CCRM · one day work up

WTF

I mean, why is it that when I need my body to actually behave it doesn’t? I just started my flippin’ period! It’s been 16 days since I last started. I wasn’t due to start again for another 8 days or so. WTF?!?! So what this means…I’m going to assume nothing right now. CCRM says they want you there between days 4-15 for your work up. This will put me out there on day 17. I’m guessing they want it done during the first part of your cycle just in case you’re pregnant. Since that is impossible for me, I’m going to assume it will be okay. I’ll put a call in to the nurse to make sure though. Please be okay! I’ve already booked flights, car rental, and hotel. Not to mention I’ve found a sub for my class for the two days I’ll be out. UGH UGH UGH!! Fingers crossed they don’t want me to change it. Or even better, maybe this is just spotting due to ovulation (even though that’s never happened to me, and I have cramps, and it’s very much like a normal period for me). Sorry if all of this is TMI, I’m just so mad at my body right now!

UPDATE:
I called CCRM and told the nurse what was going on. She said that they could reschedule me for Feb. 2, but it would have to be done by a different doctor. She said she’d have to get that signed off with Dr. Surrey and she’d let me know. I asked her if the reason for the day restrictions were to make sure I wasn’t pregnant, and explained that my tubes are tied and deformed, meaning I absolutely can’t get pregnant. She didn’t really give me an answer, but told me she’d check with Dr. Surrey on all of that. So I had about 45 minutes of freaking out, calling Ryan and crying, panicking about the flight change restrictions, etc. and then she called back. She said we can keep it for the 5th. (*giant sigh of relief!) She said that the one stipulation is that I don’t have unprotected intercourse for that cycle. (HUH?) I asked if that’s true even if my tubes are tied, yada yada yada, and she said yes. So now, how to explain this to the hubby?? I kind of want to call her bluff on that one. I mean, I feel like she’s just repeating what she’s been told without thinking it through. Thoughts?

I’m also still kind of hoping that this is some weird fluke and I’ll stop bleeding by the end of the day. Then I can just chalk it up to ovulation, increased exercise, and stress.  Don’t think I don’t find the irony in the fact that I was just complaining about playing the waiting game with nothing to do or think about!

CCRM · ivf · one day work up

Schedule for the one day work up


Here is the schedule the nurse sent me for our one day work up at CCRM. It’s pretty boring stuff, but if someone is looking at doing a work up out there, it might be nice to see the kind of day you might have. It also helps to see the costs of all the tests. 

Colorado Center for Reproductive Medicine & Fertility Labs of Colorado

10290 RidgeGate Circle, Lone Tree, Colorado  80124      (303) 788-8300

Name                  Scheduling Date: 1/6/16          

Doctor for MD appts below: Surrey               Per: Tonie                    Cycle Day 1 (est):

Appointments must be within days 5-13 of your cycle, unless otherwise approved by your physician.

We have scheduled the following appointments for you on: Friday February 5th, 2016

Out of state patients:

We strongly recommend you arrive in Denver the evening prior to your appointments to avoid last minute stress due to a possible flight delay. Denver International Airport is approximately 1 hour of drive time away from CCRM.CCRM strongly suggests that you do not schedule a flight home until 7pm or after.  Due to the number of appointments scheduled as part of your work up, we are not able to reschedule your appointments to accommodate an earlier flight time.

On your appointment day:

Please be sure to pick up a schedule when you check in for your first appointment.  This will assure that any minor appointment time changes are reflected on the schedule you have for the day.

Remember to check in with a receptionist whenever you are ready for your next appointment as scheduled.

Appt.
Time
Test or Consult
Who
Fee
1
6:45
2
7:00
Nurse:  Orientation to IVF at CCRM / required appointment
Couple
Included in pkg.
3
8:30
Baseline
Ultrasound + Doppler
Female
$670
4
9:15
Semen Analysis + Antibody Testing   (ASAB)  (+ culture to be billed by outside lab)
+ Chromatin Assay
Male
*-FLC pymt *
$240* male
$135* female
+ $465 for Chromatin Assay
(blood  draw
with other labs)
+ culture to be billed by outside lab
5
10:00
Fertility Labs of CO
(FLC) Consent Review
Couple
Included in pkg.
6
10:45
Nurse Consultation
Donor Nurse
Couple
Included in pkg.
7
11:30
Hysteroscopy
Female
$725
8
11:45
Regroup
Couple
$119
9
12:00
10
12:30
Nurse – IVF Consult
Shipping Kit:
Y or N
Additional fees apply
GC/C Collection:
Y or N
Couple
Consult included in pkg. Additional shipping kit fee may apply.
11
1:45
Standard or Extended  Workup Labs, Communicable Disease, Genetic Screening Blood Tests
GC/CT DNA urine
Important:
Discuss Genetic Screening Tests with RN prior to blood draw.
Couple
*-FLC pymt. *
Standard:
$415/male
$415/female
Extended:
$1115 /female
$1115/male
Other & Genetic:  As recommended
by your MD
12
2:30
Psychologist – Donor Recipient Consult
Couple
Included in pkg.
13
3:30
Business Office
Couple
14
4:15

