Friday, February 29, 2008
Wednesday, February 27, 2008
I woke up singing this song today. I mean that literally. My foot hit the floor, and I sang at my wagging pup's face, "Lay down the law, shout out for more, breakout and shout day in/day out, BREAKOUT!"
I don't know when I heard it last, and I didn't realize that I knew any lyrics. I do know that last night I said "Swing out, sister" to the dog (I'm alone, 'member?). She was twirling around the room in joyful anticipation of a beefy dental bone, and it just seemed to fit. I also know that as I drifted off last night, I thought back to the first time I was told that a hysterectomy was in my best interest. That was in 1987. The same year the song came out in the U.S., I see! FREAKY, no?
I almost took that uterus-removal advice. Obviously, though, I didn't, and all that is a story I'm not telling today. What I AM telling is that I went to bed thinking I wouldn't change the past. And today I woke up to a new attitude and a new cycle. (Howdy, Auntie F!) Where yesterday I was wallow-y, today I am ready to go.
I called my assigned nurse this a.m. and asked for more deets about the antagonist protocol Dr. K recommended. IFFY we try IVF again, this is my sketchy understanding of what we'll do (I didn't take notes or search the protocol, so I may be missing something):
I'd monitor for ovulation this cycle, go in for a 7 dpo progesterone test, and then take an antagonist shot at some appropriate time after that to suppress ovulation for the next cycle. No BCPs (it's part of their SOP, but she let me say no to it w/no fuss) and no Lupron. Minimal suppression all around. A week after the shot, I would start Follistim and Menopur (not sure about dosages). Once the follicles grew to 11–12 mm, I'd do another antagonist shot to prevent a natural O. Trigger to follow when things look ready. If all went okay, we'd hope to at least get as far as finding an egg or two at retrieval.
Just to be clear, DH and I have not made a decision. But I can tell you that as of today, I want to try again. The thing I keep coming back to is that had we canceled at anytime prior to the attempted retrieval, our plan was to eat the costs of the first part of the cycle and try again. IVF is supposed to be our best-possible shot at conceiving. Statistically speaking, it's supposed to be our only shot. So how can we say we tried if we don't go through a full cycle? If we come up empty at ER again or we get eggs but no fertilization and thus no transfer, well, that's another ball of wax. I wouldn't feel compelled to do another trial. But those are MY feelings. Today.
DH gets a say, for sure. I know he knows I know what I want to do. I know this because I described the basic protocol the other day and saw his knowing "I know you know what you want to do" look.
All he said then was, "When does Finance tell us what portion of the cycle fee we're getting back?"
"As soon as I ask them," I replied. Now would be a good time to do that.
Other things that inspired me this morning —
Quote of the day from my planner:
"There's as much risk in doing nothing as in doing something." —Trammell Crow
Today's literary quote on my home page:
"Gardens are not made by singing, 'Oh, how beautiful,' and sitting in the shade." —Rudyard Kipling
Tuesday, February 26, 2008
Dr. K predicts that I'll get AF early (hey, might as well), and that's seeming likely to me. Strangely, though, I'm feeling rushed by that. The sooner it comes, the sooner I need to go in and talk turkey about what comes next.
THAT prospect has just gotten more complicated because . . .
DH is working 2,8oo miles away at the moment. He flew out today. I am too tired to properly express my feelings about this travel turn. This week's trip is not a problem. But, if successful, it signals the relaunching of a project that might regularly have DH there and not here.
I don't like it.
Monday, February 25, 2008
I just got off the phone with Dr. K. We had a productive chat that covered everything I wanted to. I will go in soon to confirm that my cyst has gone away and discuss whichever treatment scenario DH and I decide to pursue. And that comes with a big "if any."
Wish I could stay and post away, but — just as Dr. K is trying to catch up on her work after vacation — I am still frantically trying to catch up on work that got the short shrift while I put making it through the IVF cycle first on my to-dos. (Well, it's not "just like" it.)
I should finish my current project tomorrow at the latest. My client has been an absolute gem about accommodating me these last several weeks. She doesn't even know why I had to renegotiate our schedule, but she just said, "Do what you need to do."
I dearly want to experience my normal feeling of slight control over my days before thinking of anything else TTCwise. A rash of evenings and maybe one whole weekend off would be cool, too.
Sunday, February 24, 2008
Rules of the game:
1. Link to the person who tagged you.
2. Post the rules.
3. Share 6 non-important things/habits/quirks about yourself.
4. Tag at least 3 people.
5. Make sure the people you tagged KNOW you tagged them by commenting on what you did.
(2) I like to move. As in, change domiciles. The project-organization, new-digs, and fresh-start aspects appeal to me. Discounting a few too-brief-to-really-count stopovers and 3 summers in 3 different towns with my parents, I tally 19 lifetime moves within 9 cities. DH and I aren't planning to pull up stakes, or hoping to. But if the need arose, I'd have little trouble embracing it.
