Dancing dubbed, Muppet Interviews and Gervais w/Elmo

To the untrained human, trying to get pregnant simply involves gettin’busy, knockin’ boots, makin’ bacon, the lust and thrust, the bump and grind, havin’ a bedroom rodeo, some hanky panky, gettin’ lucky, a roll in the hay, a good old fashioned shag…..

……but for those of us in the infertility trenches, we know getting pregnant means trying to hone your body into a perfectly balanced eco-system of hormones and chemicals you never knew you had while aligning the planets during a mystical creatures convention where a unicorn nods approvingly at you and The Cubs win The World Series.

It can be daunting.

For me, it boils down to having a constant stream of distractions, shiny objects and things to occupy my brain.  I share some here each week.

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This clip is from Awakefest 2013, and some genius figured out that it would be fantastically better to set the dancing of these festival-goers to the theme from Benny Hill. I couldn’t agree more.

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Here’s a clip from Unscripted – Jason Segel, Amy Adams, Miss Piggy and Kermit the Frog all taking audience questions re: the release of The Muppets. It’s fairly off-the-cuff and some of it gets pretty sassy. Also, at the 4:15 mark Miss Piggy does impressions of other muppets….and it’s fantastic.

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Ricky Gervais and Elmo in an off-the-rails interview…clearly most of it never made it to air.

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Happy weekend everyone!

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No Laparoscopy for This Lady

So insurance will NOT cover the laparoscopy to look for endometriosis. Shit. Not that I was in any way looking forward to going through a laparoscopy (especially since I have to fly to Boston 2 days later), but it would have been nice to have that information and something to treat if something was there.

Well….my Friday’s now open….anyone wanna catch a movie?

We are repeating the Beta 3 integrin biopsy (super gross) at the end of this cycle/end of the month so we will see if it is again negative or if it’s positive (it can change month to month). I am also taking delestrogen – injectable estrogen – every other night to see if this stronger medicine can take care of the “out of phase” issue with my endometrial lining (build up the quality not just the quantity). So that’s two things we’re hoping to fix with this trial/test cycle.

If that Beta 3 integrin’s negative again they want to treat me as if I have endometriosis: Lupron for 3 months or Birth Control pills with Letrozole/Femara (don’t know how long that would be) to hopefully shrink whatever might be there (might be there because we don’t know if I even have endometriosis because I can’t get an exploratory laparoscopy – Eat a D insurance company) and get the environment more suitable (Beta 3 positive) for implantation and occupation.

Now here’s the pickle: we don’t have that kind of time. My hubbo’s contract is up in a few months and our bells & whistles insurance is tied to that. I.e. our fertility coverage goes away end of May/June-ish – he’s in touch with his HR person to get a firm answer on what timeline we’re looking at.

So….we may have to say Fuck It to all this stuff (remember: “ignore all this info and proceed” was one of the options Dr. Hail Mary gave us) and move forward with an honest-to-goodness-low-probability-of-success-but-giving-it-a-shot-anyway IVF starting next month.

Timeline for now: some bloodwork & ultrasounds on 15th, 20th & 25th to see how body’s responding to delestrogen/progesterone trial cycle, Beta 3 integrin biopsy on 30th or 31st…..then we wait the 10ish days for that test to come back.

AND! We really need to make a decision on when to move forward with the adoption process – we’re not getting any younger and that’s a (probably….potentially) LONG process. The first step is 10-12 weeks of paperwork/interviews to get past the home visit stage….which is the point at which potential birth mothers can start seeing your profile. The woman we met with felt we were great candidates, in part because we have very few limitations on the child we’re looking for – we just need to fill out the application and get going. 

But you know – who wants to drop a few thousand on the start of an adoption process only to find out their IVF worked (Hail Mary!!!). It’s only a few more months of waiting…but I’m feeling antsy about making things happen/wanting to be proactive.

It’s alot. It’s all alot. For the first time I wonder if I’m cracking a bit under the pressure. I’m mostly okay but there are a few more “rain cloud” moments within the day where I’m thinking too much and wondering when the tide will turn. I still have all the faith that we’ll end up with our family – it’s just feeling like it’s taking an awfully long time to get there.

Clearly I need to go that Liam Neeson movie and hope for some throat punching….Friday? Anyone? Chicago? My treat!

 

 

Insurance: To Cover or Not To Cover

So Friday I had the following email exchange with my RE’s office regarding our upcoming laparoscopy to look for endometriosis:

RE’s office:    

I just wanted to give you a heads up that as of right now, (Insurance Co) is denying your surgery. A negative Beta  Integrin  test  is not justification for laparoscopy.  [We will] review your history to  determine if there  are other signs/symptoms to support a laparoscopy. I will keep you posted on Monday after we are able to review your chart.

Me:                  

Out of curiosity, with so many women asymptomatic (as I am), how does the surgery usually get justified? Or is this often a problem?

