
• Trial embryo catheter measurement
• HSG (hysterosalpingogram or dye x-ray)
• Check in at the main entrance of Overland Park Regional Medical Center at 7:00am. You can park at the main entrance...or you can also park at our building and just walk down the hall. It's not far from our office. Your doctor will then meet you in radiology to do the HSG and embryo catheter measurement (very crampy, but quick). Please eat something for breakfast, and take 800mg of ibuprofen at about 6:30am.


Getting closer! Begin the following medications on: 4-8
• Aspirin --Take one low-dose 80 or 81mg aspirin tablet once daily until 20 weeks of pregnancy. It does not matter what time of day you take it. Avoid additional aspirin-type products like ibuprofen, Excedrin, and Aleve. Tylenol products are OK to take for headaches or muscle aches.
• Dexamethasone --Take one dexamethasone tablet daily at bedtime, until your coordinator tells you to stop. It will be approximately 1 month.
• Lupron --Start taking Lupron (leuprolide acetate) injections daily.
• Draw up 10 units on the syringe.
• Administer in the abdomen or thigh.
• Give injection at the same time every evening (between 5-11pm).
• Do NOT stop taking Lupron until your coordinator tells you stop. It will be approximately 1 month.
• Even though the box says “14 days” and it looks like a tiny amount in the bottle…it will last for your
whole IVF cycle. You will need more needles than are in the box; the pharmacy should have given
them to you.
• Make sure you follow these instructions and NOT the dosing instructions on the box.
$ If you are doing Attain IVF through Integramed, your payment of _________is due TO Integramed by today.

Take your LAST birth control pill on: 4-13
• You will likely have another period in 2-6 days. You do not have to call.

Halfway there! Suppression appointment: 4-20 or 4-21 or 4-22
• This appointment will take approximately 1 hour. Your husband does not have to be present unless you choose.
• Report to the lab (Suite 125) for blood draw FIRST.
• You will then have an ultrasound (suppression scan) to confirm the ovaries are suppressed.
• Notarized consent forms are due. You have 2 stapled sets of consent forms, one set for IVF, one set for frozen/cryopreserved embryos. You must fill them both out, even if you don’t end up with any embryos to freeze. You can take them to a bank notary, or any notary that you know; or we usually have a notary here in our office and we can witness them if your spouse is with you today. The forms MUST be signed in front of a notary.
• Your IVF coordinator will review the next phase of your protocol, give you lots of new instructions, and order your injectable medications from a specialty mail-order pharmacy. The meds are usually shipped overnight and will arrive in time to begin stimulation. You should also receive a needle box from the pharmacy; you can return it to our office for disposal at the end of your cycle.
$ Payment is required today. MultiCycle Plan ___________, or Attain ___________ , or insurance __________.
Call or email Toni or Carol (Carol@RRC.com) with financial questions.

Time to make eggs!
• Stimulation shots (Gonal F, Follistim, other) to make eggs will begin approx: 4-25
• You will need blood draw in the morning to check estradiol (estrogen) level on approx: 4-27
• First office visit for a morning blood draw and scan to check the ovaries on:4-30.
• You will have ~1-3 additional scans to monitor follicle growth the following week. Usually on Monday and/or Tuesday: 5-3 / 5-4. These scans will determine the retrieval date.

Retrieve the eggs!
• Egg retrieval will be tentatively: 5-6 (give or take a day depending on follicle growth)
$ You will be instructed when it is time to pre-register and make payment to the hospital ($1000) and anesthesia ($440), or file to insurance per Carol’s instruction, if applicable.
• If you live more than 1 hour from our office, we ask that you stay in Kansas City the night before your retrieval (if you are late to retrieval due to traffic or weather, you could ovulate, and the eggs will be gone).

