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Dragging along

Posted in IUI #6, my stupid body on February 8, 2007| 2 Comments »

Last March I had the longest IUI cycle in recorded history. Or at least in MY recorded history. And since it was only my second IUI cycle, my recorded history wasn’t very extensive. That cycle went on forever. hCG trigger was on CD 31. Thirty One! IUI on CD 33! Dr. S. called me a “two-pager” meaning that in the old days of paper charts, I would have been one of those patients whose cycle notes went on to the second page.

Not to worry, he assured me. Because historically, two pagers had a remarkably high pregnancy rate compared to shorter cycles (you know, the cycles where trigger happens on Day 12 and IUI is on Day 14 like a textbook?). I remember I really appreciated his reassurance (actually, I still do), but the long cycle was slightly problemmatic because I had a one-day trip scheduled to go to Florida (to see my father and a friend from Scotland) when I figured I’d be in the two week wait, but was actually not even close to IUI day. Dr. S. said no problem and let me push off my next monitoring appointment an extra day, figuring it wouldn’t be too big a deal. It wasn’t, and the cycle dragged on another week or two after I got back before I triggered.

That cycle ended horribly and dramatically while I was away for Passover. It was probably the worst bleeding I’d ever had until that point, and that’s saying something. It was unbelievable amounts of pain, componded by the fact that I was away from home, living in a hotel for a week, not able to start a new cycle because I was nowhere near my fertility clinic (a 10 hour drive each way seemed extreme just for CD3 monitoring). I snapped a lot at my husband that week, had very little energy most of the time, suffered from migraines throughout the trip, and cried a lot. (Believe it or not, I still had a tremendously good time on that trip, especially considering the circumstances)

Do I have a point? Not really, actually. But fast forward to today’s CD16 monitoring appointment. Last cycle I triggered on Day 14 and had an IUI on Day 16. This cycle I am not anticipating triggering anytime soon. Dr. S. was covering monitoring today, so I needled him about the fact that Room 1 doesn’t have a mobile. He said they were waiting for a donation and I said that for what I’m paying this place… he chuckled. On to the ultrasound, the funnest part of the day!

Follicle growth is weird. The follicles on the Right Ovary seem to have stalled, while the follicles on the Left Ovary (previously known as the completely, utterly, evil, underperforming, useless ovary) made a little bit of progress.

Right Ovary: 12.3 (down from 12.6), 9.6, 9.4, 9.0
Left Ovary: 12.0 (up from 10.7), 11.0 (up from 10.0), 9.4
Lining: 11.41 (down from 11.75, should I be worried?)

No word yet on my E2/LH, but Dr. S. was not worried about the lack of growth of my follicles. He said that I had a beautiful jump in E2 on Tuesday (67.5 to 113!) and that we should expect to start seeing some more growth soon, based on that estrogen jump. I trust him, I believe him. I mentioned that I thought this was going to be another two-pager cycle and he laughed that I remembered that, but reminded me that historically two-pagers have relatively high success rates. When I told him that my last two-pager cycle was a resounding disaster he said, “and that’s my cue to exit stage left!” (except he was wrong, it was stage right)

Anywhozit, the bottom line is that there is very little progress happening in Ovary-Land, perky or otherwise, so I’m sorry to give you such a boring update. Not to worry, I’m sure I’ll have some dramarama for you soon!

(You know, for example, the fact that I have a trip scheduled to go to Florida for three days Feb. 18th-20th…Since I figured this cycle would be similar to last month’s I figured this IUI would already be over, at the end of the 2ww, and failing by Feb. 20th. Now I’m wondering if my IUI is going to end up being scheduled right smack in the middle of that trip, meaning I have to cancel either the cycle or the trip. I haven’t seen my father in almost a year and my father hasn’t seen J in a year and a half so I really, really, really don’t want to cancel this trip, but I also don’t want to skip this IUI. DRAT, DRAT, DRAT!)

