Cycle 2: CD 19 – Should I Be Hopeful?

Trying really hard not to get my hopes up. So far this whole TTC with PCOS thing has been brought to you by believing I probably can’t have kids. But I have a feeling (and a tiny hint of data) that this cycle may be different. And, why wouldn’t it be? I get to take my first pregnancy test on my 34th birthday.

Why do I think I might be pregnant? Well, I haven’t had any implementation bleeding yet, but apparently not all women get that. My BBT chart leads me to think this could be the cycle for BFP. It also could just be my body freaking out after being shot up with HCG a week ago and releasing a bunch of eggs. I’ll find out fairly soon.

I’ve read a bit about triphasic charts when you are pregnant… your temp starts low, it goes up after you ovulate, and then, after implementation it goes up again if you have the right amount of progesterone to stay pregnant. Two days ago, which was 6-7 days post ovulation, I had a dip in my temps (down to 97.3) and then it went back up. That’s either a fluke, or a good sign. It seems a little early to be an implementation dip (I triggered on CD 11, which means I likely didn’t ovulate until CD 13 — but with the trigger shot and what I was feeling I wonder if I released a little early. It’s apparently possible 24 hours after trigger but usually around 36.)

So far, my chart looks like this:

CD 11: trigger (9pm)
CD 12 (0 DPO): slight temp rise and strong ov. feels (97.3)
CD 13 (1 DPO): very strong rise (98.0)
CD 14 (2 DPO): remains strong rise (98.1)
CD 15 (3 DPO): possible corpes luteum dip  (97.4)
CD 16 (4 DPO): up again
CD 17 (5 DPO): slight drop
CD 18 (6 DPO): major drop – too early for implantation??? (97.3)
CD 19 (7 DPO): up again
CD 20 (8 DPO): possible triphasic shift (98.3)
CD 21 (9 DPO): tbd
CD 22 (10 DPO): tbd
CD 23 (11 DPO): tbd
CD 24 (12 DPO): tbd
CD 25 (13 DPO): tbd
CD 26 (14 DPO): — * 34th birthday
CD 27 (15 DPO): tbd
CD 28 (16 DPO): tbd

So – I think the CD6 drop was too early to be an implementation dip. The only thing that I think could have happened is that I somehow ovulated before the trigger shot (my follicles seem to grow really fast on Femera, as the doc told me to trigger the next night when I had one at 19 and one at 17) at my CD10 ultrasound.) There was a slight temp rise (from 97.0 baseline to 97.3) on morning of Trigger shot, then the next day it shot up to 98.0, so ovulation happened somewhere in there.)

Right now, all there is to do is wait. I was a little defeatist the other day when my temp dropped so significantly, but it’s a relief to see it bump back up. I’ve hit 98.3 in prior cycles in post ovulation, so it’s not strange for me, but according to temps this cycle it could be the start of the triphasic shift. Or it could be meaningless.

My BBT test times are a bit all over the place this cycle too — so it’s not 100% accurate. And I had one night of horrible sleep. But I’m hoping there’s something to it.

If we get pregnant this cycle, it would be amazing. It would mean not having to worry about spending $30,000-$100,000 on IVF treatments. So – we could buy that new couch we’ve been wanting…  and a crib. 🙂

 

Infertility Costs to Date

Here is what we’ve spent thus far on our infertility treatments (2 cycles):

  • $350 – consultation w/ baseline ultrasound, clinic #1
  • $250 – husband’s standard tests
  • $16 – Femera for Cycle #1
  • $350 – required genetic testing
  • $350 – first cycle, ultrasound #1
  • $90 – initial lab tests
  • $350 – first cycle, ultrasound #2
  • $115 – trigger shot, cycle 1
  • $525 – consultation w/ baseline ultrasound, clinic #2
  • $475 – hydrosonogram
  • $800 – Cycle #2 (2 ultrasounds + 2 blood draws)
  • $150 – Trigger Shot for Cycle #2
  • $61 – other

Total to Date: $3880

Cycle 3, Day 5. Femera, Over.

I just finished taking the 5 days of Letrozole (5mg a day) to wake up my ovaries yet again to try to develop  a viable egg for this cycle. I’ve also been taking 500 mg of metformin, which I think is giving me bad headaches – but I’m going to keep taking it all cycle to see if it helps with conceiving. It certainly can’t hurt.

On Monday, I go in for my ultrasound to see if any of the follicles are growing. Since I’ve only really been through this process once (with monitoring and Femera), I don’t know if my first time was a fluke (in terms  of two follicles growing to full size) OR if Femera will work every time. I did take Femera once unmonitored, and I believe I ovulated that cycle based on my BBT (basal body temperature), but I’m not sure.