(3) I was a Secret Shopper for 3 years in the early 1990s. My beat was the local Jiffy Lube circuit, and I got reimbursed for mileage, oil changes, and any car maintenance the JL folks hawked. The reimbursement made the gig worth it, but the scripted dialogue I had to throw in and ultra-long evaluation forms were annoying.
(4) I doused my junior high basketball coach's clothes with perfume. He wasn't in them at the time. But perhaps I should back up a bit. I had a mad crush on Mr. M (not his real initial; let's pretend it stands for "Mine"). And no other earthly reason to be involved with the team. One afternoon I overheard Mr. M arranging to meet a date after practice. Panic! No way did I want him seeing other people. Soon, a friend played lookout as I stole into Mr. M's dark office. I spritzed his date-night street clothes with Jontue borrowed from another girl's gym bag. Got his crisp yellow oxford and brown leather jacket but good.
This was so out of character that nobody even suspected me. I totally got away with it. I did feel guilty, though. Quite! But that was tempered by knowing that I'd helped Mr. M see that his date was all wrong for him. Turns out that she'd had not one flicker of a sense of humor about the situation. So, although Mr. M stressed to the team that he was NOT happy about the stink or invasion of his space, he chuckled about things working out for the best. Teenage heart crimes pay!
(5) Sometimes I have a teeny-tiny touch of that phobic urge to hurl myself down a long flight of stairs or, say, off a cliff. The feeling isn't so much "I want to jump" as "Gee, I hope I don't jump." It's very fleeting but there.
(6) Junior year of college, a good friend and I went clubbing every night for a month. We thought of it as a sociological experiment. We'd noticed during normal social habits (weekends & occasional random weeknights out; pretty typical) that certain people were out — and seemingly everywhere — every single night of the year. We wondered, "How do they manage it? How do they go to school/work/come up with the cash?" The only way to truly study it, was to try it. We set ground rules: Keep up with homework, stick together, drink very little, and spend as little as possible. We didn't start with a 30-night run in mind, but along the way we just kept going 'cause we needed more "data" . . . and it was a blast. We got in good with all the local bouncers/bartenders and learned a heap about the "regulars" we tracked. It was a pretty good lesson in not judging books by their covers — and in the clear benefits of balancing work and fun. My grades actually got a boost that semester. But, oh, the relief when we stopped the madness.
That made 6. The meme rules require me to tag other bloggers, so I say "You're it!" to Opus #6, Sarah at SarahMania, and my parallel-universe buddy Lisa. No pressure whatsoever, though. Do it if you want, please don't if you don't!
Back tomorrow or the next day with a topical post.
Saturday, February 23, 2008
No, no, no, I wasn't using it for its normal purpose. I just wanted to confirm that I had HCG in my system. It hit me that I didn't yet know whether they'd tested for HCG on Sunday. And that taking a test might be the only way I'd know for sure that the hormone had successfully made the rounds in my body. (Turns out I haven't been glued to others' tales of testing out the trigger for bupkes.) So as soon as the idea popped into my head, I got to work on hitting that wick. I thought I might be too late to see anything because by then I was 5 days past the trigger. Never mind that I was using something like 5th MU. But that second pink line popped up right away. Mission accomplished!
One perk of that little exercise was the depletion of my HPT stock. I've never been a BIG tester — quick pause to say, "BIG testers, you know who you are" — but I do like to have something in the cupboard for those rare occasions that I make it to 13 dpo. I like to celebrate such uncommonly normal-ish LPs by wasting a perfectly good test or two. Right now, though, I just don't need to have them things around.
Another bonus was to see the pretty pink develop. I've only ever seen that happen one other time. (I'll have to write about that sometime.) For whatever reason on Wednesday, it had a calming effect. For a moment I felt that maybe my body would produce that line-making chemical on its own sometime soon, while it still remembers what it's like to have it swirling about in detectable levels.
Today, I tossed the test in the trash. It served its purpose, and my mind's eye can still see the pink.
Friday, February 22, 2008
The nurse said, "So how are you doing?"
Long pause from me as I thought about how all of the "expected" words capture squat. "Life goes on, right?" I said.
That Dr. K didn't even know the result until yesterday deviates from what Doctor clearly told us on Sunday. But, her reaction is totally in line with the rest of my experience with her. And DH and I both think that if there's a weak communication link in this scenario, it is the Sunday boob. He must have been mistaken that Dr. K was home watching the procedure. Maybe that's what she'd normally be doing on a Sunday off, when she's not on vacation. I didn't mention this to the nurse. It's not her issue.
I did say that I was stunned and disappointed that it took so many days to hear from anyone. She apologized, profusely, and said that the cycle nurse I've been working with is also on vacation. I just fell off the radar. She asked about my reaction to the anesthesia, lingering pain/ovarian discomfort, etc., and I just had to say, "You know, I do appreciate your asking, but by now I obviously know that I have no need for medical assistance."