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Dragging Along Part II

Posted in IUI #6, my stupid body on February 8, 2007| 9 Comments »

Lest you think that today's E2/LH levels will shed any more light on my peculiar puzzle, I should update you on my call from my nurse this afternoon.

Three more days, two more clicks of the pen. I'm up to 108 IUs for the next three nights. Apparently Dr. Amazing is bored and ready to move on to IVF, which is good, because I'm ready to move on also. I return on Sunday for more ultrasound fun! Whahoo! I asked Mary (my nurse) what my E2/LH levels were and she said she didn't want to tell me because it was only going to irritate me. I promised her I could take it.

E2: 110 (down from 113, but that's really just a plateau)
LH: 2.5 (it went from 2.5 on Sunday, to 2.2 on Tuesday, back to 2.5 today)

Mary is pleased with my LH because she doesn't want it spiking yet because that would mean I was about to ovulate on my own and that would be bad, since apparently my eggs are too immature. They're like teenagers trying to break out into maturity, but still stuck with some rather childish behaviours and development. Curses!

I forgot to tell you all the funniest part of my ultrasound this morning. After Dr. S. left the room I was talking to Margaret, sonographer extraordinaire, and she said (JOKINGLY), "gosh what IS going on with those ovaries of yours? Whatever they tell you to take, you should take double and see what happens." I told her I'd considered it, but that would be wrong. Wrong, I say! Do I sound convincing? I reminded her that doubling my meds was probably the easiest way to land myself with a canceled cycle from overstimulation. "True," she said, "but they can't stop you from having lots of sex!"

Of course, sex has never helped us have a baby before, but if I had four perfectly mature, ripe, beautiful follicles ovulating all at once, you can be damned sure this would be the one time I'd end up pregnant. With quadruplets. And I gotta tell you… I really don't want quadruplets. Not even a little bit. Seriously!

Anywhozit. The point is my ovaries are doing absolutely nothing. I think I ought to have S provide a "sample" for cryopreservation, because I suspect what's going to end up happening is that I'll end up needing an IUI when I'm supposed to be in Florida. At least if we had some swimmers on ice, I'd be able to stay here while S and J go to Florida without me (or maybe just have me catch up with them later or something). And anyway, if I plan for that contingency, I won't end up needing it, and all this worrying will be for nothing, right??

Edited to Add: Anonymous makes a good point in the comments that I could always go for the well-timed intercourse in Florida idea in lieu of the IUI. The IUI itself doesn't really increase our odds, since our whole problem appears to be me not ovulating naturally, so well-timed intercourse COULD do it, except for a couple things:

1. We'll be staying at my dad's … and well, GAH!
2. Timing has never worked out particularly well for us, but we could still give it a shot.
3. I need to find out whether my RE would count this as one of my 2 last IUI cycles before moving on to IVF if I skipped the IUI part. I suspect he would, but I'm not entirely certain. But I am NOT doing another one of these cycles if I don't have to. It's time to move on. My insurance coverage for IVF runs out in September or October. After that, I start fighting an uphill battle. Bleh.

Still, I haven't entirely ruled out the possibility of just resorting to "the old fashioned way" if necessary
End of Edit

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Dragging along

Posted in IUI #6, my stupid body on February 8, 2007| 2 Comments »

Last March I had the longest IUI cycle in recorded history. Or at least in MY recorded history. And since it was only my second IUI cycle, my recorded history wasn't very extensive. That cycle went on forever. hCG trigger was on CD 31. Thirty One! IUI on CD 33! Dr. S. called me a "two-pager" meaning that in the old days of paper charts, I would have been one of those patients whose cycle notes went on to the second page.

