IVF a US vs. Canada Comparison

Undergoing IVF is no easy task. It is not only financially draining, but mentally/emotionally and perhaps most noticeably, physically as well. Each doctor, each clinic, is going to do things a little differently. Their processes will differ, so will their protocols... but overall IVF is IVF. Broadly looked at, we go through very similar experiences: injections, ultrasounds, egg collection etc. But when we narrow in, you'll often find each individual's journey is vastly different from the next. And I'm not only referring to how much medication is administered, how many days of injections there are, how many eggs are produced, or what fertilization rates were, but rather the process itself.

Having been born and raised in Canada, I was afforded the comforts of public healthcare. I never knew or understood what all the fuss was about in the US. I would hear grumblings over lack of insurance, or grumblings over Obamacare, but I never really had a grasp of what it all meant. I was privileged to not have to find out. I had my coverage, and that's all that mattered to me. When I discovered I was dealing with infertility, a little question in my head lingered... "Why would Americans complain when even IVF is covered there!?" Well not for everyone... and not everything. Let's compare.

When we underwent our first cycle of IVF back in Canada, we had been waiting for ages it felt like. Once referred, we had a long wait with no information. Our names were submitted and we were to wait for the call. Months went by before we finally did receive that call, only to book an appointment months out from there. It was a long arduous wait to even BEGIN the process. But once we were there we felt well cared for. We loved our doctor, he gave it to us straight, and we made the decision to go straight to IVF which he allowed us to do.

Because IVF is not covered under public health in Canada, IVF would be out of pocket. So signed the crazy amounts of paperwork, paid our deposit (I can't recall the dollar value, but as you can imagine, not cheap), and we officially were beginning our cycle. We had an in person appointment with the nurse to go over injections, how they're to be administered etc. and on our way out of the clinic we were to stop by the pharmacy window located in the office and were handed our bag of medications. It was in a purple plastic bag, all well organized with everything we would need for the entire cycle. We were fortunate to have good insurance coverage that allowed for basically all of our meds to be covered, but that was it. The price tag of monitoring, egg retrieval, ICSI and transfer were all bundled up into our out of pocket expense for IVF.

Each appointment we had a different doctor, as about 6 or more doctors rotate in that clinic... perhaps due to it being public health, I don't know. And it was the only clinic in our province!!! So we literally had no other options. I didn't see my own doctor once between stimming and transfer so when we went for our follow up "wtf" appointment, he was a bit surprised to hear we weren't successful given our age and "unexplained" diagnosis. When I told him the transfer was difficult, he was also surprised given it wasn't noted in my file. Hmm...

The second round wasn't much different, except we lucked out and ended up having him perform our transfer. It went much smoother and he gave us hope touting that perhaps our lack of success previously could have been attributed to trauma to the embryos. Our second "wtf" appointment didn't offer any new considerations, and when I asked about a lot of new techniques, tests and otherwise, I was told studies weren't yet conclusive so they won't try them. And in regards to testing, well even if it did show something was wrong, they didn't have means to treat any of it because the treatments were not yet proven. I felt like I was going in circles, and so we took a long break.

When we moved to the states for my husbands work, we were excited to give it another shot. I had been in many forums with these women trying all sorts of different techniques and treatments and was hopeful that intralipids were my winning ticket. (spoiler alert: they weren't). This time we had the luxury of actually choosing a clinic to work with. We did a lot... and I mean a LOT of research, and I eventually stumbled upon SIRM. We chose the clinic specifically due to their stance on immune related factors, something that in my gut I attributed our failures to, and set up a consultation. I could have gotten in within a week or so with one doctor, but I chose to wait and work with the clinic director, someone who I trusted based on women's experiences with him. But even the added wait was only a few weeks long, a far cry from the months to get into the clinic in Canada.

So we had our consultation and it was refreshing to hear him take all my concerns seriously and offer the various tests and subsequent treatments. Unfortunately, many of these tests would NOT be covered by insurance. So in the end we couldn't afford all the testing we wanted to have if we were going to be able to afford IVF. We had to learn quickly about co-pays and out of pocket caps and ignoring "bills" that were not bills, but could be bills... Our heads were spinning. Had I not already undergone IVF and understood the ins and outs of the actual process, it would have nearly made me collapse to the floor in sheer overwhelm combined with the complexities of insurance. In the end, portions of our treatment were covered, but even to this day it's not clear exactly how much we spent out of pocket. We still are disputing bills that should have been covered by insurance. And on top of that, a lot of medication wasn't covered.

The process itself was also different. Each and every time I went in I was seeing the same nurse, my doctor, and oftentimes the same receptionist and blood draw nurse. It had a real sense of care, and they remembered me, and I them, and I felt an investment in my care. On top of it, my doctor makes himself accessible via email anytime... which is a daunting task when you have numerous patients. I try my best to not over utilize this, respecting boundaries, but it's nice to know if something comes up In Canada I'd often have to wait for a call back, or for next appointment or whatever, to get my questions answered... and usually from a nurse. This felt like a luxury and was so much appreciated.

But when it came to getting meds, I was having them sent in the mail... something totally foreign to me. I stressed about the medications that were needing to be refrigerated, and how well they'd be packaged. Turns out, they've done this a time or two before ;) they know what they're doing. But I definitely had to do a lot of coordinating and playing middle man between provider, pharmacy and insurance. It was stressful, and confusing, a far cry from my little purple "gift bag" carried out with me back in Canada.

I'm now undergoing my next FET again here in the states. This time I further complicated things by moving states and having to do remote monitoring. Because you're not their patient, they don't seem as invested and take their sweet time getting results sent to your actual clinic. And then you have to play middle man also between the clinics ensuring one sends and the other receives. On top of it, prescriptions are further complicated when they won't ship from state A to state B. Intralipids!? Forget about it... can't be prescribed by an out of state doctor. The hoops I'm having to jump through this time are absolutely shockingly ridiculous. I'm not sure how it would have worked as an out of province in Canada, though I'm sure there'd be hoops there too. I would have happily just lived in NY for 2 months, but as you can understand, that's not exactly a cost-effective option.

Anyways, my point is, there are always pros and cons to each system. Decide for yourself what's most important to you to make your call. Anything I missed?

