Posted in IVF#1 on January 27, 2009| 3 Comments »
There was a piece of me that really didn’t want to bother taking any of my drugs tonight. Or tomorrow. I seriously considered just coasting until Wednesday. Blowing it all off. Probably guaranteeing a cancelation, but at least eliminating the uncertainty.
But I’m not good at being a rebel, so, good girl that I am, I dutifully took my drugs, as planned. We’ll see how things go on Wed.
Posted in and this is where it started to go downhill, IVF#1 on January 26, 2009| 2 Comments »
Update from SuperDoc – raise Follistim dose to 150IU. Back on Wednesday for monitoring. Wednesday is the worst possible day for me to deal with monitoring. My husband is going to work at 6:30am and I’m on duty at home until 7:30 and then have a myriad of other things to do. Dammit.
My nurse thinks we’ll get 7, not 4. I guess we’ll just see. I’m inclined to scrap the whole thing, frankly. This just hasn’t been going as expected, but I guess – when has it ever?
Frick.
Posted in and this is where it started to go downhill, IVF#1 on January 26, 2009| 8 Comments »
Right: 19.6, 12.1
Left: 14.8, 13.1, 13.9, 13.4, 9.9, 9.8
Basically, my doctor is hoping that 19.6 just floats away and that MAYBE we’ll get the others to grow enough by tomorrow to trigger. That would mean retrieval on Thursday, my 33rd birthday. And maybe get four eggs.
Four.
Originally, we were really worried about hyperstimming me. Don’t get me wrong – I’m extremely happy that didn’t happen. But… Four? Now, if I were forty, I’d take four joyfully. If I had premature ovarian failure, or even unexplained infertility, I’d take four. But I have frickin’ PCOS, for crying out loud. Four?
What if we go through all this, retrieve four, at best, and then only 3 actually fertilize, and only one makes it to blast? Or what if none make it? Gah. There are too many “what ifs” involved here. I don’t know what to do.
My doctor is inclined to go ahead with just four. But his original prediction of a 40-45% chance of pregnancy with an elective single embryo transfer (their normal rate of pregnancy with elective single embryo transfers is 67%) is now down to 30%. Me? I’m inclined to cancel. It just seems like an awful lot of work, time, money wasted for … four.
I have three IVF cycles covered per live birth. If we cancel before retrieval, this doesn’t count against my three. I get that I’m “only” on my first, but if that fails, I’m down to two. That’s 30% down.
Oh, there was another option. We could have triggered today and converted to an IUI. Over my dead body. I would have been risking quadruplets if I’d agreed to that.
SuperDoc had students with him today, and while they were poking around at my ovaries I was being as lighthearted and joking away as I could. As he reviewed my previous cycle with them to see what they would think retrospectively, I mocked him a little “Oh no, this cycle will never work. We’ll trigger you early, blow this cycle off – we know you’re moving on next cycle anyway. No possibility you’ll even get pregnant let alone with HOMs!” He said if I weren’t back for more he might pay attention to me. A fair point. I apologized later to one of the students for being such a pain in the ass, but she said it was great comic relief.
SuperDoc was jovial and calming as always, but once I sat up, I got more serious and so did he. I wasn’t happy. He was calm and seems comfortable with proceeding, but I feel like I’m being followed by a shadow. He did note that if we cancel and start over, we’ll start my Follistim at 220 IUs and we’ll be much more likely to see the 15 follicles we expected. Still, like I said, he’s comfortable proceeding as is. Me? I’m not so sure.
I waffle. The Lupron sucks so badly I’d hate to think I took it for two weeks just to cancel.
Sigh.
Update: Thanks, Bean, for noting that I should double check my insurance – I did just that on my way out of the clinic this morning… I checked in with the financial counselor to find out what the financial implications of canceling would be and whether it would count against the three, and the long and the short of it is that each of the monitoring appointments would get billed separately to my insurance and I’d have my copayment for those and coinsurance for all the labwork. I had her double check to make sure that the cancelation would not count against the three cycles and it will not.