Not to worry, he assured me. Because historically, two pagers had a remarkably high pregnancy rate compared to shorter cycles (you know, the cycles where trigger happens on Day 12 and IUI is on Day 14 like a textbook?). I remember I really appreciated his reassurance (actually, I still do), but the long cycle was slightly problemmatic because I had a one-day trip scheduled to go to Florida (to see my father and a friend from Scotland) when I figured I'd be in the two week wait, but was actually not even close to IUI day. Dr. S. said no problem and let me push off my next monitoring appointment an extra day, figuring it wouldn't be too big a deal. It wasn't, and the cycle dragged on another week or two after I got back before I triggered.

That cycle ended horribly and dramatically while I was away for Passover. It was probably the worst bleeding I'd ever had until that point, and that's saying something. It was unbelievable amounts of pain, componded by the fact that I was away from home, living in a hotel for a week, not able to start a new cycle because I was nowhere near my fertility clinic (a 10 hour drive each way seemed extreme just for CD3 monitoring). I snapped a lot at my husband that week, had very little energy most of the time, suffered from migraines throughout the trip, and cried a lot. (Believe it or not, I still had a tremendously good time on that trip, especially considering the circumstances)

Do I have a point? Not really, actually. But fast forward to today's CD16 monitoring appointment. Last cycle I triggered on Day 14 and had an IUI on Day 16. This cycle I am not anticipating triggering anytime soon. Dr. S. was covering monitoring today, so I needled him about the fact that Room 1 doesn't have a mobile. He said they were waiting for a donation and I said that for what I'm paying this place… he chuckled. On to the ultrasound, the funnest part of the day!

Follicle growth is weird. The follicles on the Right Ovary seem to have stalled, while the follicles on the Left Ovary (previously known as the completely, utterly, evil, underperforming, useless ovary) made a little bit of progress.

Right Ovary: 12.3 (down from 12.6), 9.6, 9.4, 9.0
Left Ovary: 12.0 (up from 10.7), 11.0 (up from 10.0), 9.4
Lining: 11.41 (down from 11.75, should I be worried?)

No word yet on my E2/LH, but Dr. S. was not worried about the lack of growth of my follicles. He said that I had a beautiful jump in E2 on Tuesday (67.5 to 113!) and that we should expect to start seeing some more growth soon, based on that estrogen jump. I trust him, I believe him. I mentioned that I thought this was going to be another two-pager cycle and he laughed that I remembered that, but reminded me that historically two-pagers have relatively high success rates. When I told him that my last two-pager cycle was a resounding disaster he said, "and that's my cue to exit stage left!" (except he was wrong, it was stage right)

Anywhozit, the bottom line is that there is very little progress happening in Ovary-Land, perky or otherwise, so I'm sorry to give you such a boring update. Not to worry, I'm sure I'll have some dramarama for you soon!

(You know, for example, the fact that I have a trip scheduled to go to Florida for three days Feb. 18th-20th…Since I figured this cycle would be similar to last month's I figured this IUI would already be over, at the end of the 2ww, and failing by Feb. 20th. Now I'm wondering if my IUI is going to end up being scheduled right smack in the middle of that trip, meaning I have to cancel either the cycle or the trip. I haven't seen my father in almost a year and my father hasn't seen J in a year and a half so I really, really, really don't want to cancel this trip, but I also don't want to skip this IUI. DRAT, DRAT, DRAT!)

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And the Fun Just Keeps On Coming

Posted in IUI #6, my stupid body on February 4, 2007| 3 Comments »

Another monitoring appointment this morning. I have 3 follicles on the Right Ovary measuring 11.8 and one measuring 11.6. If I end up with four mature follicles at trigger time, my doctor will cancel the cycle. My completely useless Left Ovary has one follicle measuring 8.8. Not impressive, but that’s fine since I’ve got four contenders on the Left.

