Meeting with the Doctor

Today I had both my follow up meeting from my last cycle and preparation meeting for my next cycle with my doctor.  Again, I got charged for this visit and I plan to call them later this week to hammer out what the deal is with getting charged for this appointment.  Last time they said they charged me because I had a scan, but I didn't have a scan this visit.  I should have argued when I was there but I wasn't in the right mindframe to do it.  I've been incredibly stressed all day and I just couldn't deal with it.  Probably a mistake.  Whatever.

Anyway.

Here are the things we talked about in no discernible order.

Probably one of the most important is we discussed my results from the last cycle (4 eggs) compared to the first cycle (6 eggs).  Of course this disappoints me somewhat, but then if I had 2 ovaries I would have 20 eggs total instead of 10 (lets say) and I'd be perfectly happy with that.  So I don't feel like I can be that upset about it.  I stressed this was my last possible cycle due to financial considerations.  So the doctor said that as it was my last cycle he felt we could try to push the ovary a bit more and he's going to increase my Gonal-F and see how it goes.  In both of my cycles there had been additional smaller follicles that didn't catch up or grow as fast and I guess he's hoping to catch them by upping the drugs.  As with most of this process, I have to trust that he is basing this decision on his experience and expertise and I trust him.  I'm conscious of having read other women who didn't respond well to higher drug doses, but I trust that my clinic scans me every other day, and will monitor me closely and he wouldn't suggest this if he didn't think it was a good plan.  It's hard to feel like I'm gambling with my last cycle, but on the other hand, I've read about a lot of women on the higher dose of Gonal-F, so it's not like it's that odd or extreme.  I'm sure it will be okay.  I'll obviously keep track here of how everything goes.

In keeping with that, I got my prescription for all the drugs so I need to get in touch with Healthcare at Home to send it in and arrange the delivery.  I'm going to remember to insist that they include the sharps bin this time!

We arranged my norethisterone prior to the cycle.  As my cycle is about 30-31 days, I'm going to do 9 days of the norethisterone.  For the first cycle I did 8, the second I did 7.  So this is another change although one I'm more on board with.  The nurse had suggested I do 9 for my second cycle but the drugs didn't arrive in time so I could only do the 7.

We talked about birth control pills.  Specifically about whether or not I could go back on them after the third cycle and if there were any implications for future fertility. He said there is no indication that birth control pills affect ability to conceive and that I should be fine going back on and he had no reservations.  So that was good news.  I miss my birth control pills!

We talked about my period.  Okay, skip over this if you don't want specifics.  Basically I've noticed that as I've gotten older, my period is much darker, and lighter, and a bit shorter.  Of course as I go through all of this I just panic that this somehow means my womb is an infertile place and I can't conceive.  He said the color of your period means absolutely nothing.  He also said that the frequency of your period and heaviness have more to do with your ovarian reserve than your ability to get pregnant. He pointed out that there are women close to 50 who get pregnant- they have no eggs left, but their womb can still healthily function.  Obviously I am not planning on being 50 and pregnant, but this was comforting news.

We also talked about the counseling service that is available.  I sort of wish I'd picked up on this sooner.  They have to counselors who have an office space and I just need to call and arrange an appointment and they will often schedule alongside your scan if the timing works out.  Although I might start this sooner seeing as how once my scans start there isn't much time left for any counseling.  At any rate, it will probably take time to arrange it anyway.  So I'm going to do that and will also have updates here.

So really, that was all great, other than being charged 120 quid for the visit.  This irritates me to no end, but my comfort and trust in the clinic outweighs my annoyance.

The only other thing of interest is that they are doing some building works to the clinic and so I'm lucky I didn't try to schedule for this month as I don't think they would have done it.  They're moving around some of the lab and clinical spaces on the ground floor although the doctors offices and scan rooms on the first floor aren't affected.  The building works are supposed to finish right when my next cycle starts, so that allows an extra week and a bit for them to run over before it's a problem. I am just going to assume it's not going to be a problem.

Anyway, that's the update.  One month countdown to the third and final cycle begins!

End Cycle 2, Cost Update

At the end of cycle 2, I thought I'd post a cost update.  You can see the full breakdown from the first cycle here (with the cost of my follow up scan added here).  You can also see the drug breakdown comparison from my first cycle bought direct from my clinic to the Healthcare at Home order here.  For ease, costs have been rounded to the nearest pound.