* Fertility Labs of Colorado Charges – FLC is contracted with United Health Care insurance onlyat this time.

If you have an insurance plan other than United Health Care, or no infertility benefit with United Health Care, lab testing by FLC will be considered “patient pay” and payment is due at time of service.

We will send claim forms to you upon request for you to submit claim to your insurance if applicable.

Please note: neither CCRM nor FLC accept American Express.

This is the standard/mandatory workup.  Based on your history, your physician may recommend additional testing during your visit which may result in additional fees.  Please contact the Business Office with any financial questions. Please note that if you opt to have genetic testing done, there is a $25.00 Good Start Set-up Fee in addition the fees charged by Good Start Genetics.


Test Requirements & Instructions:

ASAB (Anti-Sperm Antibody Test)2-5 days abstinence prior to test.    

Baseline Scan/Doppler UltrasoundAvoid caffeine (coffee, tea, chocolate, etc.) for 3 days/ 72 hours prior to this ultrasound examination. (Caffeine effects blood flow which is measured by Doppler.)

Hysteroscopy – The hysteroscopy can cause some cramping, similar to menstrual cramps, and you may take 800 mg of ibuprofen 1 hour prior to the procedure.  The procedure should be performed when you have a partially full bladder.

Please note:  No tampons or intercourse or submerging in water for 1 week after the procedure.

Denver, the “Mile High City,” is at 5280 feet. Our altitude is high and our humidity is low.   Please be sure to drink plenty of fluids to feel good and be well-hydrated for your blood draw.

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As for me, I have some questions to ask about some of these tests that I’m scheduled for. I’m wondering that if we’ve already done some of them at our previous work up, will we have to do them again? I know they need to do the ultrasounds and hystoroscopy, to check my uterus and baseline follicle count, but do I really need to be tested for HIV again? I’d like to save as much money as possible, and that along with the genetic testing seems like overkill. We’ve already done all of that, and it all came back negative. I realize it could be possible for someone to contract HIV in five years, but I assure you I have not.

It’s also interesting to see all of the restrictions listed below the schedule. I completely forgot about the abstinence from sex for 72 hours, and the no caffeine thing. No caffeine 5 years ago was a big deal and not fun. No caffeine now may be the death of me. I should probably start weening myself off slowly over the next couple of weeks. My morning coffee is what gets me moving!

In other life news, I have a girls’ trip planned with my college girlfriends and I am SO EXCITED!! It will be a welcomed break and I cannot wait to see all of my friends, some of whom I haven’t seen in years – like maybe 6 years? Crazy! I’ll be honest...the no drinking, no caffeine thing – well, it’s probably going to start after this weekend.Cheers!
CCRM · ivf · one day work up

Endless thoughts

Make the thinking stop! I hate this waiting game. I am a planner – type A, OCD, crazy person, planner. I can’t help it. It’s part of my nature and it’s something I have accepted about myself. It drives Ryan crazy because he is the complete opposite. In fact, our fights usually revolve around me having a plan, time frame to get things done, etc. and him, well, not.

Usually, I am proud of my planning tendencies. I am fairly organized and prepared (well, most of the time). But it’s what makes times like this, in my world of infertility, so excruciatingly painful. I’m ready to plan. I’m ready to know when we’re going to cycle, if we’re going to cycle. I’m ready to start the process of choosing a donor, if we have to choose a donor. But none of that can be planned until we know the answers. So now, all that’s left to do is wonder and make several plans, all of which probably won’t happen the way I plan them, but alas it makes me feel better anyway.

So, all of that is to say that I  have been thinking..a lot. I have been preparing myself for the worst in regards to news we’ll get at the work up in February. Call me a pessimist if you want, but it has become my coping strategy. It dates back to that horrible day I found out my tubes were “blocked.” I went in there with the idea that it may solve our problems, and came out realizing my problems were far worse than I ever anticipated. And then I got my hopes up for that first IVF since I was so young and “only had a tube problem.” After those failures, and finding out I also have an egg problem, I figured out that it’s best to never get my hopes up in regards to my fertility. Expect the worst, pray for something better.

