Hoops and Hurdles

Done with BCPs! Finally! Continuing on 10 unit shots of lupron every morning for the time being. Slowly, but surely, getting closer to the "real steps" of IVF.

Added note:
I have been doing lupron shots for one week now. On the day of my u/s appt. the nurse gave me my initial lupron shot, just as a demonstration for the IVF nurse coordinator in training. I have one bruise on my stomach. That bruise??? You guessed it...from the shot the nurse gave me! You would think she would be better at giving shots than me, but it seems that I am just a pro at this point! ;)

Florida, updates, and what-not

Matt and I are back from our Subaru sponsored trip to Orlando, FL. We had a GREAT time! We were given multi-day passes to both Universal Studios and Islands of Adventure. We took full advantage of both parks by riding several rollercoasters (Doctor Doom's Fearfall, The Hulk, Dueling Dragons), going on interactive rides (The Simpsons, Spiderman, Men in Black), taking a "river trip" with an unexpected drop (Jurassic Park), and experiencing what a real tornado might be like (Twister). The first night we had a group dinner at Jimmy Buffet's Margaritaville. The food was great, and the entertainment was a blast. They hired caricature artists to draw pictures of anyone who wanted them...or anyone who was coaxed into having one done (which would be us). Ours turned out really well (as you can see above), and we plan to frame it and hang it in the basement. Matt's brother Scott and his wife Renata came up from Tampa on Friday afternoon to join us for lunch at the Hard Rock Cafe. Good food and drinks there (Twisted Mac n' Cheese. Yum!). On Friday night we had an excellent meal at The Palm restaurant with one of Matt's dealers and his wife, in addition to Matt's boss and his family. The poolside at the hotel called out to us on a few occasions, as did the beachy drinks that they offer (Purple Haze...mmmmmmmm). On our last night, we were taken to see the Blue Man Group at Universal Studios. It is an amazing and highly entertaining show. It was better than we could have even imagined. We finished the evening off with a meal that included: lobster mashed poatoes served in martini glasses, sushi, beef tenderloin, pecan encrusted grouper, salads, a lobster pasta, and a dessert bar with cheesecake and pound cake served with a variety of fondue sauces. WOW! I think I gained five pounds with that meal alone! Well worth it, though.

We are back home now and back to the real world. Today I had my appointment at the RE's office for my u/s. My ovaries are both clear of cysts, and they are showing about 17 follicles under 10mm just hanging out. My uterus looks good. All was fine and right as usual. The IVF nurse (and an IVF nurse in training) reviewed with me all of my meds for this cycle. I started with my first lupron injection this morning, and that went off without at hitch. I will proceed with these shots throughout the majority of my IVF cycle. As of today, I only have 5 more BCPs to take...yay! On November 19th I drop down my dose of lupron from 10 units to 5 units. After that, my next appointment with the RE is scheduled for November 21st. On that day I will have my baseline u/s and b/w and will then begin stims shots. It was nice to have had that little FL getaway prior to all of the chaos of IVF really starting. I think we are very relaxed and prepared...so, bring it!

VOTE...VOTE...VOTE...VOTE...VOTE...VOTE!!!

Today is THE day, so get out there and partake in your civic duty!

Meds are being shipped!

It is all starting to feel real again. Aetna called this afternoon to say that all of my authorizations have been finalized, and they are ready to ship my meds. They will all be arriving tomorrow. Now we can enjoy our trip to FL without anything hanging over our heads. Once we are back...the crazy ride begins! Well, at least another part of it.

The Official M & M IVF Season Begins!

Well, we are finally here again. Time to start up the maniacal IVF process. It all begins today. Here is a timeline / overview of how things will go:

• Monday, October 27: begin taking BCPs
  
• Monday, November 10: appt. at SJFC for u/s. begin lupron shots once a day. bring all meds to appt. for instructions and shot demonstrations. (waiting on Aetna to call this week to finalize med order and have them delivered prior to this appt. but not during our trip to FL...fun!)
  