CANADA PROS
- pharmacy on site
- clear instructions and overall helpfulness
- ease of insurance (no playing middle man)
- clear costs
- nice facility

CANADA CONS
- long wait time
- only one clinic
- rarely see own doctor
- no email communication access
- out of pocket IVF (no coverage available)*
- coverage for meds dependent on your insurance plan
- refusal to try experimental testing/treatments

USA PROS
- short wait times
- choice of clinics
- see own doctor each time (generally speaking)
- email accessibility
- IVF coverage available (dependent on insurance)
- openness to new (perhaps experimental) tactics, testing and treatments

USA CONS
- IVF and Medication coverage entirely dependent on insurance (no equality in treatment)
- unclear out of pocket expenses
- dealing with confusing insurance providers and pharmacies
- bills
- US attitude (this is a thing... service providers by my experience have been quite a bit friendlier in Canada)
- having to be a much more active advocate in your care/service
- price gauging on medications

* my understanding is that certain provinces are starting (and some already have) to offer coverage for limited cycles. 

Financial Coordination Call

So we had the financial coordination call with the clinic and all is good to rock and roll. We have fantastic coverage under the new insurance and feel super duper grateful and blessed. It's a huge relief as you can expect since we've already paid so much up to this point. The well eventually starts to run dry...

We have a call with the nurse on Friday to discuss the calendar and meds so hopefully the costs associated with the cycle medication aren't astronomically high... we're anticipating a little bit at least out of pocket since we have quite an extensive cycle planned and much of it is out of the realm of a typical transfer so who knows what they'll be willing to pay for. That remains to be seen.

We've booked our flights and looks like my mother might be able to come watch our dog while we're away which is a huge stress off if it works out. He suffers from pretty bad separation anxiety so it's nice for him to be properly taken care of while we're gone. We board him when we're gone for shorter periods but we're gone for about 2 weeks and that's just not fair to him at all. Cycling out of town makes things a little complicated but oh well.. that's where my embryos are!!! haha... not too shabby anyway to have to go to NYC, twist my rubber arm ;)

Speaking of transfer, found out my RE really wants me to be sedated again... says the transfer is too difficult to do without it so that's a bit cray cray. Makes me feel hopeful though that if the reason for our prior failures has been difficult transfer, that now that he's done it once, it may go more smoothly... plus the addition of immune protocol... please oh please let it work!!!

ps. if you haven't already checked out my YouTube Channel, you can follow along with my journey there! :)

We Be Stimmin'

Hey all... I'm running a limited time Shirt Campaign. I personally LOVE funny printed t-shirts. For anyone going through a fresh IVF cycle, or medicated cycle (or egg banking cycle or what have you), these shirts a fun way to celebrate the crazy that is stimming!!!

The campaign is running for a limited time. Basically if at least 5 people buy, then the shirts will be printed and shipped. It runs until Oct 31st and will be shipped within a week or two of that date, so this is ideal for someone cycling mid November or later!

Have a peak!

https://www.bonfire.com/we-be-stimmin/

Share with your TTC sisters!!!!

Day 25 - 6dp5dt

Ugh! ugh ugh UGH! Why did I do it... well I know why, I am a recovering POAS addict who fell off the wagon, THAT'S WHY!!! What did I do? Well if the acronym didn't clue you in, I peed on a stick. A FRER at that. And it was a big fat glaring negative.

Okay, so I'm not as totally as crushed as I might have made myself out to  be. Disappointed that my TWW wasn't cut short by overwhelmingly exciting news? Yes. But devastated? No. I mean, I'm only 6dp5dt and my pee also did appear to be quite diluted when I went this morning. Also... I've been convincing myself that I do indeed see just a hint of a whisper of a line. Doeth mine eyes playeth a trickery of hope? Ya... probably... but its a romantic thought to hope my little second line is coming for me as I wait in the shadows of doubt for its arrival.

How/why do I believe there is "a hint of a whisper of a line" you ask? Well as a recovering, ahem, newly fallen off the wagon, POAS addict, I have seen my fair share of negative tests. Now let me preface this with saying I have believed in the past I saw just such "whispers" but they were of course actual BFNs. So I am fully aware of my delusions, but in this instance I will let them be since I need to stay hopeful.

Okay so looking at the test I'm sure any sane person would say there is no chance there is a line there. Fine, hurumph, be that way! So I decided (again, not for the first time) to try "tweaking" my pregnancy test. So I took a photo, edited on my phone, and here it is. I recommend clicking on it, and opening it to see it clearer. Even tweaked its a squinter....  and its upside down...

Now although this isn't the first time I've tweaked a photo, it is the first time I believed I actually had proof of what I was seeing. If you don't see it, shame on you for crushing a poor hopeful infertile's dreams ;) But ya, I get it, it's a pretty big long shot. It could be an evap line, it could be any old sort of anomaly, but for now, I'll take it and use it to remain hopeful for another day. Homme InFertile agreed to buy me more tests so yay for that!

On symptom spotting notes, more early night sweating last night... so unpleasant! One or two pretty weird vivid dream (not sure if they were part of the same that blended or two distinct dreams) but again not pregnancy related. I did, however, decide that my friend was being an awful parent leaving a bunch of newborns downstairs unattended. We could hear one crying, and she was like "meh, they're fine"... but I refused, so I went down and picked a little boy up and cheered him up. It felt very natural, but I've also been around a lot of other peoples' babies so it does in real life too I guess.

Other than that, most of the cramping has gone, other than a few little twinges/pinches now and again. My back still hurts but not nearly as bad as yesterday either. Very mild bloat/constipation that accompanies that dull period pain too. Generally I feel pretty normal today. Normal as in just like a normal cycle where AF is around the corner. Ohhh well. I guess I have practice at this if it is indeed a fail... yet again.

Day 24 - 5dp5dt

Finally up to the amount of days post transfer equal to amount of days pre transfer... the equivalent of 10 dpo. In the past I would have already tested by now and believe me, I've certainly been tempted. I think we might have one frer hiding in our closet somewhere, but I would rather make use of it when it is more likely to give an accurate result. Although many people get positives this early, many also don't, and I really don't need to get more discouraged than I already am. It's taking everything in me to stay positive...

Overnight I started off with some early night sweats. I woke up drenched. I immediately got scared and sad. I get night sweats usually the night before AF shows. Usually I wake up to her gracing me with her presence in full force (she hasn't...yet at least). Was I too hot? Too cold? I couldn't tell, but accompanied by the intense cramping I had the night before I was pretty certain it was not good news. Somehow I managed to push this out of my thoughts enough to fall back asleep after half-hazardly wiping the sweat off my chest.