I’m not too worried about this cycle being cancelled because of over-responding. I’ve certainly never had that problem, even in the cycles when it looked worrisome at this point. I’m more concerned about my wonky estradiol levels and the fact that these follicles are only at 11.8 on CD12, which is quite a bit smaller than in my last cycle at this point (on the same dosages). It almost seems as if my response has gotten worse with each successive cyle, but it might be me overreacting. In fact, it probably IS me over reacting, since I know they’ve been fine-tuning my protocol with each cycle, so I wouldn’t necessarily have the same response as previous cycles. For example, my 2nd IUI cycle went on FOREVER, in part because of the teeney weeney dosages. But now I’m on slightly higher dosages which means faster, but different response. I get that in theory, it’s just frustrating right now. I’m sure I’ll feel better once I get my E2 and LH levels back. I’m somewhat annoyed right now.

Actually, the reason I’m annoyed is because I had a sonographer and not a doctor today. It really irritates me that I haven’t been getting an actual doctor on the weekends. It’s one thing when it’s my beloved Margaret running the ultrasound. But no offense to Julie (the person covering today), but she’s just not Margaret. She didn’t let me look at the ultrasound display at all, so I couldn’t see anything for myself. And I also know that when there are different people measuring each time, it’s not necessarily great for comparison, since some people measure differently. Plus, I know I could have asked Margaret to send in Dr. O (the doctor theoretically covering monitoring today, even though I never saw her). I really wanted to ask if there was any possibility that my wacky estrogen response this cycle and last could be fallout from the miscarriage. I know it probably isn’t related, and it won’t make a difference even if it is, but I wanted to ask. It’s very rare that I have questions for my doctor because honestly, I’m pretty well-read on this stuff, and I trust the care I’m getting. But it would have been nice to have the option to speak with Dr. O today. I think I’ll call Dr. Amazing this week.

I’m to return on Tuesday unless I hear otherwise after my bloodwork comes back. I think it’s possible that they’ll ask me to return tomorrow, but not necessarily likely. My guess is I’ll stay at the same dosage (which was bumped to 83 IUs as of Friday), but I suppose it doesn’t much matter. If I go back tomorrow, I won’t call Dr. Amazing, since I’ll be speaking to my nurse in the afternoon. I love my nurse… she knows me very well, and while we had a bit of a rocky start (she used to have a hard time remembering specifics about me), I’ve been around long enough at this point that she knows me really well, remembers the important things, and we have an incredibly good relationship. When she called me with my results and protocol on Friday she said that I should increase to 83 IUs and return on Sunday. I said that was fine and that I’d already set up an appointment for Sunday and she said, “I don’t know what I’m going to do when you get pregnant! I’m going to have to find another patient who always knows exactly what to do.” I told her I was pretty sure I could do this without all the doctors and she agreed. She’s been there, done that, and has twins via IVF, so she gets it.

One final note: Thalia mentioned in a comment to my questions post that in the UK I’d be required to take a couple months off between IUI cycles because any kind of ovarian stimulation is regarded as needing a break between cycles. I can understand this to a point, but it still confuses me a bit. I do understand that you don’t want to muck too much with your body’s natural processes. But on the other hand, is it not reasonable to believe that there’s an enormous difference between trying to stimulate ovaries to produce one egg and trying to stimulate ovaries to produce 20 eggs. So while I could see taking a month or two off after every two or three IUI cycles, I find it odd that there would need to be a blanket policy of taking 2-3 months off after EVERY IUI cycle. I would think one would want to look at that on a case by case basis. Probably none of my readers know that I’m a dual citizen of the US and UK and it is my goal to move to the UK eventually, but the timing has never been right. We can’t move out of the State we live in, much less the country given the status of our foster son at this point. And beyond that, I’m not certain I would want to move while in the middle of all this fertility stuff, particularly since protocols between the US and UK seem to differ widely. I don’t think one protocol is better than the other, but moving to something completely different seems overwhelming, at best. Ah well, I hope it will happen eventually.