Another Update: the 19.6 is not the one. By Thursday, it’ll be gone. Definitely good points for moving forward, but it’s a lot of money I stand to lose.
Posted in and this is where it started to go downhill, IVF#1 on January 25, 2009| 2 Comments »
Not great news this morning. When I was doing IUI I never could get a dominant follicle to grow at the right time. Now I’m doing IVF and I don’t want a dominant follicle and guess what I’ve got? Yep. That sucker is still growing and coming out on top. Lots of good medium ones, though, so maybe they’ll just let that one go. I didn’t like the looks of it and neither did the sonographer extraordinaire, M. No doctor in monitoring again today. I’m feeling the love, let me tell you.
Probably have to go back tomorrow, but will update more later when I hear from my nurse. But for now, not feeling the warm fuzzies.
Right: 17.0, 10.5, 8.1
Left: 12.5, 12.0, 10.9, 10.0, 7.7, 7.6
Yeah, not looking so hot. Possible they’ll just let that 17 go and hope the others take over. But the risk with any dominant follicle is that it’ll take over and suppress the others. Doesn’t seem to be happening so far, but who knows. I suppose anything goes at this point. I also don’t love the fact that I’m still not looking at a lot of follicles – considering my typical antral follicle counts, this is suprising (My typical antral follicle counts are in the thirties). I know it only takes one to work, but seriously, I have to have something to worry about, right?
Meanwhile, headaches still suck (possible sign that my estrogen is still in the crapper – typical for me), and my ovaries feel like they’re the size of baseballs, though from the looks of today’s monitoring that’s probably not the case.
Update: My estrogen level is 226 (not great, but good rise from Thursday when it was 99). Meds stay the same, back tomorrow morning. Unfortunately, the only appointment time they had available meant canceling two meetings. Not good. Sigh.
I am not expecting great news tomorrow. Am hoping a doctor actually shows his or her face in monitoring, at least.
Posted in IVF#1, Lupron on January 23, 2009| 4 Comments »
I had lunch with LJ today and feel a million times better than I did before I saw her. We talked about the evils of Lupron. This pervasive headache. The sleeplessness, but the everpresent exhaustion. The headaches. The moodiness. The headaches. It’s torturous, really. “It’s not just me, right?” It’s totally the Lupron, she assured me. Thank God, I said, because I swear my husband’s probably going to divorce me if this is the New Me.
We talked about the suckiness of the suckitude. She empathized. She provided support. She assured me that I would return to being a normal human being with emotional control. A good wife and mother who loves her husband. It would happen, she promised, once I wasn’t on these god-forsaken drugs anymore. “But while you’re on Lupron? You’re a saint, your previously perfect husband can do nothing right. That’s the way it is. He’s evil, you’re perfect. It’s not you; it’s the Lupron.”
And I said, “And the worst part is, I don’t get to drop my dose! No sirree. I’m still on 20 units a day! Most people get to drop to 5 when they start stims!”
Her face fell into a state of shock. She reached over and held my arm. “Oh my God!” she gasped. “Oh honey! I don’t know how you’re standing up! I started out at 10! I’m not exaggerating when I say I would have been entertaining thoughts of suicide on 20 units a day!”
And suddenly, it fell into perspective. The headaches that slice through my head like a piece of glass jutting diagonally through my skull. The bitchiness. The lack of an emotional thermostat. The inability to empathize with my husband. It’s not (entirely) me.
I do hate whining about it. I know that I made a choice to do this. I know that I have children already. I know that I consciously decided that my family was not yet complete. I know, therefore, that I am the one choosing to bestow these side effects upon myself. But that doesn’t make these piercing headaches any more pleasant. And it probably doesn’t make my husband enjoy me any more than he would otherwise. I know I brought this on myself. I know that I could make it all stop by simply – stopping all the drugs, right now. It would all go away. And with it, my dreams would fade as well.
