Cycle 1: Letrozole Medicated IUI

Can I take a moment to toot my own horn please…. I am beyond excited to find out that Hubby’s sperm analysis was off the charts good!  I Give 100% credit to following fertility blogs/research and supplementing accordingly along with excellent diet and adequate excercise! If you’d like a detailed post about how we got his sperm in tip-top shape please write a comment or send me a message!!!!

Concentration : 88 mil/mL – normal is greater than 15 mil/mL

% motility : 66% – normal is greater than 32%

Morphology %: 10% – normal is greater than 4%

Our Doctor also informed us that my egg quality and quantity is much higher than average as well! We are very hopeful our first IUI will be a success. But it leaves a screaming question: Why can’t we conceive naturally? We have the “unexplained” infertility diagnosis. Hopefully this is a blessing in disguise that they couldn’t find anything major, and our efforts have not been in vain. On paper we look like the picture of fertility. The doctor offered its possible to proceed with laparoscopic surgery for me, to find out exactly if there is any endometriosis/scar tissue problems but she didn’t recommend it. It is an invasive procedure, and she is not convinced that they will find anything. The Dr recommended trying IUI and possibly revisiting surgery later, if the IUIs are unsuccessful.

Our doctor recommended using Letrozole on CD 3-7. Her recommendations for Letorozole came with a long explanation of how letrozole is safe, and described an event that tarnished Letrozoles reputation for fertility treatment. Basically she told us that the person that said Letrozole causes birth-defects was unfounded and was not even a published research paper, but was a media sensation. The Dr. let us know that Letrozole usually has less side effects than Clomid, it doesn’t diminish the uterine lining like clomid does/can, and has a higher pregnancy rate than clomid.  She let us know there is a risk of twins around 7%. The nurse gave me detailed instructions on the IUI protocol.

I started my period 2 days later, Gave our nurse a call and she sent the RX to the pharmacy in town. It only cost me $2.94! I start the drugs this sunday, I’ll be taking 1 .25mg tablet once per day for 5 days (CD 3-7), On day 10 I will have blood work and an ultra sound. This will land on a Sunday so I’ll have to drive to the farther away office: 82 miles round trip.

On CD 10 I’ll also start OPK’s in the evening. I have been using OPKs for months now so I’m experienced with taking and reading them. The office recommended the expensive digital smiley one, but I’m going to stick with my cheapies. I usually get a positive on CD 14, but I’ll be curious to see if the meds make me ovulate sooner. I’m really hoping that I’ll be able to do my IUI on my regular day off, so I don’t have to call out of work!

I can’t begin to explain how overly happy and excited I am to do this! After 3+ years of TTC naturally and being let down over and over and over, I have a renewing of hope. Wasn’t it Einstein that said “Insanity is doing something over and over and expecting a different outcome” ? I told my sisters, but no one else knows (except readers which right now I have like zero) . I have told a few friends were going to start “trying” now, leaving out the fact that I’m trying the hard stuff now lol.

I plan to update on CD 8, CD 10, IUI day, Somewhere in the TWW, and 14 DPIUI.

Stay strong ladies! Cut that caffeine, ditch the alcohol, eat your superfoods, take your meds and supplements, keep up with exercise, do your self-care!!!!!! Our baby spirit is getting ready to enter our lives.

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Questions for the Reproductive Endocrinologist Consulation

I’m sooo excited my first visit is in 2 days! I am trying to rack my brain now for questions I have for our first visit.

What is causing our infertility?

What additional testing do I need to do before diagnosis/ treatment?

What Treatment do you recommend first, how long do we have to try this?

What are our chances of having a live birth?

Can we skip right to IVF?

What is the timeline from first visit to embryo/sperm transfer?

What lifestyle changes are most important?

How much caffeine is OK, for male/female?

How much alcohol is OK, for male/female?

Is my weight OK?

What foods should I consume?

What foods should I avoid?

What supplements should we take?

Do you recommend alternative therapies during treatment? massage/acupuncture ext.

How much exercise is recommended?

Will I need time off from work?

What is the cost?

What are payment options?