Am I still a bit bloated? Do I need a stretchy-cushy bra? Am I getting daily HCG-induced foot and leg cramps? Is my skin falling off from the doxycycline? Am I still spotting a little? Yes. But all of that is normal. None of it is unexpected.
The nurse gave me her direct line and a sincere invitation to call anytime. My cycle nurse will be back before Dr. K (end of next week) and will call pronto. Or relatively so. Then I'll schedule something with the doc, who "REALLY wants to discuss options" with me. I'm not being sarcastic here. It's what the nurse said, and I believe it.
Problem is, I already know the options. There are other protocols out there. Much better ones for me, most likely. But we just did the one IVF we felt we could afford to do with my eggs. And we have paid for it.
We felt somewhat steeled for coping with a failed cycle. In many respects, I'd already grieved my fertility and come out the other side. Hope was there, yes. Otherwise we wouldn't have done it. But we hadn't given serious consideration to this particular possibility.
Wednesday night I said, "This was supposed to be transfer day." DH squeezed me and said, "I know. It's actually the first day I thought we could get really bad news."
It feels to me like we didn't really do a cycle. Like we were just pulled out of the game. To paraphrase a local ad we used to mock, "The whole experience was anticlimax."
Pity party done. It is sunny here, I'm caught up on work (for the morning, anyway), and I think it would be fun to wake my office-buddy dog with an unexpectedly early invitation to walkies. She will go pazzo for it.
Tuesday, February 19, 2008
During the day I avoided the guest bathroom, where my Injection Station still exists (cycle meds, syringes, alcohol prep pads, extra needles, biohazardous waste receptacle, injection instructions) and my now-absurd-seeming TCM foot-soaking ritual took place. I also turned a blind eye to the stack of IVF-related propaganda on the coffee table and shoved my detailed cycle calendar into the recycling bin. It was a good grab-and-shove. Barely had to look.
I took no vitamins. Not even a PNV. Nor did I consider the fertility- or cycle-supporting value of any foods I took in.
During an after-work Costco date, I winced at the sight of the fresh pineapple I'd planned to pick up on transfer day. Longtime TTC'ers, you know why. We veered left and snagged an inexpensive bottle of shiraz-cabernet instead. For another time.
I fell asleep at around 8:30 watching Paris When It Sizzles. Haven't heard of it? I know why. (Even so, a bad Audrey Hepburn–William Holden film is still not terrible.)
Now it is midafternoon on Tuesday. Two days after the failed retrieval. No word from my RE. If that trend continues, I will call her (to leave a message to call me, what else?) tomorrow. In the meantime, I am free to continue speculating about what may or may not have happened. Although on-call Doctor was unable (or unwilling?) to even suggest possible reasons ZERO eggs were found, I have had no trouble assembling a fairly straightforward list of my own.
Let me preface my info rundown info with an anecdote from the wee hours of Sunday.
At 4:30 I woke up feeling a subtle chemical shift in my body. Something changed, I don't know what. But I know that I feel certain shifts at predictable times during a natural cycle (just before O time, at mid LP, just before AF, etc.). With no previous IVFs or medicated cycles to compare it to, I hoped what I'd felt had to do with the HCG doing its thing and/or my body adjusting to not getting its Follistim/Menopur/Lupron fix.
When the alarm went off at 5:15, I sat straight up and said, "I have a sick feeling that I've ovulated. What if that was the biggest/best follicle releasing its egg?"
"Can that happen?" DH said. "I think so," I said. "But it didn't," we said.
I honestly put that out of my mind — completely — until the car ride home. Can't stop thinking about it now.
Below are up-for-debate tidbits I found about what some call Empty Follicle Syndrome. I gleaned it from sources such as INCIID, "name" clinics, and RE blogs/forums.
- Some REs say that all mature follicles contain eggs. In other words, there is no such thing as an empty follicle or Empty Follicle Syndrome. Eggs may not be good, but they are there and either not ready to come out (immature) or too sticky (damaged) to come out.
- Two common explanations: old eggs; unexplained.
- User error when administering the trigger shot can cause a problem. If you don't do it correctly (wrong time; SubQ instead of IM, maybe?), the eggs might not reach maturity.
- Problem with the drug itself. Some REs have patients take two HCG triggers from different batches at the same time to allow for the possibility of a random bad batch.
- Some women have problems metabolizing certain brands of HCG formulations. Some REs do bloodwork to test for beta HCG before the procedure. If there's a problem, they send you home with a different formulation and schedule the retrieval for 24 hours later.
- Some women ovulate slightly before the scheduled procedure. This, of course, would be next to impossible to detect. To account for this possibility (or, often, during a subsequent attempt), some RE's retrieve at 34 hours instead of 36.