Previous total cost	£6996
Norethisterone delivery from clinic	£11
Drugs from Healthcare at Home	£584
Egg Freezing Cycle	£2800
225 Gonal F from clinic	£90
Total	£10481

The total for the second cycle came to £3485.  Given my estimated budget of  £10k for 2 cycles, that's pretty much right on target.  It would have even been a bit better if I had known about the less expensive drugs from Healthcare at Home for my first cycle.  And of course I expect a refund at some point from the 10 years of storage since I doubt I'll use all ten years.  I think they refund you £150 for every year not used.

Assuming I go for a third cycle I will be able to shave off a tiny bit more- as the norethisterone didn't arrive in time, I have it set for the next cycle and don't need anymore.  I also would get a 450 Gonal-F pen from Healthcare at home as I believe that even if I don't need both doses, it would still be cheaper than the one dose I had to buy extra this cycle from my clinic.  Although I only have one Cetrotide left over so I'd need more of those, maybe it would work out to the same then.

Egg freezing is not an inexpensive process, especially when like me, you need multiple cycles.  I hope that in the couple of years between now and when I hope to use the eggs the costs may come down a bit as the popularity continues.  In the next month I will need to consider my options for paying for a third cycle.  My mother paid for most of the first two (I think I paid about £1000 of the total myself), but that is all she can afford.  I am going to speak to my step-mother about whether or not she thinks it's worth discussing it with my father or not.  I could take money out of my mortgage, or I could use my savings.  I have enough to cover the third cycle myself, although it would take a substantial amount of my savings at a time when I may need it (I'm finishing a PhD and my funding runs out at the end of the year).

Still, at the start of this process I said I probably wouldn't have done it if I had to pay for it myself, but now I obviously feel differently and that it would be worth my own savings to finish this journey.  I think that's probably worth noting.  I have no idea what the future may hold but it's clear that doing this has given me some sense of confidence or comfort that wasn't obvious at the start.

Cycle 2: Day 15

So yesterday was a big day!  Sorry to be a day behind but I got home and the phone company had shut off all the phones in my building which meant no easy internet.

Anyway, yesterday was scan day.  Back to my regular doctor.  Had a good scan and a good chat with him.  The decision was made to trigger, so my collection is tomorrow (Friday).  That's one day short of the last cycle but pretty much the same.  I have 4 large follicles and any further stimulation could cause me to lose them.  I may lose one already but we'll see.  There are also 3-4 follicles just squeaking past 11mm.  Apparently that's the threshold for finding mature eggs.  So they will sweep all of them in the hopes of finding some.  But I guess I should be looking for about 4 eggs tomorrow and anything more would be great and anything less will make me depressed and then I'll have to get over it.

So my appointment is at noon tomorrow.  This meant I took only Cetrotide last night before 10:30 (I took it around 9:30, and I did it in a restaurant bathroom.  Not ideal but it was all rather short notice and I figured that was better than cancelling my plans.).  Then at precisely 11:30 at night I did the Ovitrelle injection.  This was a different system than the one I got on my first cycle.  This one came in a pen just like the Gonal-F so super easy.  Not that the pre-filled syringe wasn't easy as well.  I like injections that are easy.

And now I wait.  Today no injections.  No food or drink past midnight.  On the first cycle my collection was early in the morning, so it was easy not to do food or drink.  This time I have to wait out half a day which is going to be a bit more challenging although obviously not nearly impossible.  Just annoying really.  Also no deodorant or anything so I'll take a shower before I go and hope it's not too warm out.  Oh, and of course there's the lovely Voltarol suppository that I just need to "pop in" before heading to the clinic.  Fun times.

I've arranged a friend to come meet me and go home with me.  Much easier this time as the first person I asked could do it.  And she's super sweet, she asked me what I wanted as some comfort food so she'd make it for me when we get back to mine.  Macaroni and cheese, you are mine all mine!

