Monday, July 31, 2017

Our Infertility Story - Part 2 (IVF)

Sorry it's taken me so long to finish part 2 of our infertility story. I started the post in the final days of my pregnancy, but didn't get a chance to finish before our baby girl decided to make her entrance into the world. The past 3 months have been a whirlwind and I'm finally starting to find sometime to finish up.

Once we were advised that our best option to conceive would be IVF I began researching a clinic that would best fit our needs. I think this was probably one of the hardest decisions for us to make. With so many IVF clinics in the bay area I found it extremely difficult to navigate all the different options. It was such an important decision and with pricing and protocols at each clinic widely varying it wasn't like you could just yelp the best IVF clinic. In the end we decided to go with Dr. Polansky and his team at Bay IVF. I liked that they offered a variety of IVF options (ie: traditional IVF and soft IVF), PGD (preimplantation genetic diagnosis), and a 3 cycle treatment plan that would refund us a portion of our investment if we got pregnant before the 3rd cycle. Most of all I liked that they were a small clinic which made me hopeful that we would get more personalized attention.

Before we were able to start an IVF cycle the doctor performed an initial physical exam and blood work followed by a sonohystogram to determine whether or not I had any uterine abnormalities. The procedure was reminiscent of the HSG I had previously done, but instead of injecting dye and using X-ray imaging they injected saline via a catheter and used a transvaginal ultrasound for the imaging. Similar to the HSG it was pretty uncomfortable with some cramping as the saline was injected into my uterus. After all was said and done they provided us with our probability for a success starting at 27% given a single cycle and 60% given up to 3 cycles. I remember being so optimistic about the statistics at first...after all 60% was better than a 50:50 chance, right?

By the end of January 2015 we were off to the races and began our first egg retrieval cycle. I was started on birth control which seemed weird given that I was trying to have a baby, but the doctor reassured me that it would to help prime my ovaries for the upcoming egg retrieval. The doctor highly suggested that while we were attempting IVF that I should cut gluten from my diet. Cut gluten??? But that's my favorite food group! To be honest I was very skeptical about how much cutting gluten out of my diet would instead I opted for moderation instead. I was also given Lupron (LH) and Follistim (FSH) injections to rev up the production and maturation of my follicles. I was honestly terrified of having to give myself daily injections and wasn't sure if I could do it. To my surprise the injections were pretty much painless and I was able to get over my fears quickly. I was lucky enough to get away with almost no side effects from the Lupron and biggest complaint were hot flashes that would come when I was stressed at work or wake me in the middle of the night. While on the injections I had to make multiple trips to the clinic each week to monitor my estrogen and progesterone levels as well as check the development of my follicles via ultrasound. When we first started IVF I had no idea that I'd have to be monitored so closely and I was lucky to have so many co-workers who were willing to swap shifts with me so that I could make it all of my necessary appointments. Once the majority of my follicles looked to be the ideal size I was instructed to administer my Novarel (hCG) injection which would stimulate my ovaries to release the mature eggs from my follicles. Unlike my Lupron and Follistim the Novarel injection stung quite a bit and even left a bruise on my tummy. Again I was lucky to get away with almost no side effects from the Novarel except for some extreme breast tenderness. 36 hours after my Novarel injection I returned to the clinic for my egg retrieval. I was super nervous for the procedure as I had read online forums about how painful it could be. Before the procedure started I was given a cocktail of IV medications that relaxed and numbed me throughout the entire procedure. I honestly couldn't tell you anything about what the actual procedure was like. Once the procedure was complete I was left to recover and let the medications wear off before I was sent home. Before we left the clinic we were told that they were able to retrieve 10 eggs. I was happy with the least we were in the double digits. However, after fertilization on day 6 we were told that we only had 5 eggs that had fertilized and matured into blastocysts. Our 5 embryos were frozen and biopsied samples of each were sent to the PGD lab for testing. It was disappointing to say the least to hear that we had lost half of the eggs that had been retrieved. Nonetheless we were still hopeful...we just needed a few good embryos to carry us through several rounds of implantation. Unfortnately we weren't so lucky, of the 5 embryos there was 1 embryo deemed normal. The news was shocking and heartbreaking for us, how could we have gone from 10 retrieved eggs to only 1 normal embryo? Worst of all we got the news while we were vacationing in New York...what a way to ruin a day. I remember going back to our hotel room and crying in the arms of hubs after receiving the devastating news. I had been so hopeful that IVF would be a quick fix for our infertility problems, but reality hit me like a ton of bricks.