Then, middle of the night I woke up. I felt wide awake yet it was still basically pitch dark out, I finally caved and checked my phone, the bright light of the screen making me squint. 4am! Ugh. I tossed and turned hoping that maybe I just had a bad dream I wasn't remembering that woke me up and I would fall right back asleep, but I was awake and alert...insomnia! I wondered if maybe I woke up to go pee (I had been doing that the last few mornings, though that was more like 630am, not 4!!!), but then all that thinking of peeing finally made me have to get up to pee. Lame. Once I get up and do that I have a really hard time falling back asleep. I came back in and Homme InFertile very groggily asked me if everything was alright. I told him what was going on and he got grumpy, as if his empathy was only worthy if I had a reason for disturbing him in the night, and apparently my insomnia and pee-needs were not fitting the bill.

I watched some "Friends" on the laptop which always lulls me to sleep. I've seen all 10 seasons a gazillion times over so know it so well it's like a lullaby. That eventually worked, but I continued to toss and turn throughout the early morning due to lower back pain. When I finally woke up to our "alarm clock", aka the jackhammer that starts up every morning at 730am, my back pain was even worse and I feel absolutely exhausted from all the lack of sleep last night.

Today we're planning to go to a mets game. Having Homme InFertile home and around during this wait has been incredible! I'm not left to stew on my own while I can't work (living in the states as a dependent without visa privileges sucks). I just hope my back feels better before then, as sitting in those hard seats for a full 9 innings isn't going to be the most pleasant for me in this state. But I love baseball, and it would be such a great distraction for me today... so I'll try and tough it out, see how it goes at least.

Anyways. I guess that's all for now. Still many a days before I'll know if all these symptoms are period or baby related. Could go either way.... might as well be a coin toss. 

Day 23 - 4dp5dt

Another day full of cramping. Wow.... really REALLY feels like I'm building up for AF up in here. And I'm none-too-pleased about it all, for obvious reasons.

I'm really trying to keep myself as calm and level-headed as possible but it's just so dang hard. I am freaking the frack out. I am so nervous and scared that this cycle is going to be another failure, and yet just hoping and praying so hard that the opposite is true.

It's been a long road to get here, and starting this cycle I've been so hopeful that intralipids were the ticket to success. Now I'm just not so sure. I'm questioning everything. Every decision, every meal, every activity. I'm driving myself bonkers and that's certainly not helping.

I want nothing more than to have faith that it'll all work out, but sometimes it's just hard. I keep my trusty stone with me always, and I rub it to calm myself... that helps a little.

If we wanna play the symptom spotting game for a minute here's what's been going on up until now:

0dp5dt
constipation
fatigue
(acupuncture)

1dp5dt
twinges/pulls
acid reflux (almost threw up when burped)
constipation
fatigue

2dp5dt
increased appetite
very emotional (crying)
sore throat
fatigue
frequent urination (but also drinking lots of water to stay hydrated)
gassy
back pain, unbearable then slowly went away

3dp5dt
bloated
constipation
cramps - started in a.m. then went away, came back worse later in day towards evening (bad overnight)
dizziness
very emotional (crying a lot again - super sensitive)

overnight - crazy frickin dreams. And very vivid - as if I was really there. Nothing baby related :(

4dp5dt
low energy (no nap but busy day... feeling almost ready for bed though and its only 630pm)
medium to bad cramps all day
average to low appetite (common for me with bad cramps)
mild nausea (common for me with bad cramps)
very emotional (crying continues)

... we'll see what tomorrow brings.

Day 22 - 3dp5dt

Woke up this morning with AF like cramps. They've been coming and going, but laying there in bed I really felt the same way I do when waiting for the monthly witch to pay her visit.

My LP (luteal phase) is generally 12-13 days. I say generally because it used to be 11, and then increased to 12, and lately seems to be even better at 13... for the most part at least. Anyway, that means that 14dpo=cd1 of new cycle. Today is the equivalent to 8dpo and I therefore have 5 days left of my existing cycle (on a normal month at least) before AF is expected to rear her ugly head. To me this seems a bit early for this severity of cramping, just knowing my own body and such. But at the same time, if we look on the low end of one of my cycles, I'm just 3 days away from AF, and that's a little less far fetched. Ugh.

Kinda crappy to be feeling so crappy too. When I say I feel like my period is coming, I really do mean it. I just want a heating pad on my lower back/pelvic region to make me feel better but obviously that is a huge no go since if I am pregnant it could hurt/hinder implantation etc.

Boo. BOO BOO BOO!

Day 21 - 2dp5dt

Oh ye 2ww.... how I loathe thee... let me count the ways.

1. Symptom Spotting 
2. Emotional Turmoil
3. Ups & Downs
4. Urges to POAS
5. Time Warp

1. Symptom Spotting

This aint my first rodeo. I've been here before, too many times to count. Yet every so often I find something "new" something "I've never experienced before" that sends me into a tailspin believing this could possibly indicate a bfp is on its way. But month after month. Cycle after cycle, I'm disappointed to find out it was all in my mind, and the supposed symptom? Well just because of this or that. BOO. 

So what's going on with me today:

• I've been eating NON-stop today. Constantly hungry and onto the next thing. It's insatiable. I was however finally able to go to the bathroom and have normal bm's so I attribute that to the increased hunger... I'm rationalizing over here...
• I have had numerous weird twinges, pulls and cramps. Now this could be attributed to my ovaries shrinking back to size, it has been years since my last egg retrieval procedure and I had a lot less eggs at that, so maybe I've just forgotten or don't know fully what it feels like.
• Sudden onset of lower back pain (sort of near tailbone level). Came of out of nowhere and made sitting/laying/moving very uncomfortable. It seems to be diminishing slightly only a mere hour after it came on. Could be I slept funny or radiated out from my hip (I have a former hip injury and it has been bothering me as of late).
• Sooooo tired. All day every day. I think I've had 3 naps today. Now I have been run down with a cold, granted, so again, this can be explained away. Maybe its the stress too, just making me feel lazier/more tired than usual, who knows.

2. Emotional Turmoil

I think I've cried 3 times today, no word of a lie. It can be over something legit, or something completely ridiculous, and even knowing its silly at the time, I can't stop it. I just feel so bloody sensitive. Homme InFertile is certainly walking on pins and needles around me. 

