ChezPerky

I don't normally blog about every single monitoring appointment during a treatment cycle. But I also usually have one or two real-life friends who are in on the fact that i'm cycling who I talk through these things with. I've been very closed about this cycle with anyone I know personally. People know I've had appointments at Shady Hell but they don't know why or really even when. And anyway, it's MY blog, so I can blog all the gory details I want. So here are today's details:

Right Ovary (always the overachiever): 16.1mm and 14.4mm (up from 14.6 and 13.6)
Left Ovary (with a surprise comeback!): 13.8mm
Endometrium: 11.16 (I've never had an endometrium this thick at this point in my cycle, so yay, I think)

Today's sonographer (my beloved Margaret) suggested that the two follicles on the right were just waiting for the Left to catch up a little bit so I could have THREE follicles come trigger time. Um. Triplets? I hope not! (I do realize that there is absolutely no possibility that I'm going to end up pregnant at all this cycle, let alone with triplets. But still…) Margaret also pointed out that on Friday it was the doctor who did the measuring and sometimes doctors aren't quite as skilled at using the equipment, since they don't do it all the time. So three different people doing my ultrasound in three different visits yielded three very different results. Not terribly shocking.

The doctor didn't know quite what to think about me, but said we'd wait to see where my estrogen was today before making any judgments. This particular doctor is usually pretty decisive, but he sure doesn't seem thrilled with the way this cycle is developing. Frankly, I don't blame him. Because although each individual visit seems to have good news, the overall trend is a little odd. It happens that I'm anal, so I keep a simple spreadsheet of every cycle and this is by far the weirdest. Thanks to the joys of Google Docs, I now have it accessible online: IUI Cycle #5.

All I can do at this point is wait and see. I'm still pretty early in the cycle, so I'm not worried. I make sure to remember that my second IUI cycle lasted over 30 days (triggered on day 31, IUI on day 33, CD1 on day 45 or so). It's just been a very weird cycle, because on Wednesday I was told I'd probably trigger Friday or Saturday, on Friday I was told I'd probably trigger Saturday, but was later called back and told to come back Sunday. On Sunday I was told I'd probably come in on Tuesday and trigger Tuesday or Wednesday, but I was called and told to come in today. Today the doctor didn't even try to take a guess on either when I'd trigger or even when I should schedule my next monitoring appointment. He just said to wait for the estrogen level to come back and we'd figure it out from there.

I probably wouldn't even be tense about it, except my husband has to staff in the Shock Trauma unit on Thursday, which would be really hard for him to get out of if I end up triggering tomorrow and needing an IUI on Thursday. We'll obviously work it out one way or another, but it's still making me tense. I'll update later when I get my status call from my nurse.

UPDATE: E2: 121 LH: 1.89. No one seems to know why my E2 is plateauing. This is a new wrinkle that I was not prepared to deal with, and I am beginning to believe this cycle is a complete waste of time. Why is this suddenly not working? I've been known to have slow cycles, but even those had predictable/appropriate rise in hormone levels. Phooey.

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I’m just Posty McPostyson today!

Just got a call from Shady Hell. My estradiol is 118 (this is not amusing me, since last Wednesday it was 103, and had apparently gone down a little bit on Friday, though I don’t know Friday’s number).

My estrogen NEVER gets as high as the nurses seem to think it should, but I’ve asked my doctor about it before and she said it’s not surprising in PCOS patients, and that she really doesn’t care as much about the raw number as she does about the comparative levels from visit to visit. My preliminary web research suggests that my doctor was being diplomatic, as it appears to be specifically excess weight that can result in lower estradiol numbers (which is weird, since fat cells produce estrogen, so you’d think it would be elevated, but I suppose there are different kinds of estrogen, so maybe that’s why).

My LH is 1.6 which doesn’t make any sense to me. Everything I’ve found suggested that the LH surge should show >20 mIU/ml, so I’m thinking they’re using a different scale (so maybe this is really a 16 on that scale?). I also find this completely unamusing. But I’ll just sit, smile, and nod and do anything they tell me.

