IVF Diary Vol III 15-20 Mar 16

Medication(s) administered and dosage(s). Ovulation Control Pill (OCP) Reclipsen 0.15MG-30MCG x 1 per day, Lupron 0.5mg (10 units) injection AM.

I started the Lupron injections on Thursday morning.  Although the amount of liquid is tiny and the needle is small, I still freaked out about giving myself the injection.  I tried to do it, but the needle bounced off my skin, so I asked Chris to do it so I could feel how hard it needs to e to pierce the skin. But on Friday, I did the injection myself! It didn’t hurt, I was just slightly hesitant and the needle went in slower than I expected.  Saturday, the needle bumped off my skin again!  I’m sure I will figure it out.  Also, there is barely any blood after these injections so I don’t really need gauze and I can’t tell where I just did the injection which means I am finding it difficult to figure out where to put a plaster over it!  I discovered putting a plaster over the injection site means that I don’t have to remember the next day where I just did my previous injection.

Medical procedures undertaken. Nil.  But – I did have a post op follow up appointment with my Doctor to go over my results from the hysteroscopy.  I knew the biopsy results were good because they come through on my clinic’s app and I am sure she wouldn’t have had told me to start the Birth control pills if there was anything wrong.  However, on the day of the appointment I started to get a bit nervous because I thought if everything was OK, why did she still need to see me?  When I arrived the nurse asked where my husband was?  At first I just joked with her “He’s working – I hope!!!”, but then it dawned on me….should he be here with me because it’s going to be bad news?  I didn’t even think about bringing Chris along.  The nurse did the usual vitals check and took me to the Doctor’s office to wait.  As I was sitting in her office there was one pamphlet on her desk that stuck out – it was about uterine cancer.  My heart started to beat faster!! My head was  racing.  Fortunately the doctor arrived quickly after I sat down.  She cut straight to the chase and said everything looked just fine! Phew.  She took a look at her computer and said that there was just one area of redness of my uterus she had seen on the camera that she thought might be inflammation, but the biopsy did not show any signs of inflammation. So all good!  A very quick appointment, I was in and out in 5 minutes…it was just like being at a doctor’s office in the UK!!!!

What are my symptoms?  I have two symptoms I want to talk about – my upset tummy and my hormones!

At my post op appointment I asked my doctor about my upset tummy.  I told her my diarrhea has been playing up, maybe it’s just my Irritable Bowel Syndrome (IBS) being bad or, is there any chance it could be something related to the hysteroscopy?  The only thing that could cause diarrhea is the cytotec pills I took that ‘softens the cervix’ prior to the surgery.  Maybe it caused a mis-balance of bacteria in my tummy, but it should go away soon.  It wasn’t the most helpful advice I’ve received from a doctor…but as usual not knowing what causes my poorly tummy I am used to.  So I decided to put into practice my knowledge of things to make diarreah go away.  The first is to take some probiotics.  After my appointment I went straight to the shops and looked for a probiotic yoghurt drink.  Now in the UK, there are these little drinks that you can take daily – there are different brands like yakult and actimel, they are very common in the supermarket.  But here in the US, I haven’t ever noticed before until now, they are not common!  I tried looking for a US store that sells Yakult and it’s typical!  The only place nearby is the Commissary!  As a civilian, I am not allowed to shop at the Commissary!! (The Commissary is where the military can buy their groceries at a discount).  Anyway…I did discover something similar in the organic section – Kefir.  Kefir is a fermented milk drink with kefir grains in it.  I wasn’t sure if this would aggravate my upset tummy or the probiotics would do its thing.  There were also some juices with probiotics added, this to my mind didn’t seem the best for my tummy because real fruit juice can make things worse for me.  Anyway either the Kefir has had a positive effect or my tummy is getting better on its own.  The past few days I have returned to normal upset tummy (where I experience diarrhea about once a day rather than 4-6 times a day for the past two weeks!)