- Some REs think that a high-stims protocol damages eggs, particularly in women over 40. This could cause the stickiness problem.
- Some think that the high-stims protocol can recruit follicles that would have been in line for the next natural cycle. In other words, this was not their time but they were hustled to the front. The eggs have been rushed and are of poor quality and/or just aren't ready for any type of action.
Monday, February 18, 2008
"The good news is that the procedure went well. There were no eggs, but the procedure itself went very well. We flushed the 4 follicles and blah—I'm sharing a dozen fascinating details about the super-cool method we use to look for the cells in the fluid, and we did it this way and that today, but, nope, 4 follicles, 0 eggs—blah, blah. This almost never happens. It's been several years since I've seen it. We usually get an average of 8 mature eggs. This is disappointing."
Pause for DH and me to ask a few questions, to which Doctor supplied only marginally topical answers. For example, I asked, given this finding, whether it's possible that I really haven't been ovulating on my own for a while, or all the time, but still producing what mimic ovulatory indicators — positive OPKs, measurable follicles that follow an ovulation pattern, appropriate hormone readings, etc.
Doctor's exact reply (after pulling a classic "I'm not actually listening to your words but am waiting for your lips to stop moving so I can insert what I most want to say next"):
"Would I try again? No. I wouldn't. You might talk to Dr. K about donor eggs.* I don't know what she'd recommend about that just now."
DH and I couldn't end our "conversation" fast enough.
Doctor wasn't quite finished though. "Oh, and you'll be glad to know that you can stop the progesterone. No more shots tra-la.** Just take your doxycycline as though you had the procedure.*** But not with dairy, because the calcium acts as a binder. Call me anytime today or this evening if you have more questions."
"I won't be calling," I said.
"Yes, talk to Dr. K. She watched the procedure in real-time at home. It's really remarkable, she could see the whole thing on a flat-screen TV."
Doctor left the area. DH and I breathed and said, "Let's go."
I dressed, fast, in the bathroom. I cried a little but sucked it up and said no . . . later.
When I came out, the nurse shared her surprise that I was up and around and ready to leave. Most people need a bit more rest, it seems. But my adrenaline had rushed at hearing "no eggs," (BP skyrocketed, too, says DH) and I would not experience any pain or feel like I'd even been anesthetized until fairly late in the evening.
As DH bundled me into my coat, the young nurse trainee came over to say good-bye. She was sweet. She really was. And when she enthusiastically said, "It's really nice out there — have a great Sunday," DH and I shared a bittersweet smile and strode out the way we'd come in 3 hours earlier: hand in hand, heart in heart.
*Guess what, dude, we already did. At length. We took the entire holiday season to weigh whether we should use donor eggs or take one shot with mine. It was a close call. But with eyes open we chose to do what has just freshly failed. Failed so much that none of DH's sperm even get to meet my eggs today. Today, we have learned my eggs are so bad that they don't even exist. So you might want to give us a minute.
**To be fair, he actually ended that sentence at "shots." And in the moment I assume he knows that I don't have to STOP progesterone, because that is not started until after a successful retrieval as defined by a harvest of more than ZERO eggs.
***Uh, I did have the procedure.
Saturday, February 16, 2008
My only noticeable s/e was persistent gas bubbles that joined forces overnight to form a big, painful, wake-me-up abdominal balloon this morning. I walked it off, though, and all is fine.
Yesterday's monitoring showed follies-of-interest at 23, 17.5, 14, 13, and 9.5 mm. I was the only one in the room interested in the 9.5 one. Sure seems possible that it might make it to 12 mm, which is where Dr. K said she wanted to see them (she wasn't in the room, btw). When I gave a "Hey, maybe," on that the sonographer chirped, "Oh, I don't even expect to find a mature egg in that 13 mm follicle." Hokay. I opted to continue happy thoughts of having 4 over 12 mm — at that moment — and a little bit of time for them to grow.
Really, who knows what they'll find. If it's pudding, DH hopes it's butterscotch. And if it's rocks, I hope they are diamonds. I'll sell 'em on eBay.
My E2 was 1,545. Not sure where that's supposed to be, but the result meant the difference between triggering last night or tonight. They don't want the 23 mm follie to overmature and do us no good.
The cyst was bigger, but not by too much. I am eager for that sucker's aspiration so it will stop stabbing me.
Retrieval is at 7:15 am tomorrow!
Thursday, February 14, 2008
DH did not believe me the other day when I emailed to say that I was unable to track a thought for more than a minute. I asked if he was calling me a LIAR, and he said no, just a HYPERBOLIST. He hasn't even noticed that since last week I regularly have almost no idea what we're discussing . . . or if we're discussing. I do know when he's talking, of course. And if I ask a question I care about, I can pay attention long enough to take in the answer. But only if I squint.