• Saturday, November 15: last BCP taken
  
• Friday, November 21: u/s and b/w appt. first "monitoring" appt. start stims shots this evening, and continue with lupron shots.
  
• Monday, November 24: beginning this day, monitoring appts. will be every to every other day to see how follicle growth and hormone levels are progressing.
  
• Monday, December 1: ER (egg retrieval done under a light sedation / anesthesia) will be during this week. the date of ER is dependent upong monitoring and follicle progress. male partner provides "sample" at this time to be used for fertilization. crinone gel use is started for female partner the day after ER and is used to supplement progesterone production to help sustain a pregnancy IF one occurs.
  
• Monday, December 8: ET (embryo transfer after fertilization and embryo development occurs) will be done around this time. it will occur 3, 4, or 5 days after ER (dependent upon how many eggs fertilize and how the embryos are progressing). ET is followed by 2 days of bedrest to help increase chances of implantation (sorry, but it is for the female partner only!)
  
• 7 days after ER b/w is done to check progesterone levels (must be adequate to sustain a pg IF one occurs)
  
• 14 days after ER b/w is done to check beta / HCG levels (official test for pregnancy)
  

Thanks to everyone for your support and encouragement during this process! We appreciate it, as always!

Hoops and Hurdles

CD one has finally arrived! I need to call the IVF Nurse Coordinator at SJFC tomorrow morning to get my BCP prescription called in. They will also inform me what day I need to start the pills. During the first half of next week I will be waiting for a call from Aetna specialty pharmacy. They will be finalizing the ordering of the rest of my meds for my IVF cycle and then shipping them out. That is where things stand for now!

On a completely random and unrelated note, but to save "post time", I am adding a link to some pictures from the early fall. We forgot to share the pics from our trip to OSU for the Buckeye football home opener!
Here you go: OSU photos

World Series 2008 - Game 3

Well, it wasn't rained out...although it came awfully close! We arrived at the park close to 7pm and waited in the car until there was a break in the torrential downpours. At our first "break" we ran for the park and headed for cover. We passed the rain time drinking Coors Light under cover with 45,000 of our "closeset friends". Finally by 10pm the rains had stopped and the festivities and game got under way. Can you say late start?!?! Oh well, it was worth the wait just to be a part of that fan crazy Philly environment. What a sports town! (I say that as both a good and bad thing, as Matt and I were actually "booed" earlier in the day at Costco just for wearing Ohio State clothing.) The rains never came back, and the full game was played. The Phillies started strong with a couple of homers early in the game. That lead did not hold, though, and the Rays came back to tie up the game 4 - 4. In the bottom of the ninth, luckily, the Phillies scored an ugly run that won them the game. Nobody ever said winning had to be pretty! So, the Phillies currently lead the series 2 - 1. Game 4 is tonight, and we will be watching that one from the comfort of our living room.

Here is a link to the rest of our photos from the game:
World Series 2008, Game 3

Another Hair Cut...

Well, one of these days I really will grow it back out again. I keep threatening that, anyway. I went in and had more cut off today, though. I am happy to report that the damage has mostly been cut out of my hair at this point. I really just needed to have it thinned out and have some shape put back into it so that I COULD actually grow it again. I think I am there...for now...maybe...

Hoops and Hurdles

Well, another hurdle has been cleared! We HAVE been approved through Aetna to do our IVF cycle at SJFC. What a relief! Now we just wait for SJFC to submit the paperwork to get authorization for the meds. Once that is done and authorized, SJFC can order the fertility meds through Aetna's own specialty pharmacy. So far, it looks like we are still on track to start the BCPs and lupron with my next cycle toward the end of the month.

Updated note: I spoke with the IVF Nurse Coordinator at SJFC. She said that I need to call them on CD1 of my next cycle, and they will call the prescription for the BCPs into a local pharmacy. It will be two weeks from that point in time to when I start the lupron, so during that two weeks they will coordinate with the Aetna specialty pharmacy to order the rest of my necessary meds and set up an estimated timeline. Aetna will then ship the lupron and all the stim meds for my IVF cycle directly to me. Simple enough, I guess. All I do now is wait for my CD1, which should be sometime around the 26th of October.

