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Archive for the ‘IVF#2 (Take 2)’ Category

Thanks to all for all your kind thoughts and well wishes. I’m fine. The decision to cancel this cycle was a mutual decision between my doctor and myself. He would have been okay with pushing forward if that’s what I had insisted upon, but that’s not a position I want to be in, especially with coverage running out with my insurance.

Several of you said it seemed so sudden given how well things seemed to be going… but that seems… odd to me, because the thing is that nothing had gone quite right yet. My Lupron Evaluation wasn’t where they really would have wanted it, with my estrogen nearly double what it should be (mine was 89 vs. optimal should be under 50), but they let me go ahead anyway because it just seems to be what I do these days.

Sunday’s monitoring appointment was… okay, but not brilliant. Four measurable follicles? (and a bunch of others that weren’t measurable yet.)When supposedly the greatest risk for me with IVF is OHSS? Last cycle after a few monitoring appointments, I had what looked to be four, maybe five follicles that were promising (but also a definite lead follicle that they were going to let fall off) and several others that had some possibility of catching up. We ended up with 10 in the end, but nothing to freeze after an eSET. The goal with this cycle was to have increased the medications such that I would have a much more significant response with the stim cycle and have 14-15 follicles growing from the start (no more than that). That would have given us more to work with.

So when I went in on Tuesday for more monitoring, I had 5 measurable follicles, and while they were definitely growing – there weren’t any others to be seen. Five. And while I tried to push my anxiety aside, knowing that I’m not the doctor and I didn’t have all the information in front of me… five isn’t… what we were looking for. I usually had more than that at this point in an IUI cycle and this is usually where they started talking about whether or not some were going to behave and drop off or whether I was going to have to cancel my IUI cycles. And that was on 1/3 of the doses of Follistim (but no Lupron).

I typed a long, long, long, long post to finish this all off…. and lost it. As I highlighted the post to copy it to the clipboard before posting it (just in case), it disappeared. This was as far as blogger saved it. I frickin’ hate blogger. I’m not going to try and reconstruct the whole thing. I’ll give you the cliffs notes version.

SuperDoc called me in the afternoon. Never a good sign when it’s the doctor that calls rather than my nurse. I told him so and he agreed. He said that he’d been hoping some of the smaller follicles from Sunday would have caught up, but they’ve disappeared, and we’re left with 4, maybe 5, if we’re lucky. Last time we had the same thing at this point and we got 10, but he said last time was a slightly different situation where we were seeing 4-5 plus a bunch of smaller ones and I had a definite lead follicle that they just let fall away. This time I have a maybe lead follicle, but possibly not, and no smaller follicles anymore. Odds aren’t looking so good that I’d have another 10 follicle retrieval in this case. Plus, the goal had been to get a 14-15 follicle growth cycle this time, and we’re not there.

That being said, SuperDoc wasn’t jumping to cancel. Yet. He said with this cycle, he’d give me a 30% chance of pregnancy. If we’d gotten the optimal cycle he’d been hoping for, he’d give me closer to 50% chance, and he didn’t think that differential necessarily warranted cancelling in and of itself. He said he didn’t want to test my patience by cancelling again after having already had one failed IVF and one cancelled cycle. But… to me, that’s not a good enough reason to move forward. So although he was leaving it up to me, I ultimately left the decision up to him. I wanted him to make whatever decision he felt was the right decision, medically. And he said that if I was giving him a mandate to maximize the possiblity of success, particularly given that I have only two cycles covered under my insurance left, he felt that the best thing to do would be to cancel. So that’s what we did.

As for moving forward….

I took the hCG trigger Tuesday night with dire warnings not to have unprotected intercourse, lest I end up with twins (or worse). Got it. I should expect my period in 2 weeks or so. I will start a 21 course of birth control pills (whoopie). I will start 20 units of Lupron on Day 19 and will continue with 20 units of Lupron after I start stims. I’ll take 225 units of Follistim and 75 units of Luveris.