So I’m going to try to stop whining about these damn headaches. And I’m going to TRY to be nicer to my husband. And I’m going to TRY to stop worrying about being so tired. Because it IS true… I did bring this on myself.
But I make no promises…. because my head? really, really, really does hurt.
Posted in IVF#1, secondary infertility on January 22, 2009| 7 Comments »
Man, I gotta tell you, I thought I missed those 7am monitoring appointments, but I was wrong. What the frick, man? This was a lot easier before when I could roll out of bed and drive there without any responsibilities at home before walking out the door. Not that I’m complaining, mind you. I most certainly am not. It’s just different, this time.
A lot of people talk about the difference between their experiences with primary and secondary infertility. I don’t think of it that way for me. For me, this is no different. I still suffer from exactly the same conditions of the primary infertility that sent me down this road the first time; I just happen to have children now. It’s different than if I’d had no difficulty conceiving the first time around (i.e. no primary infertility) and then found myself afflicted with infertility in trying to have another child (suddenly found myself with unexpected secondary infertility). But for me, this so-called “secondary” infertility is merely an extension of the same, and I hate the distinction – it belittles the experience; makes it seem less valid in a way, and frankly, it isn’t.
If anything, this experience is just as intense as the last one, but for different reasons. This time I pulled out the big guns, so while I may have been able to remain more emotionally detached (after all, if this fails miserably, can’t I take some solace in what I do have waiting for me at home?) had I been doing IUIs – the stakes are higher this time. The drugs are more intense, the regimen is stricter, the attention to detail is greater. My emotional response is artificially inflated. My ability to focus on the myriad of details that I need to focus on is understandably reduced. My stress level is increased. It is simply a different experience.
Anyway, I had my monitoring appointment at seven frickin’ o’clock this morning. Dracula only had to stab me once this time, though the little bugger dug around in there for a good bit. He reuses the same spot every time, because it’s the only spot he can get a vein in. I swear I’m going to have the biggest darned bruise on that arm by the time this cycle is done. Then into an U/S room. Last time M (sonographer extraordinaire) walked in on me before I’d even gotten my skirt off, so I hurried out of my clothes and jumped up on the table, my heart racing and then sat… and sat… fortunately I had a good book with me (The Memory Keeper’s Daughter, have you read it? I just started it, but it’s captivating) And, in she walked.
Now, I hate to be the complainer and all (sarcasm), but seriously, I’ve been gone two years now. And in those two years, they still have not hung a mobile in Room 1. Dr. S. (not my doc) brags that he personally hung all of the mobiles in all of the U/S rooms, and good for him, but hello? Room 1 does not have a mobile. And every time I saw him in the two years that I went to Ye Olde Fertility Clinic, I congratulated him on his efforts to give women something pretty to look at in the U/S rooms, and then I gave him hell for not hanging one in Room 1. Now he’s had two whole additional years to make this right and has he? NO!
Dr. S. was on call for monitoring today, but he didn’t come into my room, so M got to hear my (good natured) rant about it. She told me to give him some crap about it – but I never saw him, unfortunately. Oh, but I’ll get my chance! Oh yes I will! With the blogosphere as my witness, if I have to buy a mobile and hang it myself, by the time I’m done with Ye Olde Fertility Clinic, there will be a mobile in Room 1! (I was thinking maybe this one, what do you think?)
Anywhozit, M and I had a lovely conversation whilst she perused my ovaries. I love M – she is what makes Ye Olde Fertility Clinic entirely tolerable. M and my nurse, really. Love them both. We gave one of my follicles a stern talking to because I didn’t like the looks of its dominance. So M poked it and told it to cut it out. She also warned the little buggers that they’d better turn into a singleton. And expressed a preference on sex (but I won’t state that here lest my child someday find out that I had a preference).
