Oof, OOP

I'm the numbers person in our household. I have a rather spectacular spreadsheet were I track our monthly expenses, account balances, loan balances, and so forth. I can tell you what our budget was, what percentage of our income we spent on taxes, on living expenses, and on savings. In other words, I'm the colossal nerd in the house. (How colossal, you ask? The last two years running, I've created a Year-End Financial Review powerpoint deck to review with DH. I thought this was a fantastically swell idea, until I saw the feedback a fellow over at Bogleheads got about doing this same thing with his spouse. Let's just say the feedback wasn't positive!).

Having just wrapped up the last of the 2017 spending, I took a look at the medical category for 2016 and 2017. Counting from Jan 18, 2016 to now, the total cost of getting pregnant and then getting un-pregnant was been $25,196.66. That does not include my insurance premiums, hundreds of dollars in supplements, or the approximately, 2,000 home pregnancy tests I've bought. During that time period, it's our second greatest expense, only falling behind our mortgage. 

I know I am actually really lucky. That total covers 3 OI/TI cycles, 9 surgeries, nearly 6 weeks in-patient, and two deliveries. It could be so much higher, if we'd needed more cycles or if we need to move to IVF. It's tough, though, when I see that total and think about what it "bought" us. It bought us an hour with the most precious little girl you can imagine. It bought the chance to give our twins life. It bought five glorious weeks of feeling Quinn move inside me. It bought more tears and heartbreak than I can quantify (and as a nerd who likes spreadsheets, I'm usually really damn good at quantifying things). It's bought me near constant physically pain and months missed from work. It bought amazing, touching connections with friends and family members who have reached out. To echo what appears to be a recurrent theme: it bought us hope and the loss of hope.

I'm working on my 2018 budget now. Planning for 3 OI/TI cycles, and hitting my OOP max for medical care. I honestly can't tell if that's me being optimistic or pessimistic. I can tell you that I stand behind my response when a friend asked me "What will happen if you don't have kids from those cycles?" Answer: "I'll have more money for other things in 2019."

Anxiety in the TWW

I don't understand why, but my anxiety level is always greatest two days before I'm going to take a pregnancy test*. Cognitively, I've tried everything I can think of to reduce that anxiety:

• Remind myself that nothing at all will change the outcome of that test, not even obsessively googling 'early pregnancy symptoms,' 'wondfo 11 dpo bfp,' 'thin lining success stories', etc.
• Remind myself that I am ready to cycle again. I have a fridge full of paid-for drugs that I'd like to not waste. That means either outcome will be ok!
• Remind myself that I fully expect a BFN, and given my lining, even a BFP is likely to be a chemical. 
• Remind myself that testing at 11 dpo is really early so I shouldn't expect anything.
• Remind myself that a BFN will mean I can stop this endometrin for a few days, which would be nice. 
• Remind myself that it will be ok, no matter what. 
• Distract myself with other things. . . .ok well maybe the googling isn't such a good distraction! :)

None of that works. And now, with so many cycles behind me, I'm really getting curious as to why it's a two days pre-test issue. . . why not the day before? Why not three days before? What odd emotional/chemical reaction is going on in my brain two days prior to testing? 

I wonder if some of this is because I'm having symptoms. It's 99.9% likely that those symptoms are the result of the estrace, the endometrin, and the cold I got, but they're a perfect match to my last two pregnancies. Maybe I'd be more calm if there was no hint of a possible positive? Or maybe it's because my last two cycles should never have resulted in BFPs, but they did, so I have wholly unrealistic expectations?

Tomorrow is 11. I am more calm today than yesterday. We'll see what happens tomorrow.

*Disclaimer: although my RE says to test 14 days post-trigger, my last two cycles I tested the trigger out, and it was gone by 10 days post trigger/ 8-9 dpo. After that, I saw legit BFPs by 11 dpo, so I start testing at 11 dpo. What can I say, patience is NOT my strong suit!