See, when you've been ttc as long as an infertile, you want nothing more than the pain, blood, sweat and tears you've endured to turn into a beautiful bundle of joy. But yet at the same time you fear it will never happen. It's a sensitive time, and thus the stress can overwhelm and make you an oversensitive delicate flower (or at least is the case with me). 

3. Ups & Downs

Okay, so many today its more of just downs, but during the 2ww you go from optimistic blissful hopefulness, to depressed self-loathing pessimistic hatefulness. And it can happen in the blink of an eye too. Well today I've been feeling like no matter what we do we'll never be successful. I go from looking at stories of twin pregnancies, to research on reasons for recurrent IVF implantation failure. No matter what, I can't tell you with any level of certainty how I'll feel 10 minutes from now. Ahhh the infertile rollercoaster... quite the ride my friends, quite the ride.

4. Urges to POAS

So I swore up and down, sideways and backwards that I would not, under any circumstances, in no way shape or form, test before my beta. this was decided because I have seen way too many negatives for an entire lifetime. I have never once in TTC journey (or life for that matter) gotten a positive. Not once. Not even a hint of a line. Nadda. But yet I wish and pray so deeply that maybe this time I will. Maybe this month I'll for the first time in my life get to experience that feeling of seeing two pink lines side by side. And then starts the googling. "How many dpt (or days past transfer) did you get your bfp?" And the of course varied results. We're all different afterall. So when would the magic day be for us? I'm nowhere near the POAS time, but I'm already looking into the not too distant future and planning...

5. Time Warp

Seriously time moves at a snails pace in the 2ww. Ask any woman who's tried, even just for a month or two. That wait? Nothing worse. I would take another week of injecting myself over this torture hands down, and I know plenty of ladies who would say the same. I think of the fact that I'm somehow only 2 days past 5 day transfer and feel utterly defeated. Anyone got one of them handy dandy remotes like Adam Sandler in Click? Ya, could really use it about now...

Day 20 - 1dp5dt

Homme InFertile has fallen victim to my cold, poor guy. No one to blame but me. Looks like its going to be a lazy house this weekend. He's still being amazing about helping me out as much as possible... he doesn't seem to have gotten it quite as bad, perhaps because he didn't have a procedure to puncture his tenders we'll call them, and remove their contents at the same time.

Anyhoo... I'm continuing to improve, cough is persistent but overall definitely feeling quite a bit better "cold wise".

Now on to the whole lower portion...

Been a bit achy today in the ovaries. I know that they're shrinking back down to size and recovering, but the achy/crampy feeling isn't overly pleasant. I had some weird moments as well today where I have pulling... its like a pulled muscle between my ovaries and center line/belly button area (but lower), but the pulling is up/down (not side/side)... clearly hard to explain what I'm trying to say. Only have it on the left side mainly (a small little episode on the right when I stood up once, but nothing since). I'm wondering if it's implantation, or radiating pain from the ovary... 

I'm also very VERY tired today. I have been laying around all day and then went and took an epic, full on asleep rem nap mid afternoon. Was out for a good while. And yet, feel like I could go for another one. Or like bedtime can't come soon enough. I also have been feeling sort of light-headed/foggy with weird little dizzy moments when I turn my head too fast (even while laying down). So that's a bit odd too. And finally, I'm peeing a ton, but that I have an explanation for since I'm making sure to take in as much fluids as possible to stay hydrated, healthy, and attractive to my embabies. 

On a tmi note, straining a bit still to go to the washroom. I'm sure many going through IVF can relate that you worry that the straining could somehow, in some way prevent implantation. I know that's not the case, but it still crosses the mind. That's the horrid thing about the 2ww. You think you have control over the outcome by every little thing you do - what you're eating (warming foods, bromeline rich pineapple etc), how warm your keeping yourself, as if one small misstep will lead to a bfn. Unfortunately, its in the universe's hands. 

One thing I heard that really helped me snap out of that funk, and a mantra I remind myself each day is:

"If doing or not doing any of these things would prevent pregnancy, then women who were avoiding pregnancy would be doing them! But that's just not the case. A woman who doesn't want to be pregnant can't un-pregnate herself no matter how hard she tries, so quit being so darn hard on yourself!"

I really thought though that going through this 2ww I wouldn't be going crazy, yet here I am, a day in, and nuts already! I feel pretty hopeful, but I know that'll ebb and flow as the days go by. 

Day 18

Improvements abound! So I've been sick with a rotten cold all week (which is teetering on bronchitis which I used to get every time I came down with a cold no matter what) but seem to be on the upswing... FINALLY. My nose is no longer a leaky faucet, and my throat no longer on fire. I have, however, developed a nasty cough and am kind full of mucus. Yuk. But... still... improvement nonetheless. 

So I woke up and was definitely feeling improved from yesterday even. Not great. Not better. But improved. Going from sitting to standing was no longer as involved, and walking didn't feel like agony... I was able to pick up my pace. Also, I finally went #2 today. Yay! This was literally cause for celebration I kid you not. If you hadn't done your business in roughly 5 days... you'd understand. That helped alleviate a good amount of discomfort as well obviously.

We had to go deal with tax stuff today, so I was really happy I felt in good enough shape to do so. Then I went home and promptly took a long nap. I woke up only in time to go to acupuncture, which also felt like a big adventure (2 in 1 day!! look at me go!) and make my way home to the couch where I haven't moved from... and it's 8pm and I want to go to bed. So I'm certainly not 100% but feeling happy that the worst seems to be over with.

That being said, tomorrow is transfer day.

I'm so friggin nervous.

So for one, I have to get yet another IV because I'm going under anesthesia. This will be my 4th IV in a very very short time frame. Everyone's been really gentle so I don't have bruising which is nice... so shouldn't be the end of the world, just over it obviously.

Also, I still haven't made a final decision 1 vs. 2. I think I'll wait to see what they're graded as. If we have one stellar one that is off the charts, maybe we just transfer that one. But if we have a lot that are great, but not excellent/stellar/off the charts.... I dunno... maybe 2. It'll be a game time decision and I just dont' like that pressure.

Finally, Once my transfer happens I'm officially in the 2ww. I know technically some might consider me already being in it... but for me, until the embryo is in my body... I don't feel that way. And once I'm in the 2ww, the fear of a negative outcome sets in. I'm so fearful of finding out the result of this cycle. I almost just want to avoid it altogether somehow, but obviously that's impossible. It's like that movie click - can I just fast-forward to the good part? :(

Anyways... expecting a pretty restless sleep this evening, and can't eat/drink after midnight against. Must not forget. Wish me luck, and send me all the positive sticky bean vibes you can muster. 

