IVF Meds {1}

A huge part of IVF is the medications and treatments. In fact, the medications alone are about a quarter of the cost of the whole IVF procedure. The different medications do all sorts of different things, so I thought I'd explain each of them as I'm instructed to use them.

Saturday I began my first two injections: Gonal-F and Menopur. Both of these are follicle-stimulating hormones. FSH is the hormone responsible for stimulating the development of egg-containing follicles. We produce FSH naturally in our bodies, but with an IVF cycle, we want to increase the number of follicles (and therefore eggs) that are produced in a cycle. In addition to FSH, Menopur provides luteinising hormone (LH), a hormone that regulates our menstrual cycles and egg production. LH increases just before ovulation.

Both of these meds are self-injected into the abdomen area, just below and around my belly button. I've been instructed to do these for a total of six days, one in the morning and one at night. 

Now, of course there has to be a story:

Saturday morning I gave myself the Gonal-F injection with relatively no problem. It took a little psyching myself up, but I finally did it. Saturday evening, I was all set to give myself the next injection but freaked out when I saw the size of the needle. I was supposed to have been given a 1/2 inch needle; instead, I was staring at a 1 & 1/2 inch needle! Now in the measure of, say, a mile, an inch doesn't matter much. But when you're talking about sticking something into your stomach, an inch matters a whole lot. After checking and re-checking our paperwork, we realized it was a mistake on the part of the pharmacy, but there was nothing to do at that point except use it. I only pushed it in 1/2 inch, but it was still slightly traumatizing. 

When I've used FSH medications in the past, I've had quite a bit of negative side effects. So far in this cycle, I'm good. I've got three and half more days of injections, then Friday I head in for my next instructions, which may be to continue more of these or start something different. 

All's Quiet

Thursday was our first baseline ultrasound in our IVF work-up, and thanks to the cycle of birth control, things looked as they should have: quiet, to use the nurse's term. Birth control was used to suppress any activity of my ovaries so that follicle production can be controlled by medication and treatments. The ultrasound and all of my labs looked good -- it was a go for the meds!

The appointment was cake compared to the previous appointment last week. I had been so busy explaining all the emotional turmoil Robby and I were going through that I forgot to complain about how awful the pelvic exam was! They scraped my uterus (on purpose!) causing it to freak out and spasm and cramp--which was pretty much what I was doing in response. I've had some terribly painful experiences throughout all of these labs and procedures, but nothing was as intense as that. Thankfully it didn't last too long, and I recovered quickly. I like to tell myself I'm simply building up my pain tolerance for a future experience.

I began my medications today and did my first injection for our IVF. I had to do these with the IUIs, but the IVF injections are more numerous and more frequent. Two a day for the next week, and that'll use up only half of the boxes in my refrigerator right now.

Next Friday, March 1st, is a critical appointment for us. We'll get a first look at how I'm responding to all of these medications, and if all goes well, within 1 to 3 days we'll get the go for the injection that triggers ovulation. At that point, my eggs will be surgically removed and fertilized. A couple of days after fertilization, our teeny tinies will be placed inside of me. In other words, we will have our IVF completed within two weeks!

All might be quiet on the ultrasound, but all is definitely not quiet around our home. We are excited!!!

Appointment #2

Last Tuesday was the first of a slew of appointments leading up to my IVF, and so, naturally, I was a mess Monday night. My anxiety felt very similar to what I experienced a few months ago, and once again everything inside of me wanted to abandon ship.

There was a very clear trigger. That evening, Robby and I read through the pile of paperwork they gave us at our Protocol appointment. It probably wasn't the best idea to save that for the night before our appointment, but we had honestly forgotten all about it. A big piece of it was understanding the risks and unknowns that take place with IVF (terrifying) and indicating what should be done with any embryos that are not used this cycle (guilt-riddling).

Outlined were numerous scenarios, most of them extremely unlikely. For example, who would get the embryos if we were to divorce? If one or both of us were to die? If I were unable to carry them? For the majority of the scenarios, there were three choices: donate to research, discard, or give up for adoption. We circled adopt for all of them and felt that that would be the most loving and ethical thing to do, but it still was difficult to say even that.

I found myself again with my desperate wish to be "normal" -- to be a woman who is joyfully surprised by a pregnancy, to be a couple whose decision to have a baby doesn't involve signing on the line.

We tried to encourage each other as we worked our way through each page, reminding ourselves of what we've learned and how we've prayed and prepared for this. Still, the lump in my throat and the ache in my stomach wouldn't go away. A couple of hours later, I was sobbing. I was an inconsolable mess. I wanted to give up, to call the doctor right then and cancel, to move on and put it all behind me. But then this image would come to my mind of me and Robby and a baby. Every time I would nearly decide it was over, I'd see the image again.

I finally calmed down, and Robby and I talked about what specifically was making us uncomfortable and afraid. Neither of us thinks there is anything wrong with the IVF procedure, so what was it? Clearly, we were not okay with the thought that there would be embryos left over. We decided right then we would tell our doctor to fertilize even less than what we had planned at our Protocol appointment. Immediately, I felt the burden lift. Yes, I thought. Our God is a God of miracles. He is the one who brings life regardless of the odds. It may seem more prudent to give ourselves a greater chance by fertilizing more, but if we are uncomfortable with it, we have to trust God's whisper. He has led us this far; he will lead us still.

The next morning at our appointment, we voiced our decision with our NP who listened and supported us. She put our concerns at ease and said most likely, we will have one shot. Knowing my situation and having been the one doing most of the ultrasounds and appointments, she said she's expecting only a few embryos. Strangely, that brought comfort. It took away much of the burden to make a perfect decision with such an imperfect situation.

