IVF #2 - Day Four of Stims

I had forgotten how much nerve it takes to stab yourself in the abdomen with a needle. I started stims four days ago, and as I stood over the sink with my first of three daily injections, I almost started crying when I realized that I ACTUALLY had to put this needle in my stomach. Tears in my eyes, I looked at Derek sitting on the edge of the bathtub watching me, planted my feet, and jabbed it in. And it stung going in, but wasn't so horrible that it stopped me from preparing and taking shots two and three.

Now I've got my routine and I'm done in 20 minutes flat. 150 IU of Luveris (two 75 IU vials with multiple prep steps) and 450 IU Gonal-F. I'm also taking 7.5 mg Femera mid-morning (pills), and steroids in the evening (also pills). In a couple of days, I add a new injection mid-morning to prevent me from ovulating too early. I've added all of these reminders to my phone and check often to make sure I'm not missing anything. Good thing I'm organized by nature and enjoy routine!

When I was contemplating what I would write in this blog post as an update earlier today, I was reflecting on the fact that I've had very few symptoms so far. My abdomen is tender for sure, and I haven't been sleeping well (this is normal for me, so not sure if it's a symptom or not), but otherwise it's still early, so no major bloating. Then, this afternoon, I started getting irritable. And then, about an hour ago, I had a cry. For no reason. Yup, side effects are starting. Now the fun really starts!

This picture is worth $9,004.38

I picked up the last of my medication for our IVF this evening and had a sudden, shocking realization about how much this is going to cost us. It's one of those things people wonder, but never ask - how much does it cost? It depends on how much and what type of medication you need, how long you stim for, what your insurance covers, what types of intervention you need (i.e. genetic testing), and what your clinic fees are. In our case, my insurance covers zero IVF medications, but will cover things like antibiotics, steroids and even the letrozole (Femera). But the most costly medications, which in my case is Gonal-F, Luveris, and Cetrotide, are not covered. Luckily, we can coordinate benefits and hopefully upwards of 80% of the medications are covered by Derek's benefits and we will be reimbursed in a month or so.

In addition to this, the fee for our IVF with the Victoria Fertility Clinic is $9,500. This includes the egg retrieval and associated twilight medication/IVs, sperm collection, embryo culture, biopsy (for PGS - genetic testing of the embryos), vitrification of the embryos (freezing), our first year of cryostorage, and our first frozen embryo transfer. This does not include the PGS itself, which will be an additional $2,000 to $3,500 and is performed by a lab in the U.S. All ultrasounds and lab work is covered under our provincial health care, so no out of pocket costs. We also have travel costs to Victoria, as well as accommodations and food.

Known costs for this IVF: $20,500 -  $22,000 (not including travel and accommodations).

Pro Tip: All medical costs not covered under provincial health care or insurance in excess of around 3% of your total income can be claimed on your income taxes. In general, you should receive around 25 - 30% of your claimed expenses back.

It's a very, very expensive process, and we are lucky we can afford it as many can not. Regardless of the ability to pay, it's still a punch in the gut when you add it all up. Hopefully, in the end, it's all worth it.

Here we go again

Last Thursday we had our scheduled consult with Dr. Hudson with the Victoria Fertility Clinic. Originally, our plan was to cycle in October or November, in part so we could enjoy the summer, and I also had a few cycling goals, which I met (yay, upgrade!). During the call with Dr. H, he asked where I was in my cycle. I was expecting my period over the weekend and said as much, and also mentioned that my cycles were becoming irregular after two decades of almost textbook cycles. Based on that, as well as some of my blood work results, he thinks I might be treading in to diminished ovarian reserve and poor egg quality territory. Then he said 'You know, based on your medical history and what's going on with your cycles, you could and probably should start right away.' A little bit terrifying, but we're ready, so here we go.

Today is cycle day four, and I'm downregulating until the end of August. On September 1st, I start injections. I will be starting with a high dose of Gonal-F and Luveris, which I used for our first IVF. The difference this time is that I'm starting at a high dose, whereas during the first IVF we started low and ramped it up quickly due to poor response. I ended up stimming for longer than normal, which may have overcooked my eggs and resulted in poorer egg quality. This time we're starting with the big guns.

