Immune Results

After emailing Dr. B a few times he finally called tuesday night with my immune testing results. Although nothing came back atypical with my last pregnancy, I was wanting to hear the same this time around. 

He called around 6:30 as we were eating dinner. I could tell he was going through the results over the phone, but kept mumbling about how "this looks good, that looks good, etc". Finally he summed it all up.

He said my NK cells were elevated, but not so much that we needed to start intralipids. He said if I had been on them previously we would be starting them. He basically summed all the results up as a mild inflammatory response but that nothing needed to be done at this time. He said we could see that that neupogen was working both by my immune response and my elevated white blood cell count. 

I then asked about my medications. At 12 weeks I will stop neupogen and drop my Lovenox to once per day rather than twice. I'm happy to reduce my injections from three times a day to once.

I also asked about the Doppler ultrasounds. He said that they are very safe and actually got quiet upset that people had told me otherwise. He said next time someone said that I should ask them in what literature they read it wasn't safe or if they just made it up. He was pretty heated about it, lol. 

So, as I suspected, we don't need to change anything at this time. I'm glad to have this reassurance but just wish it didn't cost $800 to receive. 

62 Days

After my last post complaining about how long it had been since I'd had a period, my period finally arrived. It was a 62 day cycle and I wasn't thrilled to see Aunt Flo the morning of my scheduled massage. Poor timing! 

Yesterday I met with my gynecologist. Despite an insanely long wait my actual appointment was brief. I described my symptoms and he did an exam. He ordered blood work and told me he wanted me to have a sono done. Then he said I should schedule an appointment and we'll "figure things out." When I described what had happened with the ovulation tests he said I was likely having overlapping cycles. A LH surge doesn't necessarily mean ovulation. I interpret this as I'm likely making cysts. 

We talked about the different hormone tests he planned to run. When I mentioned I had high testosterone in the past he said that the testosterone is what fuels the LH surge. I'm guessing that means mine is high since I'm having multiple LH surges per cycle. 

I didn't get much of a chance to ask many questions, but I'm hoping next time I talk to him it will be more thorough. I understand he needs the blood work results to make decisions about how to treat me, but I guess I would have liked to have gotten some idea as to what he'll do. I think I was hoping for more resolution because it's not fun feeling like your hormones are crazy and all over the place. 

I left the appointment and immediately went and got my blood work done. I go back on January 7th for the sono and follow-up appointment. Dr. R did say that if I didn't hear from him next week regarding the blood work results to call for them. I also started taking Myo-inositol. I really should add in Vitamin D too. We'll see if it makes a difference.

4 Months Old

With our Christmas tree before W cut it down

Christmas dinner

Go Syracuse!

It's not a good sign that at only 4 months I'm already behind on monthly posts. I need to get this post done before the girls get any older. They turned 4 months old on the third, almost 2 weeks ago.  

This month was another great one. We started to work more on a schedule, both daytime and nighttime. The girls started napping in their cribs but not sleeping there at night. We started an eat, play, sleep routine and they've done pretty well with it. They continue to sleep in our bedroom at night either in the pack and play at the foot of the bed or our bed. W is a sucker for having the girls in our bed. We really need to get them out of our bed because I know the longer we continue to have them there, the harder it will be to break the habit. They are so cuddly in bed though I can't help but snuggle them right up next to me. 

Snuggling in bed

We had some firsts as well. The girls celebrated their first Christmas and New Year's. We did our first overnight trip away from home to visit my sister. 

Christmas dresses

cousin love

I can't believe how big my little preemies are getting. Gone are the days when I could pick them up one-handed. Both girls are on Prevacid medication for reflux and Lucy's lack of weight gain continues to be something we're working on. We've started to give her a bottle a day of breast milk mixed with Neosure formula. We recently received a sample of human milk fortifier but haven't tried it yet. I'm still avoiding dairy since it seems to upset the girls. I'd like to try to reintroduce some foods since their reflux is now under control. 

