October's path

Today in relevant history:

• 1987 — Knew my October AF was everything but normal. Couldn't begin to fathom that the things that do/don't grow inside my uterus would so profoundly affect not just that year, but the next 20+.
• 1995 — Married my sweetheart.
• 2000 — Knew I needed a second myomectomy.
• 2003 — Started TTC for our 8th anniversary.
• 2007 — "Skipped" our 12th anniversary because I was in the hospital for surgery that would allow us to try IVF.
• 2008 (that's today) — Hugged DH extra hard at 5:58 am when he whispered "Happy anniversary," then teared up when he added a soft "thank you."
  

Cycle status:

• Day 4 of stims.
• Feeling strong and not too stressed.
• Bloating is trying to start.
• Headache pops up about an hour before my shots each evening. (Can you say, "Hormone dip"?)
  
• Day 5 monitoring tomorrow.

Things I'm doing to help myself stay calm and focused:

• Staying ahead of my work.
• Listening to meditation CDs and music.
• Reading books.
  
• Watching movies.
• Flipping through magazines.
• Using the "good" lotions and potions.
  
• Going to twice-weekly acupuncture sessions.
• Soaking my feet nightly in warm water. (Gotta get that blood and good Qi moving!)
  
• Taking fistfuls of vitamins and supplements.
• Consuming IVF-/fertility-friendly foods.
• Drinking plenty of water.
• Getting enough sleep.
  
• Walking the dog (see photo for today's path).
  
• Cooking and baking.
• Consciously choosing positivity.
  
• Planning for an "IVF #3 failed" future.
• Trusting that an "IVF #3 worked" future is possible.
  

The drugs are making me weepy

Yet I haven't taken a thing. All meds are in the house. But I'm still 2 days away from my first antagonist shot and 10, maybe 12, from starting stims.

In the past few days I've teared up about all kinds of good stuff:

mistakenly cutting someone off during rush hour; receiving my cycle meds; chipping a mug I actually hate; seeing the pup take a 2-second detour on the way to her food bowl (hey, she needed to make her screaming monkey scream); getting a bill for extended storage of the sperm sample DH banked in our last cycle; buying a new sweater, then unpacking my winter wardrobe to find a near-identical match from an end-of-season sale last year; noticing (with relief) that DH looks relatively untroubled for the first time in many months; sending my brother a DVD of a goofy movie we used to watch as kids; thinking about WWII; learning that DH will be traveling during IVF . . . again; getting a compliment from a complete stranger at Target; noting the tragic fall of the Jackson family (triggered by an old Jermaine song on the radio);

AND SO ON.

My suppression check is Monday, and I am more than a little nervous about what we'll see. Hoping for no cysts. And a goodly number of resting follicles. With no cysts. And a nice batch of follicles.

And this little piggy went, "Good luck!"

Today is CD 1, marking the official beginning of our second IVF cycle. I'd thought (and hoped), it would start on Wednesday. That would have meant not only that I'd had a normal-for-me natural cycle (this was only a 9-day LP!), but also that DH would have a better chance of getting to fly home for ER at the least inconvenient time for him.

But such goals were not to be. The body does what the body does, eh?

My stims phase starts Monday. My nervous-stomach phase starts now.

Like my good-luck pig?

Suppression check in 5 hours

Will I be cyst-free? Will I get the go-ahead to do a Cetrotide injection tonight? Will my cycle calendar start to firm up? Will I need to explain the billing mix-up again in order to pay the amount originally quoted and NOT the one that's $2K higher? Will my wait time for this appointment make me late for my acupuncture appointment afterward?

I'd be okay with a yes on all fronts.

Say it with me: "April stimsies bring May eggsies"

Catchy, huh!

We concluded on Friday that this IVF process will begin with my next natural cycle. Originally, I thought we'd get going with a progesterone test as early as tomorrow. I didn't realize that the first antagonist shot would occur then or that the appointment would serve as my suppression check. A bit clueless about the workings of the new protocol, I was.