The hope is that on Monday they see my follicles are growing and there are 1-2 dominant follicles. I don’t know if I’ll have to go back for another ultrasound (another $500) or if they’ll let me trigger without a second monitoring appointment. The other clinic I went to required two ultrasounds… one on CD9 and then another on CD11 to make sure I was ready to trigger.

I still have to order the Novarel (trigger shot) for this cycle — if they say I’m ready to trigger. I really hope this cycle is a “go” because I’m hopeful to get 2 more tries in before the end of the year. Less tries, less odds this is going to work. At all.

Next year, we may switch to Kaiser – which, according to very unclear benefits documentation, covers 50% of infertility treatments (however, not IVF, unsuprisingly – though they do not make this clear at all.) If they cover 50% of the monitoring appointments and IUI (which we’ll likely try next year if femera/trigger/TI doesn’t work), then that could be a big cost savings. Of course, that means we have to go to Kaiser for our treatments… and I’m worried about appointment times being impossible to manage with my job. At least the private clinic has super early morning appointments.

I’m starting to save up for IVF as well. I think if we’re not pregnant by… say, June/July (assuming we’ve had 6-8 real attempts where I’ve ovulated), we’ll move on to IVF. Maybe we’ll move onto it sooner – I just want to give this lower cost, slightly more natural way a bit of a chance to work first. BUT – that’s $8000 down the drain that could be put towards our first IVF cycle. I guess I’ll see what the doctor thinks and go from there. They recommended 3 more cycles this way… so, that’s ~ $3000, and we’ll see what happens. Or I switch insurance and maybe it won’t be $3000 – which would be ideal, though then I’m stuck with Kaiser for all my healthcare including, if I get pregnant, my actual pregnancy and delivery. I’ve read mixed things about Kaiser, so I’m concerned… but some people really like them. Maybe it would be fine.

First of all, I need to actually get pregnant. That’s task #1. I have little control over that other than trying to destress, eat healthy, exercise (all things I’m not doing well at the moment) and just hope that something sticks at some point in the next 14 months. I’d really like to be pregnant before I turn 35. I still can’t believe I’m turning 35 in a year (that’s besides the point) but we’re definitely going to move onto IVF if we aren’t pregnant by the time I’m 35.

Cycle #3 – Femera, Trigger & TI with BC

We thought we were going to have to skip this cycle due to our travel schedule, but a new clinic we’re trying out suggested that I take the birth control pill for two weeks to clear out my system, which pushes off the timeline of everything enough that both I and my man will be back in town in time for ovulation (which is still a requirement for this making babies process.) Phew.

I haven’t been enjoying being on the monophonic birth control pills, but I’m glad it’s only for two weeks. Mostly, I’ve had some stomach issues which may or may not have to do with the pill. I stopped taking the pill years ago because I don’t like the idea of permanently pumping hormones into my body, in case it would mess with my chances of getting pregnant, so being on it in order to get pregnant is kind of ironic.

This cycle I would have preferred not to take the BC pill, since I actually had a clean 35 day cycle previously, which is better than the 45-100 day cycles of my past. But the nurse also mentioned that BC is good to level hormones and clear out my system before the cycle, which sounds good, so I’m pumping my body full of Estrogen and such for a short while. Tonight, I stop taking the pill and then I get to experience a system-emptying bleed for the next week (nothing like timing this perfectly with the first week of my new job, oy… here’s to hoping the cramps are no worse than a normal period.)

Once this happens, I will take Femera for 5 days, like the last cycles. I really only had one clean cycle previously since one was a Femera only with no trigger, not approved by doctor but accidentally administered since I was out of town when I needed to go to my appointment. But, given some people take Femera without monitoring and trigger, I’m counting that as a failed cycle. This time around is cycle #3. Lucky #3.

I believe I ovulated in my last cycle with Femera with no trigger shot based on my BBT tracking. That makes me quite hopeful. This time around will be basically like the first cycle – except I don’t know yet if the first cycle with my two fully-grown follicles was a fluke, or if Femera always works for me (at least to grow the follicles large enough so I can ovulate.)

Another concern, TBD, is if my eggs are of low quality. Apparently with PCOS having a lot of eggs is not an issue, but quality often is. I’m still waiting for the moment (since I’m a pessimist) when I’ll be told all of my eggs are unviable. Until then, though, I should assume that my eggs are ok and the only problem is timing and standard monthly odds.