A Good Taste of the Blues - shared by Matt

I had a unique experience this week as I attended a private jam session performed by Buddy Guy, one of the greatest Blues legends of our time. Buddy was in Philly this week to record a live session for WXPN, a local radio station. I was invited by my friend Brian Cavalucci who works with Subaru's ad agency, Carmichael Lynch. There were less than 100 people invited to this event. Seats were right in front of the stage and Buddy came out and jammed for just over an hour. Of course, that description does not do it justice. Buddy doesn't just simply jam. His songs tell a story, and, between songs, he tells stories. He speaks of influencing Clapton and Hendrix and jamming with Muddy Waters and Howlin' Wolf..all legends in their own right. Buddy is a legend, and certainly of a different time, and I am honored to have met him.

The following is an excerpt from his website. Enjoy!

“He was for me what Elvis was probably like for other people… My course was set, and he was my pilot
- Eric Clapton

Any discussion of Buddy Guy invariably involves a recitation of his colossal musical resume and hard-earned accolades. He’s a Rock and Roll Hall of Fame inductee, a chief guitar influence to rock titans like Hendrix, Clapton, Beck and Vaughan, a pioneer of Chicago’s fabled West Side sound, and a living link to that city’s halcyon days of electric blues.

Mystic Reunion 2008

A fabulous time was had by all at the latest reunion held in Mystic, CT. Although we "talk" to each other every day, it is still so great to spend time together in person. We went out to eat, played games at the hotel, went out to eat some more, hung out at the hotel, went out for dessert....well, you get the idea.

Here are some pictures from our weekend.

(front:Leslie, Karen, Betsy, Marie, Michele, and Adrienne / back: Megan and Allie)

(PJ party)

(Catchphrase is fun!)

(back: Marie, Allie, Betsy, Karen, and Megan / front: Michele)

Hoops and Hurdles

Matt and I had our blood drawn on Monday. Results were all "normal" and good.

I had my trial transfer (uterine measurement), pelvic cutlures, and my sonohysterogram (SHG) today. I won't get results of the cultures for a week or so, but I can only assume that will be normal. If it comes back that I have a STD...Matt would have some explaining to do! The rest of the tests were normal, normal, normal. No fibroids in my uterus. No scarring of the uterine lining. Nothing abnormal in uterusland at all.

As long as all the insurance stuff gets submitted and approved, we are on track to do the BCPs and lupron with my next cycle in late October. After that, we would be doing the IVF cycle itself in late November / early December.

Reunion...Year Two

It is soon coming upon the second "reunion" that I have planned with my other fertility warriors. Those who know me well know that I have been conversing for a few years now on a support forum for people suffering with infertility issues. I have become close with two particular groups of women over that course of time. Last year, I took a leap of faith and agreed to meet up with a fairly large group of these women that stretch from all walks of life. I guess that certain struggles in life give you focus, courage, and a sense of self...at least they did for me. I felt empowered to meet these people, as if they were sisters in some sort of secret club that it took a certain degree of suffrage and challenge in which to be included. This is a special group of people.

On this second reunion we will be once again meeting in Mystic, CT. So many of us hail from the East coast (even more so now), and this seems to be a centralized location for most. We have no special plans. We have no special motives. We simply come together to be reunited in our common ground of struggle, perseverance, strength, faith...

Not all of the group is capable of making the trip, as we stretch from as far as Trinidad and Australia. Others simply do not have the time, nor the economic means to make the trip. Once again, we will all be there in spirit. Some of our group are examples of success stories, in that they have achieved the coveted end of parenthood. Others are success stories in that they have stared down the evil of infertility face to face, and they did not succumb to defeat...even though they might never be parents. Others still suffer on the road to an unknown end. In it all...through it all, we lean on each other for support.