 

 

Fertility Goals

So It’s January first. We all know what that means, a new year a fresh start. A time where many re-evaluate their lives and Identify areas that you desire to improve. This year I took it very “seriously”. I allowed myself to relax a bit in December, with all the “rules” I tell myself to follow regarding fertility.
If you’re like me, you scour the internet daily searching for the answer to infertility. Reading about vitamins, minerals, super-foods, “do’s and don’ts”, what kinds of exercise to do, sex positions, lube, medications/herbs to avoid, old wives tails. I could literally go on forever, but you know, you’re here too with me.
What I’ve been SO disappointed about is the lack of actual research in regards to what is really significant, and which is of miniscule importance. Almost all of the “Tips and tricks” have some sort of decent reasoning behind them, so I usually just follow the advice, and see if it works for me. (Pst, none of it has and I’ve been doing this for almost a year.)

There are some “Rules” that I think are MUSTS, but most is just suggestion. So my goal for 2018 is to focus on the “Musts” and indulge with the suggestions. This means I’m not going to buy 100000 vitamins and crazy (expensive) super-foods. I am going to trust my doctor to tell me what is vital, and what is not. Up until now, I’ve had no post-doctoral educated guidance on my fertility. Hubby is tired of taking 25 vitamins a day. With that being said I probably will continue doing some of the suggestions that aren’t proven. Mostly in my diet making sure to include all the regular “super foods” like wild salmon, fresh farm eggs, grass-fed beef, broccoli, asparagus, garlic, grapefruit, chia/flax seeds, pomegranate juice, spirulina, decaf green tea with lemon, ginger tea, red raspberry leaf tea (CD 1 to Ovulation) and dandelion root tea the rest of the cycle, Pineapple core (1-5 DPO). Unless advised otherwise.  I also want to try to take the Chinese medicine “warm womb” more seriously. This means keeping your feet warm at all times, ingesting only warm food and liquids during your entire TWW. In my opinion, this kinda makes sense to me, I am very cold all the time, I can see how this could be less than hospitable for implantation, and it really couldn’t hurt.

Goals to focus on:

  1. Exercise regularly. My goal is 10,000 steps per day, and minimum 30 “active” minutes per day. As you may know it is suggested by many to do daily, low to moderate workouts. This means if you’re ultra fitness insanity, you might consider toning it down. On the other hand if you’re only exercise is walking to the car/fridge, you probably should up your game! I was somewhere in the middle. I thought I was more active than I really was.  I bought a fitbit Charge 2 last April, and was shocked how little I walked during my work day. I probably only did moderate exercise once a week. So I changed my habits:
    **Parked farther away so I get more steps walking to my car.
    **Walked on my lunch break, depending on time I would walk 1 – 3 miles, 4 x week. ** Started taking Zumba at the gym, I got a groupon for 25 classes, I didn’t really enjoy it though since I had to go after work, and really just wanted to go home, not go work out for an hour, and I suck at dancing so I felt uncomfortable. **Got and Online Yoga account, This I really enjoy and use frequently. I also got as a groupon for a whole year for like $10. **Now that it’s sub-zero temperatures, I stopped walking on my lunch break sadly. SO I have to and add my walking back in. I have a treadmill, in the basement, that is ancient and its gloomy down there and I hate it, but I walked 2 miles last night and am proud of myself. Watched netflix the whole time lol. My goal is 10,000 steps per day, and 30 active minutes per day. I strongly suggest getting a Fitbit charge 2, or other similar health tracker. It really adds accountability and non-bias recording. It makes you want to be more active, it gives you gentle reminders to get up and walk if you’re idle too long. It knows if you hit your goals, so there no pretending what “counts” for exercise. I love that it tracks sleep too.
  2. Eliminate Alcohol. This one is a work in progress for me. I used to be a bartender, alcohol was a major part of my life. All social gatherings were geared around alcohol. I’ve had to cut out many people in my life, and leave my job as a bartender to get away from the constant flow of alcohol. Peer pressure is real, I couldn’t say no, and when I start, I don’t stop. It’s a problem that runs in my family too. So I did eliminate alcohol last year, for 6 months straight. My current relationship with alcohol is only during my period, I usually will get a 6 pack and have 2 per night for 3 night. It’s suggested that alcohol is eliminated completely when you’re TTC, the reasons are unclear as if low amounts are OK. So my goal is ZERO!!
  3. Eliminate Caffeine. Similar to alcohol, it’s a blanket statement to eliminate caffeine when TTC. It may be ok in low consumption, but it may be harming to fertility, especially when there are other factors involed, its best not to chance it. I currently have caffiene 3x week, I have 2 cups of 1/3 caffinated coffee. I buy 3 bags of coffee – 2 decaf, 1 regular (organic) and mix them into a container and use that on my days off, which is 3 days per week. Im not sure how much this caffiene adds up to , but its more than zero. When I have my period I induldge in a Starbucks coffee. I’m going to ask my Dr. what she recommends in regards to caffiene consumption. I may have to go to zero!
  4. Eat Healthy. This is not much of a challenge for me, but I did let myself slip all of December, and put on a good 10 lbs. Being that I am of a healthy BMI already, my focus is to eat highly nourishing foods. I have been gluten-free for about 10 years now because of a sensitivity. Last year I went “Keto” – low carb/grain free/sugar-free. for health/fertility reasons. There are so many documentaries on why the standard American diet is extremely unhealthy, and how our food supply is covered in endocrine disrupting chemicals. I believe 100% that our infertility is caused by environmental factors.
  5. Self-care. It is very important to reduce stress when TTC. The best way to do this is to practice self-care. Identify multiple ways to relax on a daily basis, and do these things. Journaling, drawing/coloring, aromatherapy, crafts.
  6. Improve sleep quality. There is a sweet spot of sleep quantity, 7-8 hours is recommended. Getting less OR more harms fertility. ELIMINATE THE BLUE LIGHT at least 1 hour prior to bed time. No phones, tablets, TV. This is going to be hard for me. I am planning on charging my phone in a separate room. Luckily my fit bit has a silent alarm so I’ll use that to wake up. I may end up crate training my dogs. I currently have 2 Dobermans that sleep ON me every night, they frequently get up and change positions and wake me every time.
  7.  Reduce spending.  This is a goal of mine related to fertility because I need to create room in our budget for all of these new expenses relating to infertility treatment. Obviously a lot of this will come out of my savings, but I am going to cut out as much unessessary spending as possible.

Preparing for Infertility Consult

So we finally made the decision to see a Reproductive Endocrinologist. After 3 years of TTC (trying to conceive) on our own, Trust me we tried everything.
What finally was the straw that broke the camels back and made us take the plunge?

Well, it was Hubby that had been disinterested in seeking medical treatment. I think the month after month of no pregnancy, me constantly talking about babies maybe he finally realized that this isn’t going to happen with out help.
I had provided him with two options, See a doctor or start foster/adopt process. He was more keen on international adoption. (I may be misinformed but) I think international is too much work, too expensive, and there are some unethical practices in certain regions/agencies that I am skeptical about.

Once I got the go-ahead from Hubby, I started prepping for our Infertility consult.

Step 1 Choosing a Clinic / Doctor

For us it wasn’t very difficult to choose a fertility clinic, but for others this is a very important step.
Location: to me this was probably the main driving factor on where to go. I live in a rural area and work out of the home 4 days per week. A simple google search of “fertility clinic near me”. I didn’t want the commute to the clinic to be more than an hour. During treatment times it is likely that I will need to be there multiple times per week. We really only had one option, so it was easy for me to “choose”.

Hours:  Depending on your lifestyle hours of operation may be crucial to you. Be mindful of your obligations and select a doctor/center that will work with your schedule. Of course some times this isn’t always an option and you may choose to re-work your schedule around the clinic, I don’t think either is a right or wrong choice but for me, my schedule has very little flexibility and I will not re-work my life over treatments. (I say that now but we’ll see I guess!)