Disappointed in the results of our first round of egg retrieval, we were eager to start our next round in May. The procedure was generally the same...birth control, Lupron, and Follistim...however this time there were concerns about my extremely high levels of estrogen which put me at high risk for developing OHSS (ovarian hyperstimulation syndrome). Hubs and I had worked this egg retrieval around a trip back to Hawaii for one of my best friend's weddings. The clinic warned that I would have to be closely monitored after the egg retrieval to make sure my OHSS did not become life threatening and would absolutely not be allowed to travel during this time period. Again, I was devastated...I was left with the choice of canceling this round and losing all the time and money we had already invested or canceling our trip to Hawaii and missing one of my best friend's wedding. In the end we decided to cancel this round of egg retrieval. After having to make such a difficult decision we were extremely lucky that the clinic said that they wouldn't count this as one of our 3 rounds and would provide us with samples of the more expensive medications for the next round to help us recoup some the money we had essentially lost due to having to cancel our egg retrieval.

Once we returned from our trip to Hawaii we were ready to jump into another egg retrieval. Due to the clinics protocol I had to repeat my sonohystogram since it had been over 6 months since my original procedure before starting our 3rd round of retrieval. At the beginning of August we got the go ahead to start the egg retrieval procedure, again with birth control, Lupron, Follistim, and Novarel. This retrieval resulted in 12 eggs. I was excited that we had been able to retrieve more eggs than our 1st round, but given the end results of our 1st round we were much more reserved in our hopefulness. And rightfully so, because 6 days after fertilization we only had 3 embryos that had matured into blastocysts to be frozen and biopsied for PGD lab testing. The results of our PGD testing showed that of the 3 embryos, only 1 of them was deemed genetically normal. Again we were disappointed, but at least now we were ready to do a our first FET (frozen embryo transfer).

At the end of September we were excited to finally start our FET. We decided to transfer a single embryo so that we could avoid the possibility of having multiples. The FET protocol called for more Lupron in combination with estradiol patches and high dose progesterone suppositories. Again I had be closely monitored to evaluate my estrogen and progesterone levels as well as check the thickness of my uterine wall. Our embryo was thawed and transferred at the beginning of November. The embryo transfer was much faster and easier than the egg retrieval. Our embryo was implanted into my uterine wall via catheter and the actual procedure only took a few minutes. The doctor assured us that it was as perfect a transfer as he could have asked for and we were sent on our way. Given what the doctor had said about the success of the transfer and the fact that I had a very healthy uterus we were so hopeful that this was going to be it! I continued with the estrogen patches and progesterone suppositories and giddily googled all the possible signs of pregnancy that I was experiencing. We had to wait 10 torturous days before I returned to the clinic for a pregnancy test. Surprisingly I was able to muster all my self-control and I never took a home pregnancy test before returning to the clinic for my pregnancy test. The day of my pregnancy test we excitedly waited on pins and needles for the clinic to call us with our results. When they called to deliver the bad news that our embryo hadn't taken we were devastated. We'd been so hopeful that this would the happy ending to our journey that the news was absolutely crushing. With the holidays fast approaching we decided to take a step back and give our minds and hearts a little break from IVF.

At the beginning of the year with renewed hope we started another round of egg retrievals. As with the previous rounds I started with birth control, Lupron, and Follistim; then finished off with a trigger shot of Novarel. We were able to get a whopping 14 eggs from this retrieval which made us hopeful. When the embryologist called to let us know that 7 days after fertilization we only had 1 embryo that had matured into a blastocyst I was absolutely beside myself. I had prepared myself to lose over half the fertilized embryos, but to be left with only 1 felt incomprehensible. To add insult to injury the embryologist needed to know ASAP whether or not we wanted to send a sample of our embryo for PGD testing which was a costly investment for just a single embryo. Luckily, in the end the lab that did our PGD testing generously offered to test our embryo free of charge. The results of the PGD testing showed that our single embryo was genetically abnormal and we were back at square one.