Embryo transfer!
• Embryo transfer will be 5 days after retrieval, tentatively: 5-11 (give or take a day based on retrieval date)
$ If you did PGD (genetic testing on the embryos, $1500 payment is due today, shipping will be billed to you later).
• You will need 2 days off work, the day of transfer and the day after, at home resting.
• Pregnancy test will be the week following embryo transfer (approx 8 LONG days later)!!


Good luck! Please follow these instructions very carefully.
Do not hesitate to ask questions…we are with you all the way!

the facts of life, continued...

since i know i didn't post enough information last night i thought i would continue today:) the doctor ordered 5 blood tests yesterday to check my fsh (follicle stimulating hormone) level, estrogen level, thyroid, cystic fibrosis and infectious diseases. the nurse called today to inform me that they have the results for the fsh, estrogen, and thyroid and they are all normal which is terrific news, one more hurdled passed. we will have the cystic fibrosis and infectious disease results next week.

i tried to cover the process of in vitro in last night's post so today i thought i would pass along some less scientific info. the multiple rates at rrc are much lower than the national average which is great. i am pretty sure anything above twins and i am losing some friends:) there is a one in three chance that we will have twins, less than 2% chance of triplets and they have never had quads or above. let's hope i don't become the exception. for real. if it is twins the majority of the time they are fraternal, so if everyone could pray for a boy and a girl we would greatly appreciate it. two for the price of one, ya know? i was pleased to learn that i am allowed 2 diet cokes per day (cans not sonic route 44's) which is not only good for me but for anyone who has to be around me as well. we have to double check about the vino situation. i am pretty sure she said i could have a glass of wine per evening but josh swears she said only 5 drinks per week. i plan on double checking. seriously? they want me to relax but they take my wine away?? absurd. i said i would do whatever they ask but i don't have to be happy about it. as for acupuncture, they were pretty indifferent. there isn't any real medical proof that it does or does not help so they feel like it is best left up to the individual. basically, if it relaxes me to do it then i should but if not no need. i think i will be seeing enough needles in my near future and have decided at this point it is unnecessary for me.

the side effects sound like quite a vacation. my ovaries go from being the size of a walnut to the size of a baseball which causes bloating, cramping, shortness of breath, insomnia, etc. combine that will all the hormones they will be pumping me with and it sounds like i will be a real treat to be around. i will apologize in advance for my behavior in the next few months. you might want to start sending sympathy cards to josh pronto.

so, there you have it. most days it is still hard to believe that this is the path we have to go down. however, every time i think of the day josh and i finally get to welcome our baby to this crazy, bizarre, mixed-up world i am reminded of the reason for all of it. whatever it takes. we will let everyone know the instant we decide to proceed and hope for it to be in the very near future. again, we have had to rely on the support of so many and are eternally grateful for all of you.

you take the good, you take the bad, you take them both and there you have...

i am on a bit of an information overload right now but feel it is best to try to get all of these facts down while they are still lurking around in my brain. we were at rrc for 4 hours today meeting with the the nurse, doctor, scientific director, financial counselor followed by having 4 viles of blood drawn and an exam that i will not be able to talk about without mucho vino. i know i said i was going to put it all out there but you have to draw the line somewhere and the pelvic ultrasound is the line. no doubt. in a nutshell, what we have is an abundance of information and now we have to try to dissect it and decide where to go from here. we can start the process whenever we like, it is not as i originally thought based on my cycle. when we decide it is go-time they will first have me begin to take birth control pills. i know, didn't sound right to me either. i spent the last, well the number is not important, so many years trying not to get pregnant and now you want me to start taking birth control to try to conceive? apparently the birth control pills is a way to tell your body to stop ovulating and allows the doctors to come in with hormone injections and various medications and take over. so, i am going to try to describe the process to the best of my ability.