So, that leads me to now – I’m expecting them to say I need to use donor eggs. Actually, that wouldn’t be the worst thing they could tell me. If I’m truly honest, I could think of several things they could tell me that would be far worse – like my uterus is too damaged to ever carry a baby again – but we just simply won’t go there. In fact, I’m just hoping for some clear cut answers. I don’t want to go there and them say “well, you might have a chance with your eggs, but we’re just not sure.” I don’t want to have to make the decision. I either want them to say, “yes, we can do this” or “no, we can’t.”

Okay, I keep getting off track. My whole point of this post is that I am preparing myself for the idea of using donor eggs. I’m trying to get my head wrapped around it, and I’m actually warming up to the idea. I know I won’t love the child any less.  There have been studies that show that a fetus actually acquires genetic tissue from the mother while in the womb. That the bonding that happens in the womb far out ways the genetic material from the egg itself. Using donor eggs would mean a much better shot at being pregnant and having second child. We know that for a fact. It would also, most likely, give us enough embryos to freeze to possibly go for a third child later on, if we so desired. Using donor eggs would mean subjecting myself to fewer hormones, less physical pain (no egg retrieval, bloated ovaries, etc), and less time commitment (daily ultrasounds, etc). So, I’m seeing the pros more than the cons.

But, the big con I do see is this: what will other people think? I don’t mean what they will think of me. I could care less what they think of me. What will they think of my child – the one that I haven’t even conceived yet. Will they compare that child to the biological one that I have? Will they think this child less mine than the one I have? I have already heard comments from some of my family members – who told other family members – and of course it got back to me. They said “I just hope she doesn’t go the donor egg route because that’s just weird.” What a horrible thing to say! What if I do go the donor egg route? Should I take that as you feel awkward around that child? Will you think of him or her as less of your nephew or niece? (yes, it was my brother who apparently said it). I’ll be honest. It kind of breaks my heart to think about it. I think I just won’t tell anyone. But then I wonder, will I be able to keep that kind of secret? This blog is what helps me get my ideas out and feel support from some of you. Will I have to keep it a secret here, too? Should I just not tell anyone?

Sorry for all of the ramblings. This is seriously what has been going on constantly in my head over the last several weeks. And the annoying thing is, I can’t truly answer any of these questions until we get answers ourselves – Feb. 5th. Can it get here already?
CCRM · one day work up

One Day Work Up Scheduled

I finally talked to the nurse yesterday and scheduled our one day work up for February 5th. We’ll fly out there the day before and stay through the weekend. I’m really excited to have this time with Ryan out there because I feel like he missed out so much on the Colorado experience before. When we went to our egg retrieval 4 years ago, we flew out there Thursday night, ODWU on Friday, and flew out Saturday morning. I got a lot of tourist time when I was out there for the IVF cycle, but he only got to come out for the egg retrieval and bed rest part of it. So it will be nice to have a full day to just piddle around. Plus, now that we have Anadine, it’s extra nice to get that time away with each other. She’ll stay with my mom in Jackson while we go out there. AND there’s an IKEA out there now that wasn’t there before. Fun fun! So, I guess until then there won’t be much news to post. But I’m getting excited to get some real answers and know what our next steps are.
CCRM · donor eggs · estradiol · FSH · one day work up

