Transfer date set

Went to the clinic this morning for blood work (LH and E2) and u/s to see where we are in preparation for our FET. The RE was very happy - everything looked fine - lining was around 7.5 mm, so she said probably two more days of Puregon, then triggering on Sunday and transfer on Thursday, but she would confirm (or change) that later after she'd seen the results from the blood work.

The secretary called me around 5 pm to say that I should indeed take another shot of Puregon tonight (this time 75 IU instead of 100) but then trigger tomorrow and so the FET will be on Wednesday (providing our lonely embryo will survive the thaw). As I was in the car when she called I forgot to ask about my E2 and LH levels. I have to call the clinic on Tuesday to hear at what time I'm expected on Wednesday (both my sister's and my SIL's birthday - hopefully that's a good sign) and then the lab on Wednesday morning to see what the status is.

Infertility Myth: when all tests come back normal, you're just not trying hard enough

BUSTED! There is such a thing as "unexplained infertility" - many of us in the IF community are diagnosed with it, and me and my hubby part of that group.

It is, however, a very difficult diagnosis - even though it still keeps all options open regarding treatment, it brings with it a big test in self confidence. I delayed fertility treatments because of nothing showing up on the tests, of everything being normal - and for not getting the real diagnosis until much later. After each test coming back normal, there would be someone in my entourage saying "just relax", "take a vacation", "wear some nice lingerie and drink a glass of wine". Or, probably even worse: "you're probably not trying hard enough" - it's a big slap in the face when you're hearing this while your marriage is almost falling apart because you've been charting, using OPKs, checked your CM, put a pillow under your butt, stood on your head, demanded your hubby to reschedule his business trips because of your monthly fertile window, which all resulted in sex having almost nothing to do with love making anymore but just becoming a chore.

But still, sometimes I have this weird guilty feeling, thinking that probably we really didn't try hard enough. We stopped the charting, the OPKs, the CM checks, and tried to go back to normal love making, because we didn't want our marriage to fall apart. Did we really do everything possible in trying to become pregnant naturally?

And then I have to remind myself, that yes, we did try hard enough, if we hadn't, then at least one of those six failed IUIs should have worked. No, infertility, even if there is no medical explanation, is a disease, and it has nothing to do with not trying hard enough.

This post is part of the "bust an infertility myth challenge" in honor of National Infertility Awareness Week® (and by doing so I'm trying to expand it from National to International, as I'm in France!). To get a basic understanding of infertility, please visit RESOLVE's Infertility 101 website. For more information about National Infertility Awareness Week®, please visit the NIAW website.

IF ABC

I found this on Liz's blog and thought it would be nice to fill out, especially during ICLW.

• A. Age when you started TTC: me 29, hubby 35
• B. Baby Dancing or Sex: sex
• C. Children wanted: when I was still blissfully ignorant about our IF problems: 3 or 4. When going through IF treatments (and getting BFN after BFN): one would be great. After birth of our son: two would be wonderful. When hitting a low due to sleep deprivation and stress around the time my son was 4-7 months old: one is enough. When he started sleeping through the nights: two would be wonderful. When we were doing IVF#2 and we transferred two great embryos and put one in the freezer: four might still be possible! After the BFN: two would be wonderful, but maybe we'll have to be content with one.
• D. Dogs/Cats/Fill in Children: none
• E. Essential Oils/Vitamins/Snake Oils: prenatal vitamins. Have been taking them since starting TTC.
• F. Fertility Meds I’ve taken: clomid, decapeptyl, enantone, puregon, orgalutran, ovitrelle, utrogestan.
• G. Gain: didn't gain anything during IUIs and first IVF, then lost lot of weight after birth of my son (about 8 kg - due to sleep deprivation and stress), lost a bit more when my mom died. Gained about 3-4 kg around the time of IVF#2, but don't know if it was related to the IF meds, or just my body getting back to normal after too much weight loss.
• H. HSG (Hystosalpingogram): Had a sonohysterogram in the US and then a fertiloscopy here in France, which is an invention by my RE and basically is a trans-vaginal laparoscopy, which combines Lap and Dye, Salpingoscopy and Microsalpingoscopy (MSC) and Hysteroscopy.
• I. Infertile Pet Peeves: "We weren't even trying"
• J. Job title: proofreader/editor (or whatever I like to call it - I freelance)
• K. Kid’s names you’re afraid will be taken by the time you can use them: already happened - my mom's middle name. My sister took it for her daughter.
• L. Length of time TTC: 5 years
• M. Miscarriages: none
• N. Number of times you’ve switched OB/GYNS, REs, FSs: not counting the switches due to our transatlantic moves, I switched OBGYN here in France once. Still with same RE.
• O. Ovarian quality: good (but I'm getting older…)
• P. POAS or wait for AF: wait. Every time I did cave in and POAS it was a disaster.
• Q. Quote from an obnoxious fertile: "Now I cannot properly celebrate my 30th birthday (read: with lots of alcohol) because I'm pregnant" (said by someone who got pregnant on her honeymoon)
• S. Sperm: nothing wrong with it
• T. Time you tried naturally: 1.5 years before clomid cycle in US, then again 2+ years before first IUI in France (now that I write that down I can't believe we wasted so much time, especially the second period, but oh well, it is what it is…)
• U. Uterus quality: fine
• V. Vagina: would like some more privacy
• W. What baby stuff do you already have?: lots, as we have a now almost 2 year old running around.
• X. X-tra X-tra Hear all about it! How many people know the ins and outs of our crazy TTC journey? My parents, my sister, two or three friends, and my blog readers.
• Y. Yearly Exam. Do you still go in even though someone sees your lady parts most months?: Yes, even though I wonder if it's really necessary.
• Z. Zits: Not too bad - but always a few to show that either AF or ovulation is around the corner.