I had four good sized follicles on either side, and a bunch of others that she counted but didn’t measure (I lost count, can’t remember). I feel like 8 good sized follicles at this stage of the game isn’t a lot. It worries me, but it’s also early, so we’ll just have to see what they decide to do. The follicles are measuring:
Right: 11.5, 8.5, 8.7, and 6.9
Left: 8.1, 8.4, 8.1, and 6.6
I don’t know yet what they’ll do about my meds or next appointment. They’ll either screw up and tell me to come in on Saturday (no can do, doc), or they’ll let me wait until Sunday. It’s possible that the compromise will be that I have to go back in tomorrow and back in on Sunday. We’ll see. I used to be able to very accurately predict what they’d do to my medication doses after each monitoring appointment, but all bets are off on this one – I have absolutely no idea what they’re going to do to me. I’m thinking they’ll keep me the same? But who knows. For all I know they’ll double it. (Kidding)
I hope I don’t have to go in tomorrow. My kids have speech therapy at 7:30am. Gah.
P.S. Lupron headaches still suck mightily
Posted in Injections, IVF#1, Ye Olde Fertility Clinic on January 20, 2009| 4 Comments »
As veterans of infertility treatment, we do so many injections that it becomes second nature. We can practically do them without thinking about them. We joke that we could probably do them blindfolded. Well, last night, I almost got my chance. I was in the middle of giving myself one of my two injections and… someone snuck up behind me and blindfolded me! No, wait, that’s not right. Um… Oh right. I was in the middle of giving myself on of my two injections and… the power went out. And flickered back on. And off. And on. And off. And on… and off. And there it stayed. So I’m standing there with a needle hanging out of me wondering what to do, but what are you gonna do, right? So out it came, I found the cap, disposed of the needle appropriately, put everything away in the fridge and said, “Now what?”
Yeah.
So that brings me to last night’s injections. Yes, this post is all backward. The fact that I even had injections to TAKE last night is news, isn’t it? So I started stims last night. Because I had my Lupron evaluation yesterday morning. I got to Ye Olde Fertility Clinic in the morning and Dracula called me back for bloodwork. He only had to bite me twice to get any blood, poor thing. I think he was mortified that he missed, but that’s not shocking. Eventually I got called in to an ultrasound room. No sooner am I in the room and close the door, but I start to unbutton my skirt and in walk M (sonographer extraordinaire) and SuperDoc.
Oh for crying out loud, M, give a girl a minute! M kicked SuperDoc out and turned her back while I bitched at her for rushing me (jokingly of course). “Well, welcome back, huh?” she said, bemusedly. “Yeah, thanks for the warm welcome! I guess you’re the welcoming committee!” Anyway, apparently, my ovaries were sufficiently unperky (7 follicles on the right, 8 on the left… far less than usual), and my lining looked good, and my bloodwork must have looked just fine because I started stims last night – 125 IUs of Follistim and 37.5 IUs of Luveris.
There was a little bit of drama about the Luveris – The Luveris comes in 75 IU unit doses. I’m only taking 37.5 IUs, which is to say … half a vial each night. So I casually said to my husband the other night, “I wonder if I’m supposed to waste half each night, or if I’m supposed to save the other half and take it the next night.” My husband is a pharmacist, so he took a look at the packaging and said, definitively, “You need to waste it each night.”
“Really? Are you sure? I’m not sure I’ll have enough if I do that…”
“Yes, I’m absolutely positive. If you don’t, it could start growing things. There are no preservatives in here. You need to waste it.”
“Okay, I guess I’ll just refill it if I run out.”
So when my nurse called yesterday to tell me to start the Follistim and the Luveris, I confirmed that i was just taking half a vial of Luveris each night. “Yes, so put in 1cc of sterile water and mix the Luveris and then draw out half and put the rest in the fridge for the next night.”
“Um, really? Because S said I couldn’t do that…”
My nurse said they’ve been told for years you can do that and said that I’m more than welcome to refill it if that would make him happy or I could check with the pharmacy I filled it at, or whatever worked for us, but that they’ve never had a problem with it, etc. Oooookay.
