Friday, June 12, 2009

Thoughts on a Cancellation

Ok, so a BFN and a cancellation of an IVF cycle after a cross country trip to the clinic, both in the space of a week and a half is kind of alot to deal with.

You would think the BFN would be tougher to handle, as the cycle allowed us to become more emotionally vested... we made it to retrieval, survived the fertilization call, got a photo of the embie, carried the embie in my uterus and went through all the emotions of the 2ww before getting confirmation that it didn't work. There was a significant financial price as well.

A cancellation on the other hand, at CD9 so relatively early in the cycle, seems less daunting. At first anyway. Even with the travel thrown in, financially it wasn't too damaging to quit at that point. But flying back home yesterday was pretty hard emotionally. Now with my 3rd cancellation out of the last 4 cycles (one with a cyst, two with an E2 that was extremely low and never rose), and with my 44th birthday looming, which means a further drop in success rates as I move into the next age category, there is the feeling that it really is hopeless.

At least with a BFN we can say we gave it our best shot and it didn't work. But there is an extra feeling of helplessness that comes with a cancellation, that we couldn't even get a decent shot at a try. Instead of being in the running for a small chance of success, a cancellation means no chance at all, which I find particularly hard. Tubal issues for me mean a zero chance without an IVF transfer.

On a more positive note, I have made an appointment with Dr C for early next month so we can go over my cycles with the estinyl and hopefully come up with another strategy. Of course, I hope that my FSH will be low enough so that I won't need estinyl again, wouldn't that be nice!

Which is a reminder, I'm thinking I should start up with the frozen wheatgrass cubes again. Whole Foods carries them in the frozen fruits section in case anyone is wondering. The whole thing about wheatgrass helping with high FSH is probably just an internet myth and I am no longer one to jump on every bandwagon, but I actually like the taste... am I the only one that likes them? I think they taste a bit like green tea, and with the warmer weather the frozen cubes are refreshing.

Thursday, June 11, 2009

Estinyl is not my Friend

Yesterday at CD9 the bloods showed another estradiol reading under 10, so the pattern is repeating itself with the estinyl even though I stopped taking it 3 days prior. And the ultrasound showed that the follies have all decreased in size, not just a bit but by 3mm! Isn't that weird? I know a bad cycle when I see one, and this is one of the worst I have had. Shrinking follies and next to no estradiol, yuck! I hope this isn't going to be a new pattern.

I don't have the patience to sit in a hotel and wait for something to happen this cycle, so I've officially pulled the plug. As I said before, I've given it a try with estinyl a few months ago and it wasn't pretty then either. It will save me less money in the long run to come home now rather than keep paying for the hotel and rental car, hoping that the cycle will turn around. The clinic said that they "completely understand", but was also open to continuing to see what happens. Well, if I lived in NJ that might be a plan, but I don't.

I'm sitting here in Houston airport right now on a long layover, annoyed and tired with all the travel and the disappointment, but pleased to be on my way home again to see DP. It will probably be another 3 weeks or so before the next cycle so plenty of time to do some fun things completely unrelated to TTC.

I do need to come up with a new plan with the RE though, so that will be in the works too.

Monday, June 8, 2009

CD7 and not looking good

My CD3 results showed an elevated FSH of 13, so they had me start Estinyl 0.02mg, one pill a day. As predicted, my Stat results on Saturday never made it to the clinic, I don't know why I even bothered to wake up early and get myself to the hospital. Weekdays are iffy at best, but at least the clinic always calls to let me know that my results hadn't come in yet so I have time to follow up. But on Saturdays, the clinic closes early, so add in 3 hour time difference and it is a recipe for no callback. So no surprises.

Really wasn't sure if I was up for traveling to NJ with just the CD3 results and no scan. The E2 was promising at 47 and the FSH wasn't outrageously high, but estinyl is what's making me nervous. It either works great or takes down the cycle, there doesn't seem to be any in between. DP talked me into flying over, he said if it doesn't work then just come home early, but if I don't go there will be zero chance. So here I am back in NJ, trying to get some work done and slipping in a little blog update.

Today it is CD7 and I had a scan and bloods drawn. Ultrasound was actually promising, with a follie at 12 and a couple less than 10. That's pretty good for me. But after a few days of Estinyl, my E2 has dropped to under 10! So that follie at 12 isn't really a follie, must be a leftover cyst or something. Estinyl doesn't show up in blood results, so that E2 <10 is the real story of what my follies are doing. Which is absolutely nothing at the moment.

Last time on estinyl my E2 dropped under 10 and stayed there for 2 weeks. I was hesitant to give it a go again this time, but there are some differences to that other cycle. Last time we waited several days while my FSH shot up from 16 to 28 before starting it, maybe that was too late. This time I started it with a FSH of 13. Also last time I was taking 1 estinyl per day; this time I did 1 every 36 hours to keep the dose in my body a tad lower.

So my FSH today is now down to a lovely 6, but with an E2 in the toilet it doesn't look good, it should be up over 100 by now. They wanted me to come back Friday to repeat bloods but I don't have the patience to wait til then, I want to cancel the cycle and stop paying for a hotel room if the E2 doesn't budge. So we agreed to have me come back in 2 days for another check. But based on my previous experience on estinyl, I think it would be a good idea to stop taking it and see what my body does on its own at this point.

Thursday, June 4, 2009

Tips for Keeping Travel Costs Down

As many of you know, I travel to New Jersey to do IVF because it is more affordable. Many places around the country charge well over $10,000 for a cycle, and that’s before any extras like ICSI. The Cooper clinic charges a little over $3000 for a cycle and that includes AH. With ICSI, it brings it up to around $4000. Still considerably cheaper than most places, even when you factor in the travel costs.