My hormones.  I am going to do a separate post on this, but in a nutshell, the Lupron and Birth Control Pills are doing weird things to me.  On Friday evening as I was getting ready to go to the ball (!!!) I was curling my hair and tried to pin it up how I like to.  But for some reason it wasn’t working.  My hair looked awful, I was getting frustrated at it…then I flipped out at my inability to make my hair look half decent.  Like seriously got mad and threw stuff across the room.  I looked in the mirror and I felt nothing, I looked back at myself and felt nothing.  I didn’t feel sexy, I thought I looked hideous.  Chris kept telling me my hair looked lovely down and I should leave it, but I just kept looking at myself and I felt like I was out of my body – I was in somebody else’s body. I felt…..nothing.  It was weird.  I didn’t like it!  Could it be the Lupron doing this to me?

How do I feel today? Chris and I had an evening of sharing our feelings about this IVF cycle.  It got emotional.  We realised we have both been bad at not sharing our feelings, we both made assumptions about things and came to wrong conclusions.  We just didn’t talk enough about what was going to happen this cycle – the changes in my protocol and the uncertainty around dates of key things happening in the cycle like when the Egg Retrieval and transfer might be.  Particularly with the transfer (Day 3 v Day 5).  The difference being that this cycle came around quickly (we both felt unprepared for it), and my period started much earlier than I anticipated.  Because I had been so busy with work, we just hadn’t been keeping the communication lines open…but we re-opened them – that’s good, but it took us a while to figure that out!

Any results?  Other than my post op results being clear!

What’s next? I stop the Birth Control Pills next week and keep the Lupron injections going.  I am off on travels to Europe next week so I have the added issue of figuring out what times to take my pills and injections!  I made a mistake of taking my Birth Control Pills after my dinner, so now in Europe with them being 6 hours ahead at the moment, it means I would need to be taking them at 2AM! Doh!  The Lupron injections won’t be so bad – I can take them at 1PM at lunch time.  I may also have to give myself an injection on the plane as I fly transatlantic!!!! Double doh!

Weight. I still haven’t got on the scales yet!

Waist. NSTR.

Boobs. NSTR.

The Final Countdown!!!

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*Notes.  I take First Response Reproductive Health multi vitamin gummies (pre-natal), 5mg Melatonin at bed time and CoQ10 200mg gummies daily.  NSTR = Nothing Significant To Report.

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The hysteroscopy

I am insanely missing my blog right now!  I have been so busy with work and other things that my blogging has suffered, and I am constantly thinking about things I want to write about and get out of my head, I just haven’t been able to.  There is definitely a truth in writing being a form of therapy…a therapy I’ve come to rely on and when it’s not there I start to get itchy.  Anyway, I am here!  Briefly albeit 😦

Today I woke up at 4AM and could not get back to sleep, I won’t lie, I was a little anxious about the hysteroscopy procedure today.  We got up at 5AM so I could shower before inserting the cytotec pills into my vagina!  Nice.  We arrived at the clinic at 6:30AM and the nurses were great as usual.  I was first on the surgery list, a few other ladies were there for their egg retrievals after me.  I got changed into my beautiful one size fits all, modesty covering gown and climbed into a bed with freshly warmed sheets and a couple of extra because I get so so cold in that prep/recovery room!  I signed my life away and took the obligatory pregnancy test.  It would be miraculous if I was pregnant and we all joked about how we all would be happy if I had to be sent home because it turned out to be positive.  No such luck.

The nurse prepared the back of my right hand for the IV needle.  I have wonderful veins, but the nurse managed to bust it and it started swelling up like a balloon.  I started to feel faint like I was about to pass out.  I’m not a needle fan so watching this made me feel sick.  So she tried again but on the inside of my forearm.  She got the needle in, but it felt really, really weird.  She wasn’t happy with it, so she called another nurse to come take a look and try on my other hand. I was feeling really light headed at this point, so she lay me down almost completely.  The other nurse had done my IVs both times previously, so I started to feel a little better when she attempted to insert the needle in the back of my left hand.  She also used lidocaine to numb the area first so I was instantly less nervous because I couldn’t feel the needle jabbing around inside me!  Finally, the IV was in!