Random Observations from the TWW

Mostly I’m thinking of this as the TWW until my next cycle starts, and I’m praying I don’t wind up with another chemical because of my lining. Today I finally have some breathing room: We returned the last of our guests to the airport this morning, so I finally have time to be back on a computer without someone looking over my shoulder, wondering if there are plans for dinner, asking for something, etc. It was lovely seeing everyone, but it’s lovely having our house back to ourselves, too! Obsevations from the last few weeks:

• I’m now on Endometrin, 3 times a day, and Estrace twice a day. I think Endometrin must be the Alka-seltzer of the progesterone world. Crinone isn’t externally messy, but leaves a mess behind inside. Prometrium is a gloopy mess, especially with the Estrace. Endometrin, though, I swear I get bubbles out of my vagina for hours after using one. Also, the first time I stand up in the morning, I get an actual flood of endometrin and estrace. As someone whose periods have never been heavy enough to need “overnight” protection, I finally have a perosnal appreciation for why you’d need a bigger night-time pad than what you use during the day!
• Despite the fact that we agreed to a ‘no gifts’ policy years ago, MIL brought a cold and gave it to me. Fun. 
• If you’ve ever wondered if a Nissan Leaf (electric vehicle) can do an 18 mile round trip with the heat running in -5F temps when the gauge says “29 miles remaining,” let me assure you, it can’t. If you’ve ever wondered how far our house is from the airport? 18 miles, round trip. I know DH likes the car and I’m happy for him, but I’m really starting to hate it. Its range is too short for me to use for my commute without recharging at work. DH works from home. Why do we have a car that the person who commutes can’t commute in? 
• Two years ago, DH bought a remote control helicopter to play with while family visited. It broke, and two years later, it is STILL on the floor under the console table. Last year DH’s brother brought a robot to play with, and forgot it here. Rather than mailing it back, DH left it on top of our console table all year. This year, DH bought a massive 3d printer from China. It, the packaging, the table with the computer, and so forth are taking up about half of our living room. I have initiated negotiations for the peaceful withdrawal of the printer from the family room, as its continued presence there for more than a month or two will NOT end well. For it or for DH!

Wishing everyone happy holidays!

Nope

The answer to the question could my lining improve? Nope.

At monitoring appointment #4, follicles were at 24 and 18.5, lining was 5 and cystic. They told me to trigger as we weren't getting any change from more stims/estrogen.

Basically, I just spent about $4k to accomplish the same thing I could have accomplished with a natural cycle: lining that's just thick enough to cause a chemical pregnancy.

I'm sad, although not so much about this cycle as about the fact that maybe my lining can't recover. Maybe I've been through all this horror and heartbreak for nothing. I knew that was the risk if I did the TAC surgery, but I didn't know how bad the complications from that would be. I'm stubborn enough, I probably would have done it anyway, but still. . . 

Not a great place to be going into the holidays. Off to get my mom from the airport . . . mother in law, brother in law and mother in law's fiance all arrive in the next few days. There will be holiday cheer. Or something.

Oh, and crowning glory? Earlier this week I got my first "just relax and it'll happen!" From my mom. Actually she said maybe my stress was inhibiting my lining. I know it comes from a place of love, but e-gads! I believe strongly in the mind-body connection, but my stress level isn't going to fix this any more than my mom would have recovered from her breast cancer or Grave's Disease by relaxing.

Monitoring #3

Monitoring, again. Follicles look great. E2's going up, P4's stable, LH is good. Lining? Down to 5 with only patches of triple stripe pattern. Since my LH is stable, they're having me up my vaginal estrace to 3 a day, do another Menopur, another 225 of FSH, and return tomorrow. I'm super glad the follicles look good and have responded, but I'm worried about the implications of my lining. Asherman's strikes again. 


Day 4
             2016         |   Feb 2017  |     Dec 2017
R:        11, 9, 8.5   |     6.5          |     12, 10.5
L:        12.5, 8, 8   |     9.8          |     5, 3.5
E2:      803            |       ?           |     188
P4:      2.68           |       ?           |      < 0.5
LH:     8.25           |       ?            |     3.38
Lining:  6.9 triple | 5.9 triple   |     4 uniform
FSH    600             |   600           |    900
Menopur   0        |       0            |     4 vials    

Day 7
             2016                |   Feb 2017  |     Dec 2017
R:        19, 13.6, 7        |     9.5            |     20, 17.5
L:        16.5, 15, 10, 8  |     14.5         |     6, 8
E2:      1294                  |       432        |     718
P4:      1.66                   |       <.05       |      .07
LH:     1.03                    |       1.15       |     2.84
Lining:  6.9 triple        | 7.0 triple    |     6 homogenous
FSH    1050                 |   1275           |    1575
Menopur   0              |       0               |     7 vials