After 4 egg retrievals and 1 failed FET we felt utterly defeated and scheduled a phone consultation with Dr. Polansky to see how we should move forward. During our consult he admitted that we had been one of his top 5 toughest cases in his entire career. Although this news was discouraging, it also felt like a relief to validate our frustrations. We discussed whether or not the use of a donor egg would be more likely to yield a successful pregnancy. And while he agreed that our chance for a successful pregnancy would be greatly increased with a high quality donor egg, due to my young age he typically wouldn't recommend that route. He said that typically after 3 unsuccessful rounds he usually refers his patients to another clinic, as a different approach may be more successful. However, he said he wanted to give our case one more shot and left it up to us as to how we wanted to proceed. We spent the next few days discussing our options. Still feeling disheartened by all of our failures I agreed to try 1 more time, but told my husband this would be the last time. I didn't think my body and heart could take much more of this.

With a heavy heart we started our 5th egg retrieval cycle in March. Dr. Polansky switched our protocol to a soft IVF protocol in hopes that my body would respond better. This protocol still used Lupron, Follistim, and Novarel; but included Clomid (clomiphine) as well. We were able to retrieve and fertilize 10 eggs; 6 days after fertilization we had a whopping 7 blastocysts to send for PGD testing. It was the largest number of embryos we had ever been able to send for testing, but I knew better than to get my hopes up. The results from the PGD testing showed that 1 out of the 7 embryos was genetically normal. Before our FET I underwent yet another sonohystogram to make sure my endometrial lining was healthy. We followed the same FET protocol as last time, but this time I also underwent a laminaria tent procedure, where a tiny piece of dried seaweed is inserted to dilate the cervix to make the embryo transfer easier. Again, our doctor assured us that the transfer had gone smoothly and all there was left to do was wait.

I had been so defeated by the whole IVF process that I had little to no hope of receiving positive news. In fact, I remember calling my husband during a particularly difficult day at work crying and telling him that I was absolutely sure I wasn't pregnant this time. After the "10 day wait" I went in for the pregnancy test and we waited to hear the results from the clinic. I was still sure that I wasn't pregnant so I asked them to email the results of the pregnancy test instead of calling us because I didn't want to cry over the phone with them. Once we had mustered up the courage to open the email we were both shocked to see that the pregnancy test was positive. My husband and I cried tears of joy much of that day, but we knew we weren't out of the woods yet. I still continue my estradiol patches and progesterone suppositories to maintain the pregnancy until my body's own hormones caught on to the fact that I was indeed pregnant. We were scheduled for an ultrasound about 2 weeks later where they would check for a heartbeat, at which there was a 90%+ chance that I would go on to a successful pregnancy. We were cautiously joyful and shared the news with only our parents since we knew there was still a chance of miscarriage at this point. We were so nervous going into our ultrasound...I was absolutely terrified that they wouldn't find a heartbeat since I had let my hopes soar once we received the news of our positive pregnancy test. When our doctor showed us our tiny little baby on the ultrasound and we heard her heartbeat we both cried tears of relief and joy. I couldn't believe that at a time where I had almost given up hope we were finally gifted the pregnancy we had dreamed of for so long.

Going through infertility and IVF has been one of the most difficult things I've ever had to endure...the misery of being on medications that made me sick, hundreds of injections, painful procedures, and heartbreaking failures. In hindsight as I look at my baby girl's chubby cheeks and smiling face I'd do it all again in a heartbeat.

I hope that anyone reading this that's going through infertility will be given hope, and that those who know someone going through infertility will better understand the difficult journey their loved one is going through.

Saturday, April 15, 2017

Our Infertility Story - Part 1 (Pre-IVF)

As promised here's the first part of our infertility story. Our journey was over 3 years so I thought it best to split it up into 2 different entries...part 1 will go over our journey before IVF and part 2 will delve into our IVF journey.

After hubs and I returned from our Singapore/Japan trip in spring of 2013 we agreed that we were ready to expand our family. I stopped taking my birth control and started tracking my basal temperatures to help determine when I was ovulating in order to make the most of our baby making efforts. Three months after I stopped taking the pill I still had not had a period or established a normal cycle. This scenario was not new to me, as a teenager without birth control I would only have 3-4 periods a year each lasting up to 14+ days.

I made an appointment with my OB/GYN at the time to discuss my concerns. After some blood work my doctor put me on a low dose of Synthroid to optimize my thyroid levels for fertility/pregnancy. And even given my history of only having a few periods a year she told me to give my body another few months to start cycling on it's own again. After another 3 months without a period my OB/GYN referred me to a fertility specialist.