Not really keen on getting a skin infection from a random bottle of Luveris, I thought maybe my husband (who works in a hospital and therefore doesn’t work with a lot of fertility meds)… ANYWAY, I figured maybe I should call the pharmacist that specializes in this stuff. So I did and I explained that my pharmacist husband was a little jumpy about me reusing the vial, but that my nurse had told me to do so and what did THEY recommend?
“Well, I can’t recommend that. You’d run the risk of an infection, and the manufacter doesn’t recommend it either. I’m sure your doctor’s office has never had a problem with it, which is why they say it’s fine, but it’s not something I can recommend.”
So fine. Then my husband comes back with, “Well, you can put it in the fridge and tomorrow you can just look at it and see if the solution is clear or cloudy. If it’s clear, you’re good.”
“Well, is that a definitive test?”
“No.”
“Well, here’s the thing, it’s a $50 copay to refill it once vs. my personal safety here. $50 isn’t cheap. It’s an unlikely reaction I could have. $50 isn’t cheap, but it’s yet another $50 on top of all the other $50 copays we’ve paid for all the other medications. Sooner or later it adds up to real money. But it’s $50 vs. the possibility of an infection…”
“Yeah. Refill the medication.”
I mean, I’m not trying to be Ms. DramaRama here, but seriously. How stupid would I feel if I ended up with the creeping crud because of this?
Anywhozit, stims started last night. Still taking Lupron. Headaches still suck mightily. I haven’t killed my husband yet, though, which is a positive sign. Back to the clinic on Thursday.
Posted in IVF#1, Lupron, medication side effects on January 19, 2009| 6 Comments »
You’ll be happy to know my husband and I have kissed and made up, so to speak. We’re all good. I no longer think he’s the devil, though he probably thinks I am. Meh.
In less happy news, these headaches are killers. They suck. Seriously. LJ’s right – Forget torture devices, Lupron should be used to get international spies to break.
Man this sucks.
7:45am appt. for monitoring tomorrow. My so-called “Lupron Evaluation.” This time to ensure that, for once, my ovaries are NOT perky. This will be a switch. Fun!
Posted in FAQ's, IVF#1 on January 15, 2009| 3 Comments »
Lori asked, Why would you both need to take Doxycycline in the last year? That is just strange. No one ever cared if my husband took an antibiotic during our infertility journey.
Well, Lori, you got me. Now, I understand the reason to take Doxycycline during a cycle in general, but why on earth taking an antibiotic any old time at all in the last year matters is beyond me.
Per the Arizona Reproductive Medicine Specialists, Doxycycline, an antibiotic administered in pill form, is given to the male partner during the wife’s stimulation cycle to further reduce the low levels of bacteria that may be found in the semen and which may compromise the performance of the sperm during an IVF cycle.
Now, personally, I think it’s a bunch of crap. I think there’s a lot of voodoo in IVF cycles that’s done just for the sake of “Well it helps a teeney weeney tiny percentage of patients, and it doesn’t hurt any of the other patients, so we may as well make ALL of our patients do it.” Like Progesterone in Oil injections, for example. Crap, absolute, complete crap for most patients. My perinatologist told me the literature absolutely does not support the routine use of PIO injections for IVF patients – and yet, virtually all IVF patients in the US are routinely tortured with these thick, awful, painful injections for weeks at a time. For what? For a theory that it can’t hurt, and it might help.
Which brings me back to Doxycycline. Sure, there may be a VERY small percentage of patients whose male partners have low levels of bacteria in their semen which are causing issues with sperm performance or with implantation. And yes, it could be that taking Doxycycline during the stim cycle of a woman’s IVF cycle helps reduce those low levels of bacteria. However, for most patients, those low levels of bacteria are completely normal and are causing absolutely no issues whatsoever. In this case, of course, what’s the harm in taking five days of an antibiotic, just for kicks? Not much, unless you start getting into all the arguments of why one shouldn’t needlessly take antibiotics willy-nilly.