I got lots of attention and was fine with it. I arrived at 7:22 as they were turning on the main lights, and I was whisked off for bloodwork before I could even fully focus on People's side-by-side comparison of Jessica Simpson's lips from 2005 and 2007. If I am lucky, I will get to read the captions tomorrow.
Four people attended this wanding. (Verbed it!) Sonographer, nurse, Dr. D (today's normal procedure doc), and Dr. K, who came in early to try to see me. She joined Dr. D and me as he was giving his opinion. She missed the part where he brought up my Tuesday appointment and said he did not like that I'd received conflicting messages from the team. I told him I was over it but that, yes, I considered Tuesday's communication with me to be poor.
Sorry for going on and on, but I'm running on drugs and less than 3 hours' sleep and don't have the mental strength to type anything but my thoughts as they come. That's why I will now type that I didn't know it was Valentine's Day until the phlebotomist said the embryology lab was swimming in black balloons. And, did I mention that I walked on a "sidewalk" the other day during the lunchtime rush that was actually the newly paved 4th lane of a very busy thoroughfare? I won't give further details. They make me shudder.
Yes, the report! Feel free to start here:
(1) The 4 decent follicles are hanging in at 19mm, 14 mm, 14mm, and 13 mm. The sonographer went ahead and measured 2 others — 8 mm and 6.5 mm — and called the other 2 "less thans." They did not take umbrage. But the 19 mm one was told to not get too far ahead of the other 3 good ones.
(2) My cyst is still growing. And again, I am to stop thinking about that.
(3) Day 5 E2 was 545, and Dr. K said that was great and expects today's to be great too.
(4) Both Dr. D and Dr. K think we should go ahead but were careful to say that my odds have lowered since the cycle outset based on my response to the meds. They were already low, maybe 15%. But it is so much higher than 0%, which has been our actual success rate since 2003 and our RE-predicted-odds for trying naturally since 2005. I purposely bit my tongue to stop myself from asking for a new percentage. It doesn't matter anymore, because we are either making it to retrieval and taking what we get then or converting to IUI if things look worse just before retrieval. (A few minutes before? The day before? I did not clarify that one.)
Starting here works too:
(5) Current thinking is that I will trigger tomorrow or Saturday, for a Sunday or Monday retrieval.
The rest of my day will include a dog walk, a nap, some kind of takeout, a foot soaking (you are right, Polly!), and maybe the positive meditation CD that tells me my body knows what to do right now. I have acupuncture right after my ultrasound tomorrow, and I'm hoping I can get in for that on the weekend, too.
Tuesday, February 12, 2008
First of all, she still feels that the cyst is a non-concern. They will aspirate it at retrieval but wouldn't want to go in before then. I asked about its possible effects on egg quality and whether it would inhibit further follicle growth. She said there is no definitive evidence that quality is adversely affected or that follicle counts would be better without the cyst. But that, yes, if it doesn't work out, you can wonder. (See, I'm still not getting why the "nothing definitive" thing doesn't make you wonder right up front.)
Turns out I still have 8 follicles. I did not lose 4 from last week. (The NP could have easily corrected this impression during any number of the times that I voiced it.) But 4 have definitely grown ahead of the others and are measuring at 10–11 mm. In fact, contrary to my impression that only 1 of the 4 looked worth anything — an impression which to my mind was confirmed when I said, "So just 1 out of the 4 even looks viable—that sounds bad" and then the NP said, "Yes, the others just aren't where we'd like to see them" — the REs say all 4 of the bigger ones look healthy and right on track.
Was the NP talking about them not looking good if we were pretending this was retrieval day and not Day 5? I don't know. But she went all the way along with my comments about canceling. She encouraged them, spoke comforting words about a future cycle on a different protocol, offered to cancel appointments so I didn't have to, and agreed with my assessment that today's planned acupuncture treatment would be a waste of my energy.
!@^%&^%&$$!!!! Pardon my digression into testiness, please.
Dr. K confirmed that whether the other 4 will grow can go either way — and that it is too soon to tell. She also said that 4 nice healthy ones is about the best she thinks I can hope for. Not that it's not possible that I could get more during a different cycle. But there's no way to know, and why take that chance when we are here now with stims doing their thing and me with 4 tangible egg vessels.
So I will continue the meds (just finished shooting up, actually), get monitored Thursday and Friday both, and we will decide what to do then. She said, "Now is still the time to be hopeful. We can deal with deciding to cancel if we need to." I appreciate that. It happens to be the way I felt before today. I'm not sure yet whether I'll be able to get that feeling back. But I do want to ride things out to the end of the week.
DH's take on the notion of going ahead even if 4 follicles is the best we can do: "It's not like they're going to find pudding in there. Or rocks."
So one hopes, my sweet.
I don't know. The nurse practitioner seemed pretty much on board with my thinking. Nothing about this morning's check seemed positive to her.
Cyst bigger, higher E2, precious few follicles (even fewer than before). What am I missing?