We had to wait another frustrating 3 months (without any periods) until we were able to get an appointment to see the fertility specialist. The doctor took down a detailed family and self medical history. After an in-office ultrasound she confirmed a diagnosis of PCOS. I was prescribed Metformin which the doctor explained had been shown to help increase fertility in women with PCOS. I eagerly started my new medication which promptly proceeded to provide me with a constant feeling of nausea. I was never able to even get close to titrating my dose up to the recommended level because I simply couldn't tolerate the constant upset stomach.

I knew there had to be another way and started seeking out alternative options. In the spring of 2014 I started seeing a naturopathic doctor who agreed that there was no need for me to be on the Metformin given my normal blood sugar levels. After completing an extensive hormone panel the naturopathic doctor switched my Synthroid to Nature-throid in order to fine tune my thyroid levels and I started using a low dose progesterone suppository in an effort to help stimulate my body into having a cycle. I also adjusted my diet and switched from a morning cup of coffee to a green smoothie. However, after all these changes we still failed to get pregnant.

Near the end of 2014 my fertility specialist suggested that I undergo an HSG (hysterosalpingogram) to take a look at my fallopian tubes and uterus in order to determine if IUI (intrauterine insemination) or IVF (in-vitro fertilization) would be the next best course of action. I was extremely nervous for the procedure as I had read many online message boards detailing how painful it can be. As they injected the dye via catheter I remember experiencing the most intense cramping and I was so thankful when it was over. The results of my HSG were no less painful and heartbreaking. The doctor said that due to extensive inflammation in my fallopian tubes it would be next to impossible for me to have ever have gotten pregnant naturally and suggested IVF as the next step. The news was so overwhelming and I was so unbelievably frustrated knowing that we had wasted nearly 2 years trying this and that when it would've been a miracle for me to get pregnant without the help of IVF.

Throughout this first part of our journey I think the biggest lesson I learned was that I needed to be my own advocate. A lot of times it's easy to take what doctors are telling you as the end all and be all. I wish that I had been more assertive, asked more questions, and pushed to be referred to a fertility specialist sooner. I can't help but think that maybe if I had done those things we wouldn't have wasted so much time before discovering my need for IVF.

Read about our IVF journey in Our Infertility Story - Part 2 (IVF)

Monday, April 10, 2017

End of a Hiatus

After a 2+ year hiatus from I am 9 months pregnant, sitting on the couch binge watching Parenthood on Netflix. It would be an understatement to say that it's been a long journey to get here. We battled infertility for 3+ years before I successfully became pregnant. The entire time I went back and forth about whether or not to blog about the topic. In the end I decided against it because at the time I didn't know what the end outcome would be. I couldn't bear the thought of spilling my heart about our infertility challenges to only be left with a broken heart in the end.

Now that we've gotten so far along in the pregnancy, hubs has encouraged me to share our story. He thinks it's an important part of our lives that we may easily forget and take for granted if we don't document it. So the over the next few blogs I'll delve into the details of our infertility journey. I hope that our story may be able to provide some solace to other couples who may be going through the same or similar difficulties.

Tuesday, January 13, 2015

Happy Belated New Year

Happy New Year, loves! ...yeah yeah...I know we're almost half way through the month of January...better late then never?

Sorry I've been so MIA lately. Between taking our second trip to New York, starting a new job, and the holidays I haven't had a ton of time to blog. But now that things are starting to settle down a little more around hear I will definitely get back into the blogging groove. This year I'm also resurrecting my project 365, but this time instead of doing it in the form of a blog I'll be keeping up with it on our instagram which hopefully will make it more feasible to actually complete.

So stick around folks! We have a lot of exciting plans for this year!!!

Tuesday, November 18, 2014

Thankful Thirty

With November typically being a month in which people reflect on things they're thankful for I figured there was no better way to kick of my list of 30s then with a list things I'm grateful for.

1. My husband
I'm sure I don't thank the saint of a man who has found it in his heart to love and marry me with all my flaws. Always dependable and steadfast I know I can count on him to look out for me. I'm lucky to have such a thoughtful and loving partner to walk by my side through life's ups and downs.

2. My mom
A strong and funny woman who has helped guide me through some of my life's challenging moments (aka: adolecence). I'm blessed to have you as a mom and friend.