Tomorrow morning is another appointment, and another one takes place next week. We received the box of medication yesterday, and I spent some time this morning going through everything. It's all moving so quickly now. March had seemed an eternity away, and now within a month--a month!!!--we will have a result. In just a few weeks, I could be carrying what we've been dreaming of for years. We could have a baby.

Protocol Appointment

One week ago, Rob and I went in for our Protocol appointment. This is the appointment where the plan is set up for the IVF. We had an opportunity to ask any questions or raise any concerns, and we also set forth the ethical parameters for our procedure. The nurse went over the list of medications I'll be starting soon, and explained some additional blood work we needed done. Our plan for the next month is as follows:

1. General blood work for Rob and me (done!)
2. Continue birth control (doing!)
3. Exam (2/12)
4. Blood work (estradiol), appointment, ultrasound to check for suppression, and begin medication (2/21)
5. Blood work, exam, and ultrasound to check response to medication (3/1)
6. If all looks good in #5, they'll schedule my egg retrieval within the first few days of March. I'll be put under for the surgical retrieval.
7. Fertilization of eggs on day of retrieval
8. 3 days after fertilization - IVF procedure
9. 2 weeks after IVF procedure - pregnancy test :)
10. 9 months later - baby :) (Hopefully!!!)

We are beyond excited. It feels like for the last few years, all I've done is pushed down any semblance of excitement. We became too used to disappointment, and I wanted to make disappointing months less painful. This time, though, I'm just going to be hopeful. No amount of control over my emotions will make a negative result any less of a disappointment, so why even try? I'm excited! This could be it!

To Share or Not to Share

I've been thinking about this a lot lately, this whole business of how, when, and to what extent do we share our struggles with infertility. When we first began recognizing that there was something wrong, we told no one. It all felt too personal, too intimate, and too unclear. People may have guessed, but as far as directly telling friends and family that we were struggling, that came much later.

Things are different now. It may not be the first thing I tell a new acquaintance, but those who love us and are involved in our lives know about our struggle. It is simply part of us. Infertility impacts us daily and affects everything, and so for me, it makes sense for people to know.

But I understand couples who choose not to share. Opening up to others about our struggle makes us feel vulnerable. There were times when I immediately regretted sharing and wished I could take it back. Openness also brings more comments and questions, and on the days when you feel you're barely keeping it together, a question or comment--even if it is kind and loving--can be hard to receive. Being open can in a strange way bring a sense of loss: we lose the opportunity to be "normal" and share a pregnancy like other couples get to do.

For us, though, sharing our struggle has been rewarding and is worth some of the loss and vulnerability that has come. I don't mean that every couple needs to let every person in their life know about their infertility. But having our pastor, leaders at church, family members, and close friends aware and involved is a step toward healing. It also brings more knowledge to those who may not know anything about infertility. They will become people who are much more sensitive to couples who are not able to have a baby, and they may become an encouragement not only to you but to others as well.

An exciting letter

Last week, we received this letter in the mail:

If you've been wondering what our next steps are, then, the letter says it all! (And it seems I have no shame anymore -- "menses," "birth control," "eggs" -- it's all out there.) We actually had already scheduled our Protocol appointment, and it's coming up soon. If all goes well, we should be having an IVF in March.

A lot has gone on in the last couple of months. Finding out about my DOR condition was difficult, but it also gave us the confirmation we needed to continue with IVF. We thought about having the IVF in January, but I felt too rushed and overwhelmed. I needed a little time to process everything, and I wanted to enjoy Christmas without the stress of medications and doctor's appointments. We used that time to pursue God in prayer, and we know others have been praying on our behalf, as well. We feel peace and excitement about pursuing our IVF this spring! And we're so grateful for the financial gifts we received over the last month. That has relieved a major stressor with this process.

The end of a year and the beginning of a new year always brings a mix of emotions. Without fail, I feel sadness at the end of another year. We of course always hope that "this will be the year" for us. The holidays can be especially difficult, as well. But there is always hope.  The new year brought a freshness in my heart, especially with this exciting adventure just around the corner. I know that no matter what, God has good things in store for our life. And I'm ready for it.

A Concert of Prayer

We had a beautiful and powerful experience this past Sunday at our church. At our request, our entire church family surrounded us in prayer. As our pastor opened the time, he said he wanted this to be a "concert of prayer," and I love that he used this phrase. There is the musical connotation to the word concert, but the word can also mean people coming together in agreement. That is exactly what happened. Our families and friends gathered around us in agreement, asking God together to bring healing to our bodies and provide us with a child. Some of them prayed aloud, some of them laid their hands on us, and some of them silently wept with us. I was absolutely overwhelmed and overcome by the love, compassion, and deep understanding our church, family, and friends gave us that day. I still can hardly think about it without tears coming to my eyes. It was awesome -- the best concert I've ever been to.

After church, we had an early Thanksgiving celebration with the Vander Kooi side. Robby and I had to leave early, but as we were on our way out, my aunt Ann asked us to share what had happened at church. All of my family listened intently as we shared our struggle, our plans, and what God has been doing. When we finished, my uncle said simply, "Well, let's pray," and that we did. 

I know the verse well that says, "With God, all things are possible." This is so true. I keep thinking to myself, How would I get through this without God? Honestly, I couldn't. Because of God and because He listens to our prayers, it is possible to face each day and trust that He has a plan for us. It is possible to believe that good will come out of this, to know that God can and will redeem anything, even barrenness.

Thank you for praying, for gathering around us and bearing with us and lifting us up. We have so much to be thankful for this Thanksgiving and always!