UPDATE: Shit! (pardon my language) Not so much with feeling better now that my levels are back. E2: 67.5, LH: 2.5. This means my E2 levels have dropped. In fact, I snuck a look at my record after my monitoring appointment (they left it up on the computer monitor, so I couldn’t resist a peak) and my E2: level had actually be 71.8 on Wednesday, not 71.5 as it was on Friday. So it’s dropped twice in a row now. DRAT! Why in heaven’s name is my body doing this? This is utterly ridiculous. Anywho, increase dosage to 91 IUs tonight and tomorrow night and return on Tuesday. Joy of freaking Joys.END OF UPDATE

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Some Answers to Questions

Posted in general infertility, my stupid body on February 4, 2007| 3 Comments »

One of the really annoying things about Blogger is that there’s no easy way to respond to comments that I receive… It doesn’t provide me email addresses for commenters, so I can’t just email a response to a comment. And it doesn’t do comment threading, so you’d never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I’m going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I’m not certain and I’m too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I’m an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or “Shabbos”). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don’t drive on Shabbos. I don’t write or exchange money on Shabbos. I don’t cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN’T do, and that’s not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don’t have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually… occasionally it’s just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can’t or don’t do on Shabbos… it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can’t drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it’s doable. There are lots of other little problems, all of which are easily handled: I don’t write, so I can’t sign in or fill out any forms, but those things can all be taken care of ahead of time. I don’t exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they’ve grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we’d have to have someone watching J (though obviously we could take turns being at the clinic since that’s usually what happens if I have an IUI during the week anyway. It’s rare that S is present for the actual IUI (he’s been there 2 out of 5 times), but that’s because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he’s only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn’t so much of a problem. With IVF, there’s less flexibility with egg retrieval and even less flexibility with transfer, so it’s much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I’ve never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they’ve been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I’m not sure that I would do it. Given my particular issues, IUI itself doesn’t really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there’s no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There’s an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I’m not saying I definitely would not do an IUI on a Saturday, but I think it’s unlikely… besides, like I said, I’ve never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn’t able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I’ve skipped months, I’ve generally had 2 back to back cycles. IUI doesn’t require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it’s time to shape up and earn its keep!

3. re: my wonky estradiol levels… someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I’d probably ask if there would be any advantage to me taking estrace or something similar to improve response. I’m theoretically a good responder in general, it’s just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I’d considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I’ll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I’ll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I’ll be taking a bit of a break. I’m not loving staying on birth control pills for that long, because as most of you know I’ve already got crazy ridiculous migraines and BCPs will only make them worse. I’m not entirely certain how I will function, but I’m sure I’ll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I’ll post again.

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Some Answers to Questions

Posted in general infertility, my stupid body on February 4, 2007| 1 Comment »

One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive… It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually… occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos… it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely… besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels… someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.

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And the Fun Just Keeps On Coming

Posted in IUI #6, my stupid body on February 4, 2007| 2 Comments »

Another monitoring appointment this morning. I have 3 follicles on the Right Ovary measuring 11.8 and one measuring 11.6. If I end up with four mature follicles at trigger time, my doctor will cancel the cycle. My completely useless Left Ovary has one follicle measuring 8.8. Not impressive, but that's fine since I've got four contenders on the Left.

I'm not too worried about this cycle being cancelled because of over-responding. I've certainly never had that problem, even in the cycles when it looked worrisome at this point. I'm more concerned about my wonky estradiol levels and the fact that these follicles are only at 11.8 on CD12, which is quite a bit smaller than in my last cycle at this point (on the same dosages). It almost seems as if my response has gotten worse with each successive cyle, but it might be me overreacting. In fact, it probably IS me over reacting, since I know they've been fine-tuning my protocol with each cycle, so I wouldn't necessarily have the same response as previous cycles. For example, my 2nd IUI cycle went on FOREVER, in part because of the teeney weeney dosages. But now I'm on slightly higher dosages which means faster, but different response. I get that in theory, it's just frustrating right now. I'm sure I'll feel better once I get my E2 and LH levels back. I'm somewhat annoyed right now.

