Look At All Of These Drugs

I think my title says it all. I received my shipment of drugs for our March IVF Cycle from Freedom Fertility Pharmacy. I counted at least 100 syringes. They even sent a sharps container for us. I think I am going to have as many holes poked in my body as Dave after all of this. I give shots to people everyday, I suppose this would be Karma. I just wanted to show you all of my glorious (expensive) drugs. They are destined to get us pregnant. I start my first shot Wednesday, March 4.

What is IVF?

I realize that most of you have probably heard of IVF and vaguely know what it is, but I thought I would devote this post to explaining it with a little more detail.  IVF stands for in vitro fertilization.  In Latin, this means within the glass.  Babies conceived through IVF used to be called test tube babies.  There are many phases to IVF.  I will speak about IVF as it applies to my treatment plan.  

The first phase of IVF is ovulation stimulation.  I am given a couple of different hormones, a gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH) to induce ovulation.  Ovulation is the formation of eggs in my ovaries.  In a normal woman my age, one egg is usually produced each month.  During ovulation stimulation, I will produce many eggs, hopefully at least twelve.  Twelve is my own personal goal.

During the maturation of the eggs in the follicles of my ovaries, daily or semi-daily blood work and ultrasounds will be completed to monitor my estradiol levels and the maturation of the eggs.  Once the majority of the eggs measure a certain size on the ultrasounds, I will be given a single injection of human chorionic gonadotropin (hCG).  It stimulates the precise timing of the release of the eggs from the follicles in my ovaries.

Next, I will be sedated for the egg retrieval.  My doctor will insert an ultrasound-guided needle vaginally to gain access to the ovaries just prior to my eggs being released from the ovaries.  The follicles are then aspirated and the fluid is delivered to the lab.  The lab then retrieves the eggs from the fluid.

At this point, one of Dave's sperm will be injected into each egg through a procedure called intracytoplasmic sperm injection (ICSI).  The fertilization process occurs in a culture medium in the lab.  The fertilized eggs are allowed about 3 days to mature.  At this point they are 6 or 8 celled embryos.  They will look something like this:



On day 3, the embryos are evaluated closely to determine if they will be transferred to my uterus. If there are many wonderful looking embryos that appear to be of high quality, the embryos will not be transferred on day 3. They will remain in the lab and transferred on day 5 as a blastocyst.  If there are very few day 3 embryos or they do not appear to be of high quality, they will be transferred to my uterus on day 3. This is because they are probably not likely to survive in the lab much longer. If the embryos develop in the lab until day 5, they will form a 60-100 cell blastocyst that looks something like this:


There are many advantages to transferring the blastocyst on day 5 as opposed to transferring the embryo on day 3. The day 5 blastocysts have a much greater chance of producing a pregnancy.  For this reason, fewer blastocysts are usually transferred, thereby minimizing the risk of high order multiple pregnancies - no OCTUPLETS for us!  Dr. Ahlering explained to me that he usually transfers two blastocysts, but many factors are taken into consideration when this is decided. 

 The embryo or blastocyst is transferred to my uterus using a tiny catheter.  It is usually only slightly painful (similar to a pap smear).  I am an expert at this procedure as it was completed each time Dave and I did IUI treatment cycles.  I think I will be on bed rest for 24 hours following the transfer.  

Just to give you a better idea on our timeline,  I start my daily injected hormones on Wednesday, March 4.  I told the wonderful ladies at my office to hold on to their hats.  The hormones can have a profound effect, stimulating mood swings.  No matter how hard I try, I will not be able to control it.  

My appointments in St. Louis for regular ultrasound and estradiol monitoring begin on Monday, March 23.  I also have an IV infusion of Intralipid  on this day.  The egg retrieval will occur between March 27 and March 29.  The transfer will happen for us somewhere between March 30 and April 4.  I think I can take a pregnancy test somewhere around April 11, hopefully sooner.  According to my estimations, if I do get pregnant during this cycle, I will have an estimated due date around December 15.  Jeff is excited about this.  He said he would like to share his birth month with his new niece or nephew.  

I hope that helps to clarify the process a little.  Thanks for reading!