In other news I learned how I get moved from the procedure room to the recovery room.  Apparently they wheel in the recovery room bed and slide you across.  That makes sense.  I knew it wasn't the same bed!  I also asked about follow up appointments.  Apparently the reason I got charged for the last one is I had a scan.  A talking follow up appointment is free, but the scan costs.  I still find that slightly annoying, especially since I was "feeling" my ovary and I think it's reasonable aftercare to have a look and make sure nothing is wrong.  But this time I know, or rather, expect that my ovary will take a while to get back to "normal" so I won't have a scan after but I will make a follow up appointment to discuss what the next steps are.  If I do get 4 eggs I'll have 10 on ice.  That's really not enough for me to feel comfortable.  But I can probably only afford one more cycle.  So we'll see.

The only differences between last cycle and this cycle other than my taking conception vitamins was one less day of norethisterone prior to stimulation.  There haven't been any other impact factors.  I mean, other than I'm stressed, but I'm pretty sure I was stressed for the first cycle.  And I mean "life" stressed not egg freezing stressed.  Meh.  It is what it is!  I'm doing the best I can!  (Repeat).

Oh, the other thing I talked about with the doctor was in vitro maturation of eggs that aren't mature.  He wasn't in favor saying the results are really generally poor and in fact as a clinic they are so underwhelmed by the success of in vitro matured eggs they don't offer it.  Again, who am I to argue with the doctor?  Their success rates as a clinic are high.  I'm sure that it does work for some people, but I guess they look at it as an overall benefit and don't see it as panning out.  So one less thing for me to consider.  That's fine.  I'm okay with that.

So anyway, depending on when I have home internet again, I'll update with the results.  Nothing to do now but wait! (And drink gallons of water.)

F*** You, Post Office

I've had a very frustrating morning.  I only had enough norethisterone for 7 days and then the head nurse said after discussion I could take them for 9 days but they had to send me more.  So I ordered them and they mailed them to me but I was away last week when they arrived so I got a post slip and had to arrange redelivery.  I've waited all morning for it, it's not here and now the post office is closed for pick ups.  This means I will not be on the norethisterone for the 2 additional days.  I'm annoyed about this but I hasten to add, not panicked.  Mainly because my doctor suggested I only take them for the 7 days anyway (when I said that was what I had left from the first cycle) so it was a late change to add the 2 days.  And not by my doctor.  So it goes to show how... 'not rigorous' the process is.  Still, I had in my head I'm going to take pills for 7 days and then the pills don't arrive due to my FUCKING post office people and it really makes me angry.  I should have just not arranged the redelivery and gone this morning to pick everything up.    SO ANGRY.

Here We Go!

Day one of norethisterone pills.

And so it begins again!

Rolling

Well my period finally arrived and I've been in touch with the clinic to arrange my norethisterone start.  When I contacted them I pointed out that my period is definitely not on a 28 day cycle.  After my first collection, my period came March 8.  My next period started April 11.  This period has taken it's time and come May 14.  Of course everything seems to be scheduled around a 28 day cycle and that is not me.  So I commented on this and heard back that they want to put me on an extra day of norethisterone that starts June 1.  For the first cycle I was on 8 days so now I'll be on 9.  It also looks, based on this, that my collection will be late June and my injection start will be mid June.  So it's still a bit of time yet, but the ball is rolling!

OMG I Hate Waiting!

I'm waiting for my period so I can let the clinic know the first full day so I can plan my norethisterone for my next cycle.  Now, my period is slightly over the 28 day cycle, but my period was like the 8th, then the 10th, then the 11th.... and now it's the 11th and where is my period??  I'm getting a few 'hints' from my gut that it might be on the way, but really nothing. Not a glimmer.  It's ridiculous.  It's like the more I think about my period, the more my body decides it's going to keep it from me.  It's amazing how easy it is to get stressed about things that you normally wouldn't care at all about.  Because if I'm not thinking lighthearted thoughts about how silly it is, I'm thinking more damaging thoughts like, "OH MY GOD THERE'S SOMETHING WRONG."  Which is also silly, in its own different way.  But it's so easy.  It's so easy to slip into these sorts of mindsets.  And I think it's particularly easy to do it when you've only got yourself to talk about it with.  I'm sure there is nothing wrong and my period should arrive tomorrow.  Or maybe it arrives the day after.

It's fine.

But it's also annoying.

Costs

I know I promised I'd return with a cost break-down post.  After a couple of weeks I have returned to do just that!  But first some other house keeping.