Actually, the reason I'm annoyed is because I had a sonographer and not a doctor today. It really irritates me that I haven't been getting an actual doctor on the weekends. It's one thing when it's my beloved Margaret running the ultrasound. But no offense to Julie (the person covering today), but she's just not Margaret. She didn't let me look at the ultrasound display at all, so I couldn't see anything for myself. And I also know that when there are different people measuring each time, it's not necessarily great for comparison, since some people measure differently. Plus, I know I could have asked Margaret to send in Dr. O (the doctor theoretically covering monitoring today, even though I never saw her). I really wanted to ask if there was any possibility that my wacky estrogen response this cycle and last could be fallout from the miscarriage. I know it probably isn't related, and it won't make a difference even if it is, but I wanted to ask. It's very rare that I have questions for my doctor because honestly, I'm pretty well-read on this stuff, and I trust the care I'm getting. But it would have been nice to have the option to speak with Dr. O today. I think I'll call Dr. Amazing this week.

I'm to return on Tuesday unless I hear otherwise after my bloodwork comes back. I think it's possible that they'll ask me to return tomorrow, but not necessarily likely. My guess is I'll stay at the same dosage (which was bumped to 83 IUs as of Friday), but I suppose it doesn't much matter. If I go back tomorrow, I won't call Dr. Amazing, since I'll be speaking to my nurse in the afternoon. I love my nurse… she knows me very well, and while we had a bit of a rocky start (she used to have a hard time remembering specifics about me), I've been around long enough at this point that she knows me really well, remembers the important things, and we have an incredibly good relationship. When she called me with my results and protocol on Friday she said that I should increase to 83 IUs and return on Sunday. I said that was fine and that I'd already set up an appointment for Sunday and she said, "I don't know what I'm going to do when you get pregnant! I'm going to have to find another patient who always knows exactly what to do." I told her I was pretty sure I could do this without all the doctors and she agreed. She's been there, done that, and has twins via IVF, so she gets it.

One final note: Thalia mentioned in a comment to my questions post that in the UK I'd be required to take a couple months off between IUI cycles because any kind of ovarian stimulation is regarded as needing a break between cycles. I can understand this to a point, but it still confuses me a bit. I do understand that you don't want to muck too much with your body's natural processes. But on the other hand, is it not reasonable to believe that there's an enormous difference between trying to stimulate ovaries to produce one egg and trying to stimulate ovaries to produce 20 eggs. So while I could see taking a month or two off after every two or three IUI cycles, I find it odd that there would need to be a blanket policy of taking 2-3 months off after EVERY IUI cycle. I would think one would want to look at that on a case by case basis. Probably none of my readers know that I'm a dual citizen of the US and UK and it is my goal to move to the UK eventually, but the timing has never been right. We can't move out of the State we live in, much less the country given the status of our foster son at this point. And beyond that, I'm not certain I would want to move while in the middle of all this fertility stuff, particularly since protocols between the US and UK seem to differ widely. I don't think one protocol is better than the other, but moving to something completely different seems overwhelming, at best. Ah well, I hope it will happen eventually.

UPDATE: Shit! (pardon my language) Not so much with feeling better now that my levels are back. E2: 67.5, LH: 2.5. This means my E2 levels have dropped. In fact, I snuck a look at my record after my monitoring appointment (they left it up on the computer monitor, so I couldn't resist a peak) and my E2: level had actually be 71.8 on Wednesday, not 71.5 as it was on Friday. So it's dropped twice in a row now. DRAT! Why in heaven's name is my body doing this? This is utterly ridiculous. Anywho, increase dosage to 91 IUs tonight and tomorrow night and return on Tuesday. Joy of freaking Joys.END OF UPDATE

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And the Fun Just Keeps On Coming

Posted in IUI #6, my stupid body on February 4, 2007| 1 Comment »

Another monitoring appointment this morning. I have 3 follicles on the Right Ovary measuring 11.8 and one measuring 11.6. If I end up with four mature follicles at trigger time, my doctor will cancel the cycle. My completely useless Left Ovary has one follicle measuring 8.8. Not impressive, but that's fine since I've got four contenders on the Left.