Statistics

Is what I got as answers from the RE to my questions about our failed IVF#2 and plans for FET#1 when we met with him on April 7.

(He actually tried to end the consult after five minutes, by saying, "so you don't have any questions?")

• Chance that the embryo won't survive the thaw? Yes, there's that chance. We won't know until the morning of the transfer. Next.
• Why did IVF#1 work and IVF#2 not? Well - there's only about a 30% chance of it working anyway, last time you were so lucky to be in that 30%, this time you were in the 70%. Next.
• Would assisted hatching be an option for the FET or a next IVF? Well, we do offer that technique here, but you'd have to talk to the embryologist to discuss whether if it's something they'd do in your case. Next.
• Would the day 2 transfer (of our failed IVF) versus the day 3 transfer (of our successful IVF) have played any role in the result? Well, it's up to the embryologists to decide when to set the transfer date.

OK, so... I wasted time and money with that consult, I would have been better of making an appointment with one of the embryologists (who are both very friendly and even though they are excellent scientists, they are less scientific in their doctor-patient relationship than our RE).

Luckily they are also very willing to talk to you over the phone, which I did a few days ago.

My main question I wanted answered was about the assisted hatching, as it would be relevant for the upcoming FET. Well, his answer was that they do it on occasion, but only after multiple IVF failures. As we've only had one failed IVF, we do not fall into that category (yet) and would have to have at least two or three failed cycles before they might consider this option.

I then also asked about the possible different outcome because day 2 transfer versus day 3 transfer and he said (yes, another statistic) that their lab gets the same percentage of pregnancies with day 2 or day 3 (and he explained to me that they usually do day 2 transfers, but if ER is on a Friday, then ET is on a Monday, so then it will be a day 3 transfer), so that it makes absolutely no difference. The only difference is between day 2/3 or day 5, when the embryos have developed into blastocysts - and that that could be a point of discussion for us if the upcoming FET will be unsuccessful as well.

He told me that for the moment, the only real risk is the frozen embryo not surviving the thaw, and since we only have one, that would mean the FET would be cancelled at the last minute. I'm well aware of that risk, but there's unfortunately nothing I (or anyone else) can do about it, so we'll just keep our fingers crossed and hope that our frosty is as strong as that little embryo in 2008 which turned into our gorgeous toddler.

AF just showed her face, so I called the RE's office to let them know. FET#1 is officially on!

The Dollars and $ense of Family Building

This post is part of an initiative by Write Mind Open Heart and Baby Smiling in Back Seat. The financial part of my story will no doubt be very different from those of most other participants, as I live in France and therefore enjoy the benefits of the French government healthcare system, which is very generous when it comes to ART.

There are two parts to this post – first an overview of my personal family-building process (with some special attention to finances) and second a Q&A part (questions provided by BabySmiling and Lori Lavender Luz).

Background story:
We started our TTC journey when living in the US. When I finally dragged myself to the OB to find out why I wasn't getting pregnant, we were 1.5 years along. Apart from several tests (for both me and hubby) and a first Clomid cycle, we didn't consult with an RE an didn't embark on any ART treatments. This had nothing to do with finances, but with emotions. All tests had come back normal, so I was still in complete denial that something was wrong. I still listened to people who said I should just relax. No-one had really sat me down and uttered the words “unexplained infertility”. Besides, we were planning on making our second transatlantic move and I didn't feel like starting all kinds of treatments a few months before moving.

