Archive for May, 2009

Crisis averted

I had resigned myself to cancelling this cycle, with the smallest glimmer of hope that maybe tomorrow wouldn’t be too late to trigger for a Tuesday retrieval to at least get the smallest of my growing eggs. In tears, I sat in my husband’s arms and said over and over again, “I’m so sorry.”

A whole cycle wasted.

Worse: I would have to call Ye Olde Fertility Clinic tomorrow and admit to my stupidity. They have signs EVERYWHERE asking if you have your trigger shot. Are you SURE you have your trigger shot? ABSOLUTELY sure? Check with your nurse if you need it, they admonish. Their paperwork reminds you constantly to ensure ahead of time that you HAVE YOUR TRIGGER SHOT because the doctor on call can’t guarantee that you’ll be able to find a pharmacy that has it in stock if you call them in a panic in the middle of the night. On Thursday the nurse who went over my trigger instructions asked if I had the trigger shot. “Oh yes,” I said. “I’m sure I do.”

“You might want to check,” she said.
“Oh, I’ll definitely check. I wouldn’t want to be THAT patient,” I said. “You know, the one who calls in the middle of the night in a panic because she doesn’t have it?”

Right. And I did have every intention of checking to see if I had it. Really. But, well, life got away from me.

We called all the 24 hour pharmacies around and, sure enough, no one had it in stock, so calling the doctor on call wasn’t going to help me anyway. So, as I said, I had resigned myself to having completely wasted an entire cycle.

But then – my brilliant, handsome, perfect, amazing, wondermous husband came downstairs and said to me as I wallowed in my misery: “Hey, dumb question… does M have hCG?”

“M’s out of town.”
“Right. So does M have any?”
“Probably, but she’s out of town and I don’t have a key to her house.”
“So… does anyone locally HAVE a key to her house?”


Well, it was worth a shot, despite the late hour. The clock was ticking on how long I could push my luck anyway. Last time I got this far, I took my trigger shot half an hour late and my nurse said that was no problem at all. She even said an hour late was no problem at all. Any more than that and it starts to become a problem.

So at 11:38, I called M on her cell phone. She didn’t answer, but I left a message asking her to please call me if she got the message. And then, just for good measure, I tried calling her one more time, just in case she hadn’t heard it the first time. It still went to voice mail, but it turned out that calling her the second time was the thing that clued her in to the fact that the phone ringing was actually something she needed to check.

She called me back moments later.

She did, indeed, have hCG at her house. Her neighbor across the street has a key. She was willing to call her neighbor to see if she wouldn’t mind meeting me with the key. Miraculously, her neighbor was still awake and didn’t mind meeting me with the key.

M gave me instructions for how to deal with the alarm and how to find the medication, and I dashed off to her house (she’s only a couple blocks from me).

hCG in hand, I dashed home to take the trigger shot.

Tomorrow I will pick up MY hCG and return it to M. Along with some kind of super special treat. Because although there is really no repaying this kindness, I really must find a way. She said she was so glad that my husband thought to call her.

“I’m so glad we’re in this together,” she said.

Me too, M, me too.

I’m not sure she’ll ever know how much this kindness means to me. I’m not sure I can ever articulate how huge her tiny sacrifice (of an hour’s sleep to talk me through getting into her house) was for me. I don’t know how things will work out this cycle, but I do know that without her help, I wouldn’t have had an opportunity to find out. I also know that without my husband’s quick thinking (WHY DIDN’T YOU THINK OF IT HALF AN HOUR EARLIER???), I wouldn’t have had a chance to find out how this cycle will work out. I love you, sweetie. I’m so glad we’re in this together.


P.S. At monitoring today, they thought I’m probably looking at getting 10 eggs at retrieval. Just so we’re clear, the doctor more than doubled my medications this time around in hopes of getting at least a 50% increase in response this time. I got 10 eggs at retrieval last time. I know that it only takes one, but I’m not in the least bit amused that more than doubling my medications didn’t really change the overall outcome. I *did* ask the sonographer how big my ovaries are and she measured them: they are over twice the size of an average, non-stimulated, ovary. I asked if I was exaggerating to call them baseballs and she said definitely not. My left side, she said, might be closer to the size of a softball.


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There’s always a but, right?

My nanny’s father died suddenly on Thursday, so she is out of the country. I don’t know for how long. I am assuming at least a week.