The logistics of travelling to do IVF can be a little stressful at first and costs can quickly add up if you aren’t careful.

I am in the process of trying to plan travel now, in the midst of an iffy looking start to a cycle. My CD3 FSH was a little elevated for minimal stims, so I will be on Estinyl to try and bring down the FSH before starting stims, which could take a while.

Flights
This is probably the trickiest part, because cycles can be so unpredictable. Buying non-refundable, return tickets are generally (but not always) a bad idea, because chances are, you are going to have to make changes. Even if you can nail down the exact start date of a cycle, there is still the unknown of exactly how long you will stim. Even on the same protocol, the number of days to stim has varied quite a bit for me.

Even if you get to start stims, the cycle can be cut short at any time. It may be that you don’t get any follies growing, or you get a less than optimal number for you (for me, I will still go to retrieval with 1 as that is all I get a lot of the time). You may not get any eggs at retrieval despite there being mature follies. You may not have any fertilized. You may not have any embies to transfer. There are so many places where the cycle can be cut short, you really don’t want to be stuck holding a non-refundable return ticket with huge change fees.

So what’s a gal to do?

Ok, there are a few ways to approach this, and which one I do depends on the fares going at the time.

1. Always check the prices of One Way fares, and try alternative airports. I use Kayak to compare fares. For the airports that I use, it seems the smaller airports have the better prices. I can get better prices buying one way fares, often just days before departure, than I could with advance purchase return fares, especially if I factor in change fees (typically $150 plus fare difference). I don't think this is typical, but it is worth checking out.

2. Look into fares without change fees. So far, all I have come up with are Frontier and Southwest, but they both serve the airports that I am interested in.

  • Frontier (as of June 2009) has a Classic Plus fare which is often reasonably priced and similar to other airlines’ economy fares. Classic Plus fares are fully refundable too, as well as having no change fee. So buy that Classic Plus fare as soon as you think you could be travelling to lock in a good price, you have nothing to lose! Also the Classic Plus fare allows you to reserve a seat in advance (the economy fare doesn't allow this), so you won’t get stuck with a middle seat even if you buy the ticket a few days before departure. Frontier also has a Classic Fare, which is cheaper than Classic Plus but has a $50 change fee, which is still pretty reasonable in my book. The regular economy fare has a $150 change fee, so no different to the major airlines.

  • Southwest doesn’t have any change fees, but only the Business Select and Anytime fares are fully refundable. Personally, I am not a fan of Southwest for long haul travel and have found Frontier to have better prices, but this is an option.

3. If the refundable or no-fee changeable fares are too expensive, you may have to bite the bullet and get a ticket that has a fee to change. Typically it is $150 to make a change plus the fare difference. For me, if my trip will be delayed more than a few days (for example, E2 too slow to rise), it can be cheaper to pay the change fee. When I factor in the costs for hotel room and rental car, I’m looking at around $100 per day. So a two day longer stay is more expensive than the change fee.

Don’t forget to join the frequent flier program of whatever airline you use, those free flights you earn will come in handy!

Hotels
This is probably the easiest part. For stays longer than a week, you would want to look into extended stay type places, as their rates go down the longer you stay. Don’t pay in advance (like through Hotwire or Priceline) as the IVF cycle can be cut short at any time and you don’t want to be paying for a room when the cycle is clearly over. Check out Kayak for hotel price comparisons.

If you have a hotel in mind that you like but it doesn’t offer extended stay rates, then negotiate one! Ask to speak with the manager, explain that you are interested in staying for a week (or however long) and see if they can work out a deal for you. I have had success with this, I have ended up with a daily rate that was cheaper than any internet rate I could find at that hotel for a week.

Whatever hotel you end up with, join the hotel rewards program if the chain has one so you can rack up the points. You’ll be earning free nights before you know it.

Rental Cars
Rental cars are a bit trickier than hotels as the prices seem to vary dramatically for no apparent reason. Again, shop around using Kayak. You can make a booking without a deposit, so lock in a good price if you see one, but check the prices every few days to see if they have come down from your original booking. Again, don’t prepay in advance as you don’t know if the cycle will be cut short.

Look for coupon codes or discount codes online. Rental car companies seem to have many of these, and a quick search on Google should turn some up.

Join the rental car frequent renter program. Budget has a deal when you get 10-20% off automatically after a qualifying rental, other programs have other perks.

Other tips for saving money:

  • Join ebates and earn cash rebates for purchases. For example, looking at the travel section of the ebates website today I am seeing 3% cashback for Avis, Thrifty, Budget, and Dollar car rentals. 5% cashback for Candlewood Suites, Holiday Inn.

  • Get an American Express Blue Cash card. After spending $6500 (believe me this happens quick with medicated cycles), you can earn 5% back for drugstore, gas, grocery purchases and 1.25% for everything else. That 5% cash back can add up fast when you pay out of pocket for fertility meds!

Monday, June 1, 2009

Beta < 1

I had moved on a few days ago but there is always an added sense of closure with the official result.

We are doing ok, we are used to dealing with the disappointments of BFNs. I don't think there's anything we could have done differently this time, it was just the luck of the draw. After all, it was the same protocol that gave us implantation last year. At this point I just try and focus on the next cycle and not look back too much.

With the Check-sized dosages of Progesterone I was on, I think I am headed for a whopper of a AF. I have had a feeling of crampiness/heaviness since a few days after transfer, and it is starting to get worse. AF isn't even due for a few more days! And the low E2 migraines have already started, so I'm not even up for the consolation glass of wine tonight.