I told the nurse coordinator that DH and I had TTC'd this cycle. Actually, to back up, I was questioning why she wanted to do the progesterone test "4 or 5 days" before my next AF instead of doing it at 7 DPO. Her response was that it was just easier. I disagreed, as my cycle length can vary by as much as 6 days and my LP by 3. Going by my ovulation date sounds much simpler to me. She said, "Yes, but then you'd have to know when it happened."

HA!

I told her I was already 4 DPO, and she said "What makes you think that?"

What makes me think that. Seriously? I guess women who don't track their cycles do end up at the Fertility Clinic. They must. But really, would you expect a 42-year-old woman TTC #1 for 4.5 years to NOT be testing for every last dang ovulation she has left?

"Fertility monitor, OPKs, typical signs, you name it."

"Ohhhh," she said, "Did you guys try to conceive this month?"

Sure did. Had I understood ahead of time that the first antagonist shot was given during my LP (when some might argue there is a minute-but-there chance that I could be pg), I might not have. But I did not and so we did. It.

That's why we're waiting. The suppression check will be about 4 weeks from now, give or take some unknown number of days for this LP to ride itself out and my next ovulation to occur. (I'm still gonna tell the nurse when that happens, whether or not she wants to know.)

DH is a little disappointed that we aren't starting right away. But I'm not. I feel better about having more of a break before stimming it up again. I can get in a few more acupuncture sessions, let my body regulate itself, and do whatever I can to encourage healthy May eggies.

Punny P.S. The nurse warned against engaging in further, um, activities (you know, the type that get other girls pregnant) "without protection" from here on out. I shared that with DH, who has promised to go out and buy a gun.

Back to the blog, back to the IVF life

Technically it's been 10 days since my last post, but I've interacted with the blog since then. Gave it some special one-on-one time. My Blogger dashboard shows 3 half-finished posts and 1 over-finished manifesto. I'm moving that to my private journal before somebody gets hurt. The other bits originated under the influence of flu and probably weren't going anywhere anyway.

Guess what? As my title suggests, we've decided to try IVF one more time. The decision-making process was complicated, but we're doing it, for better or "we'll be okay." Good result, bad result, we want one good try on the books before turning the page.

We're working through whether to start right away or wait one more cycle. Timing-wise for DH's job happenings, it would be better for us to get going asap. But biology (mine) will trump convenience (sorry, Giant Aerospace Company). Dr. K wants a confirmed natural ovulation as the cycle go-ahead, so I'll get a 7 DPO progesterone check next week. Not sure if we check for cysts then or wait for Day 3.

I'll follow the antagon protocol this time: no BCPs, no Lupron (amen!); Ganirelix to stop the LH surge; Follistim and Menopur for stimulation; HCG trigger; Medrol for assisted hatching; PIO for progesterone support.

Here we go!

Day 7 and still in the game

Stayed off the Internets most of yesterday. I had to catch up with work. And now I am good for at least a couple of days. Hope my client can't tell that I did what normally takes me 3–5 full workdays in about 10 hours, ending at 3:15 am. Who knows, maybe it's my best work ever.

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.

Today's info:

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.

Zzzzzzzzzzzzzzzzz.

Plugged back in for now

Dr. K called half an hour ago, and we had a good chat. She understood how I got the impression this morning that this thing was a wash. (How about, because the NP said as much when I asked her to comment?) Even if she didn't understand, she said she did, and that helped.

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.

Suppression check, rinse, repeat

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.

Note to cyst: You're going down

Today's happenings:

My RE put me back on BCPs this afternoon. I gobbled up a pill as soon as the nurse called with the news. She had told me yesterday that an E2 of more than 50 might delay the cycle. My E2 was 34.2. If you're like me, you may be thinking, "Dude, 34.2 is less than 50." But the RE decided to be conservative, calling my number borderline, and I have to appreciate that. Chances are good that the cyst will shrink on its own, and I'd rather start from that point in a few days than to begin injections now and have the cyst grow and interfere later on. I go back Friday for a repeat suppression check.