With all of the holidays and traveling we haven't been getting out as much lately. I think I got burned out on how much work it is to get 2 babies out of the house. I did go to mama baby yoga all by myself and both girls were so great. They were mesmerized watching me do yoga. It was super cute. 

My mom still comes most days but I'm not as desperate as I used to be by the time she gets here. I don't feel like I'm going to lose it if she's a half hour late. I'm so much better at managing 2 babies at once. That's not to say that I don't have my moments... 

Lucy- Oh Lucy, you are so intense and dramatic. I think your reflux got the best of you this past month and you really struggled. We had some issues with getting the right medicine, but things are so much better now. We also got you your first necklace made from hazelwood. When in contact with your skin it is supposed to neutralize acid. I'll try anything to help with your reflux. Your body is always in constant motion unless you are sleeping or pooping. You always have your legs kicking, arms flailing, and lips blowing bubbles. You still love tummy time and can raise your arms and legs up while on your tummy. I know you will be rolling over before we know it. You love your hands and put them in your mouth all the time. We look over and your face and hands are soaked in drool. You are still a little peanut. At your 4 month appointment you weighed 8 pounds 6.5 ounces and were 21.75 inches long. You fit mostly in newborn or 0-3 month clothes but recently have worn some 3 month clothes without losing your legs. You are very visual and love the mobiles, your projector in the crib, or looking at people's faces. You smile the cutest little mouth gaping smile, but it's always so short lived. I finally got a picture of your beautiful smile recently. You love to get your diaper changed and smile and coo like crazy when we change you. You still love your pacifier so much. People who hardly know you comment on how much you like it. This month you had to get your blood drawn but you did so well. Your still startle easily and get upset over little things. You arch your back and get so tense when you are upset. When you get that way only me or your daddy are able to really calm you down. This month you started to notice your pets and will watch them walk around you. You are definitely my stubborn little girl. You must get this trait from your mommy. You are such a little cutie and we love you so much. 

Finally a picture of your super cute smile!

Always moving

Next to the height chart in your room. How tall are you?

Clara- You are such a happy girl lately. I look over at your and your entire face breaks into a giant smile, cheeks and eyes included. You love your cheeks to be stroked and touched and almost always smile when we do this. One morning I placed your sister next to you in bed and you looked right at her and smiled. It was so sweet! You are very talkative and social. You love your bath and cry every time daddy takes you out. You love to hang out with your arms on mommy's thighs like you are in a hot tub. When you get mad we still joke about the tea kettle since that's what you sound like. You love music and singing and hate tummy time. Your eyes are so bright and your eyelashes are so long and dark. It looks like you are wearing mascara. This past month you decided you no longer want to drink from a bottle. I really hope you get over this soon. At your 4 month appointment you weighed 11 pounds and were 22 1/2 inches long. You are wearing mostly 0-3 or 3 month clothing and recently moved into one sized cloth diapers diapers from the newborn ones. You can still squeeze into the newborn ones but they are getting super small. Your thighs are so chubby and your cheeks are so kissable. I'm so lucky to be your mommy. 

Wearing the bunting your grandma knit for you

How tall is Clara?

Wearing a big diaper

This month was another great one. Time flies when you're having fun. 

Well Shit

Today I took the day off to take my 3 hour glucose test. In all honestly, it wasn't as bad as I was making it out to be. They gave me the fruit punch flavor instead of orange and I requested ice with it this time. It was so much better. 

The first hour I felt pretty awful but from there it wasn't as bad. My mom was supposed to go with me and didn't, but that's a story for another day. I brought my thank-you notes to write from my shower and was able to finish them all. My veins cooperated and the blood draws weren't too bad. 

I came home after and took a long nap. I slept horribly last night due to heartburn. I didn't want to take anything because I was supposed to be fasting and wasn't sure if it would mess up the results.

I heard W come home after work and he climbed in bed with me a put on an episode of The Office on the laptop while I continued to nap. 

When I woke up he told me he had some bad news.