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Pre-sedation! The nurses wrapped me up all nice and snuggly

Chris came back to keep me company whilst we waited for my doctor to arrive.  After about 20 minutes she arrived and asked if I had any questions; I may have mentioned this before but she has a real awkward bed side manner, it is actually now growing on me!  Then the anesthesiologist gave me a cocktail of drugs through my IV, and I started to feel like I had 4 or 5 strong margaritas (apparently margaritas was what he was putting through my IV!).  I was wheeled on my bed through to the operating room, and I concentrated really hard on looking around the room to see what it was like.  But that lasted 30 seconds and I was out.  Next thing I knew, I was waking up with Chris next to me, and everyone was laughing and joking at me because I had apparently been dancing to Elton John music in the surgery. Hmmmm.  OK, if that’s what you say!  I think it might actually be credible thing I’d do!

I vaguely remember them also saying that everything looked good on the camera and they had taken a biopsy to be sure.  I had to ask Chris later if I imagined this conversation because I wasn’t sure if I had dreamed it!

I was really, really sleepy coming out of this cocktail of sedation drugs compared to my egg retrievals. I struggled to wake up and felt very woozy. I asked the nurse if the drugs were different, but she said they were the same, they may have given me a little more this time, or just being tired and stressed can make recovery time longer.  Well, both of those things are true so I guess that explained it.  After an hour of coming out of the operating room, I was ready to be driven home.  We stopped off at Panera bread to buy some breakfast treats.  I also ordered a decaf caramel latte and when I took a sip of it I was convinced it had no coffee in it at all!  It just tasted like steamed milk to me.  Chris tried it and said that it definitely had coffee in it.  I didn’t believe him, miffed,  I didn’t drink anymore of it until I got home, when this time I took a sip it definitely had coffee in it!  So something weird was going on with my taste buds!  I attempted to eat my giant cinnamon roll, but my mouth was sooooooooooo dry I could barely swallow a mouthful.  My throat is sore and my mouth dry now still!  Well at least this time I don’t have a drippy nose!  Ah well, I think I would rather have been sedated than have none, so I can’t complain in the grander scheme of things.

So once again, everything looks normal.  We still have no explanation as to what may be wrong.  I  am pleased that there is nothing obviously wrong with my uterus (well, I am still waiting for the results of the endometrieal biopsy they took whilst they were in there today!).

Tomorrow I will phone and see what the plan is for starting IVF round 3 because my period is due to start 3 days before my results appointment, so I need to see if they will start me on down regulation before the results.  I also don’t really know much about their lupron down regulation protocol and how long they do it for.

For now I have a very busy week ahead of me, but I have a quieter weekend coming, so I hope to catch up with the blogging then and get me some blog therapy in!

The Pre Hysteroscopy Surgery Appointment

The nurse called me back and directed me to the toilet.  I told her I had literally just gone to the toilet 2 minutes before she called me and that I apologised profusely that I did not know I was required to do a pregnancy pee test! Whoops!!!  But the silly thing is that almost two weeks ago we did a blood test after IVF cycle 2 and it was a big fat negative.  I am currently on Cycle Day 11 so it would actually be a miracle if I was pregnant right now!! But hey, I guess stranger things have happened.  The nurse took my blood pressure and temperature as usual, but this time we did something different!  A finger prick to test my hemoglobin levels.  I told her it’s always fun to try something new at the clinic, just to mix it up a bit!  I suggested a fertility test card bingo game, I might be on way my way to winning by now!!  Winning what exactly, I’m not sure…

The nurse explained that she was going to order in to my pharmacy a prescription of two cytotec pills that I need insert vaginally an hour before arriving for my hysteroscopy next week (basically I will need to do that at 0530 on the day of the procedure!!! :-s).  Cytotec is actually primarily used to prevent stomach ulcers when taking Non Sterodial Anti Inflammatory Drugs such as Ibuprofen or aspirin.  But cytotec does have an off label use – to ‘ripen the cervix’ (Haha I love the fact that one ‘ripens the cervix’ like an apple or banana)  Basically it helps dilate the cervix so it is easier for the camera to get into the uterus.  So this adds 4 types of drugs I’ve used during infertility treatment that is off label use – Letrozole, vivelle dot estrogen patches, methotrexate and now the cytotec. Off label use means that the FDA hasn’t approved that drug for the manner in which the doctor has prescribed it.  But all of these drugs are commonly used off label, so I am not worried about it.  But at no point have I ever been told these are drugs are being prescribed off label.  It’s an interesting practice!  I digress….