Follow up with Dr. Surrey RE: day three blood results

Before I get too much into what the good doc said, here is information regarding my hormone levels, more specifically compared to my levels in 2011.
FSH levels (determines egg quality and ovarian reserve)
Normal: below 10, Mine in 2011: 9.7, Mine now: 14.4
Estradiol (estrogen levels)
Normal: below 50, Mine in 2011: 78, Mine now: 48
AMH (determines egg quantity)
Normal: 1.8, Mine in 2011: 0.9, Mine now: 0.8
Okay, so the biggest difference is my FSH level. It has risen quite significantly. According to the doc, this obviously isn’t great, but the good news is that my estrogen levels dropped to a normal range. He said something about how the FSH levels and estrogen levels work together and if one is high, you want the other to be low and vice versa…I didn’t really follow and the more research that I do online the more confused I get. From what I can tell, low estrogen levels aren’t a good thing and it just means I’m closer to menopause, but I suppose I’ll trust the doc for now and ask more questions when the time is right. My AMH levels haven’t changed much, which is good, although they are very definitely in a not so great range. Dr. Surrey said that from what he’s looking at right now, I’m not in the range where he’s going to say no way, no how. But, he’s also not fully confident in my chance of success. He said that considering in my last cycle, while it is obviously considered a success, it still wasn’t a great outcome in that I only retrieved 7 eggs, only 5 of those eggs fertilized, and of those 5, only 1 made it. And while we are glad for that 1, it doesn’t necessarily predict great success for another IVF 4 years later.
He then went on to say that there are two more pieces to the puzzle that will really give us a clear picture of what we’re working with: an antral follicle count and a glimpse into my uterus. Both require an ultrasound that they want to perform in Colorado. So then came the news I’ve been waiting for: he wants us to come out for the one day work up. I’m totally okay with that (even kind of excited). I remember feeling so informed after going for the ODWU last time, and I really feel like it would give me peace of mind.
Ryan and I did have a conversation last night about all of this and I shared what we discussed with Dr. Surrey. We are both pretty adamant that we don’t want to go through multiple IVFs to achieve our goal. I simply don’t want to put all those hormones into my body. It’s been shown that they increase chances of ovarian and breast cancer, among other things like making you crazy and fat!! That’s not saying we don’t desperately want another baby, but we’re just more willing to use other means to achieve that goal this time, like using donor eggs. When I mentioned that to Dr. Surrey, he said that using donor eggs would give me about an 80% chance of success, and could even end up being the most cost effective. However, he made it clear that he doesn’t want me to rule out using my own eggs just yet, at least not until we get the missing pieces to the puzzle at the ODWU. He did say that he would make sure we had meetings set up to discuss the donor egg process while we’re out there. It will be much easier to discuss all of these possibilities in person instead of over the phone.
So anyway, now I just wait for the nurse to call and we’ll schedule to go out there. I’m thinking it will end up being towards the beginning of February. It has to be done between cycle days 5-14, so that either means next weekend (eek!) or February. I just don’t think I can get my act together in time for next  weekend. Especially since this go around I have to figure out child care. So, now it’s just the waiting game. In the meantime, I’ll try to get healthy and prepare my body to be poked and prodded. I need to eat healthier, drink less wine at night, and drink lots more water! New year resolutions!!

CCRM · ivf · one day work up

One Day Work Up Complete

Well, we are back from Denver with a lot to think about! First of all, Denver was beautiful, and CCRM was a very nice facility with very nice staff – although after everything that I had heard about it from people who had been, I have to admit I was expecting it to be a little grander! haha!

So most of the day was spent talking to a lot of people. We met with a nurse (a very scary nurse I might add) who gave us a basic run through of how CCRM works. Then we met with the nurse that we will be working with for our IVF cycle. She was super nice and informative. I had an ultrasound to check my antral follicle count (resting follicles) and they saw 9 follicles total. They also saw two cysts on my left ovary which completely freaked me out at first. Then we met with the doctor and he didn’t seem to be too concerned about the cysts. He just said we’ll keep an eye on them and hope they go away on their own. He said that an antral follicle count of 9 isn’t great for someone my age but it isn’t terrible either. He said it’s just below average so he doesn’t see why we can’t give IVF another shot with my own eggs – yippee! He said it will take a pretty aggressive protocol (lot of meds) but he’s willing to give it a shot. In that same ultrasound they checked the blood flow to my uterus – that was pretty cool to watch. Everything looked good there, and he said that the shape of my uterus looked good, too!

When I had the HSG a year ago it showed a blockage at the distal end of my tubes but no dilation which means that there wasn’t any fluid in the tubes (what is called hydrosalpinx)so the doctors I have talked to didn’t have any concern about my tubes being blocked as long as I’m doing IVF – since IVF bypasses the tubes. Well, Dr. Surrey seems to think that I need to have a laproscopic surgery to remove the tubes to be on the safe side. Just in case there is some fluid in the tubes, he doesn’t want to take the chance that the fluid could flow back into my uterus and kill any embryos that are trying to implant. We’ve been here before – trying to decide whether or not to have the lap done, although before it was to clear the tubes, now it’s to remove them. We decided against it because the lap surgery would have cost around $10,000 – about the same as an IVF cycle and we figured we would put our money towards something that would be more successful (or we hoped anyway). So at first R and I were pretty against it. We just don’t have an extra $10,000 laying around! But then the nurses talked to our insurance company and convinced them to pay 50% of the surgery. We’re still not convinced it’s necessary, and we still don’t have $5,000 laying around! So who knows – just another decision to make!