Around Memorial Day W was offered a new position with the company he worked for. He is a physical therapist and has his doctorate degree. He was offered a raise and a position at a nearby rehabilitation facility that was more his speed than the nursing home he was at.

Sometime this summer the rehabilitation facility was taken over by a new company. It was unclear whether they would keep his contract agency in place for the therapy services or not. Well, today he found out the company he works for lost their contract there. 

It couldn't be any worse timing. He will be done working there the first week of September. His boss promised he would try to find employment for the therapists ASAP locally, but couldn't promise anything.  Worst case scenario, W sticks with the company and commutes an hour and a half each way to work. 

He was planning to take a month off when the girls got here. They had hired someone to cover while he was away but now that person is no longer even working for them. Now that month of him helping me with the girls will be spent applying for jobs and interviewing. That is, unless he is able to line something up before that. It's hard to line something up when you don't know exactly when you are going to need time off. It all depends on when these girls make their arrival. He isn't planning to take off the time until they come home, but we still don't know when that's going to be. 

I know that he is in a great field and he will find a new job. It just really changes how his time off is going to look. It stresses me out and makes me want to keep working as long as possible. I had been thinking I'd be done August 16th. I'm not feeling so confident about that anymore, but know I need to stop soon. I've been having more and more braxton hicks and so easily feel like I overdo it. Working for a few extra weeks is not worth having these babies early. 

It really sucks that this happened today, but I know in the end we will be fine. I really just wish W hadn't taken the raise and change of position in May. Oh well, hindsight is 20/20, right?

Ultrasound at 7 Weeks

Yesterday morning was our second ultrasound. I woke up feeling nervous and found out that morning sickness nausea paired with fertility clinic anxiety is not a good combination. 

I got stuck with my least favorite NP. She didn't say much, and there was definitely no congratulations. When she started the scan she saw 2 and was annoyed I didn't tell her there were 2. It did make me smirk a little that she was doing the ultrasound since she was the one who warned me that Dr. Br.averman was just going to take my money. She's never been very friendly or nice, so I didn't care much. I just wanted to see our little ones again. 

As soon as she started I saw the 2 little sacs again. She pointed out both heartbeats and W squeezed my hand. She was pretty quick with everything. Both babies measured 6w5d and I was 7w1d. I'm really not concerned they are measuring a few days behind since I know there is a margin for error and that there can be a little difference with no problem. Baby A's heartbeat was 127 and baby B's was 129. She didn't let us listen to the heartbeats for long, just quickly played them in order to measure. It felt more scientific than anything else. I was a little disappointed we didn't get to hear them a little longer, but oh well. They are just so rushed at that clinic, so they don't take much time to do anything. 

I was so relived to see them both and hear their little heartbeats. It's amazing to think that I have 2 little babies growing away inside me. 

I went yesterday to get my blood drawn again to test my Anti Herparin XA. I made it just on time to be 4 hours after my Lovenox shot. The phlebotomist drew my blood and I left. A little while later I had a voicemail on my phone. It was the lab saying something was wrong and that they wanted me to come back and get it done again. I know that what was wrong is that the phlebotomist used the wrong tube. I thought about mentioning it when I was there, but didn't.  I had a done the same blood work a week prior and the phlebotomist was sure to go ask someone before drawing my blood. She was surprised as to which tube was needed.

I was pretty annoyed they screwed it up and that I had to go back today and do it again. I'm no stranger to needles and blood draws, but I'd like to avoid unnecessary ones if possible. 

Annoyance aside, I'm so happy and excited about our little twins. We are just feeling so lucky and blessed. 

What's Going On

The weekend always goes by too fast. How did we get to Sunday night already?

Last week went by fairly quickly. I worked a lot more than I have been working for the past few weeks and was exhausted by Friday night. I felt like such a bum Friday night when I napped while W did two loads of laundry, bathed the dogs, did all the dishes, and started dinner. Whoops!

Last Tuesday night I got together with my friend after yoga and we went out for Thai food. Of course we talked a bunch and had fun so I ended up getting home pretty late. 

