Doin’ it and Doin’ it and Doin’ it well.

My husband had his varicocele surgery April 17th. The sperm was supposed to be tested four months later. A week or so ago, my husband went to his pee pee specialist who said it’s too early for the Supersonic Sperm test (not sure why), but…he did a regular one. His count was lower (which, apparently, can vary from sample to sample), but his motility had improved by something like 300%. The doctor said this was a sign that the varicocele surgery MIGHT have been effective. He will officially give him the supersonic test at the end of September.

Meantime, I’ve been tracking my cycles and they have definitely regulated, ranging between 32 and 36 days long. I am taking something called FertilAid, which a friend recommended, in order to get them to continue to be regular and maybe even make them shorter. I’ve been taking it for a month and so far all seems fine. Last month, I ovulated on day 17.  Today is day 13, so I started peeing on sticks.

We have decided to make baby-making our priority. It can be very easy to let jobs and school and other obligations take over one’s mental space, and we’ve decided we can no longer afford to do that. I am starting a new job in a couple weeks and have taken a leave of absence from school so that I can just focus on what matters right now: making a baby and paying the bee-ulls. My husband thinks that if we don’t get pregnant the old-fashioned way by December, that we should consider IVF. Personally, I don’t think that gives us enough time with the good sperm (only four months), but we will cross that bridge when we come to it.

Making baby-making our priority, by the way, does not mean that we plan to sit around wishing for something we don’t have. We are very careful right now to appreciate our free time, our ability to be spontaneous, to stay up late and enjoy quiet time.

Sex has been good lately too. Even though friends tell me “getting pregnant” sex is rarely sexy, enjoyment seems to me to be important for conception.

That’s all for now.

Phoebe

Acupuncture, Malaria and Waiting

There hasn’t been much to say lately because we are still in the process of waiting for my  husband’s junk to be tested – we still have a month to go, in fact.  Meantime, we are trying the natural way and I am charting.  Up until this current cycle, my recent cycles have been pretty regular – long (34-36 days), but regular.  However, this cycle’s ovulation was delayed due to some events that occurred this past few weeks.  I:  traveled to and from Rwanda, bought a house and moved, incurred extreme stress at work…and tried fertility acupuncture.

Hmm…I hate to blame the acupuncture.  How could it stand up against all of those life stresses?  The first time I went, the Dr. said she would not only regulate my cycles, but get them closer together.  She also recommended that I drink these nasty herbs (I was later told by an RE that the herbs could actually have an adverse effect), which I never did, mainly because I was too lazy to go get the very specific type of teapot she required (for sale in their office for only $89!).  I went several times – loved how relaxed it made me feel, especially the hot light she pointed at my belly and the pulsating needles placed atop my ovaries.  The only evidence I have as to whether or not it was effective (I only went for a month and the recommended time of treatment is three months, but now I live far from where I was going, blah blah blah…) is that I didn’t ovulate until around day 36 this cycle.  And I never really clicked with that Dr.  Should I find an acupuncturist near my new place and continue or not?

So Rwanda:  the last time I went (December, 2008), I took a prophylactic anti-malarial medication called Malarone.  The thing about Malarone is that you have to continue taking it for a week after you’re back, and then you can’t try for pregnancy for a month after that.  Knowing the other ex-pats there don’t take it (they just slather on fresh smelling mosquito repellent), I opted not to on this trip.  With my cycles as long as they are, we need to take every opportunity possible to try to conceive!  It occurred to me how irrational that is that I was willing to risk contracting malaria for the possibility of getting pregnant.  That makes a lot of sense.  A pregnant woman with malaria?  Anyway, we told my father in law, the infectious disease specialist, and he went through the roof!  He said I could still come down with malaria up until nine weeks after my return.  He said if I get a fever, we must RUSH me to the emergency room – do not pass go, do not collect $200.  It’s only been a month since I got back, so I am not nearly out of the woods yet!  Hee hee.

As far as waiting is concerned…well, we had sex just a day or two before the day I (am pretty sure I) ovulated, so you never know.  I could be pregnant right now.  The only symptoms, though, are extreme irritability and intense anxiety, which pretty much describe me the second half of every cycle.  The likelihood is tiny.  As to the other waiting…for my husband’s test…what else can I say?  We really hope the varicocele repair surgery worked!  Since we just bought a house, we really don’t want to consider IVF.  We just don’t have the discretionary funds right now.

So yes, we’re waiting for my period (or not), my husband’s supersonic sperm test, and for malaria to kick in.