I'm not too worried about this cycle being cancelled because of over-responding. I've certainly never had that problem, even in the cycles when it looked worrisome at this point. I'm more concerned about my wonky estradiol levels and the fact that these follicles are only at 11.8 on CD12, which is quite a bit smaller than in my last cycle at this point (on the same dosages). It almost seems as if my response has gotten worse with each successive cyle, but it might be me overreacting. In fact, it probably IS me over reacting, since I know they've been fine-tuning my protocol with each cycle, so I wouldn't necessarily have the same response as previous cycles. For example, my 2nd IUI cycle went on FOREVER, in part because of the teeney weeney dosages. But now I'm on slightly higher dosages which means faster, but different response. I get that in theory, it's just frustrating right now. I'm sure I'll feel better once I get my E2 and LH levels back. I'm somewhat annoyed right now.

Actually, the reason I'm annoyed is because I had a sonographer and not a doctor today. It really irritates me that I haven't been getting an actual doctor on the weekends. It's one thing when it's my beloved Margaret running the ultrasound. But no offense to Julie (the person covering today), but she's just not Margaret. She didn't let me look at the ultrasound display at all, so I couldn't see anything for myself. And I also know that when there are different people measuring each time, it's not necessarily great for comparison, since some people measure differently. Plus, I know I could have asked Margaret to send in Dr. O (the doctor theoretically covering monitoring today, even though I never saw her). I really wanted to ask if there was any possibility that my wacky estrogen response this cycle and last could be fallout from the miscarriage. I know it probably isn't related, and it won't make a difference even if it is, but I wanted to ask. It's very rare that I have questions for my doctor because honestly, I'm pretty well-read on this stuff, and I trust the care I'm getting. But it would have been nice to have the option to speak with Dr. O today. I think I'll call Dr. Amazing this week.

I'm to return on Tuesday unless I hear otherwise after my bloodwork comes back. I think it's possible that they'll ask me to return tomorrow, but not necessarily likely. My guess is I'll stay at the same dosage (which was bumped to 83 IUs as of Friday), but I suppose it doesn't much matter. If I go back tomorrow, I won't call Dr. Amazing, since I'll be speaking to my nurse in the afternoon. I love my nurse… she knows me very well, and while we had a bit of a rocky start (she used to have a hard time remembering specifics about me), I've been around long enough at this point that she knows me really well, remembers the important things, and we have an incredibly good relationship. When she called me with my results and protocol on Friday she said that I should increase to 83 IUs and return on Sunday. I said that was fine and that I'd already set up an appointment for Sunday and she said, "I don't know what I'm going to do when you get pregnant! I'm going to have to find another patient who always knows exactly what to do." I told her I was pretty sure I could do this without all the doctors and she agreed. She's been there, done that, and has twins via IVF, so she gets it.

One final note: Thalia mentioned in a comment to my questions post that in the UK I'd be required to take a couple months off between IUI cycles because any kind of ovarian stimulation is regarded as needing a break between cycles. I can understand this to a point, but it still confuses me a bit. I do understand that you don't want to muck too much with your body's natural processes. But on the other hand, is it not reasonable to believe that there's an enormous difference between trying to stimulate ovaries to produce one egg and trying to stimulate ovaries to produce 20 eggs. So while I could see taking a month or two off after every two or three IUI cycles, I find it odd that there would need to be a blanket policy of taking 2-3 months off after EVERY IUI cycle. I would think one would want to look at that on a case by case basis. Probably none of my readers know that I'm a dual citizen of the US and UK and it is my goal to move to the UK eventually, but the timing has never been right. We can't move out of the State we live in, much less the country given the status of our foster son at this point. And beyond that, I'm not certain I would want to move while in the middle of all this fertility stuff, particularly since protocols between the US and UK seem to differ widely. I don't think one protocol is better than the other, but moving to something completely different seems overwhelming, at best. Ah well, I hope it will happen eventually.