Staying out late on Tuesday night made my Wednesday 6:45 appointment feel extra early. My lining measured at 7.78 and my estradiol levels were 746. We scheduled my transfer for the 26th at 10:15. We haven't made a final decision about how many embryos to transfer, but I think it will be two. I emailed Dr. Br.averman to get his opinion and it seemed to be two. He said he rarely recommends three unless the embryos quality is poor, the woman is over forty, or there have been repeated failures. We only fit into one of those categories and I'm not ready to fly through our best embryos. He also told me about the blood work he plans to repeat at my beta. Unfortunately, they were mostly tests that were only done at the out of network lab and are they were super pricey the first time around. I am going to email him to find out more about this. I don't understand the purpose of repeating these tests if my levels were within normal limits the first time. I guess to see how I responded to the new meds?

On Thursday W and I went to a vinyasa yoga class with my mom and then we went out for Indian food after. The class went much better than the previous Sunday. I felt strong and got a great workout. That one instructor is amazing. 

I had a nice friend-filled weekend. I saw my friend T on Saturday and we got lunch, walked around the mall, shopped a little bit, and got pedicures. I'm pretty excited about my new pajama pants and the festive dog collars I bough. T is due with her little boy in eight weeks! I can't wait to meet him. Her baby shower is coming up on December 8th so I really need to finish the binding on the quilt I made and then get it machine quilted by someone. The binding is intimidating me a bit which is why I haven't done it yet. I watched a little video on You Tube this weekend but still am not sure about it. I better get sure about it soon. 

Today we went to yoga and then hung out with our friends C, J, and their little girl E after. The yoga class had a sub instructor and I didn't love it. It wasn't very dynamic or fast moving. Little E wasn't feeling well and was being super sweet and snuggly. It made me want a little one that much more. We made plans with them to go cut down Christmas trees the first weekend in December like we did two years ago. 

I've feeling really hopeful and positive about our transfer. I am excited for it to be here and know the next week should fly by with Thanksgiving. I'm still bruising quite a bit. On Friday I ended up with a dark purple bruise that is bigger than a quarter. It's super attractive, trust me. I also bled for a long time when they took my blood. The Lovenox is definitely working. 

I'm really looking forward to the short work week and seeing all my family on Thursday. Then we have our transfer in eight days! It feels like it's taken a long time to get this close. Let's hope this is it!

IVF #4 CD 12- The Final Stretch

Today W joined me for my appointment. The NP measured my right side first and I thought for sure we would trigger tonight. Then she went over to my underachieving left side and the follicles were a bit smaller. On the left side I had 2x13 mm, 2x14 mm, 3x15 mm, and 2x16 mm. On the right there were: 1x11 mm, 1x13 mm, 1x14 mm, 3x16 mm, 2x17 mm, and 2x19 mm. Obviously not all of these are going to be mature at retrieval, but I'm happy with how things are progressing.

Since my clinic was only going to be open for a half day today the NP said it was important I call her ASAP to let her know if we would trigger tonight or not. She gave me her cell phone number and told me to call when I knew. I asked her if she would trigger me tonight and she said she would probably hold off another day, especially since we are planning to freeze everything. She also said it was important to find out from Dr. Br.averman on what day he wants the embryos frozen. I assumed it would be day 5, but she said sometimes the preference is on day 1. I will put in an email to Dr. B to see what he has to say. 

Once I got in the car I emailed the nurse at Dr. B's office and told her I needed to know about triggering ASAP although I was pretty sure I knew the answer. She got back to me fairly quickly and said we were going to hold off another day. I called my clinic and scheduled another appointment for tomorrow.

Based on how I felt this weekend I knew there was going to be a big jump in my estradiol levels. My sense of smell became out of control and I started feeling much more uncomfortable. I'm officially to the walking super slow phase of this cycle. Today my estradiol was 4537, up from 1094 on Friday. We are definitely planning a Lupron trigger and freeze all based on my levels today. They kept my Gonal-F the same and reduced my Menopur to 1 vial.