In this case, anything they tell me includes going in tomorrow instead of Tuesday (as I’d originally been told). Since I’m making the appointment at the last possible second, the only appointment they have for me is 8:15, a full hour than I usually like to be there. I much prefer the 6:45 or 7am appointment, but 7:15 is usually my last resort. 8:15 is all manner of inconvenient, but at least I’m still working fairly close to the Rockville office. I’ll likely be changing jobs at the end of the month and THEN it will be much harder to manage with an 8:15 appointment.

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I went in for bloodwork and ultrasound (again) this morning before the crack of dawn (no kidding… the sun wasn’t up when I arrived at the office), and the mystery is solved. My hormone levels had sort of leveled out and weren’t where they expected them to be given a 16mm follicle on Friday. This explains bringing me back for more monitoring today instead of triggering last night.

Now I have 2 follicles on the Right: 13.6mm and 14.6mm instead of one 16mm follicle. How could this be? The sonographer thinks that there were probably two follicles developing so close together that the septum was difficult to visualize. And, she said, the bonus is that I now have two good looking follicles, which is great.

So that’s where I am.

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I'm just Posty McPostyson today!

Just got a call from Shady Hell. My estradiol is 118 (this is not amusing me, since last Wednesday it was 103, and had apparently gone down a little bit on Friday, though I don't know Friday's number).

My estrogen NEVER gets as high as the nurses seem to think it should, but I've asked my doctor about it before and she said it's not surprising in PCOS patients, and that she really doesn't care as much about the raw number as she does about the comparative levels from visit to visit. My preliminary web research suggests that my doctor was being diplomatic, as it appears to be specifically excess weight that can result in lower estradiol numbers (which is weird, since fat cells produce estrogen, so you'd think it would be elevated, but I suppose there are different kinds of estrogen, so maybe that's why).

My LH is 1.6 which doesn't make any sense to me. Everything I've found suggested that the LH surge should show >20 mIU/ml, so I'm thinking they're using a different scale (so maybe this is really a 16 on that scale?). I also find this completely unamusing. But I'll just sit, smile, and nod and do anything they tell me.

In this case, anything they tell me includes going in tomorrow instead of Tuesday (as I'd originally been told). Since I'm making the appointment at the last possible second, the only appointment they have for me is 8:15, a full hour than I usually like to be there. I much prefer the 6:45 or 7am appointment, but 7:15 is usually my last resort. 8:15 is all manner of inconvenient, but at least I'm still working fairly close to the Rockville office. I'll likely be changing jobs at the end of the month and THEN it will be much harder to manage with an 8:15 appointment.

Read Full Post »

I went in for bloodwork and ultrasound (again) this morning before the crack of dawn (no kidding… the sun wasn't up when I arrived at the office), and the mystery is solved. My hormone levels had sort of leveled out and weren't where they expected them to be given a 16mm follicle on Friday. This explains bringing me back for more monitoring today instead of triggering last night.

Now I have 2 follicles on the Right: 13.6mm and 14.6mm instead of one 16mm follicle. How could this be? The sonographer thinks that there were probably two follicles developing so close together that the septum was difficult to visualize. And, she said, the bonus is that I now have two good looking follicles, which is great.

So that's where I am.

Read Full Post »

I went in for bloodwork and ultrasound (again) this morning before the crack of dawn (no kidding… the sun wasn't up when I arrived at the office), and the mystery is solved. My hormone levels had sort of leveled out and weren't where they expected them to be given a 16mm follicle on Friday. This explains bringing me back for more monitoring today instead of triggering last night.

Now I have 2 follicles on the Right: 13.6mm and 14.6mm instead of one 16mm follicle. How could this be? The sonographer thinks that there were probably two follicles developing so close together that the septum was difficult to visualize. And, she said, the bonus is that I now have two good looking follicles, which is great.

So that's where I am.