here goes. for argument's sake, let's say we are going to start this process tomorrow. i would begin taking birth control pills and lupron for the first half of the in vitro cycle to suppress my body's production of hormones that cause stimulation and ovulation. i should probably point out that an in vitro cycle lasts approximately 2 months. once suppression is confirmed by ultrasound and blood tests, i will begin gonadotropin injections which should stimulate the ovaries to produce eggs. these injections will be administered by josh once or twice daily and last about 8-10 days. the nurse actually said after informing us of this "man he looks like he wants to bend you over and throw it at you like a dart." i am assuming you can picture "the look" josh got after that. from here, i will have 2-3 ultrasounds and blood draws to monitor the follicle development. when the doctor has determined that the eggs are ready to be retrieved, josh will administer a "trigger shot" aka "the big one" to mature eggs for retrieval.

the eggs are retrieved approximately 36 hours after taking the trigger shot. i will check in at overland park regional center where an anesthesiologist will sedate me and proceed to suction the fluid from the ovarian follicles with a needle. the eggs come out with the fluid. this was the part that i apparently skipped in all of my research. it is apparently more painful than i had imagined and i will be on bed rest (only able to get up to go to the bathroom) for the two days following. if there is a silver lining it is that i will get some good pain meds:)

the follicular fluid will immediately be examined in the ivf lab, and the eggs will be counted and placed into culture dishes. they will tell us at this time the number of eggs retrieved. the embryologists will attempt to fertilize all mature eggs. they will call us each day with an embryo count. they like to retrieve 12 eggs on average with at least 70% of them continuing to mature.

assuming at least one, and hopefully two (i will have more on this later) mature, they will be transferred to the uterus through a long flexible tube. josh will be there with me and we will be able to see our embryo(s) on the monitor prior to the transfer. the transfer is a simple (their words, not mine), relatively painless procedure that takes only a few minutes. they said "relatively painless" and "comparable to a contraction" in the same sentence. i was fortunate enough to be in the room for the birth of my niece and nephew and witnessed first hand my sister's head spin around in one of those "relatively painless contractions" but i guess i will take their word on it. from here, i remain resting for 15 minutes after the procedure followed by another 2 days of bed rest. they stated, and i have it in writing, "no cooking, cleaning, chores, projects, or errands, for 48 hours." just thought i better put that out there as it is a pretty valuable piece of information. i will return to rrc 8 days later where they will draw blood to determine if i am pregnant and they will call us that afternoon to let us know. if positive, they will repeat the blood test a couple of times over the course of 3 weeks followed by 1-2 ultrasounds to confirm the heartbeat or heartbeats and make sure it is not ectopic and then my regular ob takes over from there.

whoo, if you think you are exhausted imagine having it regurgitated to you over four hours and then asked to write a nearly $700 check and be on your way. so, those are the basics, although there seems to be nothing basic about it. now, i don't want to cover it but feel it needs to be...where things can go wrong. during my pelvic ultrasound they found that one of my ovaries is much smaller than the other. while it is not something to be extremely alarmed about at this point it is certainly nothing to jump for joy about. apparently the bigger the ovaries the more the eggs and obviously the more the eggs...you get it. plenty of woman have had babies with only one ovary so at this point we have no reason to believe this will be a major obstacle. it is imperative that we have embryo's left over that can be frozen for future use for two reasons. one, if it doesn't work the first time (which it doesn't for 60% of women in my age group) then to try again we just have to thaw one or two out and implant it and can skip over a lot of the invasive stuff it took to create the embryos. two, it would cost a lot less to to do it that way, if we have to start over again we will have to pay full price, which is nearly $15,000 per try. obviously, there are a number of things out of our control that are no different than pregnancies created in the bedroom so there is no reason to worry about that.

so, in a nutshell, we have no idea where we are going from here. we could start tomorrow if we wanted but we have to have $11,000 up front 4 weeks after we start and that doesn't even cover the whole process. so unless we or one of our super generous friends or family hits the powerball tonight we have a lot of figuring out to do. we are both remaining positive, we just need some time to let it all soak in. i will update tomorrow when the doctor calls with the results of our blood tests. oh yeah, the blood tests, i don't believe i explained what that is all about...i promise to do so tomorrow.