3. My dad
The man I get my looks and extremely dry humor who has always been a quiet but strong source of love and support throughout my  life. I'm grateful to call you my dad.

4. My grandparents
The people who were always picking me up from school and taking me here or there when I was younger. And of course the ones who spoiled me rotten. I am so thankful that I've had the opportunity to spend so much time with them.

5. My in-laws
Bad in-law jokes tend to be an easy joke for most, but I really lucked out in the in-law department. They've always embraced me as part of the family and I'm blessed to have married into such wonderful family with my family so far away.

6. My friends
I've been fortunate to meet lifelong friends in all stages of my life. Although I love spending time with friends nearby I also love having low maintenance friends that live afar.

7. My dog
The first several months with my dog were challenging to say the least, but as she's gotten older she's been a great addition to our family. It's so nice to come home to her smiley face and wagging tail. She great at playing fetch with herself - a true "only child" and she loves a lazy day of naps just as much as I.

8. My health
Although I may be currently dealing with some minor health issues my general health is excellent.

9. My education
My family prepared me for success in the best way they know how and made sure that I had a first rate education starting from kindergarten all the way through college. Everything I have today is thanks to the education I was allowed.

10. My home
It's said that a home should be your escape from the world. And I can really say that's true of my home. From my cozy bedroom to my deck-filled backyard that's perfect for entertaining I love my home and it's been an amazing first home.

11. My job
Like many people I can always find something to complain about my job, but all things said I'm thankful for the opportunity to get paid well while helping people at the same time.

12. The opportunity to travel
Between traveling with my parents and my husband I've been able to see different places in and outside of our country. Now that I live in California it makes traveling even more accessible then it used to be when I lived in Hawaii.

13. The bus driver
I am so thankful for the bus driver that gets me safely to work and back home almost every day. Not having to drive myself to work allows me to catch up on my blogging or catch some much needed shut eye.

14. Friendly strangers
Sometimes all it takes is smile from a stranger or a customer who asks how my day is going. Friendly strangers really make the world a nicer place to be in.

15. Trashy reality TV
Kardashians, Hip Hop and Hollywood, Real Housewives, 15 Kids and Counting...I love it all (much to my husband's dismay). I know a lot of people hate reality TV but sometimes there's something to be said about how relaxing and therapeutic it can be to veg out in front of the TV for a marathon of Real Housewives.

16. My comfy bed
I love sleeping and my comfy bed makes one of my favorite hobbies that much better. And nothing makes you appreciate the comfort of your own bed than a restless night in an uncomfortable foreign bed.

17. Growing up in Hawaii
This is something I admittedly did not appreciate nearly as much as I should have when I was growing up. Growing up on a beautiful tropical island with my friends and family only an hour drive away at most is an amazing way to grow up. Beautiful beaches and amazing weather pretty much year round provided a great backdrop for my childhood.

18. Bay area weather
With just the right amount of seasons I could not ask for more when it comes the the weather in the bay area. I am grateful that it gets warm enough to wear shorts I'm the summer without needing air conditioning in my home and cool enough in the fall/winter to see the leaves change colors and have an excuse to wear a nice pair of boots and jacket without having to worry about snow ruining it.

19. Double stamp Tuesdays
Our favorite sushi spot has a stamp reward program and offers double stamps on Tuesday. My husband and I take advantage of this at least once a week. On a day that's not as stressful as Monday but not quite to hump day it's nice to be able to have an excuse to treat ourselves to some good sushi.

20. Acts of kindness
From the person who picked up my wallet and gave it to a BART attendant without stealing from me to the bus driver who let me on when I realized I left my wallet at home. Simple acts like these shine bright in my memories as horrible days that were averted thanks to the kindness of others.

21. Target
In December I'll be starting a new job working for Target. I'm grateful for the opportunity to shift paths in my career when I feel like I really needed it.

22. Ice cream
Always there to brighten up a bad day...thank god for ice cream. Enough said.

23. My gas stove
For most of my life I had a gas stove and it wasn't until I moved into an apartment with an electric stove top did I realize how much better a gas stove is. That being said I am very appreciative for having a gas stove in my kitchen that gives me superior control over the temperature in which I cook with.

24. Financial security
I'm extremely grateful for the financial security hubs and I have. I know that not everyone is lucky enough to never have to worry about where their next meal is coming from or whether or not they can afford that new winter coat they desperately need.