I did have a test last week that looked at my uterus and my tubes. It mostly looked at my uterus to see if it was a good candidate for IVF (it is) but it also checked if saline pumped in would come out my tubes, to see if there are any blockages. The nurse gave me a kind of mixed explanation of my tube quality. She said – some saline came through, which means at least one is at least a little open… but she also made it sound like the amount of saline that came through was very little, leaving her to believe that there may be tubal issues in one or both of my tubes. The only way to know which one is to do an HSG – and this clinic doesn’t do HSGs. My other clinic does, so I may go back to them for the HSG… or I may change health insurance to Kaiser (another post on this soon) which may cover the HSG fully. It’s concerning that there might be a tubal issue, identified but the $500 test, but in order to identify if it’s really an issue I need another $750 test. :/

The tests also supposedly push through anything blocking the follicles (if it’s movable) so sometimes people get pregnant after these tests due to that, if nothing else is wrong. Maybe I just had a little piece of dust in my tube and this test will do the trick. Infertility treatment is so weird because every month you’re playing the odds – but you don’t really know for sure what’s wrong in most cases. You just keep going until they figure “well if you didn’t have THAT problem you’d be pregnant by now” and then they move you on to the next treatment. Except every month costs $1000+++ that you’re paying out of pocket…

This month, with the hydrosonogram, bloodwork, monitoring and trigger shot we’ll be paying about $2000. I know kids cost a lot when they’re born, but it sure sucks to be spending down my childcare fund prior to conception. But so goes life. I’m still terrified of going the IVF route, spending $50,000 or more, and still having no child in the end. It’s a real possibility, and it makes me go back and forth on whether IVF is something we should seriously consider. But that’s for another post at another time.

For now, I’m hopeful, sort of, that this cycle will work. We’ve cleaned out my system with the birth control pills, and I’m a fresh slate of baby-making material. I’m having no side effects with the Femera other than ovarian cramping, and I’m feeling good about this cycle. The way the timing works out, if I happen to get pregnant this cycle, I will be finding out on my 34th birthday. I think that would be fabulous. Odds are still very slim, but it could happen.

 

 

 

 

The Potential Costs of IVF…

Although I’m still hopeful that I’ll get pregnant with less invasive and expensive means, I have to be realistic that we may have to resort to IVF in order to have a kid (or, at least, any faint hope of having a kid.) IVF, i.e., “In-Vitro Fertilization,” is a fairly common practice nowadays. When I tell people that I’m having trouble getting pregnant, everyone  jumps to share with me how they know “so and so” who got pregnant with IVF. Simple.

In many cases, these friends of friends lived in a state where IVF is covered by insurance. They mention their friend had to “pay a lot,” but don’t realize that “a lot” is actually co-pays and deductibles, which is still a lot, but it’s not the a lot a lot that is what IVF costs without any infertility coverage, which is the case for most women/couples in America. (Only Massachusetts, New Jersey, Maryland, Connecticut and Illinois require insurance coverage of IVF — elsewhere it’s up to your company if and what they want to cover, which is usually nothing unless you work for Facebook or Google or a giant bank.)

The average cost of a “fresh cycle” of IVF in the US is $12,000-$16,000. Think that’s a lot of money? That doesn’t include any of the medication required  (that’s an extra $3000-$5000+), or optional add ons, such as embryo biopsy and screening. If you get enough eggs out in round one, they can be frozen (and fertilized), for an annual fee, and then frozen cycles later are a little cheaper, at $3000-$5000+ per cycle, plus medications and the optional costs.

According to AdvancedFertility.com, IVF with preimplantation genetic testing (with meds) and a subsequent frozen embryo transfer usually costs about $17,000 – $25,000 in the US.

For women under 35, there is a 47.5% chance that $25,000 will amount to a child. There’s more than a 50% chance that you won’t get pregnant, and that $25,000 will be out the door, never to be seen again. When you turn 35, your chances of live birth decrease slightly to 39.6%. After you turn 38, those go down much more to 28%.

It’s a strange industry — medical clinics set up to give you hope, but also provide a realism in how you’re throwing substantial money at something that may not work, not to mention that if you do have a kid you really need that money to feed, clothe and shelter it. As a woman gets older, the clock is ticking, and suddenly money seems less important than just giving it all you’ve got to have a child. Maybe it won’t work, and maybe you’ll be $100k poorer for it, but at least you’ll know you tried.

Or, perhaps, you move to a state where they cover a cycle or two of IVF.