Archive for April 14th, 2009

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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And… Cancelled

Cycle cancelled.

More details to follow later?  Maybe? 


The last days of Pesach start tonight so I’ll be offline for a couple days.

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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.


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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