My retrieval which we THOUGHT was going to be either Saturday or Sunday is now… Monday. At almost exactly the time that I’m supposed to be at a school conference for my foster son. A school conference at which I’m paying for the pleasure of the company of the developmental pediatrician and the speech therapist.

And I thought I’d be missing that school conference, because of the retrieval… but it looks like… maybe not so much.

I thought the problem with Monday’s retrieval revolved around childcare for the wee ones. For if I had no care for them, I was going to have to call the whole thing off. Which seemed like an incredible waste, no?


Actually, just before 11pm tonight, I pulled out my bag o’ medication and…

No trigger shot.

I forgot I used it when my last cycle was cancelled and it was the one thing I didn’t refill this time around, assuming I already had it. My husband called around to all the local 24 hour pharmacies in the area and none of them have it in stock. So… I’m out of luck and I likely blew an entire cycle for nothing.

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The doc at monitoring today thought I *might* trigger today, but I was skeptical. Turned out, I was right to be skeptical – “same and back tomorrow…” which is the same instruction I get every day. I have three or four mature folllicles, some of which I’m probably going to lose and a whole lot of smaller follicles that they want to give time to catch up. So there you go. My right ovary is still (as usual) subpar, but what are you going to do?

So I have to go back to the clinic tomorrow, which is a logistical nightmare because it’s a Jewish Holiday (Shavuos), but I have a friend who agreed to take me, and all the important details are taken care of, so that’s all that matters.

I’m extraordinarily uncomfortable – it feels like I have canteloupes for ovaries right now, and I assure you, I don’t have room in there for two canteloupes. I will simply take this as a good sign of lots of growth even if we’re not seeing it all on the ultrasound. Yeah, that’s it.

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More Monitoring

I didn’t update you on yesterday’s monitoring because I was swamped. Anyway, yesterday’s monitoring showed 1 follicle over 10mm on the right (aka: the useless ovary) and 4-5 on the right. They ranged from 16mm to 11mm. Everything else was smaller. My estrogen had jumped from 181 to 532 and my instructions were to stay on the same doses and return to the clinic today. My nurse sounded really perky about the whole thing, and honestly I was a little surprised by that. I’d been a bit down about the follicles – I had about 12 total, but half of them weren’t over 10 yet and aren’t showing a lot of promise, and with more than double the dose of Follistim from my first cycle (and a quarter of the Lupron), I’m not showing a much better response. I was discouraged. But she sounded so perky – and so I thought that estrogen must have been a really good sign, but who knows. I can’t even tell anymore.

So I went in today and the doctor covering monitoring said right away, before the sonographer was even done with the ultrasound, “Well, we’re going to need to have you back tomorrow; we’ve got to get your estrogen under control, and we’ve got to get some of those other follicles growing.” He didn’t sound encouraged, that’s for sure. That being said, I do have 13 follicles today – but I have some clear leaders: a 21.3 and an 18.8. Everything else is much smaller. I suspect we may just lose those to let the others grow enough. We’ll see. I don’t know who’s covering monitoring tomorrow, but I’m sure it’ll be fun times, regardless.

I think I’ve decided to be optimistic at this point, despite the way the doctor today sounded. I know this is completely uncharacteristic for me, but hey, I like being unpredictable.

I have a couple posts floating around in my head, but I have so much going on I just can’t get there. Bear with me, because they’re coming. Eventually.

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Here’s the update from this morning’s monitoring…

E2 was 181, so nice rise there. Good sign. Keep same doses and return to office on Tuesday morning.

I’m not sure what to think, to be honest. My doctor was there today, but wasn’t in the monitoring room when I had my U/S (he was doing a procedure, I’m told), so I didn’t get his direct take. He’s usually pretty straight with me when I talk to him directly. But I talked with a nurse I don’t know and I didn’t bother to ask her anything other than for the directions written in my file, which were pretty straightforward since there were no changes so far.

Well, you know? My two crappiest IUI cycles resulted in pregnancies. So who’s to say that my dreadful opinion of how this is starting has any bearing whatsoever on how this will turn out?

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All that Follistim, and you’d think I’d have some mighty perky ovaries today, wouldn’t you. Try to at least consider living up to my original blog title, maybe? After all, my ovaries used to be perky all on their own without any help from Follistim/Luveris, etc.

But … not so much.