Day 8/9
             2016               |   Feb 2017  |     Dec 2017
R:        22,18,7,4        |     11            |      20.5, 18
L:        18,16,10,8      |     16.5         |     7.5
E2:      1690                |     1027        |     1087
P4:      2.59                 |      0.12        |     .18
LH:     0.76                  |      1.15       |     3.18
Lining:  6.9 triple      | 6.0 triple    |     5.0 partly triple
FSH    1200                |   1875          |    2025

Menopur   0              |       0            |     9 vials
Trigger       Yes!          |   Not yet    |     Not yet

Monitoring #2

Yesterday was my second monitoring appointment. To cut to the chase, I had follicles that were ready, but my lining wasn't. So, we keep on chugging and I start to worry about how big a follicle can get before it's "over cooked." I go back tomorrow morning, and assume I'll trigger if my lining has made it. Just for grins, I've included my cycle data below, along with my historical day 8/9 stats.


Day 4
             2016         |   Feb 2017  |     Dec 2017
R:        11, 9, 8.5   |     6.5          |     12, 10.5
L:        12.5, 8, 8   |     9.8          |     5, 3.5
E2:      803            |       ?           |     188
P4:      2.68           |       ?           |      < 0.5
LH:     8.25           |       ?            |     3.38
Lining:  6.9 triple | 5.9 triple   |     4 uniform
FSH    600             |   600           |    900
Menopur   0        |       0            |     4 vials    

Day 7
             2016                |   Feb 2017  |     Dec 2017
R:        19, 13.6, 7        |     9.5            |     20, 17.5
L:        16.5, 15, 10, 8  |     14.5         |     6, 8
E2:      1294                  |       432        |     718
P4:      1.66                   |       <.05       |      .07
LH:     1.03                    |       1.15       |     2.84
Lining:  6.9 triple        | 7.0 triple    |     6 homogenous
FSH    1050                 |   1275           |    1575
Menopur   0              |       0               |     7 vials


Day 8/9
             2016               |   Feb 2017  |     Dec 2017
R:        22,18,7,4        |     11            |     
L:        18,16,10,8      |     16.5         |     
E2:      1690                |     1027        |     
P4:      2.59                 |      0.12        |     
LH:     0.76                  |      1.15       |     
Lining:  6.9 triple      | 6.0 triple    |     
FSH    1200                |   1875          |    

Menopur   0              |       0            |     
Trigger       Yes!          |   Not yet    |

Monitoring #1

Yesterday was my first monitoring appointment. It's sadly clear that the response I had during my first cycle during 2016 was the anomaly. I have hope, in that this cycle is somewhat better than the last one. That said, I'm on much higher doses of meds. Despite that, my lining isn't doing much compared to past cycles and my E2 is staying low, even with more follicles. As always, that's worrisome.

After 4 nights of 75IU of Menopur in the morning, 225 iU of Follistim in the evening, and 2 mg of Estrace twice a day, I have two follicles in the running.

For comparison sake, here are my numbers from all my cycles. The 2016 and Feb 2017 cycles were after 4 nights of 150 iU of Follistim.

             2016         |   Feb 2017  |     Dec 2017
R:        11, 9, 8.5   |     6.5          |     12, 10.5
L:        12.5, 8, 8   |     9.8          |     5, 3.5
E2:      803            |       ?           |     188
P4:      2.68           |       ?           |      < 0.5
LH:     8.25           |       ?           |     3.38
Lining:  6.9 triple | 5.9 triple    |     4 uniform

I go back on Saturday morning to see how things are going. The nurse asked if we're doing TI or IUI, so I asked her to confirm if Dr. B thinks IUI is necessary post-TAC. It shouldn't be, but it won't hurt to ask.

Also, the person at CVS Specialty who decided to provide push-fit syringes deserves a smack upside the head. Maybe it's just me, but getting the q-cap for the Menopur transferred from the liquid to the powder without spilling everywhere is a pain. Same goes double for getting the protective cap off the needle when the needle won't stay on the syringe. I haven't stabbed myself or spilled my meds yet, but I'm sure it's coming.

Making Things Harder, 1 Fax at a Time!

Remember how I changed my flights so I would be back in MN in time for baseline ultrasound assuming I had a 9 day luteal phase?

Well, that didn't work.