I finished my crap-tastic book for book club over the weekend. I can't believe people like to read stuff like that, but oh well. It's just not for me. Promptly upon completion I shopped in the Kindle store for a new read. I came across a book called The Light Between Oceans. So far it is amazing. It was so refreshing to start reading a book with good writing! Our book club meets tomorrow and I don't think I'm going to have a whole lot of input. 

We (and by we I mostly mean W) crafted some Halloween decorations for our porch. We made some ghosts and a spider web and put out orange lights for the porch lights. Today we went to the pumpkin patch and got a bunch of pumpkins. I have a thing about white pumpkins since I had them for decoration at our wedding. They didn't have any good big white ones but I got a few small ones. 

We have a freeze warning for tonight and so we covered our raised flower bed full of dahlias with some old sheets, and boy is it attractive! I'm going to be so sad to see my flowers go, they have been so beautiful for months. 

In other news I heard that one of the girls I went to graduate school with is really sick. She is on a ventilator in the hospital in very critical condition. Some friends started a page on Facebook for updates about her. It sounds like last night was really bad. She is in my thoughts and I'm asking that anyone else keep her in your thoughts too. They think she may have an extremely rare neurological condition that has no known cure. I really hope she pulls through. Something like that really puts things in perspective.

Back in Gear

I went for my baseline on Wednesday. I spoke with the nurse at Dr. Br.averman's office (Sandra) and she gave me a schedule. The plan? Start stims on Monday and then my first monitoring appointment will be Thursday. Is this really happening again??? AAHHHH

New and Confusing Information

Yesterday was my follow-up with Dr. Br.averman. Of course the office was running behind so we waited for over an hour past our appointment before they called. 

At first Dr. B said everything was essentially normal. But I could hear him flipping through pages and pages of paperwork. Then he got to the HLA (Human Leukocyte Antigen) matching portion of the testing.

Here is information I found on HLA matching from Dr. B's website in order to explain it and be more clear:

"A fundamental part of HLA function is the presence of MHC molecules on all cells in the body. While there must be great similarity between these HLA genes with the donor and recipient during a transplant, this does not hold true when considering an embryo. There are reasons an embryo must have significant differences than the mother in order for a pregnancy to be successful and not result in miscarriage. Evolution has resulted in significant variation in the shape and sizes of MHC molecules (It is the MHC molecules that pick up virus and bacteria and present it to the immune system for eradication). The variation of the MCH molecules prevents a virus or bacteria from mutating and then evading the immune system in every person they infect, preventing an entire population form getting wiped out during an outbreak. Nature has a reason therefore to try and reject an embryo in couples with similar HLA genes as this would eliminate the ability to diversify.

Other HLA molecules on the embryo's surface, however, play an important role in beginning the process of immune tolerance. One theory is that a difference between the HLA genes of the mother and the embryo is important as it draws the immune system to the site of implantation due to the detection of something foreign. From here, the embryo begins to interact with the maternal immune system to turn off its attacking aspects and use it to its own advantage. Advantages include mild inflammation that can assist with implantation as well as the production of antibodies to protect the fetus."

 So, apparently W and I have a lot of matches. He said anything over 5 was considered significant. We have 6 that we know of for now. The test wasn't complete and the DQ Alpha portion of it was missing. This means there are another possible 2 matches that we will find out about once we complete the testing.

The HLA system is located on chromosome 6. As Dr. B said, this is the chromosome that "polices the immune system". If things are too similar, then the immune system attacks the embryo. He thought this was a possible reason for the way things have turned out in the past.

He also said that I had a PAI 1 4G gene mutation which is consistent with PCOS. I also have 1 copy of Factor V and 1 copy of MTHFR. All of these create a cumulative effect relating to blood clotting. He said this can be easily remedied with the use of Lovenox.