Read Full Post »

Weird. I’m told to increase my dosage by 18 IUs tonight and tomorrow and return for monitoring Sunday. How weird is that? I’m not sure what to make of it, but I couldn’t get any more specifics because my nurse called while J was throwing a bit of a hissy fit. So I didn’t hear any useful information, but I can only assume my estradiol or LH wasn’t where they wanted it to be yet.

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Weird. I'm told to increase my dosage by 18 IUs tonight and tomorrow and return for monitoring Sunday. How weird is that? I'm not sure what to make of it, but I couldn't get any more specifics because my nurse called while J was throwing a bit of a hissy fit. So I didn't hear any useful information, but I can only assume my estradiol or LH wasn't where they wanted it to be yet.

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So, here’s the thing. Wednesday could easily have been described as “full flow” making it CD 1. And then most of yesteday? Almost nothing. Today? Full flow is definitely a good description.

So is this CD1 or 3 or whatever?

Well, whatever it is, I went in for CD3 monitoring this morning. They managed to draw my blood in just one try today, which is nothing short of miraculous since Dracula had the day off. And I got to see my beloved Margaret, the super sonographer. My one bright spot in this whole ridiculous ordeal of having to do this all over again is that I get to see Margaret again. M is responsible for my blog name, you know. She always refers to my ovaries as “perky” because they’re always full of antral follicles, which, yes, I get is a good thing, but it was, for a time, disconcerting to hear my ovaries referred to as perky. They felt slightly mocked at first, you see, which is (I’m certain) why the first IUI didn’t work (though it doesn’t explain why the 2nd and 3rd didn’t work… surely by then they were used to the good-natured ribbing?).

MY POINT… if I ever had one in the first place, is that I adore Margaret. So while I wasn’t entirely PLANNING to see her again until April or so of 2008, I’m happy to see her now, even if it’s because my body sucks.

Anyway, today was no terrible shock. My ovaries, true to form, are definitely perky. I couldn’t count the number of antral follicles even in one single view, let alone by seeing it all the way through. So I think it’s safe to say that I’ve got good ovarian reserve. Shocker. Also that if I were to do IVF I’d be a super responder. Another shocker. But it does rather accentuate why it is that IUI is such a dragged on process for me. With that many eager follicles, they’ve got to be careful to bring just one or two to the front and ditch the rest. So teeney, teeeney, teeeeney doses of follistim for me. (More than last time, though, 66IUs) Assuming, of course, that my E2, P4, and Beta all come out indicating that it’s appropriate to start stims. And they had BETTER come out saying so, because I just spent scads of money on Follistim. Which brings me to the one surprise of the morning:

I stopped at the pharmacy on my way out to pick up my Follistim. I’m fairly certain that I have a vial at home, but I’d hate to get home and find out it was no good or had been misplaced, or had expired, or whatever after I got home. Shabbos comes in at 4:30 today, so there wouldn’t have been time to find a more local pharmacy to take care of it. So I stopped to pick up a vial just in case. Anyway, my insurance had rejected the Follistim because it didn’t “match the existing authorization.” My insurance has paid for probably 30 vials of Follistim in the last year, but I think the problem is that there was an intervening order for Gonal-F back in November, which I decided against using, because it’s such a pain in the neck for non-standard dosing.

I’m certain the insurance will pay for it once it’s resubmitted, but in the meantime I had to pay out of pocket for it. Not the end of the world, fortunately, but not inexpensive. Since I’m taking such a tiny dose, one vial should get me through about 5 days, possibly 6. And that one vial cost me $300. I know people who take 5 vials PER DAY for IVF cycles (I’d never be allowed to take that much for fear of OHSS). That’s $1500 PER DAY. If they take stims for the standard 12 days, that $18,000 in drug costs alone for an IVF cycle. Actually, that’s $18K for JUST ONE of the many necessary medications. Holy Schmoly! Suffice it to say, I’m thrilled that I have generally good health insurance and that it covers the medications as well, despite this temporary hiccup.

