Finished!

My procedure today is over, and I made it through! I thank God for providing me with a new doctor who was able to make it happen without causing me too much pain. So, I'm finished with all of my labs, and now we wait for our appointment on November 6th to hear about the results.

Please pray for us. Specifically, pray for:

• Continued guidance in pursuing IVF
• Wisdom for our doctors and nurses as they review results
• Provision of necessary finances
• Insurance coverage
• Peace

Recently, I have come across a ministry site called Dancing Upon Barren Land that has been such an encouragement to me! There was a place on the site to send a message, and so I did, thanking the woman for the wonderful ministry. The very next day, she sent me a kind response, and I wanted to share her prayer here.

I have prayed for you and will send your prayer request to our team to pray as well. I asked the Heavenly Father, "To make your steps sure and full of peace. For your eggs to be plentiful and healthy. For no adverse reactions to any meds. For our wonderful Lord to grant the desires of you and your husband's heart." As Luke 1:37 says, "Nothing shall be impossible with God." Hold daily to Jesus, He will carry you in this process, He is faithful.

I know that all of you are lifting us up in prayer, and I thank you. We have continually recognized the blessing we have in our family and friends. You have been and are God's grace to us. Thank you!

I'm up (and I'm a new creation!)

It's 3 in the morning, and here I am. I woke up not feeling great, and then I started thinking about today, and then I couldn't fall back asleep.

In just a few hours, I have to have Monday's procedure, the saline sonogram, done all over again. I'm not looking forward to this, mostly because I'm afraid that whatever happened Monday might happen again.

Monday's appointment was terrible. It was hands down the worst medical experience I've ever had. It's difficult to accurately explain how awful it was without going into lots of personal details, but I'll just say what should have been a relatively simple twenty-minute procedure took an hour and a half. And it was an incredibly painful and uncomfortable hour and a half. All said and done, the doctor performed the entire procedure twice (after first trying unsuccessfully to do it with improper equipment) only to get up, turn the lights on, and tell me it didn't work. He gave me a physiological excuse which didn't really match up with my past experiences, said he was terribly sorry, and left. When I asked for more details about his reasoning, he said it could be something permanent, some type of scar tissue or blockage. Those kinds of things cannot be said to a woman desperately trying to have a baby.

I only made it about two steps outside of the building before I began sobbing, overwhelmed by the whole excruciating and emotional experience. I could barely get the words out to Robby to tell him it hadn't worked, and it took a few minutes before I could relay the information the doctor gave me.

A bad experience, to say the least, and one that I'd rather not relive in the slightest. So it's no surprise to me that I'm up.

I've found comfort in 2 Corinthians this week. This morning, I read the end of chapter 5. It says:

Therefore, if anyone is in Christ, he is a new creation; old things have passed away, and look, new things have come. Everything is from God, who reconciled us to Himself through Christ and gave us the ministry of reconciliation. (2 Cor 5:17-18)

This passage, and specifically chapter 5, is about Christ's death bringing life for all. We have hope for today and for our future because of Christ. We are made brand new through Jesus, and we have been reconciled to the God who made us through Jesus' death and resurrection.

Sometimes we need to be reminded that we are a new creation in Christ. Sometimes, when it seems like our bodies just aren't working the way we'd like them to, we need to hear that God has placed inside us something that will never fade or dim or grow old. He's given us a new Spirit, His Spirit, our seal of salvation and our downpayment for the perfect and whole life to come. He's given us Himself and His very presence. It's true that our bodies and our flesh may fail us--Paul in this chapter writes of us groaning in this body, desiring for Heaven, longing for life to swallow up this mortality--but we have and are being saved, reconciled, and redeemed by God. Newness has already come! Salvation is already here!

Insurance Surprise

I'm feeling great today. Yesterday was a productive lab day -- we somehow managed to get three of the five labs done in one day, which was pretty lucky as most of them are "day this, day that" types of labs. I only have one more procedure to do, the saline ultrasound, which will be this Monday. I'm surprised with how quickly we have been able to do the work-up, which is nice because those tend to cause a bit of stress. The labs themselves aren't too bad (the worst one is definitely still to come), but the difficulty lies in planning them around our work and church schedules. It's nice to have them nearly over.