Cancer Update

I tagged along Friday with my mom and her boyfriend, Dave, to Ellis Fischel Cancer Center in Columbia.  I thought I would give you all an update.  We met and spoke with Dr. Paul Dale.  He examined her, did an ultrasound and reviewed all records from her previous doctor.  He then explained everything in great detail and answered all of our questions.  That was refreshing.  

Based on her previous pathology report, her left breast has been diagnosed with Extensive Intraductal Carcinoma with lymphatic invasion present.  This is a very common form of breast cancer (65% of all breast cancers) and it is usually very easily treated.  Currently, the treatment plan is to go back into surgery on Monday, March 2nd at the University Hospital in Columbia, MO.  They will inject a die into the area that had previously been biopsied.  The die will then flow to her lymph nodes.  The lymph node that collects the most die is called the Sentinel Lymph Node.  

 

Next, she will go under general anesthesia.  They will complete a sentinel lymph node biopsy and remove a small area of tissue surrounding her previous biopsy.  While she is still under anesthesia, they will look at the lymph node and surrounding breast tissue microscopically.  If they detect no cancer cells, the surgery is complete.  She will then proceed with a week of radiation via a Mammosite and possibly chemotherapy once every 3 weeks for 16 weeks.

If cancer cells are detected in the breast tissue or sentinel lymph node, there is a wide range of treatment depending on the extent of the cancer.  They will take anywhere from 5 to all of her axillary lymph nodes - the lymph nodes near her underarm.  And the worst case scenario is a mastectomy.  Whatever treatment is appropriate, will be completed that day while she is anesthetized.  

If it appears that the cancer is extensive in the lymph nodes, further tests would be completed, bone scans, PET scans, etc. to determine the extent of the metastasis.  She would then have extensive radiation and chemo.  

She was disappointed that she has to undergo further surgery, but I think she is in good spirits.  She doesn't like for me to see her upset, so it is hard to know how she really feels.  I feel that everything will go well.  I believe that there will be no more cancer detected on March 2nd.  

The Glass is Now Half Full

I can't help it. I have to go to that deep place again. If you aren't interested in being a voyeur into a small portion of my soul, you shouldn't read this blog. The process that Dave and I have gone through for almost three years has changed me as a person. I am happy that I can look at myself and recognize it. It has only been during the recent weeks that I have arrived in this peaceful place.

My first epiphany came when I learned of Mom's lump in her breast. The Tisha that you all know would have laid in bed at night worrying about it. I would have cried to Dave (and Nish) about it, expecting the worst. I never would have seen the possibility for it to be "no big deal". But, in reality, I have been positive about it. I just know that everything is going to be okay. Breast cancer is a big monster, but I know we are going to tackle it. There is no other option. Sure, I am upset, but being upset isn't going to eliminate the monster. Information, treatment, support, and a positive attitude will get my family through this. That is what I have to offer.

This was my first clue to my newfound inner peace.

Rewind back to July 2007. I was in the lowest place of my life. We had been trying to conceive for 15 months. We had been in fertility treatment for seven months. I wish I were a better writer, because I know that I do not have the words to describe the pain that I was experiencing. This was the first time in my life that I wasn't able to work hard for something and achieve it. I had no control. And this was the goal that I wanted to achieve more than anything.

I don't know how infertility treatment brings you to your knees, but it does it well. It feels like grieving the death of a close loved one for two weeks and then immediately overflowing with excitement and anticipation for the best thing that could ever happen to you for two weeks. Only to immediately grieve again for two weeks. Repeat. Repeat. Repeat. This is the infertility rollercoaster. And (although Dave was great) I felt like I was alone. Noone else can possibly understand the big black hole that is growing inside me - not even Dave, not even my mom.

I found myself crying in Hy-Vee when an unfit mother (in my opinion) was yelling at her dirty, barefoot child one aisle over from me. Twice, I cried so hard I hyperventilated. So many of my friends were getting pregnant, having babies, saying "it happened the first month we tried" and it would bring me to tears . . . in private . . . daily. I felt guilty for being jealous. I felt like a bad friend. I felt like I was failing Dave. I felt like it wasn't fair. Why me, God? It doesn't make sense. I know I have a lot to offer as a mother.