Hope to find out.
I pulled the plug on my IVF cycle this morning. Twenty minutes later I'm sitting in a coffee shop with my laptop and a subpar full-fat, all-caf latte. Actually, I finished that while waiting for the computer to boot; it wasn't very hot—or maybe my pain receptors are numb.
I meant to go straight home from my appointment, but I took the northbound freeway ramp when I wanted the southbound one. So I said "Frick it" and pointed my car toward a spot DH and I frequented when we first moved to town almost 10 years ago. Man, we were young(er) then.
At Day 5, my cyst has grown by 75%, and my follicle count is in the dumps: 1 decent one on the right, 2 small ones and 1 disappearing one on the left. Other follicles viewed at my suppression check have vanished.
I'll get my b/w results from my RE this afternoon and will confirm then that we're done for now. I wish I had talked with her after my second suppression check. Not that we wouldn't have proceeded just as we did. It's all a big what if, I know. Yet I wasn't totally satisfied with Dr. L's judgment on that day and now I am completely kicking myself for following it without giving more credence to that little piece of my gut that wasn't on board.
Now here's where I provide evidence that I had reason to second-guess Dr. L's judgment and that I was an idiot for waving off my instinct:
It was obvious that Dr. L hadn't given my chart more than a cursory glance. For four things: he was surprised to learn my age; he had no idea that his partner had recently performed a myomectomy on me (never mind that it was my third in 20 years of living a life of fabulous fibroidosity — and that I didn't need him to define subserosal, convert mm to cm, or question the veracity of my knowledge that I do not have endometriosis); he assumed I was doing a different protocol and gave incorrect "start injections tonight" advice based on that (which I didn't follow); and he was, I felt, more focused on putting on a getting-to-know-you floor show than paying close attention to my actual situation.
I don't know about you, but I prefer that my doctor save both playfully joking with me about my cyst/fibroids/clinic bill and patronizing the nurse ("You're wrong, as usual! But I still love you") till after he's done probing me. "Probing" was Dr. L's word; most at least use the term "wand" — without turning it into a verb.
You know how some guys, some gals too, will grandstand for you the first time you meet? They present an exaggeratedly charming/clever/funny self to seal the deal on that spectacular first impression. They are full of themselves (because they truly are talented, smart, charming, funny, or something good) and insecure with a capital I. They need that immediate feedback that you think they are the greatest, so they hit you with all they've got within your first 2 minutes of acquaintanceship. By the second time you've met, they feel comfortable enough to settle down into a normal personality presentation. And you do like them. Usually a lot. That was my take on Dr. L.
I don't blame him for my cyst growing or my follicles withering. And I don't blame him for answering my questions about oversuppression and why we wouldn't expect the cyst to grow with "In my experience, these shouldn't pose any problems." He gave me the advice he would have given to anyone else. And that's the kicker. Was he framing that advice within the context of my history, my age, anything about my case? I feared not then. And my incredible superpower of laser-like hindsight tells me NO now.
I do blame myself for not calling my RE directly to talk it through a little more. Had I done that, I may have gone ahead as I did. But I wouldn't be so freshly irritated by my visit with Dr. L and soooo mad at myself.
Looking forward to Dr. K calling later. We will figure out next steps.
Listen, Dr. K and I discussed the possibility of a poor response several times before DH and I signed up. I absolutely knew it could happen. I thought maybe it was even likely to. So this really is not a big surprise. In fact, I need to start thinking about it as good news. I had REALLY hoped, that if my meds protocol was wrong for me or I was just not going to do well, we'd get good indication of that early on. Before proceeding to retrieval. And so that wish has been fulfilled.
Monday, February 11, 2008
I go in for my Day 5 bloodwork and ultrasound tomorrow — they skipped the Day 3 session for me because, I think, they don't expect to see much early activity from the old girl. That and/or they wanted to minimize their Sunday visitors.
My current worry is that 34 days on BCPs oversuppressed me. I just want to start knowing how things are going.
Here's hoping that acknowledging my impatience will help me work on work now. I really do need to. In 3 hours at my desk I've only racked up about 10 minutes of productivity.
Sunday, February 10, 2008
Typically, I am slow to fall asleep, stressed or not. My head hits the pillow, and I am alert, no matter how tired I felt minutes before. (Family, DH, former roommates, and friends from my prime slumber-party years can vouch for that.) For as long as I can remember, I've been accustomed to experiencing at least one night a week in which I just don't sleep well. And whenever I feel stressed, I tend to follow up that one bad night with several nights of sleeping poorly and one night of crashing hard. Then the cycle starts fresh at Sleepless Night One and repeats itself until whatever mini-storm has passed.
I noticed shortly after posting about not sleeping that suddenly I was sleeping through the night. Every night.