RE’s office:    

It is a problem …. Beta Integrin testing (that’s the gross biopsy I had a few weeks ago and will likely repeat) is not recommended/approved by ASRM. That’s why insurance does not cover the test and you had to pay for it out of pocket.  It is a controversial subject in the field. It is kind of one of those theories that has  not been 100% proven or backed by the RE community and studies.

Me:                

Oh I get that – but what about ladies who don’t have symptoms (a 1/3 of women with endo don’t have symptoms) but it becomes necessary to check to see if endometriosis is present….that it’s the culprit for fertility problems? Do you have to go through this every time?

RE’s office:  

If patients are asymptomatic there is usually no need to check for endo.  The only reason we typically do a diagnostic laparoscopy is because someone has symptoms and we have a hunch that those symptoms are due to endo so we go in a look to confirm if our theory is correct.

So…..hopefully they’ll be able to make the case, because it would be nice to know what’s going on in there…and if there’s something going on in there, do something to fix it. We will not do the lap if it’s out-of-pocket. It would be thousands and thousands (and thousands) of dollars, and since it’s only to “look and see” we’d rather save those thousands and thousands (and thousands) of dollars to put into our adoption fund if IVF4 doesn’t pay off. (Speaking of, we had a great meeting with an adoption agency a week ago – I really need o write about that soon).

I have a pre-op phone consult tomorrow to discuss the surgery….hopefully I’ll know soon if I’m actually going to have it.

Diagnosis: Numerous Implantation Hurdles

So more tests have rolled in and unfortunately they’ve presented some issues. Luckily we were able to get in with Dr. Hail Mary this morning to get an explanation of what those test results mean and what we should do about them.

While we’re still waiting on the results of the receptivity biopsy, the Beta-3 Integrin biopsy has come back negative…and this is one that you’d rather hear “positive” as a result. Beta-3 integrin helps with implantation….without it, things are…..”tougher” – not impossible, but “tougher.”  Also, they also found out that my endometrial lining is out of phase – meaning, it doesn’t mature at the proper time (this could be causing the negative Beta integrin) which also makes implantation difficult. The negative beta integrin can also be secondary to inflammation – meaning, there could be some endometriosis in there.  (These issues are on top of the elevated Protein C we found out about that can also get in the way of implantation – I’ll take blood thinners for that).

By the way – I am completely asymptomatic for endometriosis, but the doctor roughly 1/3 of all women with endometriosis do not have any symptoms.

He gave us 5 options for how to proceed:

1. Repeat test/trial cycle with a different hormone protocol i.e. injectable estrogen to build up lining and injectable progesterone to mature the lining – see if they can build as hospitable apartment in there.

2. Ignore the results.

3. 3 months of Lupron to shut down system, shrink any endometriosis (if there’s any) that might be causing negative Beta-3 and then try to get pregnant after that.

4. Laparoscopy/hysteroscopy – go in, look for endometriosis, get rid of it if it’s there.

5. Use a gestational carrier.

We found 2 not so logical, 3 not really an option due to our insurance ending in May/June (at least insurance that has fertility coverage, so we need to get this show on the road) and 5 just made us giggle.

So, we’re going to combo-platter 1 and 4: test/trail cycle at the same time as laparoscopy.

If they get in there with the laparoscopy and there’s no endometriosis then we’ll continue the testing/trial cycle by repeating the endometrial biopsy to see if the injectable estrogen/progesterone did the trick re: maturing the endometrium during the necessary window of time for implantation. If they find endometriosis then we’ll end the trial cycle – the doctor figures that would be the cause of the negative Beta3, therefore no need to repeat that biopsy (which was a real joy to do the first time…..cough cough…hey look over there!).

I mean, it’s enough that I gotta stress about making at least one friggin good embryo – now I gotta worry about even being able to build a house that’ll accept a resident!

The laparoscopy is scheduled for next Friday, March 14, so we’ll see what we see then. In the meantime, I start injectable estrogen tonight.

Ah the joys of what we do.

Lego Outtakes, French Cats and Meatballs Speech

To the untrained human, trying to get pregnant simply involves gettin’busy, knockin’ boots, makin’ bacon, the lust and thrust, the bump and grind, havin’ a bedroom rodeo, some hanky panky, gettin’ lucky, a roll in the hay, a good old fashioned shag…..

……but for those of us in the infertility trenches, we know getting pregnant means trying to hone your body into a perfectly balanced eco-system of hormones and chemicals you never knew you had while aligning the planets during a mystical creatures convention where a unicorn nods approvingly at you and The Cubs win The World Series.

It can be daunting.

For me, it boils down to having a constant stream of distractions, shiny objects and things to occupy my brain.  I share some here each week.

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We saw The Lego Movie last weekend and it was WAY funnier than I’d anticipated. It’s one of those great movies that have tons for kids and even more for adults. And, you gotta love when they take the time to animate some of the goofs that happen when they’re recording audio.

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A friend of mine sent this to me and I can’t stop watching it. The subtitles start in French but switch to English fairly quickly, so hang in there. Poom!!