I finally got to a place where I knew that there was a master plan that was bigger than me. God's plan. I am not overtly religious, but I know that God has a plan for my family. This was a baby step. I thought that if I could force myself to accept the plan - before I even knew what it was - that I could get pregnant. Release control. I can make myself do that. Try again. It takes time. It is a process.

Once I got to the point that I could talk about our journey without crying, I liked talking about it. It made me feel better, not so lonely. The more people that know, the more people that will be in our corner. My team will knock you out, infertility. So, many months have passed. We have had a one-year break from the hormones, the rollercoaster, the quick trips to Columbia, the pregnancy tests, and it has been nice. I feel renewed. I still don't know the plan, but I am okay with the plan. Whatever it is.

I feel like I have gained so much during this process. Gratitude. Peace. Love. I am lucky. I appreciate and love Dave in a way that I may not have experienced had we not had this opportunity. If our marriage can survive this . . . This has confirmed the importance of many true friendships. I owe a debt to each of you. You know who you are. I have learned of my own strength. Parenthood will be a little sweeter for us, taking this path to get there. Our priorities will be in check when we get what we have been working for.

So, on the eve of riding the roller coaster again, I am excited. I am ready.

injections

Tish seems to think I enjoy sticking her with all the various needles required for the many injections she's had to take throughout this process. I'm just happy I can put my 20 years of insulin injections to a practical purpose and help out. If she takes my braces off, and stops posting ridiculous pictures of me on face book, I'm sure the shots won't hurt too bad.

Drug Rundown

I spoke to Andrea, my coordinator at the Sher Institute, Wednesday on the telephone for the first time. She is awesome! She is an R.N. and she has read my chart from front to back. I love the fact that one person is very focused on my case. I explained to her that I am obsessed with information gathering and that I am very detail-orientated. She put me at ease when she told me that she has the same affliction. We are a perfect match.

She sent me my first treatment calendar, drug information, some prescriptions and some consents. I received them Friday. I was like a kid in a candy store - I got the information I had been waiting for. I will speak to her tomorrow and she will explain it all in detail. This is my treatment calendar:

I know you can't read all of the fine print on the calendar, so I will explain. Each of the colors is a different drug that I will take on that specific day. For some reason, some of my drugs are not on this calendar. I will speak to Andrea about this on Monday. Here is a rundown of the 12 drugs that I will take for this first treatment cycle:

1. Progesterone: oral medication that I just took x 5 days to induce a period

2. Birth Control Pills: oral medication that I will take for about 2 weeks prior to the hormones. It is used to regulate my cycle.

3. Prenatal Vitamins: oral medication taken daily to help prevent birth defects, especially spina bifada

4. Lupron: subcutaneous injection taken daily x 20 days; It is a gonadotropin-releasing hormone agonist (GnRH). It decreases my body's estrogen production, so that follicle-stimulating hormone (FSH) can be given to stimulate follicle and egg production in my ovaries.

5. Dexamethasone: oral medication; steroid to decrease the inflammatory response of my body to foreign bodies (embryos)

6. Gonal F: subcutaneous injection; Follicle-Stimulating Hormone (FSH) that stimulates my ovaries to produce multiple follicles that will form eggs; I receive this injection once daily for about 7 days.

7. Luveris: subcutaneous injection; leutenizing hormone (LH) that triggers ovulation and prepares the endometrium (lining) of the uterus for implantation of the embryo; I receive this injection only 2 days.

8. Intralipids 20%: IV drug; This is the most exciting of all. I may post an entire blog on this drug. Look for that soon. This is an IV that I will receive once. It is used to suppress my body's Natural Killer (NK) cells. I have had immune tests completed that show I have elevated levels of NK cells that are probably attacking my embryos/placenta. This is why I have had several early pregnancy losses. A lot of fertility specialists don't buy into this theory. The Sher Institute is on the leading edge of research in this area, and I believe this is the right treatment for me.

9. Endometrin: progesterone that I take daily following the embryo transfer until I find out if I am pregnant or not. I am not telling you how this drug is administered. It's not pretty.

10. Ovidrel: subcutaneous injection; Human Chorionic Gonadotropin (hCG); This drug is given only once and it stimulates the release of my eggs from the follicles in my ovaries.

11. Progesterone in Oil: IM injection; This drug helps to prevent pregnancy loss. It is a daily, painful, intramuscular injection. I don't know how long I have to endure these injections, but I think they continue into pregnancy if I do get pregnant. I have read that they are painful, so I am not looking forward to this.