The other fantastic news came today when I decided to double-check my insurance coverage. Over the past three years, only a few things have been partially covered, those procedures that could be considered purely women's health. Some ultrasounds were covered, as well as a portion of my surgery in January of 2010. Anything related to our medications or IUIs came completely out of pocket. Turns out (fingers crossed) that our insurance will cover a lifetime max of $2000 (75/25 coverage) toward infertility once our deductibles are met. (That's right, deductibles, plural. They add in an infertility deductible on top of our regular one.) We should meet all the minimums, though, so it is likely that Blue Cross will kick in something around that amount for us. This is pretty amazing since infertility coverage at this point in time is quite limited if not practically non-existent. What a blessing that ours has it and that my doctor is a participating provider! Even the insurance representative I spoke to on the phone said that is rare to see!

It's been an encouraging week for me, and this was a beautiful, surprising icing on the cake.

IVF Answers...and Anxiety!

After I wrote my post following our doctor's appointment last Monday, I was hit with the 24-hour Anxiety. Have you ever had this? Mine came on that night, kept me wide-eyed and sleepless until about 4 am, then stayed with me all the next day. My heart was racing, my body was panicky, my breath was short, and overall I was a mess. I think it was a case of information overload, but perhaps the bigger cause was realizing that we had thrown ourselves in the midst of a huge decision...and I hate making huge decisions. Honestly, who likes them?

That has been one of the key struggles for us, this whole having-to-decide-things-that-ultimately-scare-us-to-death struggle. It was hard to make that first decision to see my doctor, knowing it was a recognition that there was something wrong. It was hard to decide to do treatments, knowing the cost and side effects and emotional strain. It was hard to decide to have our first IUI, and then the following IUIs. Decisions about cost, treatments, careers, even adoption--we've made too many to count, and I haven't liked the process a single time!

I guess I shouldn't have been surprised that anxiety hit, then. It wasn't a simple decision of having or not having an IVF. It was recognizing all the in-between decisions that must be made, decisions that stretch our thinking and planning and beliefs more than any others have. It was realizing that if this all works, we have taken only one tiny step of the journey. And it was also realizing that after everything, there is a chance we may be left with nothing.

All that jam-packed into twenty-four hours was enough to knock me flat! Thankfully, Robby and I were able to have a good conversation that following night. (He had been feeing anxious about it all, as well.) We remembered that there is no rush. We have taken a tiny first step, and the steps that follow may be tiny, too. As much as we don't want to make these decisions--because as I've shared this is not the way we would have planned it--we know God has equipped, is equipping, and will equip us to do and decide what we need to do.

I have also remembered that sometimes, when you're in the midst of a struggle, every decision and emotion is amplified. It was helpful to take a step back and allow myself to see the decisions in front of me in their real form and size. It was helpful to remind myself that we are not the first to decide what to do about infertility, nor are we alone in this struggle.

A week has passed since that visit, and already we feel more confident and prepared. I'll take that any day over anxiety :)

IVF Answers

Today was the big appointment! We left this morning anxious and excited and came home a bit overwhelmed and emotional. I keep forgetting that every step we have is like this: overwhelming and emotional. Our appointment was great, though. We were able to meet with one of the main OB/GYN Nurse Practitioners at the clinic, and I love her. She had been one of the few gals who did all of my ultrasounds and even IUIs there. Kind and patient, she explained to us what our next steps are.

She was on the same page with us as for not wanting to do anymore IUIs (we've done five) and skip to IVF. She recognized that even though my fallopian tubes appear to be open, we have no way of knowing the extent of the damage which is in those tubes. The little "hairs" (cilia) that pull the egg along to get fertilized--if that is happening--may themselves be damaged.

This bit of info was a strong confirmation for me to hear. I'm not sure if I shared on this blog but in August of 2011, Rob and I went to see a new fertility specialist, mainly to get a second opinion on our whole situation. He was great and spent at least a half an hour with us just talking about our entire journey. He said that he felt we had done everything "correctly," all of the steps there are available to do, and his guess was that the problem lay in my fallopian tubes. Incidentally, he also knew my doctor and the clinic, and said that would the place he would have recommended, the only other being a referral to Stanford.

Back to the appointment today. There were four main things we wanted to discuss:

1. Am I still a good candidate for IVF, and if so, what are the chances of conceiving?
2. What are the steps of IVF?
3. What is a cost estimate of the whole thing?
4. What about our own ethical and religious beliefs, specifically concerning the embryos?

Am I still a good candidate for IVF, and if so, what are the chances of conceiving?

I am most likely still a good candidate based mainly on my and my husband's age, health, and medical situation. Rob needs another analysis done, and I have to do three tests again, two that check all sorts of hormone levels, and one that gives a clear picture of the state of my uterus. This one is like the HSG I did a couple of years ago, which basically is an x-ray of the uterus and tubes. This new one, called an SIS, focuses on the uterus, though, and gives a clearer assessment of the health and shape of my uterus. This is better if you're not as concerned about the tubes, which at this point, we're not! Read about the procedures for and differences between the HSG and SIS here. 