Interestingly, I will be taking Femera at the same time. Femera is also used for hyperovulation, but usually on it's own, and usually for timed intercourse or IUI. From the limited research I've read so far, this should do what I'm referring to as 'slow cooking' my eggs in a way that slightly counteracts the high dose of Gonal-F. This will hopefully result in many high quality, mature eggs.

Starting on September 6th I add Centrotide to stop my body from ovulating and keep things cooking. We head to Victoria to finish things off on September 7th with estimated egg retrieval somewhere between September 12th and 15th. Using a combination of natural fertilization and ICSI (where they take a single sperm and inject it in to the egg - see image below), they will culture the embryos until day five. Each embryo will be biopsied before being frozen and the biopsy cells will go to the U.S. for Pre-Genetic Screening (PGS). This will be done to determine which embryos are genetically normal and ready for transfer, which will take place, if everything works out, sometime before Christmas.

Fingers crossed it all goes smoothly - here we go again!

Hope and Fear

Our seven year wedding anniversary was earlier this week (July 18). Derek took a long time to get around to proposing, so we have been together for more then double that, 15 years. The first time I got pregnant (that I knew of) was in 2007, right around the time Derek started with the fire department. Up until that time, we had never used any type of contraceptive, and I'm honestly not sure why I didn't think my not getting pregnant wasn't a big deal - maybe my mind just wasn't there yet. The day I found out I was pregnant I was bleeding heavily with what a thought was a really long, really bad period. At some point I figured I should probably take a pregnancy test, which I did, mid-day and at work, and it was blaringly positive. I left work and went to the hospital, had the requisite blood work and ultrasound done, and found that I was in the midst of my first documented miscarriage.


It was shortly after that loss that I began to track my cycles, and we agreed that maybe we should just go ahead and start trying to conceive. At our wedding in 2009, I remember thinking to myself that it would be just perfect if I became pregnant right around the same time, but a week after our wedding I got my period. Finally, in 2010, we started TTC in earnest, including working with the fertility clinic.


Despite the time that has gone by, and the losses we've endured, I still, sometimes, hold out hope each month. But when I think of what might happen past that positive pregnancy test, it's a fuzzy, scary black hole. I think it's inherent for us IF survivors, whether we do finally carry to term or not, to be fearful. The joy has been taken away and it makes me sad. I will never get to 'surprise' Derek with a positive test in a cute little gift box, blissfully unaware of what could happen a few weeks down the road. I will never go for just one pee-on-a-stick pregnancy confirmation test at the doctor's office, nor get a single blood test to confirm. I will never go for that first ultrasound full of joy, I will only be full of worry that there will be no heartbeat, that there is nothing there. The first 25+ weeks will be full of fear that I will lose the baby before viability, and then the months leading up to the birth will be full of the same fears plus the fear of birth complications. It won't stop there - I will be a helicopter mom, so worried that our precious prize from our hard fought battle will be hurt, injured, might die in childhood.


As we approach our last IVF, with my renewed hope that this new protocol might be what we need to stay pregnant, I think of these sorts of things and wonder if we can handle it. It's hard to rationalize these conflicting feelings - hope and fear - and I can only hope that the feelings of joy and love can overcome it all.

Reflecting and Regrets

There will always be those songs that trigger strong feelings. For me, when it comes to our journey, it's Lindsey Stirling's Crystallize:

This is because we used this song as part of a video we made a number of years ago when we entered a contest to win an IVF in the US. We didn't win, but the emotional process of making the video and the loving and overwhelming response we had from family and friends will stick with me forever. I have this song on my playlist, and every time it plays (like right now as I'm writing this post) I retreat in to a reflective mood, thinking about where we've been and where we're going.

So where are we going? Well, we've decided to give it one more shot. A couple of months ago I started reflecting (yeah, I do this a lot) on how I really felt about pursuing a gestational surrogate. Derek and I have this philosophy that we try to live with as few regrets as possible, so when making decisions, especially big life decisions, we think about the potential for regret. And I came to the conclusion that I would regret not giving it one more try on our own, especially considering the protocol I'd be following.