So no harm, no foul, but I’m not all broken up about the fact that my nurse isn’t making my husband take those darned pills.
Posted in IVF#1, Lupron on January 15, 2009| 6 Comments »
So although I was supposed to start taking my Lupron on Monday (whoops), a couple days isn’t the end of the world (even though it DOES mean two more days of the evil BCPs!), so I was given marching orders to start taking it today. Of course, my protocol has me taking Lupron in the morning, and I didn’t find out about this until, oh, 2 o’clock-ish.
No problem, because as much as the clinics all like you to *think* that the timing on these meds is super-duper important, the fact of the matter is, there’s plenty of room to fudge it. So really, it’s all good. Just for good measure, I emailed my nurse to make sure and she said it was fine to take it when I got home today, then take tomorrow’s dose around noon, and then Friday’s dose on my morning schedule. Fine. No problemo.
Meanwhile, technically speaking, I shouldn’t have been allowed to have gotten any of this started, because technically speaking, they don’t have my current pap smear on file (I just had that done this week, results aren’t in yet), my ID bloodwork isn’t back yet (I just had that drawn yesterday, and the labwork from The Hatchery hasn’t been faxed over yet), etc. But they trust me. Heh. Oh, and then there’s the fact that both of us are supposed to have taken doxycycline within the past year. I took Doxycycline in November before my HSG, so I’m covered. But they’d asked me if my husband had taken any sort of antibiotic in the last year and I’d said, “sure, I think so.” He wasn’t so sure, so I told my nurse that today and she said, “Yeah, we need to get right on that.”
So anyway, I get home to take the Lupron. Bear in mind, I’ve never taken Lupron before. And we didn’t take an injection class, because, seriously? Why would we? So I’m looking over the stuff, and it’s a multi-dose vial, with insulin syringes, etc. Easy. Except then I start realizing I’m not sure I understand the unit of dosage. My instructions say 20 units. But what KIND of unit? I call my husband and ask if he’s close to home. Fortunately, he’s just pulled into the driveway. It is handy having a pharmacist for a husband. So he came down and explained to me like I’m a five year old that “unit” was exactly the word they’d intended to use because some medicines are measured in “units of activity” or some such thing. Whereas I’d thought they were using some nebulous, non-exact unit of measurement, it turned out, they were using the technical term, and if I’d looked at the syringe, I would have seen that the syringe also had things labeled as “units” so my minor panic attack was unwarranted.
He showed me how much to draw up and then stepped far away from the needle I was waving all around (sorry honey!) as I tried to remember how to do all this. Seriously, you’d think this was like riding a bike, right? I mean, one subcutaneous injection is just like any other, RIGHT? But it’s been like 2 YEARS, people! And man, the needles on insulin syringes? They’re way bigger than I remember. (I mean, they’re not big, but they’re way bigger than the follistim needles)
Anywhozit, aside from having to shoo my eldest away a few times, it went smoothly and in plenty of time to let my nanny go for the night. Tomorrow will be trickier because I’ll have to take it at work since I’m supposed to take it at noontime, which presents two separate problems: first, now that it’s been opened, the Lupron has to be refrigerated. We do have a refrigerator at work, but … sheesh. Secondly, doing this in a cramped bathroom stall? Not my idea of fun. Nevertheless, it’s not like I haven’t done it before!
And now, the requisite IVF Med shot:
Not pictured is my Follistim Pen, which I forgot to include.
| S | M | T | W | T | F | S |
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | |
| 7 | 8 | 9 | 10 | 11 | 12 | 13 |
| 14 | 15 | 16 | 17 | 18 | 19 | 20 |
| 21 | 22 | 23 | 24 | 25 | 26 | 27 |
| 28 | 29 | 30 | 31 | |||
 | Zane on The Waffle Saga |
 | Owen on Even the Best Parents… |
 | Elyse Cunningham on No Zen This Week |
 | Whitney D on Waiting to Exhale |
 | Rachel on The Waffle Saga |
ChezPerky 