My right ovary had only one measurable follicle – 14mm. 3, maybe 4 smaller follicles that weren’t worth measuring yet.

My left ovary was a little better, but not much, with a 16, 14, and 11, and again 3-4 smaller follicles that weren’t worth measuring yet.

So with 900 IUs of Follistim and 225 units of Luveris in me (total over three nights), I’m not feeling like this is getting the brilliant response originally predicited. This was supposed to be easy, remember? Or, as easy as IVF ever is (I get that it’s never “easy” but I think you know what I mean). SuperDoc’s predictions in January were that this would be a snap. But… so far, this has been nothing but unpredictable.

I’m … tired.

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Yep.  I’m being treated as a non-PCO patient now.  Go figure.  Turns out my e2 level wasn’t 439, but it was high.  They like to see it under 50 at the Lupron Evaluation and mine was 93.  That’s three cycles in a row of elevated e2 at the LE.  Sigh.  So much for my Coke theory – I haven’t had a drop this cycle.  Now I’m going to drink one with wild abandon, darnit.  Starting now (or as soon as I finish this post).




Anyway, SuperDoc also noted that since I’m not acting all PCO and my reaction to the stims so far has been lackluster, we’re going to treat me as a non-PCO patient and see where that gets me.  SO, tonight I take 300 units Follistim & 75 of Luveris.  Tomorrow morning I drop my Lupron down to FIVE measely units (rock ON!). 

Return to the office for monitoring on Sunday as planned.


Game on!

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Yesterday turned out to be the “real” CD1, so I was able to go in for my LE today, as planned.  SuperDoc walked in, and I (ever the optimist), quipped, “You know, I think you should just cancel me now and save yourself a lot of time and trouble.”


“Well, you know, it all depends on your ovaries.  Are they going to cooperate today?”
“How should I know?  I don’t know anything about ovaries, you’re the one who went to medical school, after all.  You’re the one who should know something about ovaries.”

“I may know something about ovaries, but that doesn’t mean I know anything about your fickle ovaries.”


Hey, now.  Don’t go insulting my ovaries – they’re sensitive souls, you know!  Why, isn’t it bad enough that SuperDoc called them “goldilocks ovaries” last month?  They may just have overheard that remark and if they did… well, the backlash might not be pretty. 


SuperDoc peered at the ultrasound image of my left ovary – “Well that one looks fine…  and the right ovary… also looks good.  The thing is, your ovaries haven’t been acting PCO anymore.  I think that’s what’s been going on.”


“I’m cured!  The triplet pregnancy cured me!  It must have scared the heck out of those overly-perky ovaries and taught them a lesson!”


SuperDoc grumbled something incomprehensible, but the gerbil in my head was running furiously in his exercise wheel.  No, really.  This theory had some merit.  After all, I pointed out, I lost a ton of weight during and after my pregnancy. 


“How much weight did you lose?”
“About 50 pounds.”

“That is impressive.”


[to be fair, I actually lost 70, but I gained back 20… but I wasn’t about to admit that then and there]


SuperDoc continued to make non-commital grumbly noises, while looking through my chart on the computer.  He said we should be good to go with 75 units of Luveris and 225 units of Follistim starting tonight and we’ll see how these finicky ovaries of mine respond this time.   What happened to not insulting my ovaries within their hearing range?  Clearly he doesn’t understand their sensitive nature.  I’m back on Sunday for monitoring, bright and early.  Yee-haw!


“That is, unless my e2 comes back at 437 today.  Then I’m just a puzzle.”
“I don’t foresee that happening.  But you’re right; with you, we just never know.”


Yeah.  I’m all kinds of fun.  I think doctors must love puzzles though.  Wouldn’t it be boring if all cases were totally straight forward?  If they prescribed the same course of action for every patient, why, their jobs would be positively dull!  What would be the point of medical school, residency, fellowship and all the associated torture that goes along with those things?  I think doctors live for the “interesting” patients.  It’s the patients themselves that long to be “boring.”  “Interesting” is a distinction I could live without.  “Puzzle” is another.


But back to this cure.  I’m actually becoming more convinced of it the more I think about it.  Seriously!  One of the most common things that PCOS patients are told when they are diagnosed (if they are overweight) is that if they lose weight they may find a reduction, or even elimination of symptoms.  I lost 50 pounds fairly rapidly.  After I delivered my babies, I started getting regular periods, even while nursing three babies.  Every single month for thirteen months, I got a period.  For the first time in my life, I could predict exactly when my period would arrive with near to-the-minute accuracy. 