I had a call with Dr. Hudson yesterday and we're getting everything in place for a fall cycle. We're targeting an October retrieval, with PGD (genetic testing) on the embryos, then transfer in December or January.

So here we go, one last try, no regrets.

Infertility can make or break your relationship

I originally posted this in a Reddit infertility subforum and had a good response, so wanted to share with some tweaks for this audience.

We have been TTC since early 2007, which means we are just about to start year nine. That is a very long time, almost a quarter of my life by the numbers. Over the years, and especially recently, I reflect on our journey and where it's taken us. This is one part of it that I wanted to share.

This journey has been HARD on our marriage. We have had screaming, throwing things, slamming doors fights about infertility and what our next steps should be. Over the past eight+ years, we have very rarely been on the exact same page about the path forward. Early on when I was pushing for multiple IVF cycles in a row because I was panicking about getting older and was desperate to have a baby, he wanted me to take time to let my body recover. It drove me crazy and I was very angry at him.

About a year ago I finally passed that point where I truly am ok with being child free and it's time to move on (and have posted as much in this blog), but he is adamant that he wants to give it one more go for a biological child with a gestational surrogate - still not on the exact same page.

But through all this struggle, we have remembered (sometimes with the help of the therapist we have been with for as long as we've been on this journey) that it starts with the two of us, and celebrating the highs, working together through the lows, and learning how to compromise, has made us immeasurably strong together. Ultimately, I am happy with my husband, I feel lucky to have him in my life, and if it ends up being just the two of us, that's all I need.

Over the years I have observed many IF couples go through marriage break downs and divorces. It happens in staggering numbers. While in some cases there could have been systemic issues in the marriage that would have resulted in the same outcome regardless, I've often wondered if it was in part because they were so focused on the goal of having a child that they forgot to focus on each other.

For all those who are still in the midst of this, remember to take care of each other through this journey - you're in this together.

Gestational Surrogacy

In one of my last posts, we had outlined an ambiguous long term plan involving multiple IVF's, genetic screening of the embryos, FET's and immune system suppression protocols in the hopes that I would be successful in carrying a baby to term. After some very long and heart wrenching discussions, we landed on pursuing the use of a gestational surrogate - a surrogate would (hopefully) eliminate the unknown that is my body, and the genetic screening and use of 'normal' embryos would at least give some sense of security in that respect. We are not totally eliminating my carrying a pregnancy myself, but it's no longer our focus.

We started our search last December and I slowly entered the new world of Canadian surrogacy via Facebook groups and websites offering matching services. What we've come to discover is that this is not going to be easy. There are limited surrogates publicly offering their services in Canada via matching services or informal online groups, and while surrogacy in our country is legally 'altruistic' (you pay for actual losses, but nothing more), fee-for-service money certainly changes hands in many cases. This brings ethics in to the equation. Is it ok to skirt the law in order to secure a surrogate who expects payment for the 'service' she is providing, and is that changing the ethical implications of surrogates in Canada? If most surrogates now expect payment, and you can afford to pay it, do you still wait until you find a legal surrogate, or do you skip the line?

For now, we are sticking to our sense of ethics and the law in Canada and continuing to search for a surrogate that meets our needs and is aligned with the ethical intent of surrogacy in Canada.

I would like to highlight here that I have had multiple offers of surrogacy in the past and declined because we were not ready to pursue it. I also know that I will have friends and family that read this that may be interested in being our gestational surrogate, so to minimize the risk of uncomfortable conversations, here is a list of non-negotiables (for now):

• Must be healthy - this means healthy weight, non-smoker, no heavy drinking, no drugs (including prescription medication)
• Located in Alberta or British Columbia (preferably near Vancouver or Victoria)
• At least one successful, uncomplicated pregnancy and birth
• If there is a spouse/partner, they must be fully on board
• Available for gestational surrogacy late 2016 and in to 2017

I'd also remind you to read my previous guest post on what surrogacy means for the surrogate: Guest Post: What it means to offer to be a surrogate