First Lupron Shot

Video credit to Andie, though to be fair, I could only upload this snippet of her full 2 minute masterpiece.

First day of meds down!

The Eagle Has Landed

Meds from Freedom Pharmacy arrived on Saturday morning, as expected.  Well, a little earlier than expected, really, so I still wasn't fully dressed and had to hide behind the door when I signed for them from the Fed Ex guy.  Oops.

The goods:

The box didn't have a packing list, so I had to call the pharmacy to be sure I had everything.  They're open 7 days a week and were very helpful, so that was pretty painless and everything was present and accounted for.  There are a couple of things in the box that were not on my calendar, so I'll have to figure that out as we get closer to transfer.  One of those things was the somewhat-dreaded valium, so I guess I do have to ask if I can skip it after all.  If not, no big deal.  I just hate to take something if I don't have to.

I have everything set up on my bedroom dresser, with the calendar taped to the wall so I can cross off things as I've taken them.  This definitely works best as an old fashioned paper-and-pencil operation, since with so many meds to keep track of, it's easy to convince yourself that you forgot to take something when you didn't, or vice versa.

So right now, my calendar is nice and clean-- the birth control pill I took last night and the doxycycline I took this morning are crossed off, but that's it.  I had wondered why the double-course of doxy early in the cycle and found this article: Outcome Of Subsequent Ivf Cycles Following Antibiotic Therapy After Primary Or Multiple Previously Failed Ivf Cycles, which concludes: "These findings suggest that a certain number of failures during IVF cycles are due to an intrauterine infection that could affect the course of the pregnancy, the mode of delivery and cause maternal and fetal complications."  The antibiotics regime I'm on isn't nearly as stringent as what was used in the study (nor do I have failed cycles that we're trying to counter), but I imagine the logic is similar.

Anyway, Lupron injections start tonight.  My kids are excited-- what could be more entertaining than watching mom give herself shots?  And I'm excited!  Every day is one day closer to transfer.

Oh-- just for the sake of remembering silly details.  The other surrogacy-related activity last week was signing consent forms.  Rick and I had to sign about 20 pages of medical consents, have them notarized, and then mail them back to Houston IVF.  Thrilling paperwork.  Would hate to forget that part of the process.

Calendar!

Now it's real!  I have a calendar in hand that includes the magic words "Possible Embryo Transfer."  Woohoo!

As Barb said yesterday, I start Lupron injections (just subcutaneous-- no big deal) on Monday, April 30.  Apparently, I start a course of Doxycycline (an antibiotic) then too, which is strange to me, only because I didn't take it until the week of transfer last time.  I saw someone else on SMO with early Doxy too, so I guess it's not unheard of.  It looks like I don't even have two weeks of Lupron-- that's pretty nice.  After that it's daily aspirin and Vivelle patches until egg retrieval.  The week of transfer, I'll have progesterone (Crinone gel, I think), Vivelle, Doxycycline, and Medrol.  And after transfer, just Crinone and Vivelle.  No big scary shots!  Phew.

All in all, pretty close to my protocol the first time around.  I took estrogen in pill-form rather than by patches and I did not take aspirin at all.  I'm not sure I took Medrol either.  I notice there's no Valium on transfer day on this protocol-- I skipped it last time because they said I could, but I don't even have to mess with it this time.  Oh, and I was on Lupron for weeks and weeks, but I can't remember what part of that was because of a cancelled cycle we had and what was really part of the protocol.

In any case, super-excited to have a plan.  I love plans!  We're just about 6 weeks out from transfer at Houston IVF with Dr. Hickman.  Yabba dabba do!

Hints

I emailed Barb this morning to pester her about when I'd be getting a calendar.  Her response:

Looks like you’ll start your meds on April 30 –so next Monday ….we finish up the week of 5/28

Hooray!  Progress!  Dates!  Still a little light on details, but heck-- I'll take it.  Monday will be CD14.  Really interested to see the actual calendar.  I still have so many questions!