I told him I wasn’t trying to play “back seat patient” but wanted to know whether there would be any advantage to trying the antagonist protocol.. He said no. He would use Ganirelex if he absolutely had to, but that in my case he believed that it would, in fact, put me at a disadvantage. He believes it would produce a worse cohort of follicles and would give far less control over the cycle. Though it may be testing everyone’s patience, he assured me that they are learning more and more with each cycle that passes with me. The problem is that they are walking a very fine line with my “goldilocks ovaries”… too much and I’ll hyperstim, too little and… well, I get cancelled, because it’s just not worth doing all this for so little again. But hyperstimming isn’t anyone’s goal – the last thing anyone wants is to see me in the hospital getting liters of fluid removed from my abdomen, right? Of course right. So caution is good in this case.

By the way, he took me being a back seat patient really well. I prefaced my question with a big huge caveat about not questioning his knowledge and that I would NEVER bring it up if … well, anyway, so he said to please feel comfortable asking anything I wanted and I did ask about the antagonist protocol and he gave me his very thorough answer (which I’ve only paraphrased here). And I told him that was totally fine and I reiterated that I was NOT trying to be a back seat patient and he said, “It’s absolutely fine. When I’m 0 for 2, it’s a perfectly justifiable time to ask if a different approach would be appropriate. But I do think that as long as you think that your patience isn’t being tested to much and you think you can hang in there for a bit, we are getting there.”

And I believe him.

I just.

You know, this IVF thing was supposed to be “easy.” I was supposed to be doing the IVF thing not because nothing else worked, but because IUI worked…. too well. And… now I’ve had one failed cycle in which not a whole lot went right aside from a retrieval that went a million times better than we expected. I’ve had one cycle that got cancelled before I even got to stims. And one cycle that got cancelled after stims, but before retrieval. This was supposed to be “bada-bing, bada-boom, you’re pregnant.”

But now? Now I’m the interesting patient he uses as an illustration to his interns and fellows (no, really! I’m serious!). I don’t want to be interesting. I want to be textbook boring.

Since I started my original IVF#2, nearly all of my original cycle buddies on cyclesista have finished their cycles and gotten their results (many of them BFPs!). And in that space of time… I’ve had two cancelled cycles. Heh. Well, just time to move on to the next one, right? In about five weeks.

Now what to call the next IVF… IVF #2 (take 3)? Or just scrap it all together and call the next one IVF#3?

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After being up far too late last night, I dragged myself out of bed this morning to go to Ye Olde Fertility Clinic. It wasn’t easy, let me tell you. But I checked my email first and discovered that SquarePeg got two lines yesterday! So that was the first sign that maybe today isn’t going to completely suck!

And then I managed to get out of the house on time (with a shower, even!), which was the second sign of the apocolypse that maybe today wouldn’t completely suck.

Despite the fact that it was raining, I managed to make it to YOFC without too much trouble and I arrived at my appointment on time. (Third sign of the apocolypse, perhaps? Nah. I’m usually very punctual.)

I had a very short wait before I was called back by Dracula (definite sign of the apocolypse AND that today would not totally suck – I should have *known* that today was not going to totally suck). They drew my blood without too much trouble. Apparently I hadn’t had enough to drink, so it wasn’t easy but they managed.

When she was finished, she said, “I’m afraid you’re in room 1 again today.”
“Fine. No mobile in there, still, right?” I sighed dramatically.
“No, I’m sorry.”
“You know, Dr. S. and I are going to have a TALK, he and I.”
“I know…”
“Don’t think I won’t!”
“I’m sorry! They said they ordered one…”
“What. Ever!”
I stalked off to room one (jokingly, of course – it’s not HER fault!) and walked into Room 1.

And.

I looked up.


And I let out an ENORMOUS SHRIEK of Delight!

“SURPRISE!” she shouted!

Ohmygosh, HOORAY!

For three, count ’em, THREE years I have been petitioning for that mobile. I put myself out there in the public eye for that mobile! I waited for two and a half months after those embarrassing television interviews for that mobile to appear! I have endured random people who I never expected to have seen the evening news (I mean, really? WHO WATCHES THE EVENING NEWS ANYMORE??) come up to me in all sorts of places and say, “Hey, I saw you on TV talking about that fertility thing!” to get that mobile!