The new country (with its own culture, language, job search rules) took quite some time and energy to get adjusted to. By the time I felt like finding an OB we had been there for six months. By the time I'd built a little network and got a referral to a great RE (the OB sucked and wasted too much of my time), our first French year had passed... By the time I finally convinced myself that yes, despite all the normal test results, if I wanted to have a baby I should really get some medical assistance, we were definitely “tourist off” and finishing our second year of French live.

We talked with our RE about the options. IUI or IVF. He suggested starting with IUI, being a lot less invasive than IVF and that sounded great to us (still struggling emotionally with doing all of this, absolutely not ready for IVF yet). The government health care system would reimburse a total of six IUIs and four IVFs in our attempt to have a baby.

We did the first three IUIs in a row. All BFNs. Then we had a break, took a nice vacation, and on the plane back home I just didn't want to deal with it all anymore and was in no place emotionally to start IVF. So we opted for another three IUIs... Well, what a waste of time (and taxpayers' money, but I couldn't - and still can't - care less). Again, three IUIs in a row, again three BFNs.

Finally, after five years of TTC and three years in France, we started IVF#1. And lo and behold, I got a BFP and am now the proud mommy of a gorgeous toddler. I did a post at the time about the total cost of an IVF cycle in France. If interested, you can find it here (I think some rates have gone up a bit and I might have forgotten some costs of the hospitalization for ER (which were all covered), so I'll try redo one for IVF#2 soon).

We would love to bring a second child into our family, so we started IVF#2 last February, which unfortunately resulted in a BFN. We had one embryo frozen and should be going for FET#1 as soon as AF arrives again.

Q&A:

1. Consider your now or future children as adults, and consider the fact that you had to spend money to either conceive them or make them part of your family. What effect do you think the latter will have on the former one day? What, do you think, your grown children might feel about the funds it took to create your family?

   I hope that we can explain to them – and that they will understand - the difficulty we had in conceiving them, that we paid a higher price (financially and emotionally) for them than couples who had no difficulty conceiving and that they made (and still make) us so incredibly happy. Plus that they will go through life aware of and sensitive to the fact that being able to have children is a real gift, not readily available to everyone.

2. How did/would you handle it if your child asks you, "Mom, how much did I cost?" How would you answer at age 7? At age 18?

   I would be extremely surprised if my child would ask that at age 7, mainly because ART treatments are very well covered within the French government health care system, so the financial aspect would not really be a topic of conversation that he/she could have picked up somewhere and then ask me about it. At age 18 it would be a possibility, as by then I think my child would know exactly what it took us to bring him into the world and therefore I would be completely open and frank about the financial aspect as well (in our case, the question could also be “mom, how much taxpayers' money was spent on me?”).

3. When calculating the costs of your family building, what do you include? The direct costs are easy (such as RE fees for a cycle or homestudy fees), but what about fees that didn't directly lead to your child's existence in your life, such as cycles that didn't work, adoption outreach avenues that didn't work, failed adoptions, avenues that were explored (and that cost something) but not pursued, etc.?

   My initial reaction would be to just calculate the costs of the cycle(s) that resulted in the pregnancy and subsequent birth of my child(ren). But when I would look at it as a whole (after deciding that our family-building journey has finished, whether by our own free will or due to health or insurance constraints), I think I would add everything up, all the testing, the six failed IUIs, the first successful IVF, the second failed IVF, and any future ART cycles we would have had...

4. To what extent have finances determined the family-building decisions you have made? How have you able to balance financial considerations against other factors such as medical, ethical, emotional...?

   When we were still living in the US, I never really thought about what the financial impact would be if we would have continued with treatments after the initial Clomid Challenge Test. Had I been emotionally more ready, it would of course have been something to make us pause. The bills for the few tests did make me realize once more that health care was so much more expensive in the US than what we were used to in the Netherlands, but part of it was covered by our PPO and we had no problem paying the remaining sum. I often thought that I wasted so much time with this 'not being ready', but I guess financially it has been a good thing that we waited until we were in France.

5. Has institutional and governmental support for certain family-building paths impacted your choices? For example, ART being covered by insurance, tax deductions for adoption expenses, etc.

   When we decided to move from the US to France, it had absolutely nothing to do with the financial aspects of ART, but you'd almost think it did! We are extremely grateful for living in a country where ART treatments are so well covered by the government healthcare system. For that (and for the 30 vacation days a year, and being closer to our relatives, and a number of other reasons), we happily gave up at least half of our salaries... The details of the French deal: everyone who legally lives in France is covered under its government health care system. ART treatments are covered for 100% (but there is a cap per treatment or consult and many clinics have set their prices higher than what the government health care plan covers – for that there are additional insurances that you can either get as an individual or through your employer – we have the latter). An IVF cycle counts as one if there has been ER. Any FET is for insurance purposes part of the previous IVF cycle and has to be done before you can try for another fresh cycle. Also, if you have conceived through IVF, and you want/need to use it again to try for baby #2, the clock will be reset and you can again try four times. We do always pay great attention when our employers are about to change plans on the additional insurance and will vote against it if the proposed plan includes less coverage for ART treatments.