I had an acupuncture appointment this morning. I think I fell asleep, but I'm not entirely sure. I do know that when the acupuncturist checked on me at the halfway point I was surprised to learn that, no, it was the lights-on-and-go-home point.

DH took the heavy-duty antibiotic Zithromax last night. Four pills all at once to knock any infection-threatening bacteria right on out of his system. For side effects he reported "waves of something going on" overnight and a quite-possibly-related "flat feeling" during the day.

Suppression check, mock transfer, pay(them)day

During today's suppression check, they found a 23–24 mm cyst on my right ovary. Small enough that we think things will move forward on roughly the same schedule. But big enough that the nurse couldn't get a clear AFC on that side. Had blood drawn to see how much estrogen the thing is churning out. Will know tomorrow and get further instructions on the meds from there.

They also did a mock transfer today (that went beautifully) and showed me the catheter type they use to do the real transfer.

And, I paid the main cycle charges. An ouchie total of about $13K. That's on top of last week's meds bill for just under $4K.

Remember how I thought "Take the Money and Run" might be a sign from the Eagles? That happened the day I originally thought we had to pay up. But I had the date wrong. So, technically, that sign couldn't have applied. I wasn't looking for a sign today, not even thinking about it, but when I pulled into the lot this morning I did get one. The tune that DH tells people is "ours" (but it's not) came on (that would be "Dude Looks Like a Lady"). It made me laugh out loud and reminded me that DH was with me in spirit today.

IVF meds on the way

I confirmed the IVF medications order with the pharmacy yesterday. Waiting to see if my credit card company will balk. They did last fall when I ordered a new iMac, and the amount for this unusual single purchase is twice that one. Shiny tech items and powerful pharmaceuticals — what more does a girl need?

Things are starting to move. New pack of BCPs today, injection training tomorrow, injectable meds show up Thursday, suppression check next Monday, and then it's time to (really) pay up, shoot up, and "man up."

Starting to get started

I'm in a busy work cycle, which helps keep my mind off the pending IVF. To a small degree. (Note that I logged on today to do some actual work.) We are still in waiting mode, sort of. Waiting for the real ART business to start. That makes me anxious, because I like to be in doing mode. No doubt, though, I'll become a basket case when the doing gets under way.

Two appointments this week, injection training next week, and then I'll be off and running with the serious meds. BCPs, which I'm currently on, are for babies. Ha! I meant "babies," as in neophytes or wimps, obviously (to me). That sentence just struck me as funny since under normal circumstances BCPs are for no babies.

Tomorrow is DH's SA update. This will be his third one, and I hate it for him. You know what an SA is, right? It's a semen analysis. He gives them a sample, and they evaluate its quality, looking at criteria such as count, motility, morphology, volume, progression, viscosity, pH, and WBC. Have even one SA done, and you'll be tossing around those terms and what the measurements mean in no time. Especially when the dx is one of severe MFI. You will also learn that there is much disagreement about what constitutes a good or bad result, that nobody really knows what to do to improve a bad result, and that science has come through in a big way with the funding and development of ART therapies that make a bad result a non-issue (as long as you pursue said ART therapies). I certainly applaud that the research has been done and that solutions exist. Don't get me wrong. It's just that I can't help pointing out that no similar line can be drawn from female-specific IF factors to equally successful ART therapies.

The clinic could not accommodate an early morning or end-of-day appointment for DH, so it will be a nooner.

Is that too crass for a blog? Look, I have to entertain myself. I don't plan to write about every single bit of personal biz that goes into the whole circus. (Well, maybe I will in some form, but it won't always be explicitly related to my personal biz.) But you can't give an honest accounting of the fertility-treatment experience without acknowledging the extreme personal nature of what it means to seek medical intervention in order to have a child.

As a couple, we've paid our dues trying naturally and done all the main fertility tests (some of them multiple times), and yet I also want to point out that we haven't even scratched the surface of the full range of testing available. Tests we haven't done haven't been indicated, so for that I am grateful. Unless they should have been indicated and we are wasting our time.