As far as the HLA matching goes, I guess his plan of action is to use Neupogen. This is a drug that is administered as a shot like anything else in a IVF cycle. The way that it works is it puts the immune system to rest in order to shield the embryo from the immune system. It's a drug commonly used during chemotherapy and is experimental for use in IVF cycles. Dr. B said he's had a lot of success using it for this type of problem. 

He said we don't need IVF and that IUI's would be an option. For now we will do IVF since we already have a cycle paid for. In the future, we could have him manage the immune portion and do IUI's. They are covered by my insurance so it's definitely something to consider if need be. It's that whole missing a tube thing that deters me. 

We talked about this upcoming IVF cycle. At first I could tell he didn't want to manage it due to the logistics. He was trying to back out of it but I put more pressure on him and he said he would keep to his word. I know its complicated and difficult, but I can't keep doing the same exact thing that my clinic has me doing. It's not working!

We talked about a the protocol again and meds. We will start on Gonal-F at a higher dose and then step it down shortly after. The reason to do this is that the higher dose recruits more eggs to begin with and then once they start growing they don't need as high of a dose. We may or may not add LH depending on my levels and his preference was Menopur over Luveris. After a few days we will add in Ganirelix and will trigger with Lupron. The plan for now is to freeze all embryos. It is likely my estrogen will get super high again and it's not a favorable environment for embryos. Also, the hormone management is extremely difficult with a Lupron trigger and I guess it would be easier to wait. I'm not thrilled about this option, but it's OK. I'm happy to try something different. 

So the plan for now is I need to get doctor's orders to my current office to get a sono before coming off birth control pills. I'm waiting for them to send this over so I can schedule my appointment. Then I will get a scan. As long as everything looks good I will stop bcp's and we will start this cycle. I should get a protocol written out from Dr. B and get assigned to a nurse soon.

So the biggest question is, how am I feeling about all of this information? I'm SO HAPPY I trusted my gut and pursued another opinion. I'm glad I found Dr. B and that we went through with all of the immune testing. I definitely had my doubts about whether it would all be worth it. I now 100% believe it was! Just doing what CNY told me "keep trying, it's a numbers game" was not going to work for me. There is something bigger going on. 

I'm kinda sad to find out to the hubs and I are apparently just too compatible. At least we know that if we ever need an organ transplant we don't need to go far. I'm hopeful for changes and armed with a whole bunch of new knowledge, ready to move forward and get this show on the road! 

I Will Wait

This is the title of one of the newest Mumford and Sons songs. I have been listening to it a lot and find it fitting these days. They played it when we saw them in August and I loved it then. Check it out, buy it on iTunes and then listen to it constantly like me. At least that's my recommendation.

The week after we got back from vacation (last week) I completed the final portion of the blood work. Re.prosource told me the doctor's office would have the results in about a week.

So this week I called Dr. Br.averman's office to schedule my follow-up appointment. At first they offered me the end of October, but I told them that wouldn't work. The best they were able to offer was September 17th (a week from this coming Monday). At the time it seemed really far away and I was pretty bummed out. They did add me to the cancellation list so I'm somewhat hopeful it will work out. Otherwise, its really not that far away. 

I've been taking the pill for about 30 days now. It makes me moody and eats up my patience. I feel like I'm in the starting blocks of a race just waiting for the gun to be shot off. 

I'm a little worried something will show up that takes time to remediate or that there will be some other kind of problem. In total, it was 32 tubes of blood for the tests. I'll be upset if there's something wrong but probably also upset if there isn't. I don't think there's such a thing as winning at this point. 

It's hard not to feel like something else is going on. We've transferred 14 embryos at 5 different times and only gotten 2 chemical pregnancies. Most of these embryos were considered good quality. 

So, for now I Will Wait for my appointment and the results. Can the next week please disappear??

Oh Well

I'm not going to be able to get blood work part 1/attempt 2 done before I leave for vacation. These are the tests that I can't do in network. 

These tests are:

NKA, RIP, TH1/TH2 Cytokine, Fox P3, T-Cell Subset, KIR Receptors, CBC with differential, and LAD. 