AF showed up at 8 DPO. A day too early for my new flights. So I scrambled and with thanks to a great nurse, was able to get monitoring done in SoCal on Friday. Of course, for some reason the faxed order never reached the SoCal clinic, so I arrived for my appointment, then had to scramble to get my RE's office on the phone to re-fax the order.

Next problem: my meds were in a fridge back in Minnesota. I would need to use them Saturday and Sunday, but wouldn't be in Minnesota until Monday. I tried to get next-day delivery from an online pharmacy on Friday, but the faxed prescription never reached the pharmacy. Anyone see a trend here? Thanks to the time difference and an early day, my RE's office closed before I could ask them to try again. Thus, I spent Saturday driving two hours to Encino with copies of my prescriptions, just so I could pick up two days' worth of meds.

Important reminder to myself: Always, always have them fax the prescriptions to you. That way if the pharmacy doesn't get them, you have control and can re-send.

Anyhow, the final chapter to this particular mess goes like this: on Saturday, when the nurse called to confirm I was ok to start meds, I asked when my first monitoring appointment should be. She said Monday, which seemed early, so I asked. She confirmed Monday, and got me scheduled. We got home around 12:30 am today. I just wanted to sleep, but I set my alarm, got myself dressed and was ready to head out the door when my phone rang. It was another nurse at the clinic who had seen my name on the schedule and was calling to reschedule me because it's too bloody early for a first scan. GAH!

I go back on Wednesday. Until then Estrace twice a day, 1 vial of Menopur in the morning, and 225iu of Follistim at night.

Shameful Confession

It's time to make a shameful confession. I eat pretty healthy. I make most of my food myself. I avoid most refined sugars/flours/etc. But, <deep breath>, I hate sweet potatoes.

"What?" you say, "But they're good for you!" "They taste great!" "Everyone loves sweet potatoes!"

I told you this was going to be a shameful confession! Can't stand sweet potatoes. Until now. I finally found a recipe that's anti-inflammatory, healthy, and tastes amazing. And. . .it uses sweet potatoes!

I know this isn't a cooking blog, but what the heck, I'm sharing anyhow. This is based off of Laura Lea's Sweet Potato and Kale Eggy Muffin cups. I highly recommend her site for more ideas. I have her cookbook and love it.

Sweet Potato, Kale and Mushroom Frittata

1 sweet potato, peeled and cut into 1" slices
2 cups mushrooms
2 Tbs coconut oil
1 shallot, minced
2 cloves garlic, minced
2 cups kale, de-stemmed and chopped into 1" pieces
3/4 tsp sweet, smoked paprika
1 1/2 tsp salt
1 tsp rosemary
1 tsp thyme
10 eggs/egg equivalent
1/3 cup grated cheese (manchego and guyere both work well)

1. Set oven broiler to 'high' and place rack in middle of oven
2. In food processor, place sweet potato and mushrooms and process until pieces are roughly the size of grains of rice.
3. In large bowl, whisk the eggs, salt, paprika, rosemary, and thyme. Once eggs are completely beaten, stir in cheese
4. Add coconut oil to 12" cast iron skillet and allow to melt. Add the shallot and garlic and sautee until translucent. Add in the sweet potato and mushroom mix, and cook stirring occasionally, until softened and starting to brown. When the mixture starts sticking to the pan, you'll know it's staring to brown! Add the kale, and stir into mixture. Continue to sautee for another 1-2 minutes, until kale is beginning to wilt. 
5. Pour egg mixture into skillet. Stir to ensure egg reaches the bottom of the pan. Allow to cook until bottom of mixture is fully set.
6. Transfer skillet to oven and broil ~4 minutes, until golden brown, puffed, and fully set. Remove from oven and let cool. 

Microblog Mondays: Balance

Welcome to Microblog Mondays! Want to learn more and read more? Head over to Stirrup Queens for the details!

With the possibility of a new cycle coming up in a week or so, I'm left with the age-old question IF'ers face: How to balance optimism with pain avoidance?

Optimism: I believe it's important to stay optimistic and have faith that this cycle can work. Do I think you can't get pregnant without optimism? Heck no! But I do know that the mind and the body are linked, so I figure it can't hurt if my mind thinks that my body will get pregnant!

Pain avoidance: The chances of this cycle working are incredibly small. The chances of cancellation are much higher. If I never get my hopes up that it might work, then I'll never have to experience the pain of having those hopes dashed if it doesn't.

Oh wise internet, how do you balance these?