N started acupuncture on Friday and said it was "different."  She'll be going once a week until we get closer to transfer, then will bump it up to twice a week.  I'm hoping it has a positive impact.

We spent all weekend digging out the flower beds and mulching them.  Hard work and I'm feeling it today.  They sure do look nice, though.

I'd hoped for more exciting news

Today is my much-anticipated CD1.  Hooray!  Time to start cycling!  Calendar!  Yes!

Only not really.  I emailed Barb and she told me to start birth control pills on Thursday.  She said she's still waiting for notes/reports from the infectious disease doctors that M and I saw (a full week ago now), but that she will "start planning."

Ack.  I'm feeling so impatient.  We've jumped our hoops, let's get going!  Come on, doctors.  Fire up those fax machines.  In the meantime, I'm hoping "start planning" is code for "get your calendar ready and right out to you so that you know you're transferring in May."

Like Poodles, or Shamu

Trying to think of things that jump through hoops.

M had his "infectious disease counseling" appointment in Houston yesterday.  N texted me this morning and said his doctor had a similar reaction to mine-- that there wasn't much of a point to the appointment.  So now N and M have had two worthless appointments (this one and the MFM), in the interest of moving forward.  Yippee.

I really think there's nothing else standing in our way now (though I'm sure I'm cursing it by saying so).  I take the last Provera tomorrow night, so I could hit CD1 as soon as Monday.  Then I'll call Barb and she'll give me instructions about when to start taking birth control pills (which I have on my dresser, all ready to go) and hopefully send me my calendar.  Hopefully, hopefully.  This is such a strange world, where you eagerly await getting to start giving yourself shots every day.

My predictions are: egg retrieval sometime around May 20 (+/-), then transfer 3-5 days later.  Hoping for two pretty 5-day blastocysts, but we'll have to wait and see on that.

Hoop Jumped

As luck would have it, the doctor's office I called had a cancellation today, so I was able to get an afternoon appointment.  I met with Dr. Metzger, who was basically perplexed about how to quantify the miniscule risk of CMV infection from an embryo (go figure-- there's not a lot of data on that) coupled with the very small risk of even symptomatic CMV, should infection occur.  He said 90% of active CMV infections are asymptomatic, and the other 10% tend to be sub-clinical (lowgrade fever, general malaise).  Oh, and I've cared for an actively CMV infected infant, lived with a CMV+ husband, and previously carried for a CMV+ couple.  So no real worries about risk to me.

Anyway, we had an interesting discussion and that was that.  He is sending his consult notes to Houston IVF.

Hoping M gets in to see the doctor in Houston just as quickly.

Hiccup

Ah, there are no straight lines in surrogacy.  Here's the email I got today from Barb:

In looking over your lab testing –Simi is CMV negative for both IGG and IGM.

M is CMV  IGG  ( antibody ) positive –which is a most common finding for this virus.

The requirements by the FDA state that all parties must meet with infectious disease counseling to discuss potential passing of CMV to Simi and the unborn baby .

Simi –you can see someone close to home. N and M – we have a Dr Rensimer here in the Memorial complex that has seen couples in this situation .  Simi and Rick can also see  Dr Rensimer if they choose to .

Speedbump but not a roadblock –just an FDA requirement. There will be a consent signed  acknowledging that we’ve addressed all this .

Barb

I'm familiar with CMV, mostly because as a rare CMV-negative adult, the blood banks are happy to have me donate because my blood can be used with newborns and medically fragile people.  I don't perceive my being negative as a significant risk to me or a baby I carry, but I'm certainly willing to have a specialist tell me about it.

The first infectious disease specialist I called only sees HIV and AIDS patients-- thankfully unapplicable.  So now I've left a message with another office, Austin Infectious Disease Consultants.  The front desk person referred me to the one of the nurses when she heard I was just trying to have one consult appointment, rather than to establish care (which requires a whole bunch of paperwork).  Barb says that this has to be completed before we can start our calendar, so we're on a super-short turn-around.  I think my next cycle will start a week from today.  I would *hate* to have things delayed because of a silly thing like this.  Hopefully M and I can both get squeezed in for an appointment this week.

