So it is official…. We are doing IVF!!!!

This week starts my “calendar” and it is turning out to be quite a busy week! Yesterday Don had his physical exam. When we saw Don’s doctor yesterday and asked for preliminary blood work he was great! He works out in the community and actually likes people. He said he was so sorry we were going through IVF and asked if there was anything her could do to help. He ordered all of Don’s labs and asked us to keep him updated.

Then there is the random doc/attending I got to see at OHSU today. What a different story! I needed to be tested for many communicable diseases, such as hepatitis b and c, syphilis, varicella, rubella and HIV. At first the doctor altogether refused to order the labs, stating that to try to bill infertility under generalized medicine was unethical and unprofessional. I explained to him that the tests are not for infertility. That fact has already been established! Instead the tests were for reproductive screening for communicable diseases. He still refused, stating there was no way that I have any of the mentioned disorders. I responded by telling him that for years I was a “very, very big slut,” and added that I am sure my brain is rotting from syphilis and that I am sure I had the chicken-pox after a crazy sexual encounter! I don't think he believed me, but he finally agreed to order the tests. He then made a point to code them so my insurance probably won’t pay for them. What a nightmare! I walked out with a sore arm and many tears. I keep telling myself this is a good experience for me to have and that I am learning what it is like to be a patient. So far what I have learned is being a patient really sucks sometimes. In the long run I know this will make me a more compassionate practitioner.

I also got some more hormone levels drawn, specifically FSH and estradiol. I am still learning about all the hormones testing so here is a little info I copied from a fertility web site…

“Follicle stimulating hormone (FSH) is one of the most important hormones involved in the natural menstrual cycle as well as in pharmacological (drug-induced) stimulation of the ovaries. It is the main hormone involved in producing mature eggs in the ovaries..

FSH is the same hormone that is contained in the injectable gonadotropins which are used to produce multiple eggs for infertility treatment.

Both FSH and LH hormone are produced by the pituitary gland at the base of the brain. When a women goes into menopause she is running out of eggs in her ovaries. The brain senses that there is a low estrogen environment - and signals the pituitary to make more FSH hormone. More FSH is released from the pituitary in an attempt to stimulate the ovaries to produce a good follicle and estrogen hormone.

Think of it like stepping on the gas pedal in the car to get going. The FSH is the gas, and the pituitary gland releases FSH to get a follicle "going" at the beginning of every menstrual cycle. If there are less follicles left (and perhaps lower quality follicles) the amount of "gas" has to be increased to get a follicle developing.

Why do we measure the FSH level on day 3?
By measuring a woman's baseline FSH on day 3 of the cycle (we do it on day 2, 3, or 4), we get an indication as to whether she has normal "ovarian reserve". We are looking at how hard her body needs to "step on the gas" early in the menstrual cycle to get a follicle growing.

Therefore, if the baseline FSH is elevated the ovarian reserve (how many eggs are left) is reduced (sometimes the egg quality is also reduced).

A blood estradiol level on day 3 (we do it on any day between days 2 and 4) of the menstrual cycle is a way to potentially discover some of those women with a normal day 3 FSH that may in fact have decreased egg quantity and quality.

What we want on day three is a low FSH level in conjunction with a low estradiol level. If the FSH is normal but the estradiol level is elevated, the elevated estradiol will often be artificially "suppressing" the FSH level down to the normal range.

The idea of using day 3 estradiol levels as an adjunct in evaluating egg quantity and quality is relatively recent. Clearly defined cutoff values for normal are not well established. We like to see the day 3 estradiol less than about 80. We repeat borderline or abnormal results in another menstrual cycle to try to get a "true" FSH.
There is some evidence that an elevated day 3 estradiol indicates a problem with ovarian reserve. This is sometimes the case, but often the issue is just that the elevated estrogen level is "masking" the potential for detecting low reserve by suppressing FSH into the normal range.”

I seriously could not imagine going through this and not being an RN! So the current plan is that I will start on birth control tomorrow and continue it for about 17 days. Also yesterday we got to speak with the pharmacy supplying all my meds. They came to $2800!!!! I know that we should be focusing on the baby, but so far in the past two years we have put $4000 into this imaginary kido! And we still haven’t even put down our first payment for the actual IVF! We are freaking out about our finances and are thinking about selling the house. Keep us in your prayers. We are living in stress city!!!