Monday, April 24, 2006

Looking on the bright side

Friday's IUI went relatively well. For the first time, I was treated by the only female doctor at my fertility clinic and she was great. When she entered the room, she introduced herself and apologized for keeping me waiting. She asked me if I had any questions and then took the time to answer them all. After she inseminated me, she covered me up with my paper sheet. She really made me feel like an actual person, rather than another infertile body.

Later that day I received a call from my RE, Dr. L. He had been out of town on vacation last week, so he called to review the cycle and discuss steps moving forward. Dr. L has a metaphor that he likes to use to describe an IVF cycle. He likens it to having one foot on the brake and two feet on the gas. He agreed that my taking BCPs for so long may have acted as a second foot on the brake, thus impacting my ability to stim. However, he was reluctant to take BCPs out of my next protocol. Instead, if the IUI does not work (he has given us a 5-10% chance of success), I will take three weeks of BCPs and no Lupron. I will then start stimming with a higher dosage of Follistim and Menopur. He also recommends adding a GnRh antagonist to prevent premature ovulation.

Although one of the ultrasound technicians informed me that an IVF cycle with four or more mature follicles would go to retrieval, Dr. L would not commit to a retrieval with a low number of follicles for me at my age. He suggested that an older patient who’d already had a cancelled IVF cycle would be a more likely candidate for retrieval with only 4-5 follicles. Instead, Dr. L is hoping for at least a dozen mature follicles next time around with our new protocol. Finally, he expressed some concern about my lining and e2 levels. Hopefully, the upcoming IVF cycle (if necessary) will yield better results.

If our beta (scheduled for May 5th) is negative, Supernurse will email me our new protocol and will work us into the IVF schedule, stimming to begin in late May.

There is some comfort in knowing that we have a plan, in the likely event that we will need it. As always, thanks for all of your kind words of support.

Thursday, April 20, 2006

IUI or Bust

Yesterday we were officially advised to either cancel our IVF cycle or convert it to IUI. The u/s showed that we had only 1 follicle at 18.7, 1 at 14.4, 1 at 12.1 and the rest were all smaller than 9. Since I still have my left tube (right removed during lap in Aug. 05), and the two larger follicles are on the left ovary, we were advised to go for the IUI. I know both David and I were tempted to just cancel outright since I have tubal problems and endo but I guess we have nothing to lose. The IUI is scheduled for tomorrow morning.

Thanks for all of your comments. I know we are not ready to throw in the towel yet, but it's hard to see the light when you are so deep in the tunnel.

Monday, April 17, 2006

Is it worth it?

I find myself sitting at the computer today, surrounded by piles of paper, somewhat sore from injections asking the question – Is it all worth it?

I arrived at Ginormous Fertility Clinic this morning, only to be greeted by a trainee (we’ll call her, Newbie) behind the wheel of the dildo cam. Ok, I’ll play along, I thought, everyone has to learn somehow (grant it, I’d prefer that they learn on someone else, perhaps an unsuspecting fertile in need of an exam). Her technique left much to be desired but Techie J was there and she permitted Newbie to get some driving time in without allowing her to steer me off the road.

Eventually, Techie J assumed control and started counting and measuring follicles. She told me that I had nine, 3 on the right and 6 on the left. I began feeling relieved, perhaps this was working (9 somehow seemed much better than 7). But when I examined the screen while Techie J was measuring follicles, I grew concerned. It was obvious that one or two follicles looked very large and many of the others were quite small. I mentioned this to Techie J, who confirmed my observations about the size differentials. She informed me that she could not give me exact measurements until the machine spit them out.

Well, shortly thereafter, out it spat. 1 – 15.5mm, 1- 11mm, 1- 9.4 and the remaining six were between 5 and 6. Not so fabulous for IVF. So I asked Techie J what we should do about the size differentials and she couldn’t answer. She simply told me that I’d be receiving instructions later in the afternoon and then she and Newbie left me on the table, staring at my measurement printout. As you might imagine, I am still staring at it now.

Around lunchtime I received a call from the Nurse instructing me to take my Menopur and Follistim and advising me of the dosages. I was also instructed to return to the office on Wednesday for the next round of monitoring. When I asked about my little lead follicle problem and questioned her on our next steps due to the fact that the majority of the follicles are so small, she mentioned the letters -- I.U.I.