6. Have you considered having ART treatments abroad, either due to lower cost or due to certain methods being unavailable or illegal in your own country? In your decision-making, how did you balance the financial savings against issues like the unknowns of the country, perhaps not speaking the language, and medical practices that may differ from those of your home country? If you did travel abroad for treatments, what was your experience? Would you do it again?

   My answer is a bit the other way around, as we were already in a foreign country. When we were starting the ART treatments here in France, I briefly thought about how it might be easier to be back in the Netherlands for this, especially because of language nuances on such emotionally charged procedures. But insurance-wise it would have been hell, and medically I prefer to be in France too to be honest (as Holland often has long waiting lists before you can even do your first IVF, ER without anesthesia, only pee sticks and no beta tests to find out if it worked, etc.).

Visit Write Mind Open Heart for more perspectives on the Dollars and $ense of Family Building and to add your own link to the blog hop by May 1st, should you want to contribute your thoughts.

Finding a friend

It's CD36 today and still no AF yet. Apparently my body needs some more time to recuperate before I can inject it with hormones again, which is fine. The only thing that's slightly annoying is that I cannot plan any getaways right now (we'll have a long weekend coming up for Easter and have had two invitations to which I don't know what to respond) as I don't know if we'll be in the middle of our FET or not. But that's just minor.

I had intended to write something about the whole PETA affair (see http://hannahweptsarahlaughed.blogspot.com/ for more details if you don't know what I'm talking about), but just didn't have enough down time to find the right words for that.

I did post the FB blurb about Infertility Awareness Month on my FB Wall. And guess what? A neighbor, whom I'm also FB friends with, sent me a message, asking how long it had taken us to have our son. Turns out she had 5 failed IUIs, 3 IVFs before having her son and 5 failed IVF in an attempt to have a second child. I'm so glad she reached out. Even though the whole IF blogosphere is such a great help to me, it is wonderful to know that there is someone in my own building, whom I like a lot, who knows exactly what it feels like, and on whose door I can knock when I'm tired of other neighbors or nannies etc telling me that a BFN doesnt' matter, and that we should just try again. So yay for FB.

Random thoughts

It's CD27, I'm anxious to start our FET, but I think my body is asking me to be a bit more patient. AF lasted almost until CD10 after the failed IVF, based on my CM I would say that I ovulated last week, but this morning I had this typical ovulation pain on the right side, so who knows what's happening right now (I didn't take any OPT). Consult with the RE is on Thursday (but he will not do any u/s or bloodwork, just talk for 10 minutes and charge me 70 euros).

I don't really know what to expect of his FET. We only have one embryo frozen, how big is the chance it won't thaw properly? It's the same Grade A excellent quality as one of the embies that was transferred for IVF#2 - which didn't make it. So why should I believe its frozen brother or sister will have a better chance?

With IVF#1 I was hopeful, but didn't expect much - we had six failed IUIs behind us, so BFN had become the norm. But it worked... Then with IVF#2 I was worried that they wouldn't be able to retrieve any eggs - there were less than the first time, but still a decent amount. Then I worried that they wouldn't fertilize - but they did, and actually better than the first time. So when those hurdles were taken, and we had three perfect embryos, I was convinced that it was going to work, just like last time, and that I might even be pregnant with twins.

So the BFN hit me hard. I felt exactly the way Sarah described it in her comment on my previous post. So maybe it's a good thing that I'm a bit pessimistic, it might work better (oh, the logic of an IFer...).

The insurance stuff is almost sorted. I got a confirmation for one of the forms I'd sent them copies of, but nothing had been reimbursed yet. So I called to check what happened to the other form and when I could expect to be paid back. Well, turns out they OK'ed all procedures (for both forms), but just bothered to send a confirmation for one. And regarding the payment - I have to send them back the printout of their electronic file before I can get paid. That's insane! We have an insurance card with electronic chip, which means that payments are automatically transferred from whichever medical office you're paying your bill for, to your insurance company and you will be reimbursed with a transfer directly into your bank account - no paperwork, no checks in the mail, everything electronic. Now I have to send them back a printout of these payments that were on-hold instead of that they just click a checkbox or whatever in their software at the same time that they OK the forms... Of course I did send the printouts back, because I want to be paid ASAP, but this is bureaucracy at its finest I must say.