And we're off!

And so it really has begun! All the months of planning and preparation, of seeing those mediocre doctors in Texas for tests, of talking and obsessing with my dad and SH over the phone are finally coming to fruition. The IVF process has officially begun!

In an effort to be succinct (yeah, right!), I’ll list the highlights of my visit as bullet points.

• Dr. M is unbelievably tall, unnaturally tan with bleached blond hair (despite being 62!), and very laid back and friendly. Suffice it to say, I liked him

• Based on the thyroid tests I had done in Texas, he suspects I may have subclinical Hypothyroidism, meaning that, even though I’m technically within the normal limits for thyroid hormone, I’m at the lower edge of normal, which can have an effect on both fertility and miscarriage rate. Since we definitely want to avoid miscarriage, he wanted to retest my levels and start me on a low dose of thyroid hormone if the tests confirmed his suspicions. He also asked me if I had any of the following symptoms which can indicate Hypothyroidism: low energy/fatigue (yes), depression/low mood (yes), coldness in hands and feet (yes), difficulty maintaining my weight (not really, but I eat so healthy and have greater energy needs due to my lungs, so a dip in metabolism probably wouldn’t have much effect on my weight), low sex drive (YES, definitely!), and difficulty concentrating (yes, over the last few years I’ve felt increasingly distracted and unable to focus). He also wanted to test me for Vitamin B12 deficiency (low levels can also affect mood and energy) and start monthly injections of 1000 IU if necessary. Vegetarians and older people are more likely to be deficient. I had my blood drawn, and they’ll call with the test results tomorrow.

• I was on cycle day 23 (a good day to come in, he said), so he ordered a sonogram of my ovaries, which indicated that it was perfect timing for preparing for the IVF cycle to start after my next period! Once I get my period (which should be in about a week), the whole process should be complete within 21 days. When he said that I would be starting the Lupron today, my heart gave a little leap! It was hard to believe that everything was working out so well.

• The sonogram also showed my ovarian reserve (basically how many eggs I have remaining in my ovaries), which turns out to be good for my age, but not great. Although I felt slightly disappointed, he explained that this was actually a good thing as far as the IVF goes. If I had a huge ovarian reserve (as he had expected for someone my age), he would have to be more conservative with the stimulating medications so as to avoid Ovarian Hyperstimulation Syndrome (otherwise known as OHSS), a potentially life-threatening condition in which the body releases too many eggs and has an overload of estrogen, resulting in severe pain, abdominal bloating, and difficulty breathing since fluid fills the abdominal cavity, pushes on the lungs, and sometimes even leaks into the lungs (obviously a no-no for me!). By being more conservative with the meds, he would also risk having to cancel the cycle if I failed to stimulate at all, which would push the IVF back by a month. So, the fact that my ovarian reserve is not as high as he’d thought means my risk of OHSS is low and also that he can more aggressive in getting as many eggs as possible.

• He said we’ll transfer a maximum of two embryos (although we may do just one depending on how many embryos we have to freeze for subsequent cycles and their quality).

• Given where I am in my current cycle, his tentative timeline for the IVF cycle is as follows. I’ll return on January 27th after two weeks of Lupron injections (which will temporarily shut down my ovaries) for another sonogram. If everything looks as it should, I’ll start the stimulating hormones at that time. I need to remember to bring the meds that SH has procured for me to the appointment. The retrieval (when they remove the eggs from my uterus) should happen between February 7th-11th. The procedure will only take about 5-7 minutes, during which I’ll be asleep but breathing on my own. Supposedly, there should be no pain afterwards. The transfer (when they place the embryos into the uterus) should occur 3-5 days after the retrieval. If all goes well, I should have a positive pregnancy test by March 1st!

• As if things couldn’t get any better, when we started to ask about payment, Dr. M insisted that we wouldn’t have to pay anything! They’ll try to get what they can from the insurance, but otherwise, they’ll cover everything! Unbelievable, huh? When we later told SH, she said she’d suspected all along that he wouldn’t ask us to pay since she refers over 300 patients to him a year and really likes her. I am still so stunned at this sudden turn of events!

• A member of his staff (a very nice, fast-talking Russian woman) gave me my first Lupron injection in my belly. She said I didn’t have a lot of belly fat (which made me feel good, although if I get pregnant, that wont be for long! :), so to make sure to jab the needle straight in rather than at an angle, or it might go through the other side. I’ll be injecting myself with 10 units every evening before bed, alternating sides of my belly to avoid soreness.

• The semen analysis AC had in Texas indicates that his PH is a little high (it was 8, when it should be a 7), but SH said AC was probably just dehydrated (which I’m sure is true, since he NEVER drinks enough water!)

• If we have to use frozen sperm, we’ll need to do ICSI (where they inject the sperm directly into the egg), since thawed sperm don’t usually swim as well. Since a fresh cycle is always better than a frozen one, when I mentioned that AC may be back for a long weekend for Valentine’s Day, they said they may be able to delay the cycle by a few days, so we could do the retrieval on February 13th or 14th using fresh sperm. It would be so nice for AC to be there for the process, to wake up from the procedure and see him first thing, and to spend the next few days together waiting to hear how our little embryos are doing. Most likely he wont be able to be there for the transfer, but this is definitely more than I had expected!

• The side effects of Lupron (hot flashes, night sweats, moodiness—what fun!) should start in about a week, so until then, I’m just going to try to enjoy feeling good. AC is arriving late on Friday for a long MLK weekend (he wont have to fly out until late Tuesday afternoon!) and I can’t wait to celebrate with him. Could life be any better at the moment?