12. Z-Pack: oral antibiotic that I start taking immediately prior to egg retrieval. I'm not sure why I take this.

Summary:

80-90 pills

30 subcutaneous injections

? IM injections (countless)

1-3 IVs

6-10 blood draws

5-12 transvaginal ultrasounds

1 IV sedation

24 hours of bedrest

This all adds up to a baby on the way for us in 2009. We

can't wait!

I spoke to Ashley from Freedom Fertility Pharmacy this morning. She called me at home on a Sunday morning. Interesting. All of my drugs, needles, etc. will come from this pharmacy with the exception of the prenatal vitamins, birth control pills, dexamethasone, Z-Pack, progesterone pills. The total price tag for the drugs from Freedom Fertility Pharmacy is $2,841.04. They will be filing our insurance, and we will pay for anything our insurance doesn't cover. I'm guessing we will be paying somewhere in the ballpark of $2,841.04, because our insurance doesn't cover fertility treatment.

One final note for today. Many of you probably know that Dave has had braces for about 2 years now. I am the horrific sadist that has imposed such a misfortune upon him. Unfortunately for me, he nags me on a regular basis regarding the removal date of these braces. He thinks that I am prolonging the orthodontic treament just to be evil towards him. This, of course, is untrue. Anyway, you should have seen the smile on his face when he saw the fertility treatment calendar and realized that he would be giving me numerous injections. I think he is on the verge of a nice payback. Now, who is evil?

One more final note. I am going with Mom this Friday, the 13th to Ellis Fischel in Columbia for her first oncology appointment. We are looking forward to finding out the next course of action for the treatment of her breast cancer. Thanks for the kind words. I have passed it on to her. It means so much to all of us.

Feeling the Love

I hate to publish "mushy" blogs on a regular basis, because I would actually like for a man or 2 to read this on occasion. . . but I have to say that I am definitely feeling the love today. Since finding out that Mom has breast cancer yesterday, I feel even more confident that I have the best friends a woman could possibly have. I hate to brag about it, but noone has a better support system than I do. Thanks a million to each of you for calling and just listening. I promise to pass the support on to Mom.

We know nothing more today than we did yesterday. She has requested that her records be sent from Memphis to Ellis Fischel in Columbia. I really pushed her to have her treatment at a dedicated oncology clinic. I'm happy she made that decision. I think she is hanging in there. She is a tough lady. Thanks again for all of your support.

Rollercoaster Day

I wanted to think of a catchy title for this blog, but it must not exist. I take my first medication associated with our March IVF cycle tonight. It is progesterone. I will take it for 5 days to induce my "cycle" - sorry if that is too much information for those 2 . . .3 guys that may be reading this. Anyway, then I will take oral contraceptives to manipulate my "cycle" to align with the March treatment cycle. It may not be much, but I am happy to get something going.

I spoke to Mary, the head nurse at Sher Institute, via e-mail Friday. She said that I will be assigned a coordinator that will contact me this week. My coordinator goes through my treatment calendar with me and explains and orders all of the drugs, etc. Boy, is she going to love me. I have all of the questions, piling up, for her. Anyway, the process is finally under way.

I didn't know whether or not to include this, because we have not had a chance to contact all of our family yet, but we just found out late this afternoon that my mom has breast cancer. I do not know all of the details, because I was not at her appointment today. I am kicking myself for that one. She didn't write anything down and I think she was in shock. I am in shock. It hasn't sunk in yet.

I just have this feeling in my gut that everything is going to be okay. I tend to be a pessimist disguised as a realist, but that is turning around for me. I feel very optimistic about this. I know that everything is going to be okay. I just know it.

She had a lumpectomy last week and in her follow up appointment today, her doctor today told her that they are certain that they caught it early. They did not remove all of the cancerous cells during the lumpectomy. They believe it is Stage I, but they want to do a Pet Scan to be certain. So, we are trying to decide where we will be pursuing treatment. There is going to be one more follow-up appointment next week and I will be attending that one.

I think my mom is hanging in there. She has the attitude that she just wants to jump in and nip it in the bud. And that is what we will do. She has great support and I know we will all pull each other through this.