That said, loving the new home and spending my time not waiting, not lacking, but enjoying my life.

Love,

Phoebe

PS. At a birthday party this weekend, yet another couple of friends of ours announced their pregnancy that came after “just stopping preventing.”  I only let it ruin about three hours of my day and then got over it.

Phoebe: Fertility Musings/Melatonin for Reproduction?

Now that I have quit the IVF birth control pills (wtf?) mid-cycle, I am starting to feel better.  At around 3pm on Tuesday, all of a sudden something shifted and I suddenly went “oh, right” and just started to feel better.  I think the jet lag from Asia is finally wearing off (this is the worst case of jet lag I have ever had), and the hormone roller coaster is calming down.  Between the Clomid and the birth control pills, I was on a ride I wasn’t even aware of.  Now that we are doing the varicocele repair surgery, I’m not going to lie:  I am glad I don’t have to take any more hormones, at least for a while.  That, plus gnarly jet lag, seriously f**ks one up.  In ways one never expected.  For the past couple of weeks, I have felt despairing, self-pitying, self-flaggelating and melancholy.

Another thing I realized about it all is that once we really decided to embark on this baby-making thing and not just “not try to not try,” something shifted in my identity.  I started changing from hot mama to mom.  Not that moms can’t be hot (MILFs, anyone?), but there’s a shift in mindset that begins when you start thinking about motherhood.  As a superficial example, it just so happened that right around January, my sexy, sporty manual transmission Audi was getting to that point where it was sucking up more dough than it was worth, so we decided I needed a new car.  We figured I may as well get a mom car since we are the type of people to keep cars for a long time (like ten years long).  Certainly within the next ten years, there will be baby seats in the back of that thing!  So I got a Honda CR-V.  OK, so now I am driving around the mom car, which is big and cozy with an automatic transmission.  I have the mom car, but I am not the mom.  Also, when we were in the midst of our IUI cycles, the doctor told me to stop working out so much.  I normally go four days a week; he told me to cut down to three.  So I did.  But I kept eating the same amount (which is a lot, which is why I work out so often), and started to grow a little tummy.  I was OK with it thinking, “I am preparing my body for motherhood.”  But again, mom body and no baby.  I got a “sensible” shoulder-length haircut.  Mom haircut and no baby.  We’re looking at houses and worrying about school districts.  Mom mentality and no baby.  Now that my husband is getting his surgery, we won’t be trying again for around six months.  So now I am back to working out when I want and drinking caffienated coffee and eating sushi and all that – the old me.  I know a baby will come eventually, but in the mean time it’s like I’m between identities and it’s uncomfortable!  Of course the lesson in all of this is to enjoy the present tense, no matter what it is.  A couple of days ago, feeling really down, I went to yoga and the teacher read this quote:  “Once you realize that the road is the goal and that you are always on the road, not to reach a goal, but to enjoy its beauty and its wisdom, life ceases to be a task and becomes natural and simple, in itself an ecstasy.” It was just what I needed to hear.

In other exciting news, for the past few nights, I have taken Melatonin to fall asleep and I think it’s been making me unable to wake up in the morning and has given me weird dizzy spells.  I was looking up the side effects on the internet when I came across this on the University of Maryland medical website:

Melatonin also helps control the timing and release of female reproductive hormones. It helps determine when menstruation begins, the frequency and duration of menstrual cycles, and when menstruation ends (menopause).

Anyone heard of this before?  Should I continue with it to regulate my irregular cycle while we are waiting out the results of my husband’s varicocele repair?

Also, in all of my research and whatnot and thanks to all of your fabulous comments, I have come to the conclusion one always comes to in a medical situation:  NO MATTER HOW GOOD YOUR DOCTOR IS, YOU MUST TAKE CONTROL OF YOUR OWN MEDICAL CARE.  Our doctor is very competent and a professor in Reproductive Endocrinology at UCLA, meaning he has access to all of the latest information as well as technology.  And still, without us asking the right questions and asking for a referral to a specialist, we may still have been wasting money and time doing IUI after IUI rather than getting the detailed analysis of my husband’s sperm that determined there to be a severe male factor infertility there and the IUI’s to be 100% pointless!

That’s all for now.

Drinking ‘caf and yoga-fying to my heart’s content,

Phoebe

Phoebe: My RE Wrote Back!

While he didn’t answer any of my questions about IVF, he did respond to a few of my queries.