From my first ultrasound back at Ye Olde Fertility Clinic, I noticed that I didn’t have 30 follicles per ovary anymore in my antral follicle count.  In fact, I worried I was over-suppressed on the Lupron.  Further, I haven’t responded to the Follistim with my usual ridiculous overabundance of follicles – rather, I have produced lead follicles, something I was never capable of doing with my IUI cycles and something which is undesirable in an IVF cycle.  I attributed this to the Lupron, but even on a reduced dose of Lupron, and somewhat increased dose of Follistim …  no dice. 


The pieces all fit.  My infertility may not have been cured, but the PCOS?  Is she still alive and kicking?


I need a double blind controlled study.  So all you PCOS patients out there – how about you sign up for a triplet pregnancy and see if your PCOS is cured, okay?


Get right on that, won’t you?

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CD1… um, maybe?

This morning I was fairly certain today was CD1, so I made an appointment for my Lupron Evaluation to be Thursday (it can be either CD2 or CD3 and tomorrow is simply impossible for me).

But… now I’m not so sure. Not to be too graphic or anything, but hello? What the heck did you expect? You’re reading a frickin’ infertility blog for crying out loud! Anyway, right. Disclaimer made, so… this morning I felt certain it was CD1 and all signs pointed that way. But no sooner had I seen those signs did they all disappear.

Except, you know, the mind-numbing, debilitating cramping. I’m actually starting to wonder if that’s normal. Really. Is it? Do you all get positively debilitating cramps with your cycles? Because mine are so bad I literally almost throw up from the pain. I almost can’t stand up. The pain is so intense I see spots. It’s unbelievable. I just find it hard to believe that this is normal.

Anyway. Aside from the cramping – everything else pretty much went away. So now I don’t think today really was CD1, so I’ve got to count on tomorrow being CD1, or I’ll have to cancel Thursday’s LE. This is all very aggravating.

Today my headache was so bad and I really wanted a Coke – I knew it would taste brilliant and I also knew that little bit of caffeine would take the edge off the Lupron headache. But… I also know that the last two cycles got canceled, in part because of elevated estrogen levels, and my first cycle did not. My first cycle I didn’t have a drop of Coke (not intentionally – I just didn’t happen to have any). I’m certain that one Coke isn’t going to make a difference, but it’s a slippery slope, you know? I even called my friend, M, knower-of-all-things and asked her to talk me off the Coke Ledge. “Seriously? I wouldn’t be able to resist the siren-call of the Coke,” she said. “It’s not going to hurt you.”

“Okay,” I said, “but if I get canceled because of high estrogen levels, I’m blaming you and writing an entire blog post about how it was all your fault.”

But… I couldn’t take the guilt of the possibility that I’d make someone feel bad by doing that… so I didn’t succumb to the siren-call of the nectar of the gods. You owe me one, M. 😉

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Yee Haw!

It’s 1:59pm.  Do you know what that means?  Yep, that’s right; it means I have a raging headache.    I emailed my nurse last week to let her know that I’d started Lupron again and that I had the headaches to prove it.  “Don’t forget the headaches are not my fault,” she wrote back.  Not to worry, I take the headaches as a good sign.  Maybe this time my estrogen levels are not through the roof.  Maybe?   Hopefully? 


Am I just allowing my hopes to get up too high again?  Will the fall from hope be as devastating as before?


I just did an interview about my experience with infertility and with Ye Olde Fertility Clinic and I was asked about the rollercoaster of emotions that I had to go through to get to success the first time around – that emotional rollercoaster was huge.  Failure after failure after failure then pregnancy, but miscarriage, another failure, and a pregnancy that I couldn’t be happy about for a long time because I just had no reason to believe it wasn’t doomed to failure. 


You’d think that rollercoaster would have prepared me for the ups and downs of this experience the second time around – but…  there’s really no comparison.  I guess the first time around I really had no reason to believe it would work, but this time… I never had reason to think the big guns would fail, but I’ve found three different ways to fail so far.  Will I find a fourth?


I never wanted to be this creative.


But the headaches.  They’re a good sign, right?  And I’ll be using a lot more Follistim this cycle.  You know, if I get that far.  And… it’s different this time.  Right?  Third time’s a charm and all that?

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