(I do know that the pharmacy I use heavily discounts their Follistim for out-of-pocket IVF patients. They didn’t discount it for me, because they know that the insurance WILL cover it in the long run and because it was “only” one $300 vial. So at least I know they give a lot of folks a bit of a break, but even so, I can’t imagine how devastating the costs must be for someone with no insurance coverage in need of that high a dose of stims! Ugh!)

So, um, let the fun begin!

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So, here's the thing. Wednesday could easily have been described as "full flow" making it CD 1. And then most of yesteday? Almost nothing. Today? Full flow is definitely a good description.

So is this CD1 or 3 or whatever?

Well, whatever it is, I went in for CD3 monitoring this morning. They managed to draw my blood in just one try today, which is nothing short of miraculous since Dracula had the day off. And I got to see my beloved Margaret, the super sonographer. My one bright spot in this whole ridiculous ordeal of having to do this all over again is that I get to see Margaret again. M is responsible for my blog name, you know. She always refers to my ovaries as "perky" because they're always full of antral follicles, which, yes, I get is a good thing, but it was, for a time, disconcerting to hear my ovaries referred to as perky. They felt slightly mocked at first, you see, which is (I'm certain) why the first IUI didn't work (though it doesn't explain why the 2nd and 3rd didn't work… surely by then they were used to the good-natured ribbing?).

MY POINT… if I ever had one in the first place, is that I adore Margaret. So while I wasn't entirely PLANNING to see her again until April or so of 2008, I'm happy to see her now, even if it's because my body sucks.

Anyway, today was no terrible shock. My ovaries, true to form, are definitely perky. I couldn't count the number of antral follicles even in one single view, let alone by seeing it all the way through. So I think it's safe to say that I've got good ovarian reserve. Shocker. Also that if I were to do IVF I'd be a super responder. Another shocker. But it does rather accentuate why it is that IUI is such a dragged on process for me. With that many eager follicles, they've got to be careful to bring just one or two to the front and ditch the rest. So teeney, teeeney, teeeeney doses of follistim for me. (More than last time, though, 66IUs) Assuming, of course, that my E2, P4, and Beta all come out indicating that it's appropriate to start stims. And they had BETTER come out saying so, because I just spent scads of money on Follistim. Which brings me to the one surprise of the morning:

I stopped at the pharmacy on my way out to pick up my Follistim. I'm fairly certain that I have a vial at home, but I'd hate to get home and find out it was no good or had been misplaced, or had expired, or whatever after I got home. Shabbos comes in at 4:30 today, so there wouldn't have been time to find a more local pharmacy to take care of it. So I stopped to pick up a vial just in case. Anyway, my insurance had rejected the Follistim because it didn't "match the existing authorization." My insurance has paid for probably 30 vials of Follistim in the last year, but I think the problem is that there was an intervening order for Gonal-F back in November, which I decided against using, because it's such a pain in the neck for non-standard dosing.

I'm certain the insurance will pay for it once it's resubmitted, but in the meantime I had to pay out of pocket for it. Not the end of the world, fortunately, but not inexpensive. Since I'm taking such a tiny dose, one vial should get me through about 5 days, possibly 6. And that one vial cost me $300. I know people who take 5 vials PER DAY for IVF cycles (I'd never be allowed to take that much for fear of OHSS). That's $1500 PER DAY. If they take stims for the standard 12 days, that $18,000 in drug costs alone for an IVF cycle. Actually, that's $18K for JUST ONE of the many necessary medications. Holy Schmoly! Suffice it to say, I'm thrilled that I have generally good health insurance and that it covers the medications as well, despite this temporary hiccup.

(I do know that the pharmacy I use heavily discounts their Follistim for out-of-pocket IVF patients. They didn't discount it for me, because they know that the insurance WILL cover it in the long run and because it was "only" one $300 vial. So at least I know they give a lot of folks a bit of a break, but even so, I can't imagine how devastating the costs must be for someone with no insurance coverage in need of that high a dose of stims! Ugh!)

So, um, let the fun begin!

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