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Harold Ramis died earlier this week. He was a comedy legend who wrote/directed/starred in so many amazing films that made us root for the underdog and question authority. He was also a really great human being and he’ll be missed. Meatballs was always one of my favorite films as a kid and this scene in particular was highly quoted in our house.

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Have a great weekend everybody – hope everyone’s great!

Test Cycle: Results Starting to Roll In

So I’m at the end of the test cycle and we’re starting to learn stuff. Lots of stuff is looking good and thus far there are 3 things that have indicated that I’ll need some tweaking to the protocol:

My protein-C levels are slightly elevated, as are my antiphospholipid antibodies (say that 3 times fast: antiphospholid, antiphopholidaliheid, antiphosphiliphosenfeffer……) thankfully also called APA. This means I have an increased risk of clotting and the elevated levels may cause difficulty with implantation, and could also possibly be a cause of miscarriage. I’ll take a blood thinner to help with this, likely Lovenox. So….yay, one more injection! (I realize that they are just words on a page but I want you to feel the sarcasm…the deep deep chasm of sarcasm).

Also, I have a methylenetetrahydrofolate reductase (MTHFR) deficiency. When the body is MTHFR deficient its ability to absorb folate (also known as vitamin B9), such as folic acid, is inhibited. Folic acid and B9 are both essential to the development and health of the fetus. So, treatment of this involves taking supplemental folic acid or folate and perhaps another vitamin (I didn’t get all that as I was standing in the middle of a grocery store taking notes on the phone – I think I did a fairly decent job otherwise).

It’ll still be another week or so until the last of the blood tests and the biopsy results are in, but so far no deal breakers, all manageable stuff. I did ask the nurse if the above elevated levels and deficiencies could have been part of why I’ve had three embryo transfers and no pregnancies and she said yes. It’s not a definitive answer as to why things haven’t worked yet but it’s at least information…..and information is good.

And, now we know we can do some easy stuff to try to have a different outcome.

Unrelated: I really want to see Non-Stop, the new Liam Neeson movie that comes out this weekend. That man can throw a throat punch and I like to live vicariously through that sort of thing.

 

 

 

The Endometrial Receptivity Test Can Suck It

Playing catch-up here – busy with a mess of work lately, which is awfully nice. I’m writing you from Phoenix where I’ve got some work tomorrow….it’s warm, and that’s like a reboot to the system after the Chicago winter we’ve had.

Last Thursday I had 2 biopsies taken for an Endometrial Receptivity Array (ERA).

As the name indicates the Endometrial Receptivity Array tests to see if the endometrial lining is receptive to implantation. (I encourage you to Google a more technical description to fully define the tests). Dr. Hail Mary wanted to run these two biopsies to see if anything was afoot in there since I’ve had three embryo transfers and no permanent residents. The test is done in the implantation window of your cycle (mine was done Day 23) following at least 5 days of progesterone (which I started taking back on February 14…..how romantic).

What’s the procedure like, you ask? Well, a speculum is put into place just like for a Pap, the cervix is cleaned off with a bit of iodine on what looks like a Q-tip on steroids, and then a pipette is snaked in. Once the pipette’s in place it’s moved around the lining and with a bit of a suction it gathers tissue for the biopsy.

It. Was. Not. A. Walk. In. The. Park.

Since I was having tissue drawn for two different test I had to go through this twice. (I’m not asking for your sympothy, just stating the facts….but it was a fucking crappy test). During the first one the nurse kept saying, “you are doing really great.” Now….I know that something likely needs to be said during these things, but perhaps me “doing really great” simply sprung from not swearing out loud like a men’s rugby coach or using my fists to punch at the table….likely “doing really great” mostly had to do with my ability to just lie still. I did get my deep breathing on – that was super helpful. If you ever have to do one of these just breath as deeply and as much as you can, it does make a difference – if not, you’re just…clenching, and that’s not going to do anyone any good.

It’s hard to explain exactly how it feels…..it’s loads of heavy cramping, for about 45 or so seconds, maybe a minute. Now I know that’s not a long time but if somebody had a pipette up your business and it was suctioning out bits of your endometrial tissue, 45 seconds is 45 seconds LONGER than you want that to be done.

The only ray of sunshine I can add is that 45 seconds really isn’t THAT long and when it’s over it’s over – instant relief. I think some Tylenol or ibruprofen would have helped if I’d thought of taking it beforehand….and afterwards I just had some lingering mild cramps (like a mild period) so I was fine. The tissue’s being sent off to a lab so it’ll be a few weeks before we know anything. We are of course aiming at a diagnosis of: Receptive. Though Not Receptive isn’t a deal breaker, it gives them info to work with and likely treat….so we’ll see when we see.

I’ll keep taking progesterone shots through the 25th – 1ml in the morning (right cheek) and 1ml at night (left cheek) – and then I’m to call them when my period ensues. Then it’s on the birth control pills, and if all these tests are fine then we’ll get started with IVF4 for reals.