Fertilization

So... time for the fertilization update. I got the call this morning from Nurse Leslie (who's the bomb by the way) and she started by reminding me that we retrieved 20 eggs... probably because some women are so loopy afterwards that they don't remember haha.

So they split the eggs evenly - 10 to do ICSI with and 10 to fertilize naturally.
Of the 10 they did ICSI with, once washed, 7 were mature, and all 7 fertilized.
Of the 10 they naturally fertilized, ALL 10 were mature, and 9 fertilized.

So we have 16 embryos!!!
HuuWHAT!?!?!!?

To put this in perspective, in the past we had 7 mature eggs, and 4 fertilized. I'm over the moon at the difference. Not sure if its my health, the supplements, or acupuncture that is to thank, but my guess it's a combination of all of the above.

Transfer has been scheduled for Friday and we are expecting an update about our 16 embryos on Wednesday. So now Homme InFertile and I need to decide in the meantime if we transfer 1 or 2... and this won't be an easy decision to say the least. I swear I'd be better off flipping a coin.

Basically in the past we've transferred 2 fresh day 3 embryos (bfn) and then 2 frozen day 5 embryos (bfn) so I'm scared to revert down to only transferring 1. That being said, this cycle has been so different than the past, and we'd like to believe it will work out, so do we really want any additional risks associated with carrying and delivering twins? We'd love to have twins, sure, but I worry so much about losing one or both, or them being pre-term and living in the nicu, or having massive delivery complications... just seems scary. But, at the same time women have twins without any issues, and some women carrying only one child end up with all the complications so it really feels like a crap-shoot.

I know I must sound like I'm spinning my wheels... I AM! I have no friggin' clue what to do. For now our plan is to wait and see how the embryos develop and if we have one embryo that is out of this world on Friday, maybe just transfer that one. But on the flip side, I'm tempted to transfer one natural and one icsi and just see what happens. Ugh. Wish there was a crystal ball to tell me what to do!!!

Day 14

Retrieval day!!!

SOooo I woke up with my head cold which had gotten worse overnight. I give thanks to little to no rest due to lightning/thunder followed by sirens, followed by wind, followed by cramps and nerves keeping me awake. I literally had nightmares of ovulating all my eggs out and going in for retrieval and there being nothing to retrieve. (spoiler alert... this was not the case). So its no surprise I was a little overtired and feeling pretty crummy when I woke up.

Anyways, we headed in to the clinic bright and early. We had to be there for 830, and our retrieval was scheduled for 930. We sat in the waiting room for a while as woman after woman was taken back. Seeing them come back out assured me they were just here for check-ups. Anyways, we were finally brought back shortly after 9am, and I changed in to my sexy gown and rubber soled socks.

First the embryologist came in to discuss my "fertilization plan" which she said, although good in theory, simply wasn't practical. She explained to me that when they natural fertilization they do not clean the eggs and minerals or whatever around them, so they can't know how many are "mature" at that point. With ICSI the eggs are washed before they are fertilized so they do. So unfortunately we had to throw my entire plan out the window. I was kind of annoyed since I emailed the doc (on holiday) in advance to see if this plan was feasible, and he assured me it was, and even the nurses confirmed it, so I thought it was all good to go. I was just too overwhelmed to make a decision so made her and Homme InFertile make the new plan for me. So we settled on doing a direct split of whatever we got and going 1/2 and 1/2. Simple enough.

Today I had yet another new doc. Again, this has been annoying for me since I was so excited to be at a clinic where each and every time (almost... ) I'd get my actual doctor. Well this ended up being far from the case, but the good news is the doctor doing my retrieval was a huge teddy bear and absolute sweetheart. So in the end, whatever. I just keep reminding myself to have FAITH that it will all work out, and this is exactly how its supposed to be going. It's kept me a bit calmer I think.

The anesthesiologist was different from last time as well. Very sweet. I was out very quickly in the room again. So strange to know its coming. So here's the funny part, and still a grand mystery. I BELIEVE I woke up in the operating room just as we were finishing up, and INSISTED that I lift myself off the table onto the trolly bed. If you watch the video you'll hear me talking about it, but I'm pretty sure I probably went to throw myself off the table and they all rushed to lift me. Ahhhh good times.
And next thing I was waking up in my room with Homme InFertile by my side. He video taped me and I can honestly say I don't remember anything up until "Rock Star" ... I was calling my anesthesiologist a rock star for her timing of when I woke up on the table. I get very weird on sleepy meds. For your viewing pleasure...

In terms of the procedure, found out I had 20 eggs retrieved. I was thrilled of course, as I really wasn't sure what to expect since one day they found 17 follicles, and the next 22... so 20 sounded perfect.

In terms of recovery I was in a lot of pain and requested some extra pain meds. That helped and was able to get some fluids and snap out of my fog brain. When we got home I had lots of cramps and bloating. My appetite fluctuated from non-existent to famished. I made sure to get lots of rest and fluid and was basically a couch potato the entire day. My cold continued on as well which sucked, but I napped and am hoping to feel better soon.

Before bed I stared my progesterone suppositories (read someone who used their unused pre-seed applicators so gave that a try.... I recommend just using your finger personally), as well as my estrace. Really feels like I'm in the 2ww even though I haven't had the transfer. I guess technically ER day is like O day so technically, TECHNICALLY, I am. 

Sick + Cramping

I'm trying so so hard to fight off this cold. It's come to try and get me numerous times this cycle, but it had yet to get me down. Maybe because my friend was in town and I was in go mode, I dunno maybe that helped somehow, but after slowing down and resting, today it finally got me.

My nose was a leaky faucet all morning (it has since stopped), and now my throat is on fire. I'm doing everything I can to stay relatively healthy: lots of fluids (though that's also for OHSS), zinc, emergen-c, garlic, salt water gargles, but I wonder if its because of the intralipid infusion. I mean the whole rationale behind doing intralipids is an over-active immune system that fights off the egg from implanting.

So now I'm spinning my wheels wondering if I should just let myself be sick, or if I should continue trying to get better. Ugh. I'm confused and there's very little info out there. I go in tomorrow so will just ask doc/nurse then. For now. I'll treat the symptoms as best I can to feel relief, and just hope for the best.