My period came and went and I finally started to feel less bloated.  It probably took a good 2 weeks before I started to think I felt "normal".  However, I have noticed that I still sometimes feel my side where my ovary is.  I have not had a follow-up appointment with my clinic (though I hope to arrange one next week).  Part of me is concerned that my cysts somehow grew a lot and that's what I'm feeling.  That seems slightly irrational, but I have no other way to understand why I feel "something" even when the rest of me feels normal.

I'm also slightly disappointed that my clinic did not mandate a follow-up appointment post retrieval.  That seems poor form to me.  I'm not sure if it was an oversight, or if it's standard, but I think follow up care is important.  So I'll call that out as something that has not made me happy about my clinic.  But, as I say, I'll try to get an appointment next week.  Mainly because I need to discuss how to proceed with cycle 2 in June.  So while I'm not thrilled with every aspect of my clinic, I'm also not unhappy enough to go elsewhere.

Now, on to costs.

A caveat.

After looking around at IVF blogs, it came to me that in the UK other people try to price their drugs cheaper at certain pharmacies.  It may be that I could have gotten my drugs for less had I shopped around.  My clinic did not suggest this to me, and it honestly did not occur to me.  For my second cycle, I will try to shop around for cheaper drugs, and I will post about that here as I do it.  However, below were the costs of my first cycle, using the drugs provided by the clinic, at the clinic cost.  I had no left-over drugs at all, which I really appreciated.

Service	Cost
Initial consultation and blood work	£490
Norethisterone plus mail fee (£6)	£11
STD Blood work	£115
Gonal F 450 pen	£180
Gonal F 900 pen	£360
Cetrotide x4	£128
Egg Freezing Medical Cost	£2800
Ten year storage (unused refundable)	£1800
Gonal F 450 pen	£180
Cetrotide x1	£32
Gonal F 450 pen	£180
Cetrotide x3	£96
Gonal F 450 pen	£180
Cetrotide x1	£32
Gonal F 450 pen	£180
Cetrotide x3	£96
Ovitrelle single dose	£16
Total Cost	£6876

So here are some quick facts:

• The 'egg freezing medical costs' included all of my clinic visits, all of my scans, and the retrieval procedure and associated drugs (including suppository)
• The initial consultation and the storage are one-off fees which I won't pay again. Total: £2290
• Total drug costs: £1671
• Projected cost of cycle 2 if no changes: £4471

I suppose it's also important to note that I was on drugs for 15 days which is longer than average and so obviously increased the costs.  If I can reduce the drug cost, that will obviously make a difference.  If I could get my cycle 2 cost to under £4000 I'd be happy.  But, I'm also happy to note that this is all pretty close to my rough estimate of what it would initially cost for two cycles (I'd assumed £10k) and that was assuming I wouldn't be on the stimulation drugs for as long.  So there you have it.  Just my experience of course.  I would be very interested in hearing from women in the UK about their comparison costs.  Please leave me a note if that's you!!

Day 10

Here is some advice.  It is not always great to read the things you find on the internet.

On the other hand, it can be useful to read things you find on the internet.

I'll be honest.  I haven't done loads and loads of reading on egg freezing or IVF cycles and I don't know all the terminology and all of the steps and measures.  I've had to learn as I go.  And it turns out I often have questions.

Of course my first response is to look up answers on the internet.  And there are loads of people talking about stuff- mostly IVF, but still relevant.  But sometimes what they say makes me worry about my protocol or my results.  And that's really a bit useless.

So this is what I think I learned today.  First, I'm on an OCP-antagonist protocol (I think).  The purpose of the norethisterone was to suppress the proto eggs briefly in the hopes that they all come out together so that there are more mature eggs at collection as opposed to varying sizes of eggs which would mean many are not good enough for freezing.

I learned that follicle numbers seem to have very little to do with egg numbers.  And according to IVF blogs, even a good number of good eggs can result in only one or no transferable embryos or blastocysts.  This was depressing.  I even read someone posting about how they had 8 follicles and NO eggs.  Of course this is useless information for me to be reading.