It's overwhelming how over my head all of immunology stuff is. I try to understand things to the best of my ability, but immunology is crazy complicated. I have an extreme respect for anyone who understands any of it. 

I had made an appointment this morning for tomorrow but then found out that Repro.source doesn't process blood on Saturday. I tried to get in today to do it but my clinic closes early and I called too late. 

Oh well, it will hopefully only put us back a week. It makes it pretty clear I won't be on only one pack on birth control pills before starting stims again. Hopefully it will only mean an extra week or so. 

I spoke with the financial coordinator at Dr. Braver.man's office today and she was super helpful. We talked about what the price included and how we will move forward with things. I'm looking forward to getting all of the results and trying to understand it all. 

But even more I'm looking forward to 9 days of vacation. Look out lobster and crab, here I come!

Denied

I had submitted a pre-authorization form to my insurance company last week to see if I could get the out of network blood work covered. It was a pain to do and required a lot of calling around since the insurance company wanted all of my previous medical records.

Well, I heard from them yesterday that they denied it. The reason was because it was for IVF. The thing that pisses me off about that is that it isn't for IVF. Yeah, that's my plan, but I'm not doing this testing in order to do an IVF cycle. Recurrent pregnancy loss testing and IVF aren't mutually exclusive.

Oh well, it's just money, right? That's what's we're trying to tell ourselves.

So I have to get that blood work done again and soon since we are leaving for vacation on Friday. We are spending a little over a week in Maine and I am super excited . It's going to be so nice to have a break from work and to be able to spend time together.

The plan is to not think or worry about any of this infertility crap while we are away. I'm feeling a little stressed now because we don't exactly have a plan. Well, I guess the plan is to get the blood work results and then figure out what to do from there. Worrying about it isn't going to change anything.

I have two more weeks in this pack of birth control pills so I'm hoping it will all come together in the next few weeks.

23 tubes

Today I was successful with blood draw #1. The phlebotomist was able to get all 23 tubes from my right arm. It took a while but she had me fully reclined in the recliner type chair so I didn't feel too lightheaded or anything. My arm is super sore but I'm hoping it feels better tomorrow.

The bad news is that the lab doesn't do 3 of the tests that were ordered. I'm trying to see whether I can get those tests added to the Repro.source order and then send it again to my  insurnace comapny to get pre-authorized.

The insurance company received the pre-authorization form but are requesting my medical records. I was successful in talking to someone at my first clinic and they said they would send the info over ASAP. I was unsuccessful with my current clinic because they are only open a half day on Thursday. Hopefully tomorrow will be successful with them.

I can't believe how complicated it is just to get blood work done. Hopefully this will be behind me by the end if next week as we are leaving for a week in Maine next Friday. It would be nice to not think about it while on vacation.

I'm trying to convince myself that even if we don't find out anything ground breaking with this blood work at least we are ruling it out as a possibility. I often suggest children with speech delays get their hearing tested even if just to rule it out as a factor.

What a Headache!

Dr. B ordered an insane amount of blood work. I have been working hard at getting it completed and as much paid for by insurance as possible. The entire order was sent to an out of network lab (Repro.source) originally. Since some of the testing can be done in network I was able to get two different scripts for the testing. 

All of the following tests will be performed at an in-network lab:

 protein C, Protein S, lupus anticoagulants, antithrombin, Factor X, Factor IX, Factor VII, complete thyroid panel, prolactin, Homocysteine, prothrombin gene analysis, beta 2 glycoprotein, MTHFR, Cardiolipin, Vitamin D, platelet antibodies, DNA double stranded anitbodies, ACE insertion/deletion, Annexin 5, Prothrombin gene (factor II), C3, C4. 

Then there is a script for a karyotype for both me and my husband. 

In addition, there is DNA testing for both of us. These tests include: HLA A, B, C Class I DNA TYP-antibodies and then HLA DR, DQ Class II DNA- antibodies. I'm not sure exactly what all of those abbreviations are for, but I know it has to do with DNA. Aren't I a genius?

