IVF Abroad - The Plan

            The great lengths that we subject ourselves to in order to achieve life goals result is a test of human fortitude.  Whether it’s scholastic, endurance, personal challenge, or even infertility, a similar outlook remains the same, to gaze upon the finish line.  With any challenge though, there is always the subtle undertone of failure that lurks in the idle mind, so this is why we train; to stay focused, conditioned, and goal oriented.  As with infertility, an adversity that directly affects both individuals in the relationship is met with the same spirit and fortitude that any life changing event has the tendency to create.  Of course with any obstacle in life unfortunately we often face scrutiny from our peers and loved ones, usually innocent in nature, but sometimes hurtful nonetheless.  Comments typically range from, “oh you just need to relax and it will happen.” Or my personal favorite, “just go out and get drunk.  That’s how I got pregnant.”  These types of insinuations lead me to believe that some people don’t even realize that they are indeed blessed.  All the while this disease is affecting 1 in 8 couples, but yet, infertility remains underrated and unappreciated by health care and health insurance alike.   However, like many diseases, infertility is not life threatening, but it is life altering.  The Merriam-Webster dictionary defines disease as: a condition of the living animal or plant body of one or more of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.  By this definition it would appear to me that infertility is the diminishing function of the reproductive system, and thus a disease.  And yes I can see that a 45 year old woman having trouble conceiving can be suffering from aging, not infertility.  Though in our case and many others, Jill and I are still young, healthy, and been trying for a long time.  So please, next time don’t tell me I should just adopt.  Adoption should be a choice, not caused from unfortunate circumstances.  We want to explore all options before adoption is necessary, because we also need resolution and the clarity that only comes from knowing you did all you can to conceive.   In other words, this is not the end of the road for us; it’s the beginning of a new chapter.

                

               So we bought our plane tickets with Delta Airlines and will be traveling for our European IVF journey on August 28^th through September 18^th.  Our adventure begins at Denver International Airport at 8:20AM.  We bought modestly priced tickets, so to be expected, there are some speed bumps along the way.  We fly from Denver to Cincinnati where we change planes and have a 3 hours and 45 minute connection time.  At 4:40PM we leave Cincinnati to arrive at JFK in New York where we change planes once again and have a 1 hour and 20 minute wait.  At 8:10PM we finally leave America to arrive in Prague, Czech Republic at 10:40AM the next day with a total travel time of 18 hours and 20 minutes.  Jill and I decided it would be best to rent an economy car, something comparable to a ford focus, and drive from Prague down to Brno where ReproGenesis is located.  We have already made reservations at Orea Hotel Voronez in Brno, and during that time Jill is scheduled to have an ultrasound on Aug. 29^th and Sept. 2^nd.  Tentatively on Sept. 5^th is the egg retrieval and sperm collection. 

               

               TVOR (transvaginal oocyte retrieval) is the technique used under general anesthesia to remove oocytes (immature ovum, or egg cell) from the ovaries, enabling fertilization outside the body.  With the use of ultrasound to guide a needle through the vaginal wall and into an ovarian follicle, our doctor will carefully aspirate follicular fluid containing the oocytes.  The procedure will then be repeated on the other ovary with the hopes of having several quality eggs to choose from, and if we are really lucky to freeze any extra embryos for future use.  Before all this happens though, the ovaries need to be pharmacologically suppressed and then hyper stimulated.  The treatment started with one birth control pill a day from July 30^th- Aug.14^th.  From Aug 15^th- 18^th Jill will take two birth control pills a day plus prednisone and a massive dose of folic acid every day.  On Aug. 19^th Jill ceases the birth control but continues folic acid and the uses prednisone to suppress the immune system, because in an IVF pregnancy the body may consider the embryo to be a foreign invader and declare war upon our embryo.  On Aug. 22^nd her period will come.  Then Jill starts daily injections of 225 iu gonal-f to hyper stimulate her ovaries on Aug. 24^th, which will continue through Aug. 29^th.  On Aug. 30^th in the Czech Republic Jill will have an ultrasound and adjust medications accordingly, though will receive some injections of orgalutran, to keep her from ovulating to soon.   On Sept. 4^th Jill will receive a shot of HCG to trigger ovulation, and TVOR is typically preformed 34-36 hours after HCG injection.  Assuming Jill will be wiped out after her invasive procedure, we will go back to the hotel for recuperation.  The next day Jill will be on progesterone in oil injections for 2 weeks daily, and we will be told how many eggs have been fertilized.  The fertilized eggs (zygotes) are carefully cultured as cell division immediately begins, and approximately 5 days after fertilization, the zygote has about 100 cells and is now a blastocyst.    Between day 5 and 7 a healthy blastocyst begins hatching from its outer shell, called the zona pellucid.  This is when the embryo transfer takes place (tentatively Sept. 10), and two of Jill’s best quality blastocysts (assuming we get at least two blastocysts) will be released into her uterus via catheter for the embryos to (hopefully) implant in her uterine lining with the hopes for the embryonic period to begin (the beginning stages of formation.) 