I'm just getting anxious to get to this particular finish line.  I have another scan in the morning with a different doctor.  I'm going to try and get them to tell me as much as possible.  I know there's no use in worrying over things I can't change, and at the moment I don't have anything specific to actually worry about!  I suppose in the space of waiting for what will be, my mind just continues to manufacture a steady stream of 'what ifs'.  I will be very relieved to finish this cycle, one way or another.

Although obviously I will be happy with a good outcome!  I'll be relieved but terribly disappointed with a poor outcome.  Just hate all the waiting!!

All Systems Go!

I've just returned from my meeting at the clinic.  Had an ultrasound scan of my ovary to see if it's good to go, and it is!  So had a chat with the doctor to answer some of my questions, he prescribed the drugs, I met with the nurse to collect my drugs and learn all about how to inject myself.  Got a blood test for sexually transmitted diseases and so now it's just a matter of waiting for my period to start.  Last norethisterone is tonight!  I start injecting on day 2 of my period, and need to go in for a scan and possible blood work on the 4th day of the drugs.  I'm nervous, but I'm actually really excited.  I felt really positive about it today!

So I'll do another post with all my drugs but I wanted to also record here some of my questions and answers, in part so I won't forget, and also because maybe it might help other people.  So in no particular order:

• How am I supposed to understand AMH numbers against having one ovary?
• The doctor told me this is a two part answer.  He said if I want to know how many eggs I have left, I should stick with the number as it stands.  But if I'm trying to understand how my ovary might respond to medication, then I should consider the number to be doubled.  Of course I will only get half of what one would expect from the doubled number, so again, tempering my expectation.  But this is kind of great news because it bumps up my AMH to a better bracket.  So that was good news.  Actually, he said my one ovary was actually very promising.  So I felt really good about that (I may regret these words later!)

•  If I think I'm going to need two cycles, how much time should I prepare to leave between cycles (if any)?
• The doctor said they recommend to take a two or three month break in between cycles.  Now on the way home I realized I still didn't understand this perfectly.  I'm having a February cycle now.  March would be one month off.  Then is April possible?  Or does a two month break mean not to do it in March or April?  May won't be any good for me as I'm traveling to the States to see family for the annual trip home so I guess I'm looking at June.  If I want to do a third cycle, and need to take a break, that means my third cycle will happen when I'm 39.  I'll cross that bridge when I come to it, it depends on a number of other factors.

• Is there a way for them to know if an ovary has twisted?
• I was reading up about how you shouldn't do any impact activities or twisting activities while stimulating.  Because when I lost my other ovary, it had twisted 3x, I'm a little worried about it happening to this one.  Twisting cuts off the blood supply and is pretty much bad.  I mean, why does it twist??  So apparently there is no actual way for them to 'see' if it's twisted and the only way for them to know would be if it was very painful.  He said that as the ovary gets larger, that's what might make it twist.  Now my cyst, that was large- around 15cm.  He said under stimulation, the ovary will grow to between 7-8cm so hopefully not so large to make it twist, but large enough that I need to be careful.  That's fine.  I plan on being very careful.  They said to call of course if I had any pain or worries during the treatment.

• How many eggs should a woman freeze to have a very good chance at one future baby?
• Okay, this one has been bothering me because a lot of the egg freezing stuff I'm reading have women talking about freezing 10 or 11 eggs.  When I met with the doctor the first time he said ideally I would really want around 20.  I saw a different doctor today who will be managing my process and he actually said 20-30!!  But that 20 was probably a good number to have a very good chance at one successful baby.  His rationale was because the clinic results (see chart below for 2011) show a 33% success for clinical pregnancies with women 38-39.  So because I am 38, the eggs I am freezing now will give me about a 1 in 3 chance of a successful pregnancy.  He said that one IVF cycle will use about 7 eggs. So 20 frozen eggs accounts for 3 cycles and the odds show one of those would be likely positive.  It's important to note that for live birth the number drops slightly.

Patients age	<35	35-37	38-39	40-42	43-44	>44
% clinical pregnancies*	44%	37%	33%	13%	6%	-
Clinical pregnancies per cycle commenced	72/165	27/73	20/60	11/84	2/32	0/12

On the Pill and Considering Diet

Just an update.  I've been taking the norethisterone for six days now.  No side effects that I can tell, not that I think there are supposed to be any.  I have my scan and nursing appointment on Tuesday which is just two days away.  I'm so anxious to get to it!

