CD 13, Early Trigger Shot, and the TWW

In two weeks, I’ll know if this cycle amounted to anything other than $1000 in medical bills. I have a strange feeling in my heart this cycle is going to work (no reason other than I will be testing on my birthday and I want that to be my birthday gift) — but I’ve also been reading a lot about the super-high rate of miscarriages amongst women with PCOS and I’m now more concerned about getting pregnant and losing the pregnancy than getting pregnant to begin with.

There’s a little logic behind this. Not much. But my logic is that I seem to be a prime candidate for infertility treatments. Unless I have more tubal issues than we think, my only issue / reason for not getting pregnant, as far as we know thus far, is not ovulating. Well, with the Femera I’m producing 1-2 mature follicles each cycle — and they seem to be releasing properly when using a trigger shot to force ovulation. Assuming nothing else is wrong, we have a 15-20% chance each cycle of conceiving using this method.

Yet, the chances for women with PCOS to miscarry are 30%-50%, or even higher, according to numerous studies. I’m quite concerned that even if I can get pregnant, I won’t be able to stay pregnant. This is all personal hypothesis at this point — my eggs could be of horrible quality, or my tubes could be blocked, or something else could be wrong making it impossible for me to even get pregnant. Or, maybe my body isn’t set up like a typical woman with PCOS and I won’t have any issues with miscarriage.

I just like to plan ahead for these things so I’m emotionally prepared. I’ve been fairly sure my whole life I won’t be able to have children – or it would be very, very hard to get pregnant. So as much as I’m saddened over this, I’ve dealt with it a while ago. But – if I DO get pregnant and then lose the child, it’s going to be a whole new emotional ballgame.

I’ve been reading all of these horrible stories about miscarriage and I just think about how awful it is for all the women who have been through this. It’s actually fairly common, even for perfectly healthy expecting mothers. Most miscarriages happen in the first 12 weeks, but some happen later. I just worry about getting my hopes up — and also, actually I worry about worrying every day that the fetus might not make it to another day… not to mention reading those horrifying stories about miscarrying at work (I can’t even imagine!) Well, here’s to hoping this cycle is my ticket to pregnancy and I won’t have to experience miscarriage. But, I prepare for the worst… and hope for the best.

 

Cycle 2, CD 12: Day After Trigger Shot

This Femera + Trigger Shot cycle has been similar to the one I did last spring at the other clinic, with the exception of my Trigger Shot being bumped up a day. Last time I triggered on CD 12 and this time my RE told me to trigger on the evening on CD 11.

I understand so little of the logic behind any of this, but I think some clinics are more risk-averse regarding multiples. This clinic certainly is (they only implant one embryo at a time for IVF) so perhaps they wanted to trigger sooner than later, in case other follicles caught up and released. My doctor did clearly state that I have a chance of twins since I had two large-ish follicles.

Interestingly, my body reacted to the cycle almost identically as it did to my last Femera cycle — one fast-growing, large follicle on the left side (that I can definitely feel) and a couple of medium and small sized ones on the right. The one on the left grew from 15 mm to 19mm in between my CD 8 and CD 10 appointment, so I guess it’s safe to assume that it was about 21-23mm when I triggered the night of CD11. Who knows what the others were, if any in the right ovary were ready to release.

Right now I’m massively thirsty and I feel a lot of action in both of my ovaries. They are very sore and bloated. I am looking forward to ovulating so this discomfort can go away… unless, of course, I do get pregnant from this cycle – and there will be more discomfort, but at least it will be for a good reason. 🙂

I’m not getting my hopes up but I know there’s a possibility I will get pregnant this cycle. I’ll find out in a few weeks one way or another. If I am not pregnant, I’ll likely let my body have a natural cycle which will take us through the remainder of the year, and start trying medicated again in January.

For the record, the cost of this cycle was $960 ($800 ultrasounds and bloodwork, $150 trigger shot, $10 femera), bringing the total costs of infertility treatment to date to $3745.50.

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.

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.