And it was worth the wait, ladies. WORTH THE WAIT.

The picture was taken with my cell phone, so it doesn’t do that beautiful mobile any justice at all, but it is gorgeous, really gorgeous.

I snapped a photo of it, disrobed, hopped up on the table, and while I was waiting, I emailed it to my husband with a simple note: “Hooray!” The message was still sending when M (sonographer extraordinaire) and Dr. S. walked in the room. I was still elated and overflowing with joy at the sight of that beautiful mobile. Dr. S. truly outdid himself. He told me he didn’t care if it took two hours that morning, I wasn’t getting any other room today, I was getting room one! Oh yeah, baby. Oh yeah.

As for today’s monitoring results? I dunno. Dr. S. says I’m on the every day plan, now. My lining was 10.1. On the left, I’ve got a 16.3 and a 15.2. On the right, I’ve got a 17.7, 12.6 and a 10.4. My fears of a lead follicle are evaporating, thankfully, but there’s nothing else to be seen. And I feel like – the whole point of shifting around protocol this time was to avoid another scenario where we were looking at 4-5 follicles at this stage of the game. I know I’m being greedy. And I know last time we were looking at four and ended up with 10, so all is not lost yet. But this is my 2nd of 3 tries at this clinic and then I’m done. I’m feeling anxious about it, even if I know it’s unfounded. Better not to worry until I hear what my E2 and LH are, which I should know later in the day. I’ll keep you updated.

Meanwhile, I feel like I have finally accomplished something. Now, all women who come after me to Ye Olde Fertility Clinic and are in the Stirrups in Room 1 will have something pretty to look at. And maybe, just maybe, that will ease their anxiety just a little. I feel like I did something for many, many infertiles to come. 🙂

At least, I hope I did.

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I’m going to say something that’s going to sound absolutely contrary to common sense. I do realize that I’m taking Lupron every day and that likely has something to do with my lack of sense right now and I probably shouldn’t be held responsible for my actions. Hell, being on Lupron should be reason enough to keep me away from a keyboard at all times, lest I do something stupid, like type something as nonesensical as I’m about to type. But, alas, if I kept myself away from the keyboard every time I was on Lupron, how would I fill the (virtual) pages of my blog? How would I keep my faithful readers on the edges of your seats?

No, I simply cannot stay away from the keyboard every time I’m shooting myself up with that G-dforsaken drug. That wouldn’t be fun for anyone, would it?

ANYWAY. On to my complete lack of logic.

I am petrified to get pregnant.

No, really! I am. I’ve had such a phenomenally crappy year that… I just… There’s this huge piece of me that just feels like it just couldn’t turn out well right now if I did get pregnant. But then again? Part of the crappiness this year has been the NOT getting pregnant and the canceled cycle, etc. So I dunno.

It’s really stupid, I know. But there’s also the fact that my two pregnancy experiences weren’t… great. The first one I bled for the entire first trimester and then miscarried a day into the second trimester. The second one was an HOM pregnancy in which I went into preterm labor at 17 weeks and spent most of the pregnancy petrified of losing all of the babies. I know that we’re doing everything right this time to avoid exactly that scenario, but there is good reason to believe I won’t necessarily have the easiest of pregnancies. You know, if I actually got pregnant in the first place, and if it lasted long enough to get to be crappy.

Sigh. I know that I’ll be ecstatic if I get pregnant and devastated if I don’t, so this is probably an exercise in frustration and futility. I don’t know why I’m even whining about it.

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Left Ovary: 12mm and 11mm
Right Ovary: 14mm and 11mm

Do I sense the possibility of a lead follicle in the making? Does this sound familiar??

Yeah.

Edit: Results from clinic are in. E2 = 145. Endometrium = 8.1. Stay on same doses of medications and return to office on Tuesday. This gives me absolutely no information upon which to base my feelings one way or another, and I didn’t see a doctor today, so who knows.