                 

                After IVF our clinic requires a 48 hour bed rest with only getting up to use the bathroom.  With this in mind I insisted on Jill to stay in the nicest hotel Brno had to offer from Sept. 9^th-12^th, and not mention September 10^th being particularly special to us because we exchanged vows on 09/10/11.  So not only for our anniversary, but also implantation we will be staying at the Barcelo Brno Palace, the swankiest place in town, and by looking at the pictures online, I’m not sure if I would want to leave.  Fortunately, Jill and I always believe in having a contingency plan, so we built in 5 extra days after bed rest for any unexpected mishaps or miscalculations with IVF, and of course relaxation and recovery.  So maybe I could talk Jill into staying another night at the Barcelo before we downgrade to a cheaper hotel for the duration of our stay, since she will be bedridden during our anniversary. 

                

              With high hopes for success we leave from Prague, Czech Republic on September 18, 2013 at 1:25PM.  We arrive back at JFK in New York at 4:38PM.  From there is a 2 hour and 22 minute connection time and then we leave for home at 7:00PM.  We finally arrive in Denver Colorado at 9:31PM with a total travel time of 16 hours and 6 minutes.  In our minds, totally worth it, especially if we come back with a souvenir or two!  Never know, so stayed tuned as the IVF abroad chronicle continues, and as always thank you to everybody that has extended their prayers, support, and sympathies towards our cause.  Your empathy and selflessness helps fill the void in our life.  

IVF Abroad - an Introduction

              There have been times in my life that I have been consumed by guilt, anger, confusion, and sadness.  Typically these emotions result in short-term internal dialogues of pessimism and melancholy points of view.  Internal debates on why life is not fair.  These emotions, however, are only temporary.  As they say, “life goes on.”  That is until you have been diagnosed by what some may call a condition, while others refer to it as a disease.  Like any disease, our condition doesn’t just magically disappear; it manifests itself into our lives and consumes our emotions and thoughts daily.  The only disease that affects two people at once: infertility. 

                My wife and I began our journey through Infertility approximately two years ago.  When we married Jill was 35 years old and ready to start her family.  Being 6 years younger I honestly could have waited another year to have children, though Jill instinctively insisted on starting on our honeymoon.  Being concerned about her age and her mother’s infertility, Jill feared that her prediction of infertility would come true.  Of course being completely naïve of this lurking disease, I reassured her an innumerable amount of times that there is no need for alarm.  I’m a young healthy guy.  I got this!  Ha, what an idiot.

                A year later I find myself in a doctor’s office filling out a questionnaire about all the lovely details of my past.  How much do they really need to know?  There should be a box to the top right hand corner of the medical screening sheet that says, check here if you are not currently dying.  Once done we were subjected to a slew of test conducted on us, and were referred to a specialist.  At first nothing really seemed to be medically impaired for Jill or I.  Nonetheless, the poking and prodding continued.  The first invasive procedure Jill was subjected to was an HSG (hysterosalpingogram.)   A contrast enhanced exam that examines the reproductive organs.  The test results showed a possible blockage in the left fallopian tube, due to the left ovary not spilling out the contrast in a fashionable manner.  The right tube and ovary had a good report though, however, we had mixed emotions on our prognosis.  We were told about the flush effect the contrast may provide after the HSG.  Being that the contrast acts as a roto rooter for fallopian tubes, cleaning out the menstrual debris from the past two decades.  Well that sounded great at the time, but with no avail, we were back at specialist a few months later.    