The chances with IVF sky-rocket compare to those they gave me with IUI. A textbook answer is at least a 30% chance of conceiving, but the NP told me it is more like 50% if one embryo is placed, and 65% if two embryos are placed inside the uterus. These statistics are based on a blastocyst stage embryo transfer, which is an embryo that is five days old instead of three. (More on that in the next section.) I was on Cloud Nine when I heard these stats!

What are the steps of IVF?

Any research will tell you there are four steps: Stimulation, Monitoring, and Triggering; Egg Retrieval; Fertilization; and Embryo Transfer. Our NP broke them up in different ways, though, so I'm going to use what she said:

1. Suppression: This is the first step in the process, and it definitely feels like you're headed in the wrong direction. Before any stimulation of the follicles occur, you are put on birth control to encourage suppression of the follicles. This is because each month, there is always one follicle (potentially mature egg) that is a little bigger and that sucks all the follicle-stimulating hormone (FSH) the body produces. We want all the follicles to be the same size when starting so that more than one will get to grow because of the FSH.
2. Stimulation: After a cycle of birth control, you are ready to begin the real process! Follicles are stimulated by injecting FSH into the body. This is something our bodies produce naturally each cycle, but we want more than one mature egg. Naturally, just like in a normal situation, eggs may "die" or fertilization may not occur, so the goal is to get a good number of mature eggs. This step also includes a medication that triggers ovulation. Timing is everything, whether fertilization is occurring inside or outside of a clinic! This "trigger shot," as it's called, ensures when the woman ovulates. Once ovulation has been triggered, it's time for egg retrieval.
3. Retrieval and Fertilization: Because IVF means that an egg and a sperm are coming together outside the body, the egg has to be retrieved. In the case of IVF, there are multiple eggs being retrieved. Now, we can't see eggs -- they are smaller than a single piece of dust. Basically, the fluid from the follicle (which we can see in an ultrasound) is withdrawn and examined. At that point, the embryologist can see if the egg was retrieved, its size, and even its health! This is done one-by-one with the embryologist examining each bit of fluid and ultimately each egg. The woman, by the way, is completely sedated, so she doesn't feel any pain and often doesn't remember anything. The eggs are then placed in an incubator. Within a couple of hours, the eggs are fertilized using the cleaned sperm sample. 
4. Embryo Transfer: The fertilized eggs, now embryos, "grow" for a few days. A typical IVF places three-day-old embryos in the uterus, but it is possible--and higher success rates come--from giving the embryos a couple more days to grow. At five to seven days after fertilization, the embryo is called a blastocyst. All kinds of factors may go into whether a three-day-old or five-day-old embryo is placed inside the uterus, but the NP definitely favored the five-day-old guys. The main reason is there is a higher chance of implantation and survival, as well as a better way to control the chance of multiples. In typical IVF, more embryos are placed inside the uterus, but with the blastocyst embryo transfer, only two are placed inside the uterus. The transfer is straight-forward: the embryos are placed inside the uterus at the appropriate time, and the woman is on bed-rest for 24 hours. Fourteen days after the transfer, a blood test lets everyone know whether the IVF was successful...and hopefully it was!

What is the cost estimate?

I won't go into the breakdown, but if you would like it for your own knowledge and benefit, please ask me. Basically from initial visit to pregnancy test a couple is looking at anywhere from 12,000 - 15,000 dollars at our clinic. This includes all the ultrasounds, doctor visits, tests, medications, hospitalizations, sedation, embryologist fees, clinic fees, lab fees, doctor fees...you name it. There is the slightest of chance that our insurance may pick up some of the non-fertility labs, but I don't like to count on them. They haven't helped much in the past.

When I looked into this a couple of years ago, the cost alone sent me running. But now--especially after multiple IUIs and many dollars poured into this--my view on it is simple: it is worth it. If it works, and we have a baby, it is worth it. If it doesn't work, and we don't have a baby, it would still have been worth trying because the potential is so wonderful. Plus, I always like to tote that this cost is less than what most people our age are spending on cars...and we don't have a new car and would gladly go without in order to have a baby.

Although the clinic doesn't offer financing, they do have a few companies that they recommend, so we will research that if needed.

What about our own ethical and religious beliefs?

This ethical issue is so huge that entire books have been written on the topic. What we believe is this: Life occurs at fertilization. Those embryos are not little cells that we view lightly; we believe they are life, and we will treat them as such. This means that we will limit the eggs fertilized and ensure--to the best of our ability--that the embryos have the best possible chance of survival.