It was at this point that my mind went blank. I didn’t ask about my e2 levels, I didn’t say much else. I kind of wanted to yell – I.U.I?!!?!?! WHAT DO YOU MEAN IUI? ARE YOU AWARE THAT I HAVE ONLY ONE TUBE AND IT IS QUITE LIKELY BLOCKED AND MAY OR MAY NOT HAVE A HYDRO???? I kind of felt like reaching into the phone and shaking her (kind of the way Jimmy Steward did in “It’s a W*nderful Life” when Uncle Billy lost all of the Building & Loan’s deposit money. *)

In the end, I just calmly listened to her instructions, repeated the dosages and hung up the phone. I have spent much of the day googling “lead follicles” and “small follicles” and IVF, to little avail. So I am now left with the question – Is it worth it? If this cycle is cancelled b/c I have fewer than the requisite four mature follicles to proceed with egg retrieval, would it have been worth it? If this cycle is a bust after day after day of injections (and nary an egg to show for it), what do we do next? Will I want to begin again knowing that the next try may merely yield the same result? How far am I willing to go with this? Maybe I am simply not meant to have my own biological child. I really don’t know what my answers are to these questions but I have the next couple of days to think them over.

*This happens to be my favorite movie and if you are unfamiliar with it, it’s great to rent around the holidays. In this particular scene, George Bailey, played by Jimmy Stewart, realizes that his absentminded uncle has lost all of their businesses’ money. He fears that they will be ruined, that his life is over and he’s headed to jail, he grabs Uncle Billy and shakes him asking him “What do you mean you lost the money, you stupid old fool?”

Sunday, April 16, 2006

Hoping for the best

We went back to Ginormous on Saturday morning and things are pretty much the same. My estrogen is only up to 87.7. I still have 7 follicles and my meds have been increased again. I go back in on Monday for our latest update.

The technician was great this time. She was very kind and expressed concern about my endo. She also mentioned that, as a few of you noted in your responses, a few more follicles may pop up on the next ultrasound. I am hopeful that they will but more importantly, that those we do have will yield just a few good eggs for fertilization.

Thursday, April 13, 2006

Gynecological Train Wreck

My appointment today began with an ever so slightly hungover Dr. T and Ultrasound Techie J jovially entering my little u/s room joking about how many glasses of wine Dr. T had had at dinner last night. Dr. T joked that Techie J needed to watch her wand motion b/c he’d gotten dizzy from all of the follicles that the lady in the u/s room next door had had. ‘Hee Hee, hopefully’, he said, ‘Chee Chee, you will have a similarly high follicle count.’

Nope. Techie J inserted the dreaded dildo cam and looked at my right ovary and said hmmm. Then she moved to the left and said 'It looks like your left is your big producer with 1-2-3-4-5 follicles. (She stopped counting at 5!!!! FIVE, FIVE, MY BIG PRODUCER HAS 5? ) She then returned to the right ovary and noticed 2 follicles. Yep, a grand total of seven. All seemed too small to measure.

The rest of the exam was spend noting my host of uninvited guests including cysts, endometrioma (at least 2 now), fibroids, and the dreaded possible hydro (and for those of you who have been following along for a while, I too thought that was no longer an issue). Did I mention that my lining didn’t look particularly good either? Dr. T began by saying ‘There’s a lot going on in there.’ (Gee, thanks, now what do we do?) He then tried to provide some comfort by saying that women with endo often have a difficult time producing many follicles. Wonderful, is that like saying it’s not your fault that your body is the gynecological equivalent of a train wreck????

I guess it goes without saying that this was not my best day ever. Oh and by the way, today is our 4th wedding anniversary.

After commiserating with David and attending a series of meetings with some of our service providers, Supernurse called and told me that my estrogen level was also low (48) for 4 days of stimming. (Could there be anything else wrong?) She advised me that they are doubling my dosage of Menopur and taking me off Lupron. She also assured me that many women have difficulty stimming after an extended break. I assumed this very same thing, particularly given the BCPs.

Unfortunately, the reality of it is so much worse. I may have a difficult time stimming in general now. This may be indicative of future cycles. What if the endo is placing too much stress on my ovaries? What if age is becoming a major factor given everything else? What if this never works? So many questions and no answers.

I return to Ginormous on Saturday for the next round of tests.

Tuesday, April 11, 2006

Ready, Set, GO!

At 4:40 pm I got the call that this cycle is a go! I was instructed to begin Follistim and Menopur last night and Follistim and Lupron this morning. We are to continue this regiment until Thursday, when we go back to Ginormous for our ultrasound and bloodwork to see if we are making any process.

So at 4:45 I raced out of my office to pick up my meds. (I know, I know, why did I wait for the last minute? Honestly, a part of me felt that we'd never get to the stims, so why spend the money.) Well, the pharmacy closes at 5pm and when I arrived at about 4:56, the doors were already closed. I wasn't sure what to do. Call Supernurse and tell her we'd have to start a day late? Ask if she'd call the prescription in to another pharmacy? Frankly, at 5pm I wasn't sure that I'd be able to catch her either.

I did the one thing that I could think of, I tried the door and it opened! Two of the ladies at the pharmacy clearly weren't pleased to see me and didn't even acknowledge my presence. (This is a very small pharmacy located in the same building as Ginormous and the clock on their wall said 5:03 pm.) Fortunately, a third lady, who was very nice, greeted me, took my name and located my big bag o’ drugs on the shelf. She also retrieved my Follistim from the refrigerator and offered me an ice pack to keep the Follistim cool. Within minutes, she rang me up and I was in my car.