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Back

So here I am. Now under lock and key, sort of. I’m nearly at my 100 reader limit, so I don’t know that I’ll really stick with this lock down for long, but I wanted it for now. Why? Because a friend of mine requested to follow my notaclowncar twitter account. The only place I’ve ever advertised that account is on this blog. So how else could she have found out about that twitter account than by reading this blog? I don’t want her reading this blog, really. There’s not a really good reason I don’t want her reading this blog, but honestly? If she’s reading it, why isn’t she just telling me that she’s reading it? I’m not in a really good place right now, and you know? If she’s reading my blog(s), she knows that, and she’s made no effort to reach out to me in any way. And if she’s not saying anything because she thinks I’d be upset that she’s reading … well, then maybe she should respect my space and not read it.

Anyway. Enough of that.

Here’s the update on me.

Firstly, Wednesday I proved that I am a Real Infertile. I mean, the 5 Clomid Cycles, 6 IUIS, 1 miscarriage, HOMs, 1 failed IVF, and 1 canceled IVF weren’t enough to prove it, right? Nope. But now? Now I’m really part of the Real Infertile club. Because I gave myself a Lupron injection in the car. I had forgotten to take my Lupron in the morning before I left for my appointment, but fortunately, my pharmacy is in the ground floor of the building with Ye Olde Fertility Clinic. So right after my appointment, I refilled my Lupron prescription, sat in my car, drew up the syringe, and stabbed myself with the needle before heading off to work (my office is way closer to my RE than my house is – so it didn’t make sense to go home).

(I will point out that I have previously given myself injections at the Opera, various restaurant bathrooms, at my office, in friends’ houses, and most recently in a Rabbi’s house in the middle of Shabbos dinner – so I’m no stranger to giving myself an injection in odd places. But I hadn’t done the car thing yet. At least not from the driver’s seat.)

So, Wednesday morning I went in for my Lupron Evaluation. This is where things started going wonky in my previous attempt to start IVF#2. At the LE, the RE wants to see the E2 level below 50. Last month, at the LE my E2 level was 98. Double what it should be. I was told to stay on Lupron for a few days and see if it came down. It came down a few points, but not enough, so we kept playing the dance for several appointments, until it became clear that it was time to cancel because I was going to ovulate on my own. Gah.

So this time, I went in for my LE and my E2 was… 89.

Fan. Tastic.

But, SuperDoc wanted to move forward anyway. I have to say, as joyful as I am not to be in an endless loop of canceled cycles? There’s a piece of me that worries that we’re starting this cycle under less than ideal circumstances. Would I have been better off if I’d canceled, gone on the pill for a couple months and started over? I don’t know. But then again, going on the pill for a couple months isn’t really an option for me. One month at a time is one thing, but extended periods of time on BCPs isn’t really an option with my health history. Anyway, my nurse said that after he reviewed everything, he didn’t just resign himself to starting, he wanted to start. He’s the expert, not me. I trust him.

Fortunately, SuperDoc agreed to let me wait until Sunday to come back into the office for monitoring, though normally they would have preferred to see me on Saturday. No doubt next week I’ll have to go in on Wednesday or Thursday, which are the last days of Passover, when I can’t drive, write, use the phone, etc…. but at least I didn’t have to go in on Shabbos.

So, Wednesday night, I started Follistim (166IU) and Luveris (50 units). Now, the thing about the Luveris is that it comes in 75 unit bottles. One vial has the powder, you draw up 1ml of sterile water, add it to the powder and draw that 1ml into the syringe, and voila! you have a 75 unit dose of medicine. In IVF#1, I took 37.5 units of Luveris, so it was easy – I just drew up .5ml and I had my dose. Fifty units is not so easy. I have to draw up .66mls, which I knew courtesy of my pharmacist husband. He rocks. But when I went to do that Wednesday night, I discovered that the syringes I had for the Luveris didn’t have sufficient markings on them to draw up .66 ml. Um, ugh? My husband did his best to draw it up for me. Afterward he asked if I had any insulin syringes because those would have better markings on them to draw up what I needed. The Lupron comes with insulin syringes (plus I have a whole box of insulin syringes leftover from my IUI days when I was using multidose vials of follistim), so I said I’d use those the next day. I hurried up and gave myself the shots and we ran off to our friends’ house for the first Seder.