                Being 36 now, Jill and I felt more of a sense of emergency to conceive a baby before all the dreaded statistics of conceiving after 35 become a reality.  So our specialist recommended surgery to visually inspect the reproductive organs, and Jill underwent her next invasive procedure, a hysteroscopy: a laparoscopic general anesthesia exam that allows the doctor to correct certain fertility issues.  A day I’d never forget, and think about often.  It started with our RE (reproductive endocrinologist) telling us right before the surgery that there’s a chance he will have to take Jill’s fallopian tubes from the result of the HSG.  Jill and I were shocked because we were lead to believe that this surgery would be at most exploratory, and to clean up any scarring.  It’s scary enough to go under anesthesia for abdominal surgery, but then to tell us something completely different from the consultation right before surgery is horrifying.  Being in the medical field for the past 10 years I have seen some bad bed side manner, but this just seemed unprofessional.  So naturally I said “What are you talking about?  You’re freaking us out man!”  Then he reassured us that it was a last case scenario, and left us to prep for surgery as I sat next to Jill while she lay in her stretcher looking helpless and frigid from only wearing a gown and hair net.  I held her icicle fingers tips and tucked her tightly in with her only blanket. 

                I was eventually ushered to the waiting room where anxiety and boredom slowly crept in.  I tried to entertain my brain with magazines, TV, and IPhone games, but I became more restless as the minutes added up.  About an hour later our doctor came to my rescue of burdening myself with every worst case scenario and gave me the rundown, and a nurse eventually walked me back to the PACU.  Seeing Jill after an elective surgery lying helplessly on a stretcher in the recovery room for us to have a baby made me infinitely sad.  The thought of her diligence and willingness to create our family tugged at my heart.  My cheeks became heavy as they pulled the sides of my mouth down towards my chin.  My eyes felt like reservoirs, holding back my emotions.  However, I stood strong as possible to give Jill the support she needed.  “The surgery went well,” I said.  “The doctor believes we will be able to conceive with a low tech solution.”  A sign of relief came across her face as I held her hand, and she sighed from the anesthesia wearing off and pain increasing. 

                Jill’s surgery results revealed that the HSG was a false positive and both of Jill’s tubes were completely clear after all; however, the surgeon did remove all the endometriosis he found.  A moderate amount of scarring at best, and the best news we have had in a while.  The specialist recommended that we do IUI (intrauterine insemination) as soon as possible, due to the endometriosis can start to come back within six months.  So a few months later Jill followed through with her next “low tech” invasive procedures.

 

                To successfully conduct an IUI, first you need to hyper stimulate your ovaries with the drug Clomid.  During our first IUI, Jill took Clomid from days 3-7 of her cycle and was then given a shot of Menopur on day 9.  At an ultrasound on day 12 the nurse told Jill there was only one follicle developing on her left side.  This was disappointing as she normally ovulates every month – to take all those meds and only get one follicle was the worst case scenario since she would already normally produce a follicle anyways.  This is when we started wondering if our RE was the best option for us.  When Jill went back two days later for her next ultrasound, another nurse showed her two big follicles on the right side and one still on the left.  How the first nurse missed two follicles was beyond us but definitely a cause for concern.  With three good-looking follicles on day 14, the nurse gave Jill a shot of a huge dose of HCG (human chorionic gonadotropin) – the pregnancy hormone that forces ovulation during IUIs.  The next two days the sperm were washed, counted, and placed directly into the uterus via catheter.  That is if the nurse can find the cervix and push through it without spending too much time hunting and pecking, which apparently I’m told is very uncomfortable.   Jill was then prescribed progesterone twice daily every 12 hours vaginally for the remainder of the cycle and into the first trimester to reduce the risk of a miscarriage.  Not only progesterone is taken in an uncomfortable manner, but it is the also the hormone that gives women PMS before their period.  So in other words, they don’t call it “progesterage” for nothing. 

                After fertilization there is a two week wait for a positive pregnancy test to appear, and the first one we’ve ever seen together.  Jill was so excited to finally see a positive test, however faint at the time; so she peed on a new test strip six more times over the course of the weekend.  Each one becoming darker and darker as the pregnancy hormones began to populate her body.  A weight had been lifted off of us and I just simply look up, smiled, and said, “thank you.” 

                The next day her blood was drawn to confirm the pregnancy and her HCG level was at 22.  Two days later the HCG measured 15 (in a healthy pregnancy it should approximately double every 48 hours), and last blood draw on the fifth day was 14.  A positive indicator for a chemical pregnancy and an extremely sad, confusing, and overall depressing day for us.  What torment my wife had to endure.  After several failed months, surgery, meds, procedures, and appointments we’ve got good news for one day.  Then our fertilized egg which could have become the child we’ve been working towards ceased to live.  Surprising, however, this supposedly happens all the time and women have no idea that they were even pregnant or had a miscarriage.  That is unless you are struggling with infertility, and are all too aware of how difficult it is to conceive.  How guilty you become from the self interrogation of your past and how anything could be linked to this short coming.  The confusion of why this would happen to us when we’ve tried hard to be healthy, balanced, and positive.  The void and disconnect from lack of answer for unexplained infertility ultimately conjures my worst emotion: anger.  If this is a test, I don’t think I’m passing, or even learning from it.  I’m just too upset.