We met with the business office and signed all sorts of consents – R and I felt like we were buying a house we signed our names so many times! I had another ultrasound of my uterus done where he checked to see if there were any fibroids or polyps that would get in the way and all was clear. It wasn’t the most comfortable experience because he also did a trial transfer to make sure there wouldn’t be any problems when the actual transfer happened. But it was just some cramping that went away pretty soon afterward. During that time R had to give a sample – the boys always have the easy part!

Then R and I both had to give blood for some tests. R had to give 2 whole vials and he was such a baby about it. Until I got in the chair and had to give 10 vials of blood – after that I felt a little light headed but the nurse gave me some juice and cookies. R got some juice and cookies too for being such a good support system! 🙂 We should get those results sometime this week – they’re checking hormone levels as well as testing to see if I carry the fragil x gene. We opted not to get the other genetic tests run because we don’t have any reason to think we are carriers. We might get the tests done at a clinic here, because there’s more of a possibility that insurance will cover it.

All of our meetings regarding donor eggs were very short or canceled because we no longer needed to discuss that possibility, so we got to leave a little early. It was a long day for sure, but very informative!

Now we’ll wait to get the blood test results back and we have a phone follow up with Dr. Surrey on the 23rd. In the meantime I have to wait for my next cycle to start and I have to go some place here to have my blood drawn on day three of my cycle, freeze it in my freezer, and ship it to CCRM for them to test my day three hormone levels.

Lots to think about! I will post more when I find out results!

CCRM · ivf · one day work up

One Day Work Up

Well, the one day work up is scheduled — for February 11! I can’t believe how soon it is. I got the schedule yesterday and it looks like hubby and I are going to be poked and prodded from head to toe from about 7:30 in the morning until 3:00 that afternoon. We’ll fly out to Denver on Thursday, do our testing on Friday and then we’ll get to spend our Saturday enjoying the sights of Denver. There’s a lot to get done between now and then. I have to book a flight, hotel room, and rental car. I have to figure out how to finance all of this – ugh! If anyone has Southwest frequent flyer miles that they don’t plan on using send them my way! (just joking)

CCRM · Dr. Surrey · ivf · one day work up · phone consult

My CCRM phone consultation

So my phone consultation was last night. It went pretty well, I guess. Dr. Surrey didn’t tell me much of anything that I wasn’t expecting, or didn’t already know. He threw out some idea of tests that I need to be sure to do, to make sure the hubby and I aren’t carriers of certain disorders. He said that women under the age of 40 with a high FSH (that’s me!) tend to be carriers of the fragil x gene – which causes mental Retardation. He also wants to be sure that hubby and I aren’t carriers of cystic fibrosis. He also told me some supplements I could take to improve egg quality, which I will start taking IMMEDIATELY!

The main thing he told me was that he was concerned that at my last egg retrieval I had 5 follicles but only got one mature egg from them. He said that I may not have responded to the trigger shot and that CCRM fixes that by doing blood work the day after the trigger to make sure you’ve responded to it, and if you haven’t they give you supplementary injections to make you respond to it. Or it could just mean that my egg supply is so low that there were never any eggs. If that’s the case there’s not much they can do. Let’s hope it’s the first option! I mentioned that I felt like my RE may have jumped the gun a little bit – that he was so excited that I was actually growing some follicles that he may have triggered me too early, and Dr. Surrey said that was very possible – the he would normally like to see the follicles be larger than mine were at egg retrieval.

Anyway, he wants me to go out and do the 1 day work up with them. He wants me to go through all of the testing for IVF plus all of the testing for using donor eggs. That way if we find out that we need to go the donor egg route, we are already set to do that – no more wasting time! I’ll do lots of blood work, ultrasounds to look at my antral follicle count which will give me a good idea of how many eggs I actually do have left, and an extensive look at my uterus to make sure there aren’t any problems there. Hubby and I will also have a session with the psychologist to discuss our thoughts on donor eggs – which will probably be very beneficial. In fact, I think that’s the part I’m most looking forward to!

So I’ll call today and set all that up, I guess. And then it’s a matter of waiting for my next cycle to begin and figuring out when I can go out there. He didn’t seem very optimistic that my chances are great with my eggs, but I appreciate his honesty nonetheless. I guess we’ll just have to wait and see what all of the test results from the one day workup tell us! Colorado, here we come!