In other news I've been trying to moderate my diet in preparation for the procedure.  This has meant trying to eliminate caffeine and alcohol from my diet.  This has not been easy at all.  I could do alcohol fairly easily, but it gets hard when you can't have a coke instead of a glass of wine.  I've managed fairly well but I've had 2 glasses of wine in the past week because... well, I have no excuse.  I read that and then I think, what the hell, I haven't managed fairly well at all!!  But I've turned down quite a bit of alcohol in the past week, so I feel like I've done well.  Ugh.  This will be it until the procedure is finished.  I fear it's too much money to be wasting and not taking it seriously.  I've looked on forums and seen mixed information on how strict you should be and when you should start.  Some people say to cut all caffeine and alcohol three months before the procedure (which I have completely missed the boat on) and some say only when you're on injections.  Most seem to agree that a small cup of tea or coffee a day is okay, but caffeine isn't really my issue as I don't drink many hot beverages.  It's the alcohol.  I've cut back, and I'm happy to cut it out completely for the next three weeks.  But it is hard.

My mind still wanders to worrying about egg collection and how few there might be.  It's the whole one ovary thing.  I read other blogs and other people's experiences and then I have to remind myself that they have two ovaries.  I want to be hopeful but I am so terrified that I'll only get one or two or three when I really want seven or eight or nine.  I know I just need to do it and see what happens but it is actually incredibly stressful.

First Pill

Popped my first pill this morning.  Two a day until my scan and meeting on the 5th.  I'm excited and nervous.  I can tell that this whole egg freezing thing is going to be fairly emotional.  I can't predict what's going to happen obviously, but I would have to be some sort of grand master to keep my mind from occasionally wondering if it will go well (ie, a good number of eggs collected) or if it will go badly (ie, a poor number or even no eggs collected).  When these thoughts come upon me I just need to take some deep breaths and remember that whatever it is going to be is what it will be and the best thing I can do is stay calm and positive.

All Systems Go

Alright.  Lots of back and forth from the clinic.  Back from my trip to Australia.  All systems are go for egg freezing round one.  This starts with taking Norethisterone on the 29th of January 2x a day until my first scan on February 5.  On this day I have my nurse appointment and get to learn all about giving myself injections and will also collect the rest of my drugs, as well as be tested for a slew of STDs.  Collection is tentatively scheduled for around February 22 depending on when periods start and how scans are going.  This works fairly well with my schedule though it looks like I need to move one appointment.  I'm both nervous and excited for it all to be underway.  In some ways it doesn't seem real.

So current issues are:

• Get to the 5th of Feb and ensure that all planned scans, etc do not conflict with my rather hectic back and forth schedule.
• Move that one appointment that is likely to conflict with collection day.
• Try to find someone to meet me at the clinic on collection day as they don't want you to go home alone.

Although I asked and they said if I really can't find anyone, I just need to arrange a taxi to take me home and not take public transportation which seems fine.  It's just that I'd be asking someone to take off work and that seems unlikely.  I have one friend I can maybe ask, but I'll try for that as it gets closer and I have a better idea of the actual collection day.

In other news my mother started freaking out that the treatment was going to create another dermoid cyst and that I'd lose my last remaining ovary in the process.  She lost both ovaries to dermoid cysts and I lost one.  So there is a fair worry there, but I reminded her that I asked the doctor specifically about this issue and he said it was very unlikely.  On top of which, given all the scanning I'll be having, if any cyst starts to develop, I imagine that they will be able to notice it and stop the process.  Also, early cysts can be dealt with, without losing the ovary.  It's a risk, but a minimal risk.  And my only option is otherwise not to proceed.  The doctor did not think it was a high risk.  I think I need to go with his experience on the matter.

So that's where I'm at.  Now I'm getting nervous that it's all going to fail and there won't be any eggs or not enough eggs.  It's really kind of amazing the mental ups and downs you go through.  I mean, I understand it, and it all seems a bit text book.  But being typical doesn't change that I'm still going through it!  Deep breaths.  Calm thoughts.  After all, if I meet someone in a couple of years, and we wanted kids and tried IVF then, it would be worse then.  This is the best I can do, doing this right now.  We'll see what happens.