                As they say, “life goes on.”  My wife and I waited two months for the second IUI due to the doctor’s request.  We used the same protocol, though Jill only had two follicles, one on each side.  She was triggered on day 12, and we waited for two weeks.  Jill once again began her progesterone regimen, however, to no avail, we were unsuccessful.  The next month we tried our third IUI and we enhanced the protocol.  This time Jill stilled received a 100 mg of Clomid on days 3-7, though we did two Menopur injections on days 3 and 6.  There were 2-3 follicles for the HCG injection on day 10, with progesterone after ovulation.  Then begun the agonizing two week wait.  We tried our best to stay happy and healthy, but we were let down once more.  After this we naturally felt a little defeated, however, Jill and I don’t give up that easily, and during our ordeal we managed to save the money needed to do the high tech solution. 

                IVF (in vitro fertilization) is the process by which an egg is fertilized by sperm outside the body.  A high tech and high price elective procedure to conceive our biological baby to fulfill our dreams and aspirations of joining our hearts and souls in harmony to raise our child with love, respect, and good Christian values.  This is our goal in life, and I’m guessing some people with children who are reading this right now are probably saying to themselves, “ok, good luck.”  Though unless you have been down this rocky road, and come out on the other end with more love and respect for your spouse than ever before, I can see how some may find it hard to understand how overcoming adversity in life and marriage molds you into a better person and lover.  I wouldn’t necessary say this experience has been humbling, but a true test of character for sure.    However, fortunately, in life tough times don’t last, just tough people do.

                We decided to break away from our current RE and look into highly specialized IVF fertility clinics.  We found numerous clinics in the nation and around the world.  Ironically the best IVF clinic in the nation is about 30 minutes from our house.  Though one cycle of elective IVF would cost us between 20 and 25 thousand dollars, and unfortunately that’s just too expensive for only one cycle.  Always believing in a having a contingency plan, we looked elsewhere, though found the same results.  Any clinic with a good success rate would break our bank without any chances of doing a second cycle if needed.  Then Jill found our clinic, which seemed a little unorthodox at first, but the price and success rates were right for us.  ReproGenesis in Brno, Czech Republic, a highly rated and specialized clinic for reproductive medicine.  The cost of IVF at Reprogenesis is 2000 euros (2654 dollars), plus 500 euros (664 dollars) for advanced embryo monitoring, a technology only beginning to see use in the best clinics in the US.  Add in the cost of medications (about 1500 dollars) and it still adds up to significant savings.  With Jill’s parents showing enormous generosity they offered to buy our round trip plane tickets for just over 2000 dollars.  So with travel, lodging, food, IVF, and a little sightseeing we have estimated that we will spend at most 10,000 dollars.

                Whether it’s greed, governing bodies, supply and demand, or health care that drives the cost of IVF in America to be the highest in all developed counties, not sure, but Jill and I are adding to the statistic of 40% of Americans traveling aboard for reproductive medicine.  We just want the same insurance as the other pioneers of infertility, the ability to afford a highly rated clinic and second cycle if needed before age really becomes an issue.  Not to mention the six month window Jill was given before her endometriosis starts to reappear.  Europe is also specializing in new practices and procedures that increase the chances of conceiving by 10%, which have only recently begun to be used in some clinics in the US.  So a little extreme, some may think so, however, we are willing to do what it takes.  Besides, anything worth having in this life is worth working for.   

                Originally this blog was intended for our family to catch them up to speed with some insight into our personal lives; however, I thought it would be appropriate to share our story with friends as well.  This is our journey through infertility from my point view, and with reading other people’s blogs and stories of infertility, our journey fails in comparison to the horrors some people are subjected to.  We feel blessed that we have had relatively uncomplicated ordeal.  It could be way worse.  Nonetheless, we also always find time to laugh, love, live, and appreciate life even when the stress becomes overwhelming.  A trick that took a while to learn, but yet, I’m sure I’ll never master.  I want to thank everybody that has given us kind words and encouragement throughout the past two years, and for letting me vent from time to time.  A big shout out to my co-workers in MRI that have adjusted their lives for three weeks to allow Jill and I to explore IVF in the Czech Republic.  Also Jill and I will be writing daily in Europe and plan on posting a blog at the end of every week of all updates, adventures, and shortcomings.  So stay tuned as the saga continues, because as they say “life goes on.”