The magic of blogging? I doubt it. I'm thinking it might be a result of pushed-down stress. My theory is that the effort it takes to maintain the even keel I've been on results in a super-tired brain/body at night. And so I sleep when normally I would not. Or maybe I am simply handling it well. Or, maybe acupuncture helps, or BOOM, I broke a lifelong behavior pattern without even trying.
Tough to know. Then again — does it really matter? Sleep is good for me right now. It's probably best to let sleeping "rhymes with w!tches" lie.
Saturday, February 9, 2008
I started stims last night. We went out for dinner (ordered a rare dessert to stall) and then raced home to figure out what the heck we were supposed to do. The injection class covered it, sort of; all I really did there was follow step-by-step cues to open this, secure that, draw from the other, and jab a small peachy-pink patch of fake rump. I was a comfortable, confident, quick-study student. But last night at my home Injection Station (yes, I set one up!) — at which I felt I'd already mastered the art of self-administering Lupron — I was quite thumby.
The Menopur syringe is bigger, and you have to mix the medication with a diluent. So it's just more steps and a bulkier item in your hand. The stick itself stung, but I think that was from the medication (the diluent is a saline solution) and not the needle.
The Follistim pen is bigger yet and I think a little hard to manipulate with one hand, but it is convenient and better than using the older, bigger syringe-based method. I loaded two days' worth of doses into it and so now it's ready to go for tonight. I did feel that needle (small prick), but the main difficulty was pushing the medication into the skin. I'm sure it will go more smoothly tonight.
Side effects of last night's shots:
Teeny minute of wooziness directly afterward, followed by a brief shooting pain in the sciatic nerve and an ache in my groin (both on same side as injections); bruise at the Menopur site, bruise and lump at the Follistim site. I woke up pretty warm and had a stiff neck (not necessarily due to meds) this morning. Then I caused a big bleeder with my expert Lupron-injection technique. I just hit something, there was no pain whatsoever. I have felt totally fine during the day. No effects that I'm noticing.
Friday, February 8, 2008
The following quote from the MSNBC copy sums up the reasoning (plus $5K or so) behind our decision to give acupunture a go:
"IVF costs around $12,000 per attempt, so a treatment that improves its effectiveness might save money in the long run."
It won't save us money, because this is "the" attempt. But an extra few hundred dollars added to the astronomical total cycle cost seems fine when the treatment might help and won't hurt.
Had my first encounter with electro-acupuncture yesterday. J, my clinic's acupuncturist, set me up in Transfer Room 1. That's "my" transfer room, where all the magic will happen in a couple of weeks (knock on wood, fingers crossed, and all that). She explained that just on the other side of the long wall is the embryo storage room, and she pointed out the pass-through window through which the embryologist and various minions will pass the goods to the doctor, watch the peep show, er, procedure, and provide commentary as needed.
J also said, "And this is the chair for your partner. He can hold your hand and watch the process on the TV screen, if he is able to make it that day."
"Oh, he's makin' it that day," I said.
She laughed and said, "You'll make sure of that, huh," and I said yes but thought, It's not a case of me making him do anything. Why on God's green earth wouldn't he be there while the doctor tries to knock me up? Why????
Then I realized that DH and I hadn't explicitly discussed his being there, and I recalled the few times I've been burned by ass-umptions about our joint understanding of things. Luckily, though, I didn't have to suffer for my initial haughtiness. The first thing DH did when he got home last night was spread his work calendar in front of me and ask when we'll know which days he should take off for the retrieval and transfer. Whew.
About the electro-acupuncture: I liked it. J stuck a bunch of needles in me as usual, but she shifted the focus from general health (reproductive and otherwise) and stress relief to the specific stimulation of follicle growth and uterine blood flow. For some reason, my meds dosages mattered to her (level of medi-stimming going on, I suppose). She hooked up a few needles to the E-Stim II. (I think. Whatever she used looked a lot like the pic — or maybe it was just an iPod.) Then she slowly turned the dials until I felt sensation at the needle sites. She seemed surprised that I didn't feel it before I indicated. Or maybe I just thought she seemed surprised. I described the sensation as a spinning top, to which she clearly acted surprised. But that's what came to mind. (DH said she was probably on her acupuncture forums last night saying "How would someone even know what that feels like?")
My brain adjusted to the electro-feelings very quickly. J said that the currents essentially do the work she would if she were to sit there and manipulate the needles for the entire session. Okay. I'm cool with it. I think I fell asleep again. I must have because the session lasted 45 minutes and I only managed two complete thoughts. I came to hearing (through the window) the raucous embryology lab team returning from lunch. The light on the other side of the window came on, I heard a small crash, and then during a quick scuffle, someone said "I thought there was one in the middle." I love hearing conversation snippets out of context, don't you?
Post over, smoke coming from the washing machine — will update later!