I look forward to this adventure (as my husband so lovingly calls it, a "retreat") again this year. These women hold a special place in my heart, as only those who have walked in our shoes can truly understand the separation, anxiety, emptiness, strength, isolation, empowerment...and all the other random emotions that we feel at any given time. We welcome support and empathy in any form in which it is received...but it truly means so much coming from those who have drudged the path that we continue to travel. See you soon, friends....

Hoops and Hurdles

Hoops and Hurdles is going to be our new "update" section. Anytime you see that title...it will just be a brief update on another hoop jumped through or hurdle jumped over on our track to IVF.

Matt had his semen analysis, and we just received the results on Friday. His sperm concentration came back at 207 million. 187 million were motile (moving), which translates to 90% motility. This is read as a "normal" semen analysis...but we think it is better than normal...we think it is pretty great! Matt especially. He claims the state of NJ is going to hold a parade in his honor because his results were soooo good.

Matt and I will both be going for our required bloodwork on Monday.

Matt and I both have to start a required course of antibiotics (Z-Pak) on Wednesday. We only take the five day dose, and we are done.

I will be going into SJFC for all of my other testing on Friday: uterine measurement / trial transfer, cervical cultures, pelvic ultrasound, and sonohysterogram.

Results of all testing will be posted when as we receive them!

Calendar Coercion

It is an intricate and delicate choreograhpy of multiple items that needs to take place in order for our calendar to be appropriately coerced into suiting not only our social and work lives, but also our upcoming IVF cycle. I have been diligently working on this routine for the past week, and I have certainly made some progress. Things are decidedly falling into place, and I am amused that I have become so good at feeling out and setting up this process. Perhaps bemused is a better description. So many things need to happen at the exact "right times" in order for us to be able to: get all of the screenings done, get the appropriate approval for the IVF cycle, entertain friends coming to town, attend a class reunion, take a company trip to Orlando, AND enter the IVF cycle prior to Christmas. To those on the outside, it might not seem like this would be overly difficult to achieve...however, there is always SO much involvement, not only for the testing portion of all of this but also for the IVF cycle itself, that it can be a daunting task.

I received a call from Kat, the IVF nurse coordinator at SJFC, and she will be helping me to work through and choreograph this process. She had to wait until she had all of our information back from the billing department before she could call me and start the planning. Billing interfaces with the insurance company in order to find out what hoops we all need to jump through while on this course. The billing department notified Kat that in order to even get the ball rolling for the IVF approval process, Matt and I both need to have our infectious diseases bw done, Matt needs to do his SA, and I have to have cycle day (CD) 3 bw done to test my FSH levels. However, in order for Matt to do his SA, he first has to have a referreal from our primary care physician (PCP). See how this starts to get complicated? Well, that is just for starters!

My next cycle is coming up...and in order to move forward with an IVF cycle prior to the end of the year, I would need to have ALL of my RE required screenings done with this upcoming cycle. So, I asked Kat if this was feasible and possible. She said that I need to be sure that I have approval for all of the screenings, so Kat referred me to the billing department. The billing department "thought" that I would be covered for all of the testing, but they recommended that I call Aetna just to be on the safe side. So, I called Aetna...and lo and behold...I am covered for all of the screenings. Several hours and phone calls later into this mission, I now had answers! As long as SJFC can fit me into their schedule, I will be able to complete all of my tests with my upcoming cycle..and this DOES keep us on course to do ER and ET prior to Christmas. It also would allow us to keep all of our committments that we had penned on the calendar prior to reentering the world of IF and IVF.

For those of you who are well-versed in the world of IF and expect these miniscule details, or for those of you who are just simply interested, this is what is in store for this cycle:

• SA for Matt
  
• infectious disease panels for both Matt and I
  
• blood typing for Matt
  
• CD3 bw for me to test my FSH and E2 levels (ovarian reserve)
  
• pelvic evaluation for me, to include: uterine measurement (trial transfer), cervical cultures (to check for disease or infection), and a pelvic u/s to check ovaries
  
• sonohysterogram for me: they will inject saline solution into my uterus through a catheter. they will then use transvaginal u/s to check the uterus for abnormalities (fibroids, tumors, scar tissue, etc.). this will reveal whether or not there is anything in my uterus that could affect implantation or that could cause m/c

Once all of this has been accomplished, AND we have received our approval to do the IVF cycle...the treatment part will actually begin. It can be a dizzying venture, but for old pros like Matt and myself...these pieces of the venture are just simple and necessary evils.