Success rates:  It seems like every clinic says their success rates are higher than the national average! Success rates do not take into account your personal diagnosis.  I have found the most non-bias information would be from the CDC 2015 Assisted Reproductive Technology Fertility Clinic Success Rates Report . Luckily the clinic closest to my home has higher success rates than any other in the state, and is higher than the national average. But again this doesn’t mean anything in particular for me as I have no clue our actual diagnosis or how challenging it will be for us.

Step 2: Set up the appointment

Call the number, and see what happens. Different clinics have different new patient intakes. The lady I spoke with was very well-organized, listed the info I’d need to be able to schedule the appointment with her. Like insurance card info, PCP / OBGYN names/numbers, Basic personal and heath info. She told me it would take about 20 minutes and asked if I had the time/info now to do this. I did, so we continued. She also let me know I had called during a busy time of day where she may need to put me on hold periodically to check other patients in. We were lucky again and were able to schedule our first visit only 2 weeks away, I think they typically book at least a month out.

Step 3: Paper work / medical records

We had to get out paper work/ medical records transferred ASAP due to Christmas /new years coming between the day I scheduled and our first visit. I called all my Dr.s that day and had them fax my records. This was easier than I expected, I didn’t have to sign any record release forms or anything, and they all agreed to do it the same day. I printed our new patient packet off the website and filled it out, it was pretty in-depth on health, sex and genetic questioning.

Step 4: Insurance

I live in a state that mandates fertility coverage. Boy did I think I hit the jack pot. Turns out it’s still very expensive even with “Insurance coverage”. This was the most difficult step for me. My employer doesn’t offer health insurance. I buy my health insurance through our state health exchange, and because of our income level I don’t qualify for any subsidies. It was open enrollment period so I had the option to change health insurance plans, but only for a very limited time. The health exchange website gives ZERO information on services covered/not covered for infertility. I had to call each insurance company directly and ask lots of questions, it was time-consuming and frustrating, eventually I got them to e-mail the actual plan policy to me so I could read and digest the info.  Turns out even the most expensive policies only cover fertility treatments after the deductible is met and is still subject to all co-pays and co-insurance.  It’s hard to really estimate what that would be as they don’t tell you what procedure costs what.

The “Gold plan” costs $550/mo. (x 12 months is $6,600) the deductible is “low”  at $1200. So Premiums + Deductible would be $7,800. Each visit to the specialist is $40 and does not count towards the deductible, RX co-pays do not count towards deductible. Even AFTER the deductible is met you still have to pay the same co-pays. They also have a long disclaimer on how cheaper/less successful procedures need to be done first before IVF, It’s a mess. So basically in my opinion it was not a cost-effective plan for me. Why would I throw away $7,800 to possibly get coverage but still have to pay $40 per visit and  up to $150 per medication? with an out-of-pocket max at $4,400. So the maximum price out of pocket (including premiums) would be $11,000.

I selected the Catastrophic plan. They make this plan sound horrible, but I wish I took advantage of it sooner. The Premium is the lowest possible ($200/mo). Preventive care and 3 doctor visits are covered at 100%. The deductible is astronomical @ $7,150. After the deductible is met every thing is covered at 100% , no co-pays or co-insurance.  So premiums are $2,400 + deductible of $7150 = $9550.

Infertility is expensive with or without insurance. The clinic probably has many options in how to pay, and may even offer cost sharing or multiple cycle discounts. I am going to look into this more once we get and actual diagnosis.

I did need to get a referral from my PCP sent to the insurance company, This was somewhat confusing as some people on the phone at my insurance company said I needed it, some said I didn’t. Turns out I did, and I’m glad I kept asking for clarification.

When dealing with insurance companies keep pressing them if the information they are giving you is unclear. You will always be at fault for not following their rules, even when they don’t tell you about them, and they frequently give false information. The people at the call centers are human just like us, and do not know every detail of every plan so keep asking if something seems unclear. It’s a good idea to take notes while on the phone, and ask for things in writing when possible.

Step 4: prepare yourself / show up

This is the time to do research and write down questions to bring with you. I’m so excited for the actual visit!

Leave me feed back in the comments section! What questions are on your list to ask at your first visit?