Tuesday, February 19, 2008

Processing, second-guessing, waiting, fuming, aching, coping

The good news about yesterday, as Doctor would no doubt concur, is that nobody needed anything tangible from me. I floated through the workday, focusing on the simplest of tasks (filing, invoicing, outlining, staring at a boxelder bug for an hour) and saving any important client communications I felt like initiating for another day. I also managed to cancel the Darvocet Rx we never picked up and ask the clinic (using their online contact form) to be sure to tell the acupuncturist that the transfer was off.

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.
No logical post ending. It's just back to work and waiting for I-don't-know-what.


Anonymous said...

I find 'user error' in injecting the HCG shot tantamount to 'pilot error' when the wing falls off a plane. User error conveniently ignores the fact that the HCG is either SQ or IM - period. I've never heard of one or the other making a difference (although there might be one). Anyone else?

I wish someone could give you an answer, so at least you could know, even though it wouldn't make a difference in what's just happened.

Anonymous said...

I have always given myself HCG SQ - in the belly to be exact. I really do not think it was your fault. I am sure you did exactly what thousands of other women have done.

I would speak to your RE about trying a flare cycle next time (no bcps).

Best of luck.

Ms Heathen said...

Reading this post took me back so clearly to the feelings of bewilderment and confusion I experienced after my own recent cancelled cycle. My first thought was that I must have done something wrong - had I administered the injections incorrectly, or else at the wrong time?

I know it's easy to say, but please try not to blame yourself; you were simply following the instructions that the clinic gave you.

You've come up with a list of good questions - hopefully Dr K will able to provide you with some answers when you speak to her.

Thinking of you!

Anonymous said...

Thank you for the kind thoughts. Don't worry about one thing: I don't for a second think I did anything incorrectly with the HCG. The shot was the shot, mixed and given at the assigned time and in the assigned upper-outer butt.

I'm sure user error must happen, rarely, but this is interesting: Dr. K actually told me about one patient "who thought she'd taken her HCG but things didn't look right" at retrieval. So they did b/w (which was negative for HCG), sent her home w/another trigger (no idea whether it was the same formulation; she told me the story before this experience), and did the retrieval the next day. The patient is pregnant with twins now.

I will be asking for more particulars about that story. And, obviously, looking for feedback on what I found about the various problems with the drug/process — and just going down my list of issues to revisit (protocol, cyst, and the very real patient care/business issue of the retrieval doctor's behavior).

Now, about not blaming myself in general. That one's gonna be tough.

MissNoAngel (find me on Twitter) said...

Hi...I surfed onto your page from FF. I just wanted to say that I am so, SO sorry about your crappy IVF...my heart just broke for you read I read your last two posts. I hope you don't mind if I continue to follow along. ((hugs))

TABI said...

I am so sorry about the retrieval. I know it is hard not to think of what you might have done wrong but I agree with others that I highly highly doubt you did anything. Anyway, I do hope that you get some answers soon and agree with other comment about seeking a new protocol. You have eggs(!) and maybe you need a better protocol for your body. Good luck to you and hope you can start up again right away!