1st IVF Ultrasound & Bloodwork

Yesterday was my "suppression check" at OHSU for our IVF cycle.  It consists of a bloodtest to measure estradiol level and also an ultrasound to make sure the ovaries are "quiet," or not yet developing follicles for the month.  The idea is to control the rate of maturation of the follicles, so that they are retrieved at just the right time, before the body would normally ovulate on its own.

I arrived at the clinic feeling optimistic and practiced taking deep breaths in the waiting area while listening to soothing music on my iPod.  I don't think I was really expecting anything negative to happen; maybe I was excited more than anything else. 

I ended up having to wait for awhile since there was a retrieval scheduled before my appointment.  OHSU had called me on Monday in fact, to change my original appointment time in order to allow for the retrieval appointment.  No big deal.  I figure that when it's our turn for retrieval, someone else will probably have to rearrange their schedule for us.  It's just the nature of IVF. 

I'd been waiting for about 15 minutes before a medical assistant took me back and did my bloodwork and then I waited for about another 10-15 minutes before the doctor was ready to see me.  They asked if it was okay for the medical student shadowing the doctor to observe the procedure, which is something that has been my experience every time I've been there.  I said that was fine.

Dr. Amato (the lone lady doctor in the practice) performed my ultrasound.  She looked at my womb first and didn't have anything to say (good sign), and then it was on to measuring the cysts on my ovaries.  She pointed out the endometriosis to the medical student, which didn't really upset me in itself.  What got me was that the doctor made it sound like I only have a small part of each ovary that is "normal" tissue--since the cysts are so large.  She asked me if my drug therapy was going to be aggressive.  I told her that I didn't know; we were told to start 175 IUs of Follistim in the morning on Saturday, followed by two vials of Menopur in the evening.  She commented that no, that was not very aggressive, but that we would see how I responded. 

Now I was upset--not from any specific thing that the doctor did or said, but from all of it.  I left the office crying and tried to pull it together in the car, but the fear was (and still is) pretty overwhelming.  It's not only fear that there won't be enough eggs to complete the cycle, but also that we are investing a great deal of money in this venture, and if it doesn't work it will be some time before we're able to explore a different option.  I can't convey in simple words how it feels except to say that it is a place of dark worry and sadness, frustration that all I am doing doesn't seem to be having an effect on those cysts, and fear that we are going down a fruitless path.

I had to go back to work and try to get through the day after the appointment.  First I tried finding Strohecker's, the specialty fertility pharmacy we are using for my meds, but the Garmin had me driving around in circles for about 20 minutes before I finally gave up and just headed to work.

Luckily, Michael was able to leave work earlier than he normally does and picked up the drugs and assorted paraphernalia (needles, sharps container, etc.)  He texted me that he ended up putting the cost of the drugs on our credit card since it was way more than we had been expecting (about $3600), although in retrospect, I remember being told that in our inital consult back in April . . . cost of drugs for one fresh IVF cycle is generally between $3-5,000. 

Right before I got Michael's message about the cost, I got a call from OHSU with the results of my suppression check.  The nurse or medical assistant was curt and not really friendly.  She said that I was fine to proceed to the next step of the cycle (Estradiol level was less than 20 which is what they want, but she couldn't give me a specific number since they don't do that specific of a test during the suppression check), but that based on what they found during the ultrasound (cysts, big surprise), Dr. Patton is bumping me up to taking 300 IUs of the Follistim instead of 175.  The amount of Menopur stays the same. 

I was both relieved and saddened.  Relieved because all day my mind had been racing from Dr. Amato's reaction to my not-so-aggressive scheduled drug plan.  I was all set to ask to have Dr. Patton call me so I could ask him if I should be on a higher dosage.  I do know that the team of clinic doctors (there are three of them), meets every day between 1 and 2p.m. to discuss each patient currently going through an active IVF cycle.  Maybe Dr. Amato told Dr. Patton she thought I should be on a higher dose of drugs.  I like the fact that they all discuss my case, because it's kind of like having three doctors for the price of one--three insights into our specific situation.

I made it home close to 8p.m. and Michael showed me all of the stuff he picked up at the pharmacy.  He had already gone through and put certain of the drugs in the refrigerator, but there was still a big bag of supplies on the table--mostly packets of needles of different sizes, the sharps container which is larger than I thought it would be, and some of the drugs that don't need refrigeration.  I felt much better when he told me that he was able to get all of the drugs we will need for $3600 because at first I thought he paid that much for 8 days' worth of Follistim and Menopur which was what we were going to start with.  Apparently, you can't order less than 10 days' worth even if you don't need that much.  Since I'm now on a higher dosage of Follistim, we'll need to buy more of that because 10 days has now become about 6 days worth of drug, but I'm hoping we won't need a whole lot more of it.  The nurse did tell us it keeps for 3 years, so I guess that's good in case we need it for another cycle. 

I feel like I've run the gamut of emotions in about 24 hours and am now in a kind of neutral place.  We've begun and all we can do is see where the road leads us.  I'm so thankful that Michael is helping me as much as he is.  He doesn't seem worried, even about all the money we are spending, which is quite the opposite of how it usually is--usually I am the calm one and he stresses financially.  Maybe he can tell I couldn't handle it if he were stressed about it and is putting on a brave front.  Whatever it is, I'm thankful for it and hope we can get through this in one piece. 

Please think good thoughts, pray for us, send us good energy--whatever works best for you.  I go back to OHSU on Tuesday for another ultrasound and blood test.  I will have been on the drugs for four days by then.