Also, side note, I have some ovulation cramping going on. I'm assuming from the HCG trigger, but seems odd that I'm made to ovulate before the egg retrieval. I'm sure my cramping is partly due to how many follicles I have as well as the mild OHSS...

Faith.

Day 11 (day 9 stimms)

Intralipid time...

So today was a gloriously lazy day. Without my friend in town, I turned into the ultimate couch potato.. and unapologetically so. Hubby was super sweet and brought me to my intralipid appointment and hung out with me.

When we got there, the nurse brought me into the room (hubby had to wait outside) to hook me up to the IV. I got super lightheaded when she did it, even though she was super gentle, so I had to spend a bit of time slightly inverted to get blood flow back. Once I was hooked up she brought Homme InFertile in and we set up the laptop to watch a movie.

We rented a documentary for 99c, not because we're cheap but because it intrigued me, it was called Barista and was about 4 individuals headed to national barista championship competition. It was pretty good, and passed the time nicely.

In terms of the intralipid itself, my hand got a little numb/cold from laying it so straight and not moving it for so long.

Also the intralipids made me super sleepy so I really had to struggle to stay awake. All I wanted to do was sleep. Though I'm not sure if that's just me catching up from the busy days with my friend in town. I'm still super sleepy and its only 830pm but I have to wait up until 9pm to do my shots. Oh goodness I'm getting old haha.

Anyways, fingers crossed that the intralipids do the trick and we're successful. I'm back to being super bloated/constipated so I kinda waddle when I walk. Every step feels like a ton of bricks in my ovaries crashing around... not so pleasant. I go back in to the clinic tomorrow for ultrasound and bloodwork to see progress from Wednesday. I feel like theres definite progress, but that could just be the constipation bloat. Who's to say. We'll have to wait and see. I'm super nervous/excited to find out how things are moving along. Part of me doesn't want to trigger tomorrow, because my doc is back at work Monday, and if we trigger Saturday instead then he'll be able to do my retrieval himself. Just would give me more piece of mind, but I'm trying really hard to just have faith. 

Day 10 (8 stimms)

DAY 10 - day 8 stimms
Ganirelix done. Check.
Ultrasound done. - - -> My 21 follicles lowered to 17 (I guess some of the 5mms just dissipated). Disappointing, but still solid. Hoping all 17 hold strong.
BW done. - - -> Good to continue with same dosages, and am going back in Friday for another check up. I'll probably be ready to trigger Friday night it looks like. That'll make retrieval Sunday, Transfer Wednesday or Friday of next week.

I had another different doc today. I guess it truly does take a village. I liked her a lot better. Might try requesting her for my Friday appointment and retrieval. She just had a much warmer demeanor in my humble opinion.

Was so fun having my friend in town to distract me, but now she's left just as I was getting more uncomfortable and closer to the finish line. I am a bit relieved to have some down time. I feel like I'm just going to hermit it up for the next little while through our trigger, retrieval, and transfer.

We found out we might have to go back up to Canada while our new USA visas are processed, which is a bit of a pain in the butt. Maybe we'll do it during the 2ww. That'll make for a good distraction I figure. Problem is, if they want us going sooner rather than later the timing is tricky and may be a quick turn around situation. That's fine too, and maybe better if it means I can fly instead of having to drive. No chance I'd risk flying in the 2ww. No sir.

I go in for my intralipids tomorrow. Really nervous about that. No clue what to expect, and who in their right minds likes IVs? No one. I'm hoping Homme InFertile can join me and we can cuddle up and watch a movie. We haven't really had any alone/chill time since my friend was in town. I wanted to be respectful to her as she's single and I know it can be hard being around super lovey dovey couples (which we are, but just not in public). So soaking up some cuddles tonight. 

Days 9 (7 stimms)

DAY 9 - day 7 stimms
Just another day in stimming paradise... or hell... whatever way you personally feel about it. For me, I'm trying to feel as much gratitude for being in a position to be able to be as proactive as we are. I'm grateful for 21 follicles growing. I'm grateful for the financial ability to do a cycle. I'm grateful for being unemployed and being able to focus fully on fertility. It helps a little to think of all the things I'm thankful for as my belly becomes increasingly bruised and my ovaries more and more bloated/painful.

Today was Homme InFertile's Birthday. 31! Wasn't anything overly special, but he had been wanting to check out this place Katz in NY (a staple) so we did lunch there, and while he went bowling with my friend visiting, and his friend who's also unemployed until they start their new jobs, I went to acupuncture. She seemed impressed at how well I've been doing/feeling, so that made me feel even better about everything... if that was possible.

I called to schedule my appointments for the next day (bw/us and intralipids) and got a lecture on how I was supposed to book intralipids weeks ago. I don't want to go into the nitty gritty of the conversation, as I'm trying to let it go, but basically instead of simply telling me unfortunately at this point there wasn't an appointment time left for Wednesday, but I could go Thursday instead (which I would have been totally chill and fine with... my bad for not calling earlier), I instead was told that I wasn't being responsible for not calling weeks in advance, and that's generally when people book these, and there are no appointments for today. So naturally I freaked out thinking I wouldn't be able to get an intralipid appointment time for 2 weeks, and thus started to cry. See I believe the intralipids are what could make or break this cycle so my mind started racing a million miles a minute. I just wish she would have handled the conversation a little nicer and preceded the lecture with "I can fit you in tomorrow" at bare minimum. No one told me the precedent on timing to book intralipids, and all other appointments I have been making a day or two in advance. Without this knowledge, how was I supposed to know any different, especially after checking on Monday that they received my intralipid medication, and that all was good for Wednesday... which clearly it was not. Grrr. Very different "service" level in the U.S. from Canada. They try and make it as stress-free as possible, where as in the states, its all on you the patient at an already overwhelming stressful time. Kind of silly, but cultural differences I suppose.

Shake it off.

Later we went out to a nice dinner followed by Les Miserables on Broadway which was A-M-A-Z-I-N-G!!! So great!

I had to push my evening injections to 10:15pm (I normally do at 9pm) as I wasn't sure how I'd go about timing it, doing it in the bathroom at the theatre, not to mention bringing the injections and keeping them cold (the gonal-f needs to stay in the fridge). It was all too stressful, so I just did it a little later. RE said it was fine if they weren't exactly at the same time, although that is ideal. FX all is well. I'm sure I'm not the first patient to do an injection an hour off schedule one day.