UPDATE: Shit! (pardon my language) Not so much with feeling better now that my levels are back. E2: 67.5, LH: 2.5. This means my E2 levels have dropped. In fact, I snuck a look at my record after my monitoring appointment (they left it up on the computer monitor, so I couldn't resist a peak) and my E2: level had actually be 71.8 on Wednesday, not 71.5 as it was on Friday. So it's dropped twice in a row now. DRAT! Why in heaven's name is my body doing this? This is utterly ridiculous. Anywho, increase dosage to 91 IUs tonight and tomorrow night and return on Tuesday. Joy of freaking Joys.END OF UPDATE

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Some Answers to Questions

Posted in general infertility, my stupid body on February 4, 2007| 3 Comments »

One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive… It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually… occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos… it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely… besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels… someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.

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Craptastic!

Posted in IUI #6, my stupid body on February 2, 2007| 7 Comments »

Let’s Review!

Me: 31 years old.
Diagnosis & History: Anovulation due to PCOS; Four (+) year history of infertility. 5 IUIs. 1 pregancy, resulting in 1 miscarriage at 12 weeks. No male factor.
Usual response to Gonadotropins: Super-responder. No problems whatsoever. Go me.
This cycle and last? SERIOUSLY MESSED UP.

Okay, so here’s the deal. If you don’t remember, last cycle, I had a little plateau problem… my E2 level went up, went back down, went up a little bit, and hung out for a couple days without doing anything interesting prior to IUI. Follicles were all wonky (splitting, disappearing, whatever). It kind of freaked me out a little bit, but it had to be a fluke, right? Yeah…No.

And now we find ourselves caught up to date for everything prior to this cycle. Now just to refresh your memory….

CD8 (Wednesday)
Right Ovary: 9.6 & 10.2. Another 10 follicles smaller than that
Left Ovary (hereafter referred to as the useless ovary: a bunch of small, meaningless, boring, uninteresting ones.
Lining: 9.2
E2: 71.5
LH: Unknown (they didn’t tell me)

CD 10 (Today)
Right Ovary: 8.5, 8.9, 9.2, 10.3, 11.9 (and about 7 smaller ones)
Useless Ovary: 7.0, 7.1, 9.0 and 6 smaller ones
Lining: 9.6
E2: 71.5
LH: 1.85

Follicles are expected to grow at a rate of about 1-2 mm per day (I’m nearly always on the low end of the growth chart… averaging a little over 1mm per day… most normal humans are closer to 2mm per day). My biggest follicle on Wednesday was 10.2, so they would have hoped for it to be 12-14 (preferably closer to 14) today. Instead, it was 11.9. Not quite 1mm per day. And did you notice that lovely E2 level? I didn’t either. I only see the craptastic one. That is, the craptastic 71.5 that has not changed at all in the two days since the last level was checked. So again, I’m facing a plateau which might possibly mean this is all useless.

Now, the truth is, I never ever put much faith in any individual cycle. I have complete faith that eventually something will work, but I never believe any individual cycle will work. However, I’m not normally so ridiculously negative as to believe any given cycle is a waste of time. I’m beginning to feel that way now.

And by the way, should I be worried that my right ovary (hereafter lovingly referred to as the “Not-As-Bad-As-The-Left Ovary”, or NABATLO for short) is always the producer? Is my Useless Ovary really and truly useless? Is it just there for looks? Did God just want me to have a matched set, even if they don’t work? Or is it purely coincidental? I get that none of you actually know the real answer to that question, but I’m asking anyway, even if I’m not sure what kind of answers I’m hoping for.

BLEH.

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