Not our first rodeo

Altogether true. Wholly, an understatement. We have been here many times already and have thus far been quite disappointed. Each time is always full of new hopes, anxieties, and excitement, as we allow ourselves to dream just a little. Not too much that a defeat will knock us down and not allow us to get back up, but just enough to make the effort worth it. Each time is filled with a new bit of cynicism, too. We are wounded but not ultimately defeated.

So, to the rodeo we travel once again. I think going back into treatments is somewhat bittersweet. As much as we enjoy the prospect that maybe this time will be THE time, it is hard not to be a wee bit apprehensive. We have been enjoying just being a couple, doing the things that couples do when they aren't worried about black clouds hanging over their heads. Starting this process once again throws us into a whirlwind of unknown and sometimes unexpected emotions. We now have to start planning ahead, changing plans to fit into or around any upcoming cycles. Everything starts to be affected by what we will or may possibly be doing on a given day or during a given week. Everything is affected by how things will or may end up. Some people who haven't walked in similar shoes, albeit unintentionally, start to tread lightly around us because they just have no way of fully understanding. None of this is easy, but ALL of this IS outweighed by the potential reward. We cling to that. We have to.

Today was in someways a "kickoff" to all of the above. I had my initial consult with South Jersey Fertility Center (moving forward, known as SJFC). I met with my new RE, Dr. Van Deerlin to discuss our fertility history and our fertility future. Dr. Van Deerlin was extremely sincere, thorough, and likeable. He made a point to memorize our history prior to coming in to speak with me. This was impressive and the first time that an RE had really put forth such an effort. It was refreshing. The recommended treatment our RE proposes is quite simple: IVF. Getting to that point is a little bit stickier, but it will happen. Here is what things look like for us:

• Matt needs to see our PCP in order to receive a referral for a SA
  
• Once the referral is in place, the SA will be done at SJFC
  
• I need to contact the IVF Nurse Coordinator to get set up for all of my screenings. She will need to coordinate all authorizations and approvals with Aetna.
  
• We will both need to repeat testing that we had done in the past, namely the infectious disease screening (for HIV, AIDS, Hepatitis B and C, measles, etc.)
  
• Starting with my next cycle, I will have a plethora of things that need to be done: pelvic evaluation, uterine measurement, cervical cultures, a
  sonohysterography (which checks for uterine abnormalities), and day 3 FSH and E2 bw

All of this will take at least one cycle to complete, so it will be at least one to two months before we will even begin the actual IVF cycle. The cycle will be a straightforward IVF cycle. Nothing too fancy. Nothing too new. Much more on the actual IVF cycle will be noted once we get closer to that time.

So, we have unofficially blown the dust off of the cowboy boots and are ready to climb up on that bull and get back in the ring. Hold onto your hats...rodeos can be rough...

Red Tape

As usual, there is always red tape to get through in the infertility world. I finally looked into what needed to happen for me to be able to make a consultation appointment with the Reproductive Endocrinologist. I first spoke with a lovely woman on the Member Services line for Aetna. She answered some very general questions for me regarding all of our coverages, referrals, referral processes, and more. She could not offer me any detailed information regarding infertility coverages, though. Luckily, Aetna has its own dedicated Infertility Services department / line for the state of New Jersey. See, NJ is a "mandate state" for infertility benefits. Go, NJ!!!