Anyhoo. Shots were less painful than the previous day which was nice. I'm a pro now it seems, although I still friggin hate my ganirelix injection which I'm delaying taking as I write this. Boo.

Days 7-8 (days 5-6 stimms)

Wow have things progressed. Getting real ya'll...

DAY 7 - day 5 stimms a.m. & p.m.
So yesterday I continued with my a.m. ganirelix and p.m. gonal-f and menopur shots. My stomach has little prick marks along with mini bruises where I clearly did a less than stellar job injecting myself. Oh well. I'll be a pin cushion if it means I have a baby!!!

Yesterday was Easter, so we started our morning off with Easter Brunch at Lafayette in New York. Delicious little brunch with some friends and then we headed over to the bonnet festival which is a street filled with crazy New Yorkers in crazy hats. So random, but quite a spectacle. We then tried to get lottery tix to a broadway show, but after no such luck, walked across the Brooklyn Bridge instead. So needless to say, it was a busy day and I was just beyond pooped. We had a chill night and went to bed reasonably early.

DAY 8 - day 6 stimms a.m. & p.m.
Maybe it was me pushing myself to hard, maybe it was the meds, maybe my IBS, or maybe even something I ate, but I tossed and turned with a stomach ache all night, and woke up with diarrhea around 6am. Annoying since I had been incredibly constipated for days. I guess the relief was welcomed, but the stomach cramping not so much. Sorry for the TMI but I don't believe in such a thing on this journey ;)

So my day started off a bit rough since I wasn't feeling great but we had to go to my check up appointment at the RE. I was super duper nervous, having been a poor responder in the past. I trusted my doc lowering my meds, but at the same time was just really hoping it worked out well. My friend came in to the room with me for sheer curiosity more than anything. Was quite the learning experience for her.

Well the doc covering for Dr. T was fine and dandy, but not overly personable. I like someone I can joke with and they all take it a bit too seriously for my taste. Fair enough, as they need to be sensitive to all infertile types. I support that... but still, when I crack a joke, at least crack a smile ;)

Anyways, had 21 follicles. Yes!!! 21!!! I was thrilled!!! Our first IVF was only 11 so we almost doubled our amount and I couldn't be happier. Many of them are still quite small, so I'm not sure how many will mature to size, but I still feel confident we'll get a good yield and may be able to go for a day 5 transfer. Fingers crossed.

I felt completely drained today and tried to be a trooper but had to take a mid-day nap to recuperate. My ovaries are just so sore. I feel like I need to invent shock absorbing shoes for women going through IVF. I swear with each step I could feel them slosh around in my ovaries. Ouch. I'm okay with it if it means I have 21 great eggies in there. Feeling positive vibes today. :) :) :)

Days 3-6 (1-4 of stimms)

DAY 3 - day 1 stimms (p.m. only)
So I've clearly not been keeping up my blogging duties, but I've definitely been busy busy with all the injections and pill taking.

So first night of stimms I was so so nervous. Like, had no clue I would feel that way given I had done it before. I wasn't nervous to actually give myself the needles so much as just mess it up somehow. My hubby took some video of me doing it all which I might try and cut down and post below at some point if I get a chance, but forgive me if it never happens as I'm a little distractible at the moment and the full video is like 20 minutes long since I was such a nervous wreck.... No one wants to watch 20 minutes of me pouting haha.

:) possible video placeholder :)

I got it all done in the end and went to bed feeling pretty proud of myself. Plus... we had officially begun our cycle of IVF stimms and I was looking forward to moving forward. Yay.

DAY4 - day 2 stimms (p.m. only)

I woke up day 4 (day 2 of stimms) feeling pretty a.o.k. I didn't sleep great, a bit of tossing and turning as the meds started coursing through the ole body. I went about my day quite normally. Then Homme InFertile got the call. HE GOT A JOB!!! So if you've been following my blog you might know that we are Canadians who moved down to New York for his job. Well, oil and gas markets essentially crashed and the company layed off his whole team (and many others). Since he was sponsored to work, and that job no longer existed, we were in fear of being deported. All this as we had started IVF. Ridiculous amount of stress. All of that was lifted with one phone call. Phew. That being said, we're Houston, TX bound next. His whole team got picked up so we'll be moving with people we know which is nice... and best of all is that we get another 6 months in New York while they ramp up coverage. That means I get time to finish IVF (and a frozen if needed) before leaving, as well as take time to say goodbye to this great city and do all the things off my NY bucket list before we go! So great! 

So we were off to the boss' to celebrate... just one hitch. I had to do my shots. Luckily everyone knows our situation so I just brought them along for the champagne toast and shot myself up in their living room. Infertility accommodates no one ;) 

I feel it necessary to include a little commentary here on that whole situation though in case you find yourself in a similar circumstance. Now know, although my husband works with these guys, 1 of them knows me better than the other, and neither of them are overly familiar with me yet, so comfort levels aren't incredibly high. One guys wife, although very sweet, I also don't know all that well... so this wasn't exactly a group of close friends if you get what I'm saying...

So what I found interesting was their curiosity and wanting to look/stare, but their blatant efforts to not! I tried to crack a few jokes to make everyone more comfortable, and they gave me a few kind chuckles to break the awkwardness, but you could definitely sense they didn't know how to act. Totally fair. Now I could have gone off to the bathroom and done it in privacy sure. But I'm pretty stubborn and believe I shouldn't have to hide my life. I don't do it in the bathroom at home. I do it in the comfort of my living room, perched on the couch (or in my bed for the morning shot this morning that I'm writing). Not only that, but I WANT them to see what it's all about. I WANT people to understand what an infertile or person going through IVF goes through, because for the most part, it happens behind closed doors, and under hushed voices. Me? Infertile here loud and proud. I refuse to let someones discomfort with it be the reason I don't educate and break down the stigmas. So there you have it. Everyone in that room now knows exactly what IVF injections look like, and what the woman has to go through with organizing, timing, mixing (lupron/menopur I'm looking at you!) and actually self-injecting. 

DAY5 - day 3 stimms (p.m. only) 

Today my friend arrived from out of town. I went for acupuncture beforehand, and the hubs and I went for a game of pool with one of his other unemployed but soon to be re-employed colleagues. I was still feeling pretty good, although a little more bloated and uncomfortable again today. Acupuncture seemed to have helped a bit there... I listened to circle and blooms IVF program while I had it done. Ahhhhh. 