3:30 p.m. update:
No fire, thank goodness. Just smoke. Rest assured, I did turn off/unplug the machine, check the whole house for fire, and make sure the dog was safe before closing the original post. I think the machine's motor went bad. The basement — utility room, family room, my office — still smells, but I went ahead and closed the windows just now. It's been 3 1/2 hours, and it's cold!
Thursday, February 7, 2008
So, this morning, I didn't flinch. Just went for it. Didn't even pinch the pooch. Think I'll remember that part tonight — a taut injection site does make the difference between feeling/not feeling the needle. I wouldn't say that the stick hurt at all, though.
Wednesday, February 6, 2008
"So this is where you want to do it," he said, nodding slightly toward the unadorned sliding glass doors behind me. "You'll have to raise your tunic." (that's a nightshirt to you and me)
I knew what he meant. Anyone lurking outside in the early-morning blackness — and sitting in the neighbor's blue spruce — might be able to manage a largely obstructed 3-second ogle at my belly button as I rammed a needle into the small area of nearby pinched flesh.
"I'm doing it here," I confirmed.
Then . . . I did it! The first poke failed as my natural instinct to not stab myself prevailed. (I thought the needle would go in with less momentum. Nope, ya gotta stick it quickly.) But the second poke 2 seconds later was a smashing success. No pain whatsoever.
Mild side effects:
- sliiiiiiggghht nausea lasting 2–3 minutes, starting 1 minute after the shot
- fleeting tingly-burning feeling in both hands as the nausea faded
- intense but short-lived urge to head out for donuts and coffee (what do you mean that's not the drug talking?)
- little bit of a tingly-burning feeling as I digested my sensible one egg w/asparagus breakfast
- continued slight feeling of warmth throughout my upper body (that's 3 hours later)
- red bump at the injection site
- mood swing: extreme annoyance that the clinic's acupuncturist didn't return my calls Thursday, Friday, Monday, or Tuesday (wait, that happened before the Lupron)
Tuesday, February 5, 2008
Monday, February 4, 2008
There's nothing on TV tonight, DH is deep into solving an equation of some sort (the long sort, I guess), and I have nothing cycle-related to do until Wednesday. So I poked around the CD library. In 1995 I listened to Annie Lennox's Medusa album a lot, and I repeated this cut — a cover of Bob Marley's "Waiting in Vain" — every time. DH and I lived in different cities then while I pursued burning career interests and he finished his doctorate. We were married in October that year after 5 years together — 3 of which had seen us doing the long-distance thing (we actually did THAT for another year after the wedding, but that is another story).
We'd hatched our brilliant long-distance-for-happiness scheme thinking DH had just 1 year, tops, before finishing up. But fate and a broken million-dollar laser crucial to DH's research had a different adventure in mind for us.
I got pretty fed up with the wait. We both did, and many times we came close to scrapping you-name-it: his PhD (it's not worth it, he'd say), my job (I'll move in with you and work retail, I'd say), our wedding plans (let's just drop out and elope, we'd say), the whole shebang of a possible life together (nobody ever actually said that one).
Back to the song. I love the Marley original. But this cover gives the work an emotional spin that I think is just devastating . . . yet gorgeous and painfully hopeful. It hit home for me as I struggled hard with waiting, season after season after season, for us to get our life together on "the" track. Of course we did much more than just wait. We looked for solutions. Worked on 'em all the time and chipped away, making progress we couldn't see. But. It. Took. So. Long. Much like our struggle to become parents. That sitch runs so parallel to this one that I may have to get out some old calendars, compare peaks and valleys, and creep myself out.
That the song hits me where I'm living now/again, took me by surprise. Here's where it got to me tonight:
'Cause summer is here
And I'm still waiting there
Winter is here
I'm still waiting there
Like I said—
It's been three years since I'm knocking on your door
And I still can knock some more
Ooh, boy, ooh, boy, is it crazy? Look, I wanna know now
For I to knock some more
In life I know
That there is lots of grief
But your love is my relief
Tears in my eyes burn
Tears in my eyes burn
While I'm waitin'
While I'm waitin' for my turn . . .
That's all for now. I'm off to hug my husband and enjoy the last hour of the type of evening we used to think we'd never get to have together.
Friday, February 1, 2008
Little Miss Cyst measured the same today as she did at my first suppression check Monday. She's also throwing off essentially the same level of E2. Dr. L (not my primary RE) thought it looked like it was "trying to collapse" and agreed with me that yesterday's pain was good. He said that these few days of watching it simply confirms that things look fine for liftoff — and that this type of cyst, in his experience, will not affect the outcome one way or the other. Does that mean you already know my outcome? is what I thought to that. And then I asked more questions until I felt good about making the call.
So, the cycle is back in motion. I'll take my final BCP on Super Sunday, do one more suppression check on Monday, and start my Microdose Lupron on Wednesday. Stims to begin Friday. I'm exactly one week behind my original schedule. Not a big deal.