The woman I spoke with on their dedicated IF line was VERY helpful. Imagine that...a helpful benefits representative! She walked me through the entire process. I need to get "authorization" from the HMO in order to go for the initial consult. The rep handled that over the phone through a brief, yet detailed interview. I am now approved and authorized to go for a consultation AND to have the South Jersey Fertility Center put me through a "monitoring cycle". This cycle will involve bloodwork and ultrasounds in order to show that all looks good and that I am ovulating. After this cycle, the Reproductive Endocrinologist will decide if any more testing for Matt or me is necessary AND / OR what the next treatment steps would be. When we get to this point, all authorizations will be applied for by the RE's office and approved (hopefully) by Aetna. I will personally be out of the red tape loop!

So, our consultation is now scheduled for Wedensday, September 10th at 3pm. I will be seeing Dr. Van Deerlin. I scheduled this appointment, of course, on the only day that Matt was not available. Given that we are "old pros" at this game, we decided it didn't matter, so I will be going solo.

Here is what I learned today about our GERNEROUS coverages:
* UNLIMITED lifetime IUI cycles (artificial insemination)
* Four lifetime fresh IVF cycles (includes past covered attempts, so we have 3 left)
* UNLIMITED frozen embryo tranfers
* diagnosis, treatments, and related meds are all covered

* cyropreservation is NOT covered
* PGD is only covered on a case by case basis, and at this point I would be denied

All in all, looks really great!!! Aetna also uses a "less before more" approach, so you have to exhaust less invasive and less costly treatments before you will be authorized for more invasive and more costly treatments. Given that I have already been through 4 IUIs (not to mention IVF and FETs), the rep from Aetna thinks I will be have no trouble getting approved for IVF right off the bat. All that needs to happen is the RE's office has to fax over my past IUI cycle information / results to Aetna so that they can review them and hopefully approve them (aka:"behind the scenes" red tape). No big deal.

That is the scoop for now.

I am including in this post some general abbreviations for amateurs in the world of Infertility (IF). This will be the last post in which I write out all the big words...just takes too much time, and, after all, this is MY WORLD...you are just visiting it!!

IF = infertility
tx = treatment
dx = diagnosis
RE = reproductive endocrinologist (aka, fertility specialist)
IUI = intrauterine insemination (aka, artificial insemination)
IVF = invitro fertilization (eggs removed / fertilization with sperm in petri dish / embryos grow / placed back into uterus)
PGD = pre-implantation genetic diagnosis (testing of embryos for chromosomal abnormalities prior to being placed back in uterus)
b/w = bloodwork
u/s = ultrasound
pg = pregnant / pregnancy
BFP = big fat positive (positive pg test)
BFN = big fat negative (negative pg test)
OV = ovulation
OPK = ovulation predictor kit (at home)
endo = endometriosis
m/c = miscarriage
s/a = semen analysis
POAS = "pee on a stick" (home pg test)

If we think of any others moving forward, I will try to fill you in!

Stay tuned...

A chopping we will go....

Hair chopping, that is. I finally took the plunge and had all of my hair hacked off. I needed to get rid of all the damage from the unfortunate color mishap that took place back in CO. There were also some funky layers left from my last haircut in CO, and it all looked disconnected. So, I am starting from scratch to get my hair healthy so I can grow it back out again. Oh the joys of being a woman...

Housewarming

Matt and I had our first housewarming party. I now live closer to some of my friends that I met through the fertility support board, and they came out to spend the afternoon with us. It was nice for Matt to finally be able to put faces and names together, and it was fun having the husbands all there. A great afternoon, and we can't wait to do it again! I look forward to having more parties at the house to really "break it in". It certainly is feeling like home now for both of us. The area / location just could not be any better for us, and we look forward to sharing more of our new adventures as they take shape. I am sure there will be oodles of them knowing us.

Our New Home - Slideshow now available

Hello there! I have finally taken photos of our new home and compiled them into a slideshow. Instead of embedding the show on this site, I am providing you all with a link to our web album. This way you can see and read all the captions, too. Once you click on the link below, it will take you to the web album of our house. On that page, simply click on the "Slideshow" button...and it will do the rest! I hope you enjoy it!

Matt and Megan's new home

Thanks for stopping by!