After being prodded and poked by the nurse I saw my doctor who went over the procedure with me and updated my medical history.  The procedure is relatively simple.  I arrive at 0630 AM at the surgery operating room, they get me prepped and ready in a fabulous gown.  No eating or drinking after midnight until after the procedure.  No make up, jewellery etc.  Similar to the egg retrieval.  The anesthetist will give me a cocktail of sedation drugs, probably similar to ones to the egg retrieval.  Once I am knocked out, they insert a camera through my cervix into my uterus – there are no cuts required.  Then they take a look around.  If there is anything there that shouldn’t be there, they will remove it there and then.  They will probably also take a biopsy of my uterus.  The whole procedure typically lasts 15 minutes.  Then I am back out of surgery into recovery for about an hour for the sedation to wear off, then I am driven home by my lovely, patient, husband.  So it really is a quick and simple procedure.  I might be in a bit of pain afterwards, but there is no requirement for me to rest afterwards, however, I won’t return to work until the next day because of the anesthesia drugs.

Simples!

Finally after my doctor gave me the low down and I signed my life away for all potential risks, I moved to the business admin office to pay my dues.  Here is the complicated bit.

My insurance provider is United Healthcare.  Well kind of.  My actual insurance company is Allianz.  I work for an international organisation where the majority of its employees work in Europe, but there are a small number of us here living in the US, so although Allianz provides us with worldwide coverage, it doesn’t have a primary market in the US.  So, Allianz pays United Healthcare to be the ‘front man’ for all of us employees who live in the US.  This means that Allianz gets access to all the in-network negotiated benefits and doesn’t have to worry about administration costs of billing etc in the US.  So all my healthcare providers bill to United, United then bill Allianz.

Have I lost you yet???!!

For anything dental or vision I have to pay for it upfront then claim it back from Allianz, then they re-imburse me 90%.  But I also have the choice of paying for any other healthcare service upfront and then claiming it back directly from Allianz,  I don’t have to go through United.  Most of the time this isn’t beneficial because of the in-network negotiated costs can sometimes be ridiculously discounted so it is better to go through United.  Except in the case of my hysteroscopy….

United demand that the hysteroscopy procedure is performed at a hospital and not the clinic.  If it is not performed at a hospital they won’t pay up.  If I went to the hospital, there is a longer wait time, particularly co-ordinating it so my doctor from the clinic can go to the hospital to do the procedure.  Then there is the high cost of doing it in a hospital – approximately $20 000!  Now, there would be in-network discounts on that, but still that is a lot of money when you compare it to what my clinic charges – just $1300 if you self pay.  Also, it is also far more convenient to have the procedure done at the clinic, especially as I know their surgery room well now!  So it doesn’t take a rocket scientist to work out what needed to be done.  Today I payed the $1300 ($400 of it in cash for the anesthetist, sounds dodgy right??!) , and then I will claim that back from Allianz directly in a couple of weeks time when I get the itemised bill.   Allianz don’t care where I have it done as long as it doesn’t cost more than the limit.  This made me think may be I could pay for all my IVF treatment upfront and claim it back – I reckon I could save about $500 if I did that.  But then I remember how many bills I got through and realised that there is no way I could easily track all of that and then track all those claims to Allianz in addition to also handle the pre-approval process.  I did that for my IUIs and it was a headache.  It’s not worth the stress.  Even if it were to give me a crap load of credit card points!!!!

Insurance in the US – what an absolute nightmare.  But I think I probably have it easy despite the unusual arrangement we have with United & Allianz.  I have it easy because I have amazing infertility coverage, and for that I am truly grateful.

Anyway, here I am, ready to go now for my hysteroscopy procedure next Tuesday!!! Who’d have thought I’d be excited for a diagnostic procedure that requires anesthesia!  This is what infertility does to a woman, it turns you into a masochist-craaaazy!