Regarding the CGH test, which is a new DNA test I read about in the Fertility Advocate blog, a test that one clinic feels so confident in that they are offering a refund plan based on it:  CGH is still experimental.  Not of proven benefit yet.

Regarding IVF Refund Programs:  Most “refund programs” have a catch – they profit by charging more up front.

Regarding why the supersonic semen analysis is not done on every patient (ostensibly saving them time and money):  The SCSA test is a newer sperm test.  “How” it is used in reproductive medicine is still being established - which is why it is not ordered initially in all patients.  It does not predict outcome in all patients.

I asked him what we would do next if my husband’s varicocele repair was effective.  He said we’d try a couple more IUI’s.  I assume that if the varicocele repair isn’t effective, we’ll move on to IVF, in which case dude will have to get around to answering my questions.

Emotionally, I am feeling really down.  Don’t know why, other than it all feels very overwhelming, what with other things that we are doing in our lives right now.  Job, school (both of which I am really not into and yet they are a big portion of my life), buying a house, bad economy, etc.  And my poor husband has such a good attitude about the surgery, but we were reading about the aftermath and whatnot and I can tell he is worried about the pain.  Wouldn’t it be nice to just f**k and have a baby like normal people?

Phoebe

Phoebe: IVF Refund Plans. Really?

I have been doing a lot of fertility research lately.  Thank god for my meaningless job and the internet and all of you amazing people out there spouting off about this stuff.  One of the things I heard on the Twin Peas podcast is that fertility clinics are suffering in the economic downturn.  You wouldn’t know it from walking into mine, but if this is the case, isn’t it time they started offering discounts?  One of the myths that was dispelled on this podcast is that doctors can’t negotiate prices.  It turns out doctors are the only people who can negotiate prices.  In fact, a friend of mine had two failed IVF’s with a doctor and after she switched, he offered her a free one if she was willing to come back.  Sounds like they have some pull after all.

On a blog called The Fertility Advocate, I read about a clinic called SIRM that has offices all around the US and is offering a risk-sharing plan “for qualified patients.” In other words, they don’t make you a baby, you don’t pay.

Here is the link: http://www.thefertilityadvocate.com/wpblog/?p=753

Can anyone speak to the legitimacy of something like this? It seems too good to be true. Like, they’ll get you in the door and then figure out “oh gee that’s so funny ’cause you’re not qualified.”

I contacted this SIRM joint to see what they had to say. Here’s how it went down:

Hello,

I have had two unsuccessful IUI’s and we recently learned from a fertility urologist that my husband has pretty severe male factor infertility. He has a varicocele that is likely the cause of 57% of his sperm having damaged DNA. I am about to turn 37, so we feel we cannot wait six months to see if the varicocele repair surgery will be effective. We are in the process of beginning an IVF cycle now that will involve taking the sperm directly from the testicle, rather than from the ejaculate. I start Lupron injections on Monday, 3/30. I read about your CGH risk-sharing plan, and would like more information on it. It would be nice if our fertility clinic shared in some of the risk we are taking on. Especially in these times, $20k is a lot of money. Please contact me at xxx xxx xxxx.

Thank you,

Phoebe

The prompt reply:

Dear Phoebe,

Your timing is great in inquiring about risk sharing because we released another program that screens all embryos for chromosomal problems and if you have normal embryos and don’t become pregnant you get 100% of the medical fees refunded. I would highly encourage you to call Jennifer at the front desk tomorrow and set up a free consultation with me. Once we determine the specifics of your case, you can talk to our office manager, Linda, and get all the details of the full refund program. Additionally, there are other programs such as the two-cycle program or the outcome based program, which re the most popular programs. All of the programs are much less than the amount you’ve mentioned below with up to 100% refund.

Hope to speak with you soon.

Aykut Bayrak, M.D.

Medical Director

SIRM – Los Angeles

1520 E Chevy Chase Drive, Ste. 101

Los Angeles, CA 91206

Tel: (818) 291-1985

Fax: (818) 291-1986

www.haveababy.com

I got online and starting asking other advocates if they had heard about such a thing. One woman who is an attorney specializing in fertility asked me if I had read the contract associated with the risk-sharing plan.

Dr. Bayrak,

Thank you for your prompt response. Would you be willing to show me the contracts involved with the risk-sharing plans you mentioned in your previous email?

Thank you so much,

Phoebe

Again came the prompt reply:

Let’s evaluate you first to determine which type of treatment and plan would best work for you. The we can give you the specifics. Please contact us at the number below for a consultation.