The next morning, I took my Lupron, but realized later that I was supposed to have dropped the dose to 10 units, but I accidentally stayed at 20 units. Crap. I’ll have to own up to that at some point, won’t I?

Thursday night I drew up the Luveris with insulin syringes, but the Lupron insulin syringes are .5ml syringes, so I had to use 2 syringes to give myself the full dose, plus the Follistim, which was running low on the cartidge, so I had to switch cartridges partway through the dose – for a total of four injections for just two medications. My husband realized that my huge enormous box of insulin syringes upstairs were 1ml syringes, so… problem solved for subsequent evenings. Yeah.

I did remember to drop my Lupron dose the following morning. Good thing. Maybe I’m not such a screwup after all? Bah.

Tomorrow morning (well, I guess it’s really today at this point… golly it’s late!) I go in for more monitoring to see how things are going. I’m not holding my breath.

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Well, it turns out reverse psychology works! What the heck? I have never, ever in my entire life had a period without at least one day of completely debilitating cramps the day before, and typically for the six-to-eight hours before it appears I am in total agony. So I knew with absolute certainty when I typed my post at 1:30am that there was no possibility that my period was going to arrive any time soon. Right? Of course right.

Except that she arrived at 7am.

Ooooooooookay.

So I shouldn’t be complaining, right? Of course right. I’ll make my CD2 appt. for tomorrow. (CRAP, my kids have appointments at 7:30 tomorrow morning. DAMMIT! Sigh. Whatever. We’ll work it out.) And that will mean they’ll want me back… (let’s see, Wed … plus three, carry the two divide by the square root of 17…) Saturday. FANTASTIC. They’ll probably let me hold off until Sunday. I hope.

Which will still probably mean me being back in the clinic on the last days of Passover, but it can’t be helped and I just… don’t care right now.

Edited to add: Hey, the lack of cramps could be related to the copious amounts of pain medicine I’ve been taking… except that pain medicine usually doesn’t help anyway. Hmmm. Anyway, it’s now 8am and the cramps are here to make up for lost time. This is going to be a *fun* day. Whee!

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And Here We Go Again

So.

Here we are again. I have to be up in six hours to have bloodwork drawn to find out if I can start Lupron again for IVF#2 (Take 2) aka IVF 2.1 or whatever you want to call it.

So the bloodwork is simply a P4 check. To see if I ovulated. Because, you know, after all that, and after injecting my buttock with 10,000 units of hCG I just might not have ovulated, right? But I can tell you with absolute certainty that I ovulated. Why? Because I’ve been snapping at my husband for no good reason since Thursday. My saint of a husband who can literally do no wrong except for about 10 days before my period. Because I’ve been all sniffly and teary-eyed over the stupidest stuff.

Because I fired my cleaning lady 12 days before Pesach in a fit of rage at her inability to clean my house properly. Which, I should add, is nothing new. She hasn’t been actually cleaning my house for about 2 years now (she’s been working for me for four). Oh, but Friday morning she asked me for the nine-bazillionth time whether I’m pregnant yet. And I lost it. But I didn’t fire her. No sirree. Because that would be stupid. But then I came home to discover that the outside of my oven was filthy and clearly hadn’t been cleaned in weeks. So I called and fired her.

Twelve days before Passover.

Yeah. Because that’s rational, right?

So I have little doubt that tomorrow Ye Olde Fertility Clinic will call and tell me that I have most definitely ovulated and that I am set to start the evil drug (Lupron) on Wednesday. And I should expect my period on, oh, about the most stressful day in the universe (next Monday or Tuesday). You know, right before Passover.

Did I mention that I fired my cleaning lady?

Twelve days before Passover?

And right before starting IVF #2 Take 2?

Yeah. If Ye Olde Fertility Clinic even tries to suggest to me tomorrow that I have not, in fact, ovulated yet, well, let’s just say that heads will roll!

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