I won't lie, friends. This is tough for us. This was the hardest part of our appointment today. We were honest with the nurse, though, and she assured us that they act based on our beliefs. I'm not going to go into too much detail yet because Robby and I need to formulate this together. There are many different opinions, even among Christians (perhaps more among Christians!), and we plan to continue with prayer and counsel. We already have our key beliefs which will be the foundation; there are just some other trickier situations that may arise.

I had picked up a small book a few months back published by Bethany Christian Services. It is called Christians and IVF: Wise Choices and Life-Affirming Options. It has been very helpful! I would encourage everyone to read this as IVF and other forms of AI are part of our culture today. 

Robby also reminded me that this is not our first choice as the way to have a baby. How we wish we could be "normal" and get pregnant on our own! But this is where we are, and every step of our journey has been drenched not only in tears, but in prayer, as well. 

The Big Question

As I shared the Cliffs Notes version of this with my mom this morning, she was of course concerned with the big question. When will this happen for us???

We chose not to rush into the next IVF cycle that the doctor is performing, which is in November. (To which my mom responded with a sigh.) This is, as I've already said, huge. No rushing is necessary! The following IVF cycle will be in January, so our plan, our tentative plan, that is, would be to begin our cycle at the beginning of the new year. This gives us time to get all of our labs done and discuss the outcome of each, budget the cost, and spend lots of time together in prayer.

We are excited, friends! We are also overwhelmed and a bit terrified. We desperately need your love, support, and prayers. Thank you for caring enough to read this long thing and stay updated on this huge step in our journey!

First Steps...Again

Yesterday, Rob and I arrived home after a week-long trip with our family in Washington, DC. We had a great time and were busy, busy, busy, seeing the sights and savoring the unique time together. As busy as I was though, I kept thinking about a key event coming up on our return home.

A few weeks ago, I felt a strong peace come over me about pursuing IVF. It came out of nowhere, like a sudden storm, and I knew it was the Holy Spirit. We pray about what to do with our infertility all the time. Not only do Rob and I pray, but our families and friends also constantly lift us up. I knew it was no accident that I felt this, but I simply tucked it away for a few days. This wasn't what we had planned, you see. We had decided a few months ago that this year would be a year of saving, and next fall would be the time to act. However, as it was very clear to me that God was speaking, I finally told Rob that I thought we should look into IVF sooner than we had been planning. There wasn't even a discussion about it -- he said he had been feeling the same way.

The next day, I called my doctor in Clovis and set up an appointment. It has been a year and a half since my last visit there, so I have to do another major appointment with all the initial tests and talks. It's scheduled for tomorrow, Monday, October 8, and we're hoping to find out if I'm still a good candidate for IVF, what the cost estimate is, and when I could begin the process.

It's exciting, terrifying, and all the other adjectives in between. Not doing any treatments this last year and a half has been good in many ways, lessening the physical and emotional strain. But it also feels like I'm starting all over, and that is hard. I thought that there would have been an "end" by now. I had hoped that we would have already had our baby.

And, strangely enough, starting this again throws a wrench in the groove we've finally settled into. We are never truly content with our family of two, but we have tried to be positive and recognize we have worth as a couple even if we don't have children. I'm enjoying my job, and Rob is at a great place in his ministry. Starting all over means shaking things up, and that's scary.

Finally, IVF is just plain huge. It's a huge financial, emotional, and spiritual commitment. It's something I recognize we cannot do without the support and love of our family and friends. That means that people need to know, and that means that people will ask, and that means that we'll have to share news, even if it's heartbreaking. It's hard to allow others to bear that burden with us, and it's hard to open myself up to that vulnerability when so much of our struggle is private and personal.

So, tomorrow is a big day. There are all sorts of unknowns, and my stomach is in knots just thinking about it. Providentially, yesterday when we got home, there was the latest newsletter from Stepping Stones on my counter. The cover article is called "A River of Optimism." I love what the author wrote:

The hope of a Christian is not just positive thinking; it is absolute certainty about who God is, His goodness and love, and ultimately, His plan of salvation in my life. While the path I am walking is certainly not one I would choose--maybe one I will never understand, already filled with heartaches and disappointments--I know that I will ultimately not be disappointed. This is not because God answered my every prayer according to my wishes but because He drew near to me in my time of deepest need and loves me with an unfailing and sufficient love.

I don't know how any of this will turn out. I may find out I'm not a good candidate for IVF anymore. We may be overwhelmed by the cost. We may go through the process unsuccessfully in countless different ways. But I am certain, as that author wrote, about who God is, His goodness and love, and ultimately, His plan of salvation in my life.