Aykut Bayrak, M.D.

I am somewhat suspicious, but now that my husband and I have decided to get his varicocele repaired, I am thinking it might not be a bad idea to go in and get the consultation. What harm can it cause?

I also sent a long email to my RE with a litany of questions about the consent forms and the IVF procedure. My final question was about the risk-sharing plan and how he felt about such things. I have not yet gotten a reply. I am glad that I decided not to start Lupron injections TODAY. They asked me to sign their consent forms promptly. Ironically, one of the things they want me to sign says that I HAVE BEEN COUNSELED BY MY DOCTOR.  They really expect me to spend $20k and sign my life away without being counseled?  I won’t get an oil change without talking to someone.

Now that we’re going the varicocele repair route, I have at least three months if not more to chill and figure things out.  In that time, I’m glad I can drink ‘caf coffee again and exercise whenever I want. I am also thinking about fertility acupuncture. Anyone know whether it’s covered by insurance and/or whether or not it is effective?

Please advise, ya’ll…

Phoebe

Phoebe: Decisions, Decisions. Now it’s Varicocele Repair.

After much back and forth and back and forth and back and forth and back and forth (seriously, people, make up your frigging minds), my husband is calling today to schedule his varicocele repair. The doctor said that we could see changes as soon as three months from now and we’ll definitely know something in six months. At my age (37 in April), that’s not too long to wait, according to most everyone we’ve talked to. The procedure is covered by insurance (we think), and we can always do IVF if it’s not successful. Going to email my doctor’s office now and tell them we’re holding off on IVF. They will have to wait to get my $24k. Let’s hope we don’t have to go there!

Later today update: the varicocele repair surgery is scheduled for April 17.  BTW, the reproductive urologist pointed out that DNA fragmentation is more important than morphology or motility in predicting pregnancy, and yet it is not part of the initial semen analysis given by most clinics.  I realize the test is expensive, but people should be given the option, for Chrissakes.  Had we done that “expensive” test, we wouldn’t have lost more money and time on pointless IUI’s.

Just sayin’,

Phoebe

Phoebe: IVF Consent Forms Have Officially Freaked Us Out

We spent last night reading “bedtime stories” or, as the lawyers call them, consent forms.  Holy shit, they just led to more questions.  One of the things they wanted me to attest to is that I have been counseled by the doctor who has explained what the procedure consists of, and what the risks are.  Um, no.  The doctor has not even contacted us.  For $20,000 +, I’m calling that some shitty customer service.  Anyway, here are some questions.  Can anyone answer them?
1.  We read that ICSI is riskier than “regular IVF,” but then we were also told in the same breath that these studies were statistically insignificant.  What gives?

2.  Why were we given an ICSI consent form?  Is that just in case fertilization is unsuccessful?

3.  Should we do genetic testing and/or counseling?

4.  When is Assisted Hatching used?  In every case?  How is it determined whether or not it will be used?

5.  We got an estimate from the billing person at our RE’s office for around $15-16,000 for IVF.  Does this typically include ICSI and/or Assisted Hatching?  If not, what are the additional costs of those?

6.  What is the basic information a couple needs to hear from their doctor before moving forward with IVF?

Octo-Mom To Be (joking, joking.),

Phoebe

Phoebe: Back from Asia, Leaning Toward IVF

The pregnancy test, as suspected, was negative.  Before my trip, the doctor gave me a prescription for birth control pills just in case we wanted to start IVF right away this upcoming cycle.  Why do they give you birth control for IVF?  I have no idea.  Anyway, my husband and I are going back and forth trying to decide whether to get the varicocele repair surgery, which is 90% covered by insurance, or just go for IVF, which is going to come in at around $20,000, actually $24,000 with the added procedure of taking the sperm directly from my husband’s testicles.

While I was in Asia, my husband was trying to get an opinion from our doctors in time for me to either start taking the pills (day 2 of my cycle) or not.  This didn’t happen.  He still hasn’t gotten an opinion from his urologist, but our RE said basically we could go either way.  On one hand, we could get the varicocele repair and wait six months.  The risk is that a) my eggs could be degraded by then, although it’s not super likely (as far as age is concerned, 37 is kind of on the bubble) and b) the varicocele repair might not even do the trick.  In fact, my husband showed his test results to his dad’s friend, a urologist, but not a fertility urologist, who said the varicocele doesn’t look big enough to make a difference even if it is repaired.  We’re still waiting for a reply from the fertility urologist about this.  The RE also said that if money were no object, he would suggest going to IVF right away.  We do have the money in savings, only it was for a house.  But if that’s the case, we could just buy a cheaper house.  So basically, the RE left it up to us.  Either way, he told my husband I should start taking the pills regardless so that we could have the choice of doing IVF this cycle.  I started the pills on day 5 or 6 of my cycle (hard to tell since I was 15 hours ahead), and I hope that’s ok!  I just put in a call to my nurse at my RE’s office to let her know the latest.  Tomorrow I am supposed to go in for “Lupron Injection Lessons.”