25. Lazy weekends
Little in life is as satisfying as getting to cuddle in front of the TV in your PJ's all weekend. With the busy holiday season coming up soon it reminds me of how rejuvenating it can be to have no obligations at all. I'll take them whenever I can get them.

26. Fun co-workers
I can honestly say that I've stayed with the company I've been at for 3 years because I truly enjoy working with the people. The pharmacists and technicians I work with make coming to work bearable day in and day out. I will miss them dearly when I leave at the end of this month.

27. SHN season tickets
This is the second year hubs and I have been SHN season ticket holders and we have yet to be disappointed. I love having great musicals to look forward to year round. Not to mention the perks of being able to buy tickets in advanced for shows that aren't included in our season.

28. Online shopping
Online shopping has taken the shopping experience to another level. With free shipping and returns your home becomes your dressing room (sans overly flattering mirrors). And with websites like ebates who gives you with cash back and coupon codes for shopping it's like being paid to shop (that might be a stretch... lol)

29. Care packages
Nothing says I love you from family and friends from afar like a care package. Big to little it doesn't matter...when someone takes the time to curate and mail a package to me it always warms my heart.

30. Google
Thank goodness for google! Always there to answer those nagging questions like "who's that actor in that movie?" or "how yo tell a coworker how to stop singing at work?" on a whim. I can't even remember a time when I had to do without the convenience of google.

Thursday, November 6, 2014

Not So Dirty Thirty

October marked my thirtieth year on this planet. We celebrated the momentous occasion bu going to CPK to partake in one of my favorite desserts, butter cake, and then we caught a double feature at the drive-in. It may not be what most people think of when they think of how they want to or how they had celebrated their dirty thirty...dirty isn't really my stye anyway. Hubs and I did it low key just the way I like it.

warm buttery goodness

beautiful birthday flowers from hubs

With such a big birthday under my belt I figured some life reflection was in order. Throughout this year I'll be doing a series of reflections of things I've learned, things I'm grateful for, things I aspire toward, etc. So stay tuned for some hopefully interesting reflections on my life and what lies ahead.

Monday, September 22, 2014

NYC Advice and Tips

Getting Around: Use Public Transportation
Before we left for New York we looked into possibly buying a 7 day pass for a hop-on-hop-off style bus. We have them all over San Francisco and it seems like the easiest way to get around in the city without getting lost. However due to the higher cost we decided against it and went with the 7 day unlimited metro card for $30 each.
We found that getting around in New York was very easy with the aid of our friend Google Maps. We did a lot of walking which is made relatively easy due to their grid like numbered streets and avenues. And with the help of Google Maps we always knew which subway or bus we needed to take to get to where we wanted.

Attractions: Buy Online and Go Early
We considered buying one of the many city passes available for New York. However, after careful consideration of the attractions we actually wanted to go to it was cheaper for us to pay the individual entry fees instead (especially when you take into account that many museums offer discounted/free entry days, student discounts, or are donation based).
We purchased most of our attraction tickets online a day ahead of time which meant we didn't need to stand in line at the attractions to buy tickets. This ended up saving us a lot of time. We also tried to go to the attractions earlier in the day. We went to the Top of Rockefeller Center as soon as they opened and because we bought our tickets online ahead of time we had no lines to wait in to get up. Not to mention that it was so nice and peaceful up there since there were only a few other people at the top while we were there.

Tapings: Only if You Have an Extended Stay in NYC
The tapings we went to were great and definitely a ton of fun. But if you're only in NYC for a few days don't waste your time. Going to the tapings was a huge time investment between standing in line to pick up tickets and then standing in line to get into the studio. Attending the live tapings we went to took up a good 5-6 hours of our day. If you have a short stay in New York don't waste it all by standing in line. There's so much more New York has to offer.

Broadway/Off-Broadway: TKTS for Deep Discounts
Tickets for almost every Broadway and off-Broadway show are available at the TKTS booth in Times Square. There are only a handful of extremely popular shows you won't be able to get there (ie: Wicked and Book of Mormon). I think it'd also be safe to assume that if a show has won any Tony awards this year (especially best musical or best play) you'll need to buy your tickets ahead of time.

While I'm no travel expert hopefully those of you who may be visiting New York for the first time will find these little tidbits helpful.