Otherwise, all is well.  Still on Provera through Saturday.  Really hoping we're still able to transfer in May!

Not Crazy

Rick and I headed to Houston yesterday morning after dropping the girls off at school.  First up was a lining check at Houston IVF.  No grouchy front desk person this time and no wait-- I was whisked right back to a room.  Lining was 17.2mm by one measurement and 16.4mm by another and had a triple stripe pattern, just as they want to see.  Then I gave one tube of blood for an estradiol check which must have been fine too.  Mock cycle complete!

Then Rick and I had our interview with Leslee Murphy as part of the psychological evaluation.  We talked about our backgrounds, our relationship, our previous experience with surrogacy, and our expectations for this journey.  Leslee was great-- very easy to talk to and covered all of the bases.  Once we'd talked for a while, Rick was excused so that I could take the MMPI.  I've taken it before and what a treat-- 567 true/false questions designed to reveal my darkest inner secrets.  Fun way to spend the lunch hour.

Hmm.  No idea why that picture is rotated.  Oh well.  That's my before and after MMPI series.

When I finished the test, I went downstairs to grab something for lunch.  Then Rick and I came back up for our joint session with Leslee, M and N.  In the joint session, we talked about lots of "what ifs"-- pretty much all of the worst-case scenarios.  Even on the issues we hadn't already worked on through the contract negotiation process, we were on the same page on just about everything.  I think we're all pretty easy-going people, so that helps.

When Leslee gave us her blessing, we asked to talk with Barb about next steps-- when do we get to transfer???  She said my protocol will be 5 weeks long and N's will be 3 (she's doing a micro dose protocol, I think?).  So I have a prescription for Provera that I will start tonight.  I will take it each night for 10 days, then I will get my period 2-3 days later.  I am to call Barb on CD1 and she will tell me when to start birth control pills (I have that prescription too).  Meanwhile, N is due to start her cycle Monday or soon thereafter.  She'll also start birth control pills and that will help regulate when the next cycle starts.

No real details about the protocol otherwise.  I did verify that I'll be using Crinone instead of PIO injections for progesterone.  Hallelujah.  The only shot will be Lupron, which is subcutaneous and truly no big deal-- I've done that before.  Otherwise, pills, patches, and Crinone gel.  Perfect.  I don't want to be a weenie, but after experiencing IVF without IM injections once, I was not seeking a new experience!

After we talked with Barb, she had Rick and I get updated STD blood testing.  So with my second needle stick of the day, I gave another 5 (or 6?) tubes and Rick gave two.  Then, N and I went to the Eastern Harmony office down the hall to find out about acupuncture.  Studies show as much as a 40% increased success rate from using acupuncture, so I am really glad that we're doing this (I did it with my first surrogacy as well).  But poor N, who is not a fan of needles, has to go 1-2 times per week from 4/20 through transfer and I only have to go the day of transfer, once before and once after.  Sorry N!

So then our marathon day at the clinic finally came to a close.  We decided to stop by N and M's house before going to dinner.  They're at the tail end of an extensive (and beautiful) remodel, so there were a LOT of people around-- workers and family.  Everybody was so nice and welcoming to us.  We got to meet their daughter, A, who is lovely-- smart, friendly, affectionate, and articulate.  She showed off their spectacular backyard and the neighborhood peacocks.  My girls are never going to want to leave!  N's mother was especially warm and friendly and told us she prays for this every day.

We had dinner at Perry's Steakhouse, which was indulgent and just super fun.  We ate an enormous amount (and could hardly get up afterwards) and talked and laughed.  Totally easy conversation.  Rick and I left with such good feelings about this whole experience.  We really, really want to make A a big sister-- this is just an incredible family (immediate and extended) and I know good times are coming for them.  I absolutely feel like we're all in the right place for this to happen.  Come on, May!