Before I left for Asia, I talked to a nurse who said that if I were to go to IVF I would start taking injections two weeks after starting the pill.  The RE said I would take them one week after starting.  So I have a message into their office to clear that up.  And if it is all good, I gotta talk to the husband to figure out whether we’re IVF-ing it this cycle.  I have a feeling we are.  The odds of success with the ball slicing are like 66%.  That sounds pretty damn good to me!  Also, who knows?  We could have twins.  Two for the price of one…  That makes the bargain hunter in me all tingly.

Later today update:  OK, we’re IVF-ing.  It’s official.  Apparently, it’s OK that I didn’t start my pills until day 5 of my cycle.  My doctor’s office just sent me a shitload of consent forms that have to be witnessed by a non-family member.  I am now officially overwhelmed.  I will start my injections on March 30th and the “retrieval” will take place around April 20th.  Freaked out!

Phoebe

Phoebe: Supersonic Semen Analysis Results

My husband got the results of his supersonic semen analysis and they were not good.  57% of his sperm have damaged DNA caused by a varicose vein that is squeezing his left nut.  What does this all mean?  Well, his urologist said that IUI’s with this condition are pointless and that we should move immediately to IVF.  He gave two options:

1.  My husband could have a surgery to correct the varicosele, but we would have to wait six months before trying again to get pregnant.

2. They could proceed with the IVF cycle and, instead of using sperm from the ejaculate, actually make an incision in his scrotum to get the sperm directly from the testicles.  Ouch, but I love my husband because he didn’t even flinch at the thought.  Dude is hell  bent on having a baby.  The urologist has found this procedure to lead to 65% effectiveness in IVF.  Of course it costs $4000 and is not covered by insurance.

We are in the process of getting this big equity loan to buy a new house because, let’s face it, this is a good time to buy a house.  Now it looks as if we are probably not going to buy a new house for a while, which is OK, but who the hell wants the loan anymore?  Argh.  Obviously the baby is the priority, so there you go.  IVF, here we come. And then once we get pregnant, my husband can have the surgery for when we try to have another kid…

The news is disappointing, but it feels good to know exactly what’s going on inside my husband’s scrotum.  I have always wondered.

Of course I am still getting the pregnancy test Thursday and you never know, but the odds are VERY SLIM that I am actually pregnant.  I leave for Singapore Thursday night.  Does anyone know what the IVF cycle is like?  Is it something I can start while I’m overseas or is it more involved than that?

Lemme know…

Update:  My mom pointed out that if the varicosele surgery is covered by insurance, then maybe we should get that.  Six months isn’t that long to wait.  I turn 37 in April.  Thoughts on that plan from the peanut gallery?

Yours in ball-choking veins,

Phoebe

Phoebe: Pregnancy Test Next Thursday

Normally I would just wait for my period, but I am leaving town two days before it would likely come. So my RE is having me come in for a blood pregnancy test 12 days after my procedure that will determine our next course of action. Either I’m pregnant, in which case we know what the course of action is there, or I’m not. If I’m not, then the doctor will either prescribe more Clomid or start me on injectables since the last round of Clomid only produced one egg. I don’t think we can consider IVF at this stage with me leaving town for ten days.

My husband went for a scrotal ultrasound (it was a bummer for all involved), and we are waiting for the results. His urologist’s initial thought is that he has a varicocele. Here is a definition: A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.) Varicoceles are found in 15% to 20% of all men and in 25% to 40% of infertile men.

It can be corrected with surgery, but that would put our reproductive efforts off for about six months, so we are not sure how to proceed there. Anyway, he got a supersonic semen analysis and the aforementioned bummer of a scrotal ultrasound, so we’ll wait for the doctor’s assessment in order to figure out where to go on that.

Meantime, every gas pang and slight cramp I feel is immediately presumed to be implantation. I’m trying not to drive myself crazy with it, but failing miserably on that front.

Just very excited to be doing this…

Woo hoo!

Phoebe