When my friend got in we were able to go grab a quick bite before having to head home for my nightly shot. Once again, I know she felt discomfort. This is a friend I know very very well, and have been friends with for years, but we haven't lived in the same city since we were 18 (we're 31) and although we know each other very well, the comfort level may not be the same as it would be if we were around each other more often. Once she realized we could joke through it, and it didn't have to be a big serious thing, she loosened up, but it was interesting for me to see the same sort of behaviours and reactiosn as the previous night with Homme InFertile's work colleagues, as I did with a close friend. Huh. 

DAY6 - day 4 stimms (a.m. & p.m.)

Woke up this a.m. knowing I had to add Ganirelix to my regimen. Wasn't so worried about it. No biggie. No mixing... no adding/changing needle heads. It's prepared for me and ready to rock and roll. WELL...... little did I recall this is the little guy that stings like a ... well stings bad lets just put it that way! I forgot the little trick that my last clinic/nurse taught me of pre and post icing. I just went in without a care in the world. Ouch!!! My stomach was quite red and a large circumference stung. I grabbed ice and remembered it was my friend, making a mental note for all mornings to come.

We spent the day out and about. Homme InFertile had to go meet with new boss for lunch, and a few other things came up for him, so it was just my friend and I out playing tourist. I got to do some things in NY I had really wanted to do for some time (aka boating on the lake in Central Park, and taking the boat cruise around the Statue of Liberty). We came home, had some down time, played a board game and I took my evening shots before heading out again. 

Well... evening shots have taken a turn. A dark, dark turn. Eep. I dunno if it's because of the added morning shot or what, but my evening shots SUCKED. Not only was my stomach all of a sudden way more sensitive, but about 10 minutes after taking them I looked 4 months pregnant. I'm a pretty skinny minny, so I understand this doesn't look like much, but I'm generally completely flat. The bloating was sooooo painful. Felt like my insides might pop like a balloon if I sticked myself with another needle. 

But the show must go on so we went out for dinner where I stuffed myself further and felt even more bloated, and then showed my friend Time Square before heading home and me collapsing in bed in pain. Hosting during IVF apparently is a no go ;) I should have known, but at the same time, the distraction is kind of nice. 

Day 3

Nerves anyone?

I woke up with a lot of anxiety today. First day of being monitored and I certainly wasn't looking forward to being reunited with the ole giant jelly-lubed ultrasound wand. Especially not while still on my period. Doesn't get much more awkward than that... ugh.

Morning Pick Me Up

At least its a nice waiting room....

When I arrived into my little wee exam room and undressed, I noticed a printed sign on the wall. My doc is going to be away from March 24-April 4. Huwwwhhhhaaaaaat!!?!?!?? We literally were all geared up to go last month, but postponed just because Homme InFertile lost his job and it was stress mania. Part of me regretted that the instant I saw the sign, but on the flip-side, I know that the stress and chaos was just too much at that time.

When he came in, I asked who'd be covering while starting to tear up. I think I made him feel pretty bad, but I couldn't help it. I'm friggin stressed. After 5 years of infertility, I'm really ready for a successful cycle, and being passed around from doc to doc at my last clinic in Canada, made me question my level of care and attention to detail. So to be dealing with passed on information once again, I'm just a bit jaded...

Anyways, lining looked good (6mm I think), and he found 8-10 follicles on each side, so decided I was ready to start. Wait... what? I had it so fixed in my brain that I'd likely not be starting until tomorrow. I was looking forward to the remainder of the day with no worries or cares, just likely another appointment to go to tomorrow. Well, clearly I was incorrect.

Then I had my blood drawn and she punctured me pretty bad. I have a small bruise, which I'm hoping will heal before I need more bloodwork Monday.

Feels worse than it looks :(

Afterwards, Homme InFertile took me for lunch. With all my dietary restrictions it can be hard to eat out, but Peacefood Cafe is one of my go-tos. Not only is it Vegan AND full of Gluten Free foods... its also super duper tasty. Can't get much better than that! I had a delicious "Quiche" made with sweet potato, cashew cheese, tofu etc., and the hubs had a "chicken" potato salad.

After lunch we still had some time, so we walked down towards Loft a fav store of mine where I picked up some new sunglasses and a comfy cute t-shirt. The cherry blossoms were kind enough to come out to bloom to help with the cheering up too! Though retail therapy works wonders on its own generally haha ... soooo bad. 

So they emailed me my updated calendar and I officially start stimms tonight. I get a lump in my throat just typing that. I add in the morning injection starting Saturday, and as mentioned go back for monitoring/check up on Monday to see how I'm progressing.

I've been watching all my injection videos (the clinic has really great clear instructionals) and feeling about as prepared as I can be for getting going. I'll point a video of it tonight. If you're intererested in the videos check them out at this link!

Day 2

Ahhhh. Last day of RnR before embarking on this crazy ole journey of IVF! I chose to not start monitoring today as day two is general my heaviest, most painful day. This cycle did not disappoint ;) so I'm really glad that I made my first baseline ultrasound and blood work appointment for tomorrow instead. I'll feel much better.

Cramps have ceased this afternoon somewhat thankfully, so I can enjoy a whopping day or two of feeling relatively normal before I start pricking myself with needles like a junkie. Need to re-watch the ole videos reminding me how to do this all... I feel like it's been so long that I have forgotten. Don't want to mess it up that's for sure!

Tonight I have a volleyball game. I'm guessing it'll likely be my last one since next week I have a friend in town and it also happens to fall on the hubs birthday. It's such an outlet for me... the following week April 5/7 is playoffs, but I'm likely going to be close to retrieval and feeling insanely bloated so that'll be a no go. Jumping with two ovaries full of eggs probably isn't in the protocol! hah! Then season's over :( So I gotta soak it all up tonight. I guess I'll have to just get back into yoga more. Gentle yoga that is.

Homme InFertile and I are both still unemployed. On the one hand its really super nice that he'll be around to take me to appointments and baby me (I need a lot of babying). But then on the other hand, we're investing a LOT of money to hopefully get pregnant which will cost even MORE money (one the birth happens of course), and neither of us has any income, nor do we know where we will like a few months from now. There is one job possibility that we are hoping will pan out, but we still won't know much more until Wednesday-ish. I say ish because realistically they said by Friday, but we're feeling as optimistic about it as possible. If all goes through, then we'll probably be in New York throughout my first trimester (possibly second as well), and then moving. So lots of potential changes on the horizon.

Best be off.