I did my shots last night and this morning (accidentally stabbing myself in the finger with the used Follistim needle, while attempting to discard it).

And yes, stumbling out of the blocks, we are on our way.

Monday, April 10, 2006

Two steps foward and . . .

Things have been so hectic here. Last Thursday I started spotting and experienced horrible painful cramps and stabbing pains in my lower abdominals but by Friday I felt much better. On Friday morning we went to the Ginormous Fertility Clinic for our IVF injection class with Nurse Dizzy. David and I and one other couple (Zach and Yvette) were in attendance. Nurse Dizzy began the class 15-20 minutes late. After explaining to us that she'd slipped and injured her ankle earlier that morning, she left the conference room to fetch her tray of meds. Well, her tray was completely disorganized and apparently not well-stocked, so she repeatedly left the conference room in search of the correct meds. In many cases she couldn't find what she was looking for and returned rifling through her tray making statements like "Where is the Lupron?" "No that's not Lupron." "Well Lupron kinda looks like this." "Oh no, my ankle is getting swollen." Great . . . way to instill confidence.

She then walked us through the IVF process. Since Yvette and I have the same protocol, Nurse Dizzy gave us some estimates on the length of the Luteal Phase Lupron Protocol and stim phase, along with an overview of ER and ET. She stressed the importance of proper trigger timing and informed us that excuses like "I had theater tickets and so I did the trigger shot three hours late" were not acceptable. Apparently, couples have done this in the past. Given my masters in Googlelogy, I learned nothing new. Zach, however, took copious notes and corrected Yvette when she referenced the wrong meds during a break.

Finally, Nurse Dizzy returned to the meds discussion and talked about Follistim and Menopur, HCG and PIO. She then escorted David and I out of the conference room to find a room to do my practice IM shot. After being unable to find a free room, we returned to the conference room and asked Yvette and Zach to wait in the waiting room. Nurse Dizzy looked at me, estimated my weight about 10-15 pounds less than what it is (and wouldn't believe me when I corrected her) and suggested that I request one-inch needles for IM injections. She then went on a hunt for a one-inch needle for my practice shot. After several minutes, she returned with the needle. She and David filled the syringe with saline solution. I was told to lean on the large conference room chair (although she said it's best to do IM shots lying down), lower my pants and lift one leg off the floor (shifting my weight to my other side). I was then sharply injected in my upper rump. Hmmpph!

Later that day I spoke with Nurse F, who reminded me that they needed our consents and updated infectious disease screening. I mentioned the spotting and expressed my concerns about possibly not getting a normal period. I thought that perhaps I should return to Ginormous on Saturday or Sunday for my Lupron Evaluation but I was assured that we should stick to the schedule and have u/s and b/w on Monday (today). So following a very hectic weekend (including a surprise party that I hosted for David, which I will describe in a later post), we went in for testing.

The waiting room was packed this morning and we waited about 45 minutes. I had a nice nurse draw my blood rather painlessly. The ultrasound, though painless, showed an endometrioma on my right ovary. So now we get to wait and see whether we can proceed with stims or, or . . . I don't know . . .

After another 20 minutes or so, we signed the consents for IVF, embryo freezing, storage, etc. A nurse witnessed our signatures and checked our ids. From there we went down to the pharmacy, requested that the meds be packed up for us and had our infectious disease screening at a nearby lab.

So now we wait for the call about next steps. I'll let you know where we go from here.

Tuesday, April 04, 2006

Master Injector

My dear David is great at doing my Lupron injections! Today was my third day of Lupron shots and I will admit to having been a bit concerned about his administering the shots (and he is kind of squeamish about needles), but he is a real pro! I tried administering my own Lupron yesterday and I ended up with a little lump just beneath my skin where the medication sat for a few hours (it turns out that I didn't inject the needle deep enough). Hopefully, that won't affect the outcome of this cycle (fingers crossed, ladies). Now I know that I'd best leave the injections to my expert.

In related news, we are scheduled to attend an IVF injection class at Ginormous Fertility Clinic this Friday morning. Although we are great at the sub-q injections (ok, I'm only great at receiving them but I think that counts, does it?), the intramuscular injections are a whole new ballgame. Despite the fact that I've been told that they really aren't so bad, I am not looking forward to the P.I.Ohhh injections! Does anyone use suppositories instead?

Finally, today is my last day on BCPs for now. I am concerned about the level of pain that I may experience from endo without the aid of BCPs, but there is no other way to achieve this end without putting the BCPs aside for now. Besides, Dr. L has assured me that I can take strong meds throughout the process to control the pain. Hopefully, they won't be necessary but it is good to know that they are available if and when I need them.

Good luck to all of you wherever you are in the process. I will continue checking in at your blogs.