For this blood work I had better success today with Quest Diagnostics. I had been try Labcorps but decided they sucked and I should go elsewhere. Today at Quest they seeemd initially overwhelmed and annoyed but then told me that I can return tomorrow afternoon and get all of the tests performed. I'm sure it's going to be a lot of blood, but I will be so happy to have it done and behind me. 

There are a few tests that cannot be performed in network and I therefore have to use a specific company (Repro.source). They sent me two boxes by FedEx and instructed me to take these to my clinic and have them draw the blood and then they would send it. 

Etsy shop lilflower

I brought the boxes with me to my baseline appointment yesterday. When I pulled them out the nurse got a bit upset and wanted to call in the NP to see what to do. I heard them talking about it in the hallway and then the nurse and NP came back. 

The NP came in and was a bit rude about it all. She asked me who ordered these tests and why I was doing them. When I mentioned Dr. Br.averman she appeared even more upset. Things didn't improve much from there. I felt like I was being lectured. She told me that he thinks outside the box and that he does some different things, but that I have to be careful because he will take a lot of my money. She asked if he would be managing my cycle and I said he would. She asked if he would be doing the retrieval and I said he wouldn't. She then said she will need to have written orders from him during my cycle and that her past experiences with him did not include any formal instructions. This is the only way it will be possible. 

She then left the room and the nurse came back in to draw my blood. Once again she seemed annoyed but got it done. The NP popped her head back in the room and seemed to have calmed down a bit but was obviously not happy about the situation. She wrote me a prescription for birth control pills and then said she was going to need the plan to know what to do next. At one point while I was getting my blood drawn I heard Dr. K in the hallway talking to her but I wasn't sure what about. It's pretty rare to hear his voice down in that part of the hallway.

The worst part of this whole thing is that I learned the extra blood work through Repro.source could be covered by my insurance with pre-authorization. I hadn't gotten it prior to getting my blood work done the other day so I had to cancel that set of tests in order to wait for the pre authorization from my insurance company. Then I get to do it all over again. Yay!!

For the past two days I have been upset about it all. I'm frustrated that my clinic appears so upset about an outside opinion. I tried to get their opinion about what I could do differently and I feel like they told me to keep doing the same thing. I can't expect any different results if I keep doing the same thing. I need to make changes and know that I am trying my best and maximizing each cycle to increase success rates. It's almost like the goal of getting me pregnant was forgotten at my clinic and everything was taken personally. I'm not trying to offend them but I don't feel like I am getting what I want from them. I'm willing to pay extra money to feel like we are making positive changes.

A big issue is that I'm too sensitive. I internalize others people's feelings and let it bother me way more than it should. 

One of my friends previously told me she didn't like this NP. She said she didn't feel like the NP includes the patient in discussing the plan or making decisions. I like her because she tends to be more aggressive than the other nurses. I guess I found out that she doesn't like to be told what to do. She really took it personally that I was seeking outside input.

Obviously an option is to not use Dr. B for this cycle and if it doesn't work this time to go to him. That would still involve using my local clinic for monitoring. W and I talked and we still want to move forward with using Dr. B. It is more expensive, but this whole process is so expensive so does it matter that much if it helps? At this point it just feels like a drop in the bucket.

So the questions I could use some input on are: Do I continue with the same NP and hope she turns around on her opinion/attitude?  There are plenty of other nurses at the office but none that know me as well as she does. I think it would be awkward if I suddenly stopped requesting her and then saw her in the office.

Do I send my RE and email telling him the plan for using Dr. B? I was planning to let Dr. B deal with that but from the interaction with the NP I'm wondering how good he is about being in contact with the nurses and doctors. At my clinic it really feel like I only see my RE for retrieval and transfer. There isn't much discussion with him throughout the cycle and I feel like the NP is the one making the decisions.

I also don't know how to put the negativity behind me and move forward. Like I said before I'm really sensitive about other people's reactions to things. I care too much and then worry about it a lot. I just want to move forward and reduce stress as much as possible leading up to this next IVF cycle.