Contemplation

Lunartik in a cup of tea, originally uploaded by Kodamakitty.

I don't have a good photo to illustrate this post, but I am pretty pleased with this new toy, so there he is.

Ok, so since my last post I've finished my second round of 150 mgs of Clomid, which didn't do anything. It probably didn't help that I got a terrible head/chest cold right around the start of classes and was pretty much hopped up on Sudafed and Mucinex for the better part of a week. Still, sick or no, I kept my appointment for my day 12 ultrasound and we kept trying in case an egg decided to make a surprise entrance.

An ultrasound on day 12 and another on day 15 showed that nothing was really happening. My follicles were on the small side and a blood test showed that my estrogen and progesterone levels were not anywhere near what they would be if ovulation was imminent.

We met with Dr. Puschek on Thursday and we essentially have two options: Gonadotropic Injection Therapy or In Vitro Fertalization (IVF). Neither one is super cheap - I think the estimate for the injections are around $4000, and IVF is around $15,000. But, since I turn 35 next month, the odds of my having a viable pregnancy begin a very sharp decline.

So, if I do go with the injections, I would need to wait until I had a period at the end of October (we will be doing some extensive traveling and it just makes more sense to aim for November). Three days after my period begins Geoffrey or I give me a shot, usually in the abdomen. Starting on day seven, I would have to go in every day or every other day for a vaginal ultrasound and blood work to monitor my level of Estradiol, which measures egg maturity. Once it seems my follicles have matured and the Estradiol is at a specific level, I would then need an hCG shot to release the egg, followed by insemination. In order words, this is a lot like the Clomid regimen, but with injections, ultrasound and bloodwork every day for a week or so.

( source: http://www.ivf-indiana.com/gonadotropin-therapy.html)

According to the American Pregnancy Association, the steps for IVF as follows:
There are basically five steps in the IVF and embryo transfer process which include the following:

Monitor and stimulate the development of healthy egg(s) in the ovaries.
Collect the eggs.
Secure the sperm.
Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
Transfer embryos into the uterus.

Step 1: Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. This is often referred to as ovulation induction. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples to check hormone levels.

Step 2: Your eggs are retrieved through a minor surgical procedure which uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to remove any discomfort that you might experience. The eggs are removed from the ovaries using the hollow needle, which is called follicular aspiration. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may last for several weeks following the procedure.

Step 3: Sperm, usually obtained by ejaculation is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman's uterus anywhere from one to six days later, but most commonly it occurs between two to three days following egg retrieval. At this point, the fertilized egg has divided to become a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

These steps are followed by rest and watching for early pregnancy symptoms. A blood test and potentially an ultrasound will be used to determine if implantation and pregnancy has occurred.

( Source: http://www.americanpregnancy.org/infertility/ivf.html)

If money weren't an issue (and my mom generously continues to support the cause), I'm still not sure which way to go. Neither is assured.

Much much thinking and soul searching....

Geoffrey has found that our insurance will not cover IVF. And, at this point, it would seem that adoption would cost the same as IVF. So, we are going